The most widely-spread disease in elderly men besides cardio-vascular disorders is benign prostatic hyperplasia (BPH). Smart Canadian Pharmacy specialists (team information) confirm global tendencies to gradual increase of BPH frequency from 11.3 per cent at the age of 40-48 years up to 81.4 per cent by 80 years. Chronological co-morbidity of erectile dysfunction is evident.
Benign prostatic hyperplasia accompanied by symptoms of lower urinary tract disorders in combination with erectile dysfunction takes adverse impact on sexual life of a man decreasing the quality of his life considerably. Medications of choice with proved efficiency and safety for treatment of BPH symptoms are selective alpha adrenoceptor antagonists. Their application in combination with PDE5 inhibitors allows achieving the decrease of irritative symptomatology and improvement of erectile function. Moreover, monotherapy with PDE5 inhibitors leads to decrease of irritative symptoms pronouncement and doesn’t affect urodynamic indicators.
What Is TURP?
Notwithstanding the apparent success of conservative therapy of prostatic hyperplasia, around one of three patients undergo operative treatment. Transurethral resection of prostate (TURP) is a golden standard of BPH therapy. Its main purpose is not only restoration of adequate urination, but also improvement of patients’ quality of well-being. Sexual activity is of considerable importance; it preserves after surgery in 84 per cent of patients belonging to elderly age groups. The frequency of erection impairment after transurethral resection of prostate reaches from 16-20 per cent to 30-39 per cent.
In 1984, neuroanatomic causes were considered to provoke erectile dysfunction after TURP. There are common mechanisms of ED pathogenesis after transurethral operations and radical prostatectomy. The development of complications was connected with impairment of cavernous nerves passing through posteroexternal surfaces of anatomic capsule of prostatic gland during the operation. In 1997, it was stated that perforation of prostatic posteroexternal surface more often leads to erectile dysfunction, whereas impairment of capsule integrity in projection from 10 to 2 hours decreases potency rarer (in 2 per cent of cases).
Spontaneous restoration of erection was connected with impairment of cavernous nerves functioning, rather than with their physical damage. ED therapy of any etiology should be based on unified follow-on approach which implies application of PDE5 inhibitors in the first line. In case of their inefficiency, intracavernous therapy with vasoactive remedies is assigned; and if there is no response on treatment – vascular operations or penal prosthetic repair.
In 2005, the relevance of follow-on ED therapy was estimated after transurethral removal of prostate hyperplasia. Scientists have confirmed that therapy on demand with PDE5 inhibitor (vardenafil) allows a patient to achieve good results only while using maximal dosage which may be explained by impairment of function of cavernous nerves resulting from surgery performed. After a couple of months of such treatment with periodical intake of vardenafil (Levitra) twice or thrice per week, erectile function gets completely restored. And patients may continue sexual life without medications stimulating erection.
In case of intolerability of ED treatment with PDE5 inhibitors, intracavernous injections of prostaglandin E prove to be not less effective. Nevertheless, non-invasiveness of this method and the risk of priapism development do not allow using it by all types of patients. It is worth mentioning that application of follow-on approach hasn’t induced any patient to make use of operative method of ED correction.
Nowadays, phosphodeisterase 5 inhibitors (PDE5) are medications of the first line in ED therapy. Their effect is based on selective inhibition of phosphodeisterase5 which catalyzes degradation of cyclic guanosine monophosphate. This group includes sildenafil, vardenafil, tadalafil, etc. Their efficiency in restoration of capacity to have sully-realized sex in case of erectile dysfunction makes around 83-85 per cent. One of the latest developments is vardenafil (Levitra from Bayer), a new selective PDE5 inhibitor.
Levitra (see our Levitra guide: smartcanadianpharmacy.com/generic-levitra.html) takes its action quite fast – in ten minutes after the intake and lasts 8-12 hours providing successful sexual relations. Levitra may be taken regardless of food intake and alcohol. It is 10 times more effective than Viagra and 13 times active than Cialis. High selectivity of this remedy to PDE5 creates a beneficial profile of safety and tolerability. After operative treatment, PDE5 inhibitors should be taken as per requirement (before sexual intercourse) or on the daily basis in standard and small doses before going to bed. For prophylaxis, these medications are used daily in standard and small dose beginning from post-operation period.
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Materials and Methods
The research study of efficiency and safety of peroral intake of Levitra by patients with ED after TURP of prostate hyperplasia included forty patients with normal erectile function before operation. Twenty patients took vardenafil in dose of 10mg as per requirement, whereas 20 of them received this remedy in dose of 10mg before going to bed on the daily basis during 90 days. Esteem of erectile disorders was conducted three months after the operation. The indispensable condition was minimal dysuria, absence of laboratory signs of pyoinflammatory process, and adequacy of urination restoration.
Average age of the patients varied between 51 and 74 years. All patients were diagnosed based on the data of the research study which included PSA blood research and its fraction, transrectal ultrasound, digital rectal examination, histology acquired during operation.
Primary effectiveness of Levitra was estimated in accordance with International Index of ED by means of collation of responses sum on some of the questions resulting from 12-week vardenafil intake. The secondary efficiency was estimated as per comparative analysis of the questions 3 and 4 of IIEF questionnaire (How often erection was sufficient for penetration during the attempt of coitus? How often were you able to preserve erection after penetration during coitus?). In addition to the afore-mentioned method, the responses on the following questions were also estimated: Did you manage to penetrate after each Levitra administration? Did erection preserve enough to consider coitus successful after each Levitra intake?
A successful penetration was achieved by 70 per cent of patients after vardenafil application (exclusive vardenafil guide by Smart Canadian Pharmacy: smartcanadianpharmacy.com/vardenafil.html), whereas in the group of patients taking it daily – the figures achieved 90 per cent. Patients able to preserve erection before orgasm made 60% among those ones who administered Levitra when required and 85 per cent – among those who took 10mg of vardenafil on the daily basis. Normal result indexes of total IIEF score were achieved by 70 per cent of patents who took 10mg of vardenafil on the daily basis and by 40 per cent by those who used it when required. By the moment of the real estimation of results, not longer than in 56 weeks after TURP, 14 out of 20 patients taking vardenafil daily noted the return of spontaneous erections. 8 patients out of 20 who took it when required noted similar effect.
All in all, vardenafil showed good results on safety and tolerability. The majority of undesired reactions were slightly pronounced and manifested themselves with blushing, nasal congestion and rarer in headache. Muscular pains, color perception issues were not observed as opposed to sildenafil intake. In comparison with tadalafil, vardenafil administration does not cause myodynia.