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(255)(256)dysfunction. Psychopharmacology 2001;156(1):86-91.Meinhardt W, Schmitz PI, Kropman RF etal. Trazodone, a double blind trial fortreatment of erectile dysfunction. Int J ImpotRes 1997; 9(3):163-165.Nickel M, Moleda D, Loew T et al.Cabergoline treatment in men withpsychogenic erectile dysfunction: arandomized, double-blind, placebocontrolledstudy. Int J Impot Res 2007;19(1):104-107.(264)(265)Speel TGW, Kiemeney LA, Thien T et al.Long-term effect of inhibition of theangiotensin-converting enzyme (ACE) oncavernosal perfusion in men withatherosclerotic erectile dysfunction: A pilotstudy. J Sex Med 2005; 2(2):207-212.van Ahlen H, Piechota HJ, Kias HJ et al.Opiate antagonists in erectile dysfunction: apossible new treatment option? Results of apilot study with naltrexone. Eur Urol 1995;28(3):246-250.(257) Peskircioglu L, Karabulut A, Deniz E et al.The role of pentoxifylline in the treatment oferectile dysfunction due to borderlinearterial insufficiency. Br J Urol 1996;77(4):563-565.(258) Piha J, Kaaja R. Effects of moxonidine andmetoprolol in penile circulation inhypertensive men with erectile dysfunction:Results of a pilot study. Int J Impot Res2003; 15(4):287-289.(259) Reiter WJ, Pycha A, Schatzl G et al.Dehydroepiandrosterone in the treatment oferectile dysfunction: a prospective, doubleblind,randomized, placebo-controlled study.Urology 1999; 53(3):590-594.(260) Safarinejad MR. Therapeutic effects of highdoseisoxsuprine in the management ofmixed-type impotence. Urology 2001;58(1):95-97.(261) Agostini R, Rossi F, Pajalich R.Myoinositol/folic acid combination for thetreatment of erectile dysfunction in type 2diabetes men: a double-blind, randomized,placebo-controlled study. Eur Rev MedPharmacol Sci 2006; 10(5):247-250.(262) El-Shafey H, Atteya A, el-Magd SA et al.Tianeptine can be effective in men withdepression and erectile dysfunction. J SexMed 2006; 3(5):910-917.(263) Sommer F, Klotz T, Steinritz D et al.Evaluation of tetrahydrobiopterin (BH4) as apotential therapeutic agent to treat erectiledysfunction. Asian J Androl 2006; 8(2):159-167.C-272
Appendix D. Reference List of Excluded Studies Not relevant.The link between erectile dysfunction and cardiovasculardisease. Cardiovasc J S Afr 2006;17(5):277Drugs for rare diseases: Mixed assessment in Europe. PrescrireInt 2007;16(87):36-42.The 'effectiveness' scale therapeutic outcome of pharmacologictherapies for ED: An international consensus panel report.Zhongguo Nankexue Zazhi 2006;20(1):70-72.Finasteride and minoxidil for alopecia revisited. Medical Letteron Drugs & Therapeutics 2005;47(1222):95-96.Duloxetine (Cymbalta) for diabetic neuropathic pain. MedicalLetter on Drugs & Therapeutics 2005;47(1215-1216):67-68.Sildenafil (Revatio) for pulmonary arterial hypertension.Medical Letter on Drugs & Therapeutics 2005;47(12151216):65-67.Japanese Society of Hypertension Guidelines for theManagement of Hypertension (JSH 2004). Hypertens Res2006;29(SUPLL.):S1-S102.Reply by Authors. Br J Urol 2006;175(6):2367-2368.Voices and choices: Physician, patient, and partner, and partnerperspectives on the management of erectile dysfunction. Br JSex Med 2006;3(SUPPL. 1):4-9.Managing the side effects of androgen deprivation therapy. TheJournal of Supportive Oncology 2006;4(2):97-98.Aanestad O, Flink R, Norlen B J. Interference pattern in perinealmuscles: A quantitative electromyographic study in patientsbefore and after transurethral surgery of the prostate.Neurourology & Urodynamics 1997;16(2):101-109.Aasebo U, Gyltnes A, Bremnes R M et al. Reversal of sexualimpotence in male patients with chronic obstructive pulmonarydisease and hypoxaemia with long term oxygen therapy[abstract]. Eur Respir J Suppl 1993;Supplement. .6 Suppl 17,pp.422S, 1993.Abascal K, Yarnell E. Increasing vitality with adaptogens:Multifaceted herbs for treating physical and mental stress.Alternative & Complementary Therapies 2003;9(2):54-60.Abbou C C, Salomon L, Hoznek A et al. Laparoscopic radicalprostatectomy: preliminary results. Urology 2000;55(5):630634.Abdo C H. The male sexual quotient: a brief, self-administeredquestionnaire to assess male sexual satisfaction. Br J Sex Med2007;4(2):382-389.Abdo C H, Oliveira Junior W M, Moreira Junior E etal. The impact of psychosocial factors on the risk oferectile dysfunction and inhibition of sexual desire in asample of the Brazilian population. Sao Paulo Med J2005;123(1):11-14.Aboseif S, Riemer R K, Stackl W et al. Quantificationof prostaglandin E1 receptors in cavernous tissue ofmen, monkeys and dogs. Urol Int 1993;50(3):148-152.Aboseif S, Shinohara K, Borirakchanyavat S et al. Theeffect of cryosurgical ablation of the prostate onerectile function. Br J Urol 1997;80(6):918-922.Aboseif S, Shinohara K, Breza J et al. Role of penilevascular injury in erectile dysfunction after radicalprostatectomy. Br J Urol 1994;73(1):75-82.Abraham N G, Asija A, Drummond G et al. Hemeoxygenase -1 gene therapy: Recent advances andtherapeutic applications. Curr Gene Ther2007;7(2):89-108.Abrahamsson P-A, Anderson J, Boccon-Gibod L et al.Risks and benefits of hormonal manipulation asmonotherapy or adjuvant treatment in localisedprostate cancer. Eur Urol 2005;48(6):900-905.Abts M, Claus V, Lataster M. Blood pressure controlwith valsartan and hydrochlorothiazide in clinicalpractice: The MACHT observational study. BloodPress 2006;15(SUPPL. 1):27-32.Ackerman D L, Greenland S, Bystritsky A et al.Relationship between early side effects andtherapeutic effects of clomipramine therapy inobsessive-compulsive disorder. J ClinPsychopharmacol 1996;16(4):324-328.Adaikan P G, Gauthaman K, Prasad R N V et al.Proerectile pharmacological effects of Tribulusterrestris extract on the rabbit corpus cavernosum. AnnAcad Med Singapore 2000;29(1):22-26.Adami H O, Baron J A, Rothman K J. Ethics of aprostate cancer screening trial.[see comment].[Review] [31 refs]. Lancet 1994;343(8903):958-960.Adamopoulos D A, Nicopoulou S C, Pangalos G et al.Attitudes of aging Athenians to andropenia and itsconsequences, and to potential hormone substitutiontherapy. Aging Male 1999;2(1):44-52.Adamopoulos D, Venaki E, Koukkou E et al.Association of carotene rich diet with hypogonadismin a male athlete. Asian J Androl 2006;8(4):488-492.D-1
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This report is based on research co
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This document is in the public doma
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AcknowledgmentsThe authors would li
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ContentsExecutive Summary..........
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Table 17: Intra-urethral Treatment:
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Figure 63. Absolute Mean Change Fro
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associated with ED treatments. Two
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ED as a main complaint. In only one
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different formulations/modes of app
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Evidence Report
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flaccidity are no less important th
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prostatectomy, antipsychotic agents
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disease). Furthermore, there is ins
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Analytic FrameworkFigure 1. Analyti
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KQ 3. Harms of pharmaceutical treat
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Figure 2. Modified QUOROM Flow Char
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that included intervention characte
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Prevalence of Hypogonadism (Total S
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stimulation and a challenge test wi
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Overview of Trials79-84,86-88,90,91
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131,137,138,142,143,147,151,155,156
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pectoris occurred in a participant
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statistical test results for the ob
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individual Q1-Q15 items, 104,106,15
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Proportion of participants with hea
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erectile maintenance frequency, IIE
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Oral Treatments — Phosphodiestera
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Patients were instructed to take th
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Results obtained from two trials 19
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improved erections was higher in pa
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Clinically homogenous groups of pat
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Oral Treatments — Phosphodiestera
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The approximate proportion of smoke
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value was not reported). Even thoug
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Tadalafil (20 mg) versus tadalafil
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scheduled dosing regimen (90 percen
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Proportion of patients with improve
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Sublingual Treatments - Apomorphine
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been taking over the past two or fo
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apomorphine (5 and 6 mg: 38 and 49
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heterogeneity with respect to popul
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Finally, two studies reported on wh
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the second study, prolonged erectio
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Moxisylate versus placebo. One tria
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Quantitative SynthesisThere was a l
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erection” versus one placebo trea
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methods of allocation concealment.
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Prazosin (IU) versus placebo. One t
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reported adequate allocation concea
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Hormonal Treatments Literature Sear
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Harms. In the first trial, the diff
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sex with partner (scale 1-6, with =
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daily for 4 weeks followed by concu
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(MEDQoL) score (range 0-100) compar
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group (16.7, 12.5, and 8.3 percent,
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Question 3a. What Are the harms of
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Chapter 4. DiscussionThis evidence
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Question 1: What is the Clinical Ut
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Questions 2-3: What are the Benefit
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Harms. There were no obvious differ
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alone. Compared with trimix alone,
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PhentolamineEfficacy. The results i
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Question 2a-b: Do Specific Patient
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Methodological and Logistic Limitat
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Tables and Figures.Summary TablesTa
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123Study details 1 Study Design Set
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125Table 2: Prevalence of Hypogonad
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127Study Details 2 Study Design Set
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129Table 4: Prevalence of Hypogonad
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131Study Details 5 Study Design Set
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Table 7: Prevalence of Hyperprolact
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135StudyEDDetails 8 Study Design Se
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Table 10: Serious Adverse Events in
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Table 11: Efficacy Results of Tadal
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Treatment Control Relative RiskStud
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Treatment Control Relative RiskStud
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Table 14: Intracavernosal Injection
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StudyAdverse EventsTreatmentGroup%
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StudyAdverse EventsTreatment Contro
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Study / Typeof PatientsOutcome Defi
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Study ED Etiology OutcomeWilliams*1
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Physiologic:60.0 (18/30) 90.0 (27/3
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StudyAdverse EventTreatmentGroup% (
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TreatmentStudy ED Etiology Group% (
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StudyAdverse EventCavallini 1991 Pa
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Study/patient CharacteristicsGooma
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Aversa 2003Men witharteriogenicEDYa
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Study/patientCharacteristicsClopper
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Study/patientCharacteristicsOutcome
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Table 26: Testosterone Treatment: P
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McNicholas2002Patients reporting
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175Table 27: Miscellaneous Treatmen
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177Table 28: Nonarteritic Anterior
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Table 29: Penile Fibrosis in Studie
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StudyStudyDesignPatientsage range 4
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Figure 6. Improved erection (GEQ-Q1
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Figure 11. Visual disturbances (all
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Figure 16. Any adverse events (trea
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Figure 23. The mean IIEF-Q4 score:
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Figure 30. Improved erection (GEQ-Q
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Figure 37. Visual disturbances (all
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Figure 43. IIEF-EF ≥ 26 at follow
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Figure 49. Dyspepsia (all cause)Fig
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Figure 55. Serious adverse events (
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Figure 61. Mean per-patient percent
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Figure 67. Any adverse events (all-
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Figure 73. Any adverse events (all-
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in men with erectile dysfunction. J
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parameters in obese men with erecti
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comparative crossover study. Androl
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153. Shabsigh R. Efficacy of silden
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190.191.Stief C, Porst H, Saenz dT,
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treatment of men with erectile dysf
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randomized trial. J Urol 1997 Oct;1
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moderate and severe ED. Int J Impot
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349.350.351.randomized, placebo-con
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395. Moher D, Schulz KF, Altman DG.
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PSVRCTRIRIASBPSCSDSETTGTRTWMDpeak s
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dDegDept.Ff/uFHxhrHxIGMmaxminmoNANI
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30. or/24-2931. (ANIMALS not HUMAN)
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27. limit 26 to yr="1990 - 2008"28.
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5. exp clinical trials/6. random$.m
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20. or/17-1921. 16 and 2022. limit
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A systematic review of harms associ
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B-4Summary Table- Randomized Contro
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The Quality Assessment of Studies o
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AuthorFundingN; study design; eligi
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C-10 AuthorFundingN; study design;
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C-146 C5-Intracavernousal Injection
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C-202 C8-Topical Treatments of ED A
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C-216 C9-Testosterone Treatment of
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Page 792 and 793: (84) Zinner N. Do food and dose tim
Page 794 and 795: (117) Carrier S, Brock GB, Pommervi
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Uckert S, Stief C G, Jonas U. Curre
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Leungwattanakij S, Flynn V, Hellstr
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Musacchio Najah S, Hartrich Molly,
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Akkus E, Kadioglu A, Esen A et al.
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Ashok S, Sigman M. Bioavailable tes
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Briganti A, Salonia A, Gallina A et
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Chinegwundoh F, Anie K A. Treatment
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Dundar S O. Visual loss associated
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Giammusso B, Gattuso U, Vanaclocha
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Hawton Keith, Catalan Jose, Fagg Jo
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Kell P. Cardiovascular safety of si
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Mulhall J P. Deciphering erectile d
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Parsons J K, Marschke P, Maples P e
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Shabsigh R. Testosterone therapy in
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Webb D J, Freestone S, Allen M J et
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Katlowitz N M, Albano G J, Morales
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Sparwasser C, Treiber U, Bahren W e
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van Basten J P, Van Driel M F, Jonk
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Youssef A F, Fort F L, Ronsen B et
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Cooper A J. Evaluation of I-C papav
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Buvat J, Montorsi F. Safety and tol
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Hatzichristou D G, Apostolidis A, T
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Kim E D, McVary K T. Topical prosta
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Terradas C, Levalle O, Nagelberg A
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Anonymous. New erectile dysfunction
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La Pera G, Franco Giannotti C, Tagg
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Mann R D. Introduction - Tadalafil.
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Montorsi F, Burnett A L. Erectile d
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Ramasubbu Rajamannar. Switching to
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Reznik I, Zemishlany Z, Kotler M et
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AuthorYearHellstrom 2005 37 Jadad Q
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AuthorYearJadad Q-1 Jadad Q-2 Jadad
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AuthorTotal AllocationJadad Q-1 Jad
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AuthorYearSaylan 2006 265 Jadad Q-1
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F-10STUDY IDQ1:SpectrumQ2.Selection
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Figure G-2. Sildenafil (any dose) v
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Figure G-8. Sildenafil (25 mg) vs.
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Figure G-10. Vardenafil (any dose)
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Tadalfil20 mg vs. PlaceboFigure G-1
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Figure G-14. Tadalafil (20 mg) vs.
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Figure G-16. Tadalafil (20mg) vs. T
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5 = Eleven+ attempts Q7: When you a
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The IIEF-5 score is the sum of ques
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El Malik EMA. Erectile dysfunction:
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