Interview with S. I. by Samedovym about therapy erectile dysfunction
Questions answers MD, Professor, Department of obstetrics, gynecology, Perinatology and Reproductology fpgpep of the fgbi "First MSMU named after I. M. Sechenov" of rmph, Professor, Department of urology, Federal state budget institution "Russian national research medical University them. N. And. Pirogov" of rmph, head of Department of andrology and urology fsbi "Nzagi them. Acad. V. I. Kulakov" of rmph S. I. Gamidov
– What is the prevalence of erectile dysfunction (ED) in Russia? How often is the combination of ED and benign prostatic hyperplasia (BPH) occurs in Your practice?
– It is a complex question, because in our country very few well-planned epidemiological studies on the prevalence of ED. And the results of existing individual works differ greatly. According to one, in Russia every third man over the age of 40 has erectile problems, and the results of other work indicate a fairly high incidence of ED (80%). Our own clinical experience, namely the results of the oral survey of more than 4,000 patients, referred to our clinic about male infertility have shown that erectile dysfunction is found only in 14.7%. This takes into account the results of only those patients who on admission were together with his wife, which increased the accuracy of the information. This fact is most probably connected with several factors. First, patients with reproductive disorders that were treated in our clinic, mostly of young age, when the prevalence of ED is low. Secondly, it is not always patients with mild or moderately mild ED, which is found also among men of young age who actively complain of erectile dysfunction. Existing occasional problems with the rigidity of the penis, they are associated with emotional or other factors. Finally, patients with infertility in the first place set up to address the issue of reproductive function, and therefore in the presence of pulmonary erectile dysfunction they are silent about it. Perhaps this aggravates the treatment of men with ED since the early stages of the disease when we can really help and to restore erectile dysfunction, patients the doctor treated, and complain of the late stages of ED, when there are more significant structural changes and requires invasive, expensive and long-term therapy.
As for the combination of ED and BPH, based on the results of international studies and on the basis of our own observations, we note a clear link between these two diseases. We know that with agethe incidence of ED and symptoms of dysfunction of lower urinary tract (SNMP) increases. According to some international reports, the prevalence of ED among men with SNMP is 88%. Naturally, the combination of these two diseases affect the quality of life of men middle-aged and elderly, and aggravates cardiovascular (CVD) and other comorbidities. It should be noted that ED in patients with Luts is not only psychological but also organic factors and the key role played by endothelial dysfunction. We can assume that these diseases are different manifestations of the existing system, including neurovascular and hormonal disorders in men of middle and old age as ED and CVD.
– How do You follow when choosing a therapy for ED? Why many patients prescribed for daily therapy – Cialis® 5 mg?
– Fortunately, today there are quite different ways to treat ED, and each of them has its advantages and disadvantages. Accordingly, the physician requires care in the choice of treatment, individual approach to the patient. For a long time men with ED dreamed of a "magic pill", after taking which it was possible to expect a quality erection. At the end of the twentieth century, their dream came true, appeared on the market a revolutionary group of drugs inhibitors of phosphodiesterase 5-th type (PDE–5). The appearance of these drugs not only improved the quality of sexual life of men, and has intensified treatment of patients with ED, this in turn has motivated scientists to a better understanding of erectile dysfunction. We have known the basic pathogenetic aspects of ED in different groups of patients, including CVD, diabetes mellitus (DM) and after of radical operations on the pelvic organs.
When choosing a therapy for ED, we use an individual approach to each patient taking into account his physical health, and sexual preferences. Mostly orientirueshsya on the effectiveness and safety of the method. In addition, an important non-invasive, naturalness and accessibility. Before appointing therapy, we in detail tell patients about all available treatment methods. The use of oral medications, more precisely, inhibitors of PDE-5 is often starting treatment, and only at their inefficiency and intolerance, we are considering other invasive treatments. Although there are exceptions, when a patient chooses invasive methods of sexual rehabilitation, refusing to accept the inhibitors PDE-5. Most likely, this is due to the lack of awareness of the patients about these drugs. After extensive discussions it is often possible to convince patients tothe efficacy and safety of inhibitors PDE-5.
Relatively daily dosing Cialis® 5 mg can say this: long before the advent of this drug in the clinic, we mainly tried to use inhibitors PDE-5 in regular mode. Taking into account the duration of the action was the selected remedy Cialis® 20 mg, which we appointed to be taken regularly 2-3 times a week. This provided patients with the spontaneity of sexual life, improve the quality and frequency not only spontaneous, but also morning and night erections, increasing the confidence of patients to therapy. In addition, patients are psychologically more favorably perceived regular therapy than medication "on demand". Inhibitors PDE-5 just before intercourse scares many patients because they regard the pill as a stimulant of sexual activity, doctors have to spend with them for additional outreach. So we, like many urologists, with impatience waited for the appearance of the drug Cialis® 5 mg for regular use. Today, this drug does increase the capacity of specialists involved in the treatment of ED, especially in patients with risk factors (Smoking, DM, CVD and so on), while along with improving erectile function, in our opinion, improves endothelial dysfunction. Also Cialis® 5 mg indispensable in the treatment of patients undergoing radical surgery on the pelvic organs, in such cases, the long regular use of the drug effectively restores erectile function. In other words, the drug Cialis® 5 mg is an effective, convenient, safe and cost-effective method of treatment.
– It is known that Cialis® 5 mg is well studied in terms of effectiveness in ED, and now for BPH. As evidenced by Your personal experience with the drug in patients with ED and BPH?
Yes, Cialis® 5 mg is quite effective and most convenient drug. And the main advantage – a long period. On the one hand, it enables physicians to use the therapy on a regular basis, with another – creates conditions for spontaneous sexual life of the patients. Use of Cialis® 5 mg as a monotherapy and in combination therapy in patients with BPH/Luts is not surprising, since, as shown by experimental and clinical studies, an enzyme PDE-5 is not only in the corpora cavernosa, but also in the tissue of the prostate and the bladder wall. So today we can say that the application of Cialis® 5 mg in the treatment of patients with BPH is not symptomatic and has a pathogenetic basis, evidenced by the results of large-scale, multicenter international studies./> We also use Cialis® 5 mg for the treatment of Luts in patients with BPH and observed good results. This effect was noted when use of Cialis® is not just a dose of 5 mg, but in the regular regimen dose of 20 mg, which I already said. And this fact we attributed to the improvement of the condition of the prostate gland on the background of regular sex life. The main contingent of patients who we prescribe Cialis® is patients with mild and moderate Luts, a wish to preserve antegrade ejaculation. Most often we prescribe Cialis® 5 mg patients with combined urinary symptoms with BPH and ED.
– There are many different points of view about the use of Cialis® is 5 mg in patients with BPH. The effectiveness of the drug evidence that reducing the number of points on the scale of total evaluation of prostatic symptoms, IPSS (this is the main criterion of efficiency of treatment according to the European and American associations of urology). And in Russia doctors always say only a small improvement in Qmax. What is Your opinion on this issue?
– To begin with, find out which SNMP increasingly worsen the quality of life of patients with BPH: obstructive or irritative? International studies clearly indicate the important role of the irritative symptoms. And in practice we see that while taking Cialis® 5 mg reduces the severity of irritative symptoms, thereby improving the quality of life of patients.
When using the drug Cialis® 5 mg as monotherapy indicator of Qmax, according to international studies, is changing almost as well as the use of blockers. In addition, we know that a variety of the world's urological Association believe that it is the change in IPSS is an important clinical criterion for the improvement of urination in patients. As I mentioned above, when expressed SNMP, especially when the prevalence of obstructive component, we often use α-blockers or combination therapy with inhibitors of PDE-5 on demand. For me personally, an important criterion is to improve the urination and erectile function is the sensations of the patient, namely the dynamics of the IPSS. In addition, when there are significant obstructive symptoms and receiving α-blockers the desired effect is not always achieved, and the problem mostly solved with the help of surgery. Therefore the inhibitors of PDE-5 can make a real competition of α-blockers for the correction it irritative symptoms in BPH patients. In addition, improved erections while taking Cialis® 5 mg makes it a drug of choice in certain groups of patients with SNMP.
– What is Your opinion about the recently published study on the combined use Cialis® 5 mg andfinasteride? Do You feel that this combination will be used by urologists in Russia?
– Men age number of comorbidities, and regular use of drugs increases. Accordingly, the consumption of large amounts of drugs causes some discomfort patients. It is no coincidence that they prefer drugs that are taken 1 time per day. In addition, statistics show that more than 80% of cases SNMP combined with erectile dysfunction and age the incidence of ED and BPH increases. From this point of view, the emergence of combined preparations is welcome. But it should be emphasized that, in addition to convenience, receiving combination Cialis® 5 mg finasteride will increase the possibility of conservative treatment of patients with BPH. First, as already stressed, both drugs have a positive effect on SNMP. Second, as is well known, inhibitors of 5α-reductase, according to various estimates, in 7-30% of cases cause ED, what makes you be careful when prescribing these drugs, especially in relatively young patients. In addition, the frequently used combination of inhibitors of 5α-reductase inhibitors with α-blockers further increases the frequency of sexual disorders in patients with BPH. In turn, the studies confirm that the inhibitors PDE-5 helps to correct existing violations of erection. So, in my opinion, the combination of Cialis® 5 mg finasteride in patients with BPH has a great potential, and I'm sure many urologists in Russia will apply in their practice this combination.
– Which patients often would You recommend Cialis® 5 mg?
– First of all that sexually active patients with vascular risk factors (Smoking, diabetes, dyslipidemia, metabolic syndrome), patients after radical prostatectomy. As shown by our clinical experience in these patients, it is preferable to regular use of the drug. Cialis® 5 mg is also a drug of choice in patients who want to have spontaneous sexual activity. Patients with mild and moderate Luts, especially in conjunction with ED, and receiving inhibitors of 5α-reductase. They prescribe Cialis® at a dose of 5 mg in a regular mode.