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Low dose daily versus on-demand high dose tadalafil in diabetic patients with erectile and ejaculatory dysfunction

International Journal of Impotence Research volume 30, pages 102–107 (2018)Cite this article

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Abstract

The aim was to compare the differences between daily 5 mg and on-demand 20 mg tadalafil use in diabetic patients with erectile dysfunction (ED), and the effects of two different tadalafil protocols on ejaculatory and lower urinary tract symptoms (LUTS). Of the 63 diabetic patients with ED, 31 were given 5 mg tadalafil once a day, and 32 were given 20 mg tadalafil on-demand four times a month over three months. Erectile function, erectile hardness, ejaculatory function, and LUTS were assessed at pretreatment, first- and third-month controls. Both tadalafil protocols increased International Index of Erectile Function (IIEF) scores in all patients under 65 years, whereas patients older than 65 years did not benefit. Ejaculatory function, the quality of the hardness of an erection, and LUTS improved in both groups in the study. Tadalafil improved sexual function with acceptable side effects in diabetic men with ED. Both protocols equally improved LUTS and the quality of the erection. Daily use of 5 mg of tadalafil significantly improved the quality of ejaculation and LUTS more than the on-demand use of 20 mg of tadalafil. It may be beneficial to give 5 mg tadalafil daily to patients over 65 years old who do not benefit from treatment with 20 mg of tadalafil or in patients who have LUTS over 65 years old.

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References

  1. Vickers MA Jr, Seiler M, Weidner N. Corpora cavernosa ultrastructure in vascular erectile dysfunction. J Urol. 1990;143:1131–4.

    Article  Google Scholar 

  2. Rew KT, Heidelbauch JJ. Erectile dysfunction. Am Pham Physician. 2016;94:820–7.

    Google Scholar 

  3. Global report on diabetes. World Health Organization, Geneva, 2016.

  4. Giugliano F, Maiorino M, Bellastella G, Gicchino M, Giugliano D, Esposito K. Determinants of erectile dysfunction in type 2 diabetes. Int J Impot Res. 2010;22:204–9.

    Article  CAS  Google Scholar 

  5. Thorve VS, Kshirsagar AD, Vyawahare, Joshi VS, Ingane KG, Mohite RJ. Diabetes-induced erectile dysfunction: epidemiology, pathophysiology and management. J Diabetes Complicat. 2011;25:129–36.

    Article  Google Scholar 

  6. Maiorino MI, Bellastella G, Esposito K. Diabetes and sexual dysfunction: current perspectives. Diabetes Metab Syndr Obes. 2014;7:95–105.

    PubMed  PubMed Central  Google Scholar 

  7. Ciocca G, Carosa E, Stornelli M, Limoncin E, Gravina GL, Iannarelli R, et al. Post-traumatic stress disorder, coping strategies and type 2 diabetes: psychometric assessment after L’Aquila earthquake. Acta Diabetol. 2015;52:513–21.

    Article  CAS  Google Scholar 

  8. Cellek S. Let’s make NO mistake! Int J Impot Res. 2005;17:388–9.

    Article  CAS  Google Scholar 

  9. Hurt KJ, Musicki B, Palese MA, Crone JK, Becker RE, Moriarity JL, et al. Akt-dependent phosphorylation of endothelial nitric-oxide synthase mediates penile erection. Proc Natl Acad Sci USA. 2002;99:4061–6.

    Article  CAS  Google Scholar 

  10. Corona G, Rastrelli G, Burri A, Serra E, Gianfrilli D, Manucci E, et al. First-generation phosphodiesterase type 5 inhibitors dropout: a comprehensive review and meta-analysis. Andrology. 2016;4:1002–9.

    Article  CAS  Google Scholar 

  11. Ritchie R, Sullivan M. Endothelins & erectile dysfunction. Pharmacol Res. 2011;63:496–501.

    Article  CAS  Google Scholar 

  12. Porst H, Giuliano F, Glina S, Ralph D, Casabé AR, Elion-Mboussa A, et al. Evaluation of the efficacy and safety of once-a-day dosing of tadalafil 5 mg and 10 mg in the treatment of erectile dysfunction: results of a multicenter, randomized, double-blind, placebo-controlled trial. Eur Urol. 2006;50:351–9.

    Article  CAS  Google Scholar 

  13. Williams SB, Goldfine AB, Timimi FK, Ting HH, Roddy MA, Simonson DC, et al. Acute hyperglycemia attenuates endothelium-dependent vasodilation in humans in vivo. Circulation. 1998;97:1695–701.

    Article  CAS  Google Scholar 

  14. Kensinger C, Bian A, Fairchild M, Chen G, Lipworth L, Ikizler TA, et al. Long term evolution of endothelial function during kidney transplantation. BMC Nephrol. 2016;17:160.

    Article  Google Scholar 

  15. Morelli A, Sarchielli E, Comeglio P, Filippi S, Mancina R, Gacci M, et al. Phosphodiesterase type 5 expression in human and rat lower urinary tract tissues and the effect of tadalafil on prostate gland oxygenization in spontaneously hypertensive rats. J Sex Med. 2011;8:2746–60.

    Article  CAS  Google Scholar 

  16. Park HJ, Won JE, Sorsaburu S, Rivera PD, Lee SW. Urinary Tract Symptoms (LUTS) Secondary to Benign Prostatic Hyperplasia (BPH) and LUTS/BPH with erectile dysfunction in asian men: a systematic review focusing on tadalafil. World J Mens Health. 2013;31:193–207.

    Article  Google Scholar 

  17. Turunç T, Deveci S, Güvel S, Peşkircioğlu L. The assessment of Turkish validation with 5 question version of International Index of Erectile Function (IIEF-5). Turk J Urol. 2007;33:45–49.

    Google Scholar 

  18. Francis SH, Corbin JD. PDE5 inhibitors: targeting erectile dysfunction in diabetics. Curr Opin Pharmacol. 2011;11:683–638.

    Article  CAS  Google Scholar 

  19. Burns PR, Rosen RC, Dunn M, Baygani SK, Perelman MA. Treatment satisfaction of men and partners following switch from on-demand phosphodiesterase type 5 inhibitor therapy to tadalafil 5 mg once daily. J Sex Med. 2015;12:720–7.

    Article  CAS  Google Scholar 

  20. Tang YX, Zhou HB, Peng SL, Jiang XZ, He LY, Li DJ. Effects of tadalafil on erectile dysfunction: on-demand versus once-daily dosing. Zhonghua Nan Ke Xue. 2012;18:472–4.

    PubMed  Google Scholar 

  21. Limoncin E, Gravina GL, Corona G, Maggi M, Cioccia G, Lenzi A, et al. Erectile function recovery in men treated with phosphodiesterase type 5 inhibitor administration after bilateral nerve-sparing radical prostatectomy: a systematic review of placebo-controlled randomized trials with trial sequential analysis. Andrology. 2017;5:863–72.

    Article  CAS  Google Scholar 

  22. Carosa E, Martini P, Brandetti F, Di Stasi SM, Lombardo F, Lenzi A, et al. Type V phosphodiesterase inhibitor treatments for erectile dysfunction increase testosterone levels. Clin Endocrinol (Oxf). 2004;61:382–6.

    Article  CAS  Google Scholar 

  23. Jannini EA, Lenzi A. Ejaculatory disorders: epidemiology and current approaches to definition, classification and subtyping. World J Urol. 2005;23:68–75.

    Article  Google Scholar 

  24. Karabakan M, Keskin E, Akdemir S, Bozkurt A. Effect of tadalafil 5mg daily treatment on the ejaculatory times, lower urinary tract symptoms and erectile function in patients with erectile dysfunction. Int Braz J Urol. 2017;43:317–24.

    Article  Google Scholar 

  25. Paduch DA, Bolyakov A, Polzer PK, Watts SD. Effects of 12 weeks of tadalafil treatment on ejaculatory and orgasmic dysfunction and sexual satisfaction in patients with mild to severe erectile dysfunction: integrated analysis of 17 placebo-controlled studies. BJU Int. 2012;111:334–48.

    Article  Google Scholar 

  26. Huang YP, Zheng FF, Yao FJ, Liu GH, Bian J, Gao Y, et al. Daily medication of low-dose tadalafil improves endothelial function and erectile hardness of ED patients. Zhonghua Nan Ke Xue. 2010;16:1052–5.

    PubMed  Google Scholar 

  27. Yokoyama O, Igawa Y, Takeda M. Tadalafil lower urinary tract symptoms secondary to benign prostatic hyperplasia: a review of clinical data in Asian men and an update on the mechanism of action. Ther Adv Urol. 2015;7:249–64.

    Article  CAS  Google Scholar 

  28. Morelli A, Sarchielli E, Comeglio P, Filippi S, Mancina R, Gacci M, et al. Phosphodiesterase type 5 expression in human and rat lower urinary tract tissues and the effect of tadalafil on prostate gland oxygenation in spontaneously hypertensive rats. J Sex Med. 2011;8:2746–60.

    Article  CAS  Google Scholar 

  29. Thieme M, Sivritas SH, Mergia, Potthoff SA, Yang G, Hering L, et al. Phosphodiesterase 5 inhibition ameliorates angiotensin II-dependent hypertension and renal vascular dysfunction. Am J Physiol Ren Physiol. 2017;312:F474–F481.

    Article  CAS  Google Scholar 

  30. Fukumoto K, Naga A, Hara R, Fujii T, Miyaji Y. Tadalafil for male lower urinary tract symptoms improves endothelial function. Int J Urol. 2016;11:1–5.

    Google Scholar 

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Authors and Affiliations

  1. Urologist, Samsun Training and Research Hospital, Department of Urology, Health Sciences University, Samsun, Turkey

    Mustafa Suat Bolat, Onder Cinar & Ekrem Akdeniz

  2. Professor, FECSM, Department of Urology, Urology, Ondokuz Mayıs University, Samsun, Turkey

    Ramazan Aşcı

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  1. Mustafa Suat Bolat
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  2. Onder Cinar
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  3. Ekrem Akdeniz
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  4. Ramazan Aşcı
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Correspondence to Mustafa Suat Bolat.

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Bolat, M.S., Cinar, O., Akdeniz, E. et al. Low dose daily versus on-demand high dose tadalafil in diabetic patients with erectile and ejaculatory dysfunction. Int J Impot Res 30, 102–107 (2018). https://doi.org/10.1038/s41443-018-0019-5

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