International Journal of Impotence Research (2014) 26, 120 & 2014 Macmillan Publishers Limited All rights reserved 0955-9930/14 www.nature.com/ijir
LETTER TO THE EDITOR
Pharmaco-induced erections for penile color-Doppler ultrasound: oral pde5 inhibitors or intracavernosal injection? International Journal of Impotence Research (2014) 26, 120; doi:10.1038/ijir.2013.43
We read the article by Yang et al.1 with great interest. This prospective study aimed to compare the clinical responses and penile color-duplex ultrasound (PCDU) results of oral phosphodiesterase type 5 (PDE5) inhibitors (sildenafil and tadalafil) with intracavernosal injection of papaverine (ICI). The primary end point was to demonstrate whether PDE5 inhibitors could be used as an alternative to ICI under certain circumstances. Although this topic was previously highlighted in several papers,2,3 the authors are to be congratulated for conducting such a well-designed prospective study. However, there are some points that need to be addressed. The development of oral medications revolutionized our approach to patients with erectile dysfunction (ED) and limited the indications for specific diagnostic tests (such as PCDU).4 Nowadays, these expensive, time-consuming and invasive tests are rarely used for patients with post-traumatic ED, Peyronie’s disease and/or systemic diseases that may cause ED. Therefore, it seems that the indications for performing PCDU in this study population may not be appropriate. The mean age (37.3±10.1 years) of the study group was relatively young for an ED study population and 92% of those patients demonstrated normal erectile responses, confirming our concerns regarding the PCUD indications among these young men. Furthermore, the incidence of priapism was almost twice as much as the previously reported5 (4 vs 2.68%). It seems that the authors did not follow the standard diagnostic algorithms defined in the recent guidelines.4 We believe that the authors should have performed PCUD on patients among
whom performing this test was indicated, prior to making any conclusions. Moreover, they could have explained why the differences in end-diastolic velocity measures were observed only in the right cavernosal artery and not in the left one.
CONFLICT OF INTEREST The authors declare no conflict of interest.
M Akcay1 and EC Serefoglu2 Faculty of Medicine, Department of Urology, Bezmialem Vakif University, Istanbul, Turkey and 2 Department of Urology, Medicana International Hospital, Ankara, Turkey E-mail: [email protected]
1
REFERENCES 1 Yang Y, Hu JL, Ma Y, Wang HX, Chen Z, Xia JG et al. Pharmaco-induced erections for penile color-duplex ultrasound: oral PDE-5 inhibitors or intracavernosal injection? Int J Impot Res 2012; 24: 191–195. 2 Ardicoglu A, Kocakoc E, Tuygun UO, Bozgeyik Z, Orhan I. Effectiveness of vardenafil versus papaverine in penile Doppler ultrasonography. Urol Int 2005; 75: 75–79. 3 Arslan D, Esen AA, Sec¸il M, Aslan G, Celebi I, Dicle O. A new method for the evaluation of erectile dysfunction: sildenafil plus Doppler ultrasonography. J Urol 2001; 166: 181–184. 4 Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F et al. Guidelines on male sexual dysfunction: Erectile dysfunction and premature ejaculation. Eur Urol 2010; 57: 804–814. 5 Kilic M, Serefoglu EC, Ozdemir AT, Balbay MD. The actual incidence of papaverineinduced priapism in patients with erectile dysfunction following penile colour Doppler ultrasonography. Andrologia 2010; 42: 1–4.
LETTER TO THE EDITOR
Pharmaco-induced erections for penile color-Doppler ultrasound: oral pde5 inhibitors or intracavernosal injection? International Journal of Impotence Research (2014) 26, 120; doi:10.1038/ijir.2013.43
We read the article by Yang et al.1 with great interest. This prospective study aimed to compare the clinical responses and penile color-duplex ultrasound (PCDU) results of oral phosphodiesterase type 5 (PDE5) inhibitors (sildenafil and tadalafil) with intracavernosal injection of papaverine (ICI). The primary end point was to demonstrate whether PDE5 inhibitors could be used as an alternative to ICI under certain circumstances. Although this topic was previously highlighted in several papers,2,3 the authors are to be congratulated for conducting such a well-designed prospective study. However, there are some points that need to be addressed. The development of oral medications revolutionized our approach to patients with erectile dysfunction (ED) and limited the indications for specific diagnostic tests (such as PCDU).4 Nowadays, these expensive, time-consuming and invasive tests are rarely used for patients with post-traumatic ED, Peyronie’s disease and/or systemic diseases that may cause ED. Therefore, it seems that the indications for performing PCDU in this study population may not be appropriate. The mean age (37.3±10.1 years) of the study group was relatively young for an ED study population and 92% of those patients demonstrated normal erectile responses, confirming our concerns regarding the PCUD indications among these young men. Furthermore, the incidence of priapism was almost twice as much as the previously reported5 (4 vs 2.68%). It seems that the authors did not follow the standard diagnostic algorithms defined in the recent guidelines.4 We believe that the authors should have performed PCUD on patients among
whom performing this test was indicated, prior to making any conclusions. Moreover, they could have explained why the differences in end-diastolic velocity measures were observed only in the right cavernosal artery and not in the left one.
CONFLICT OF INTEREST The authors declare no conflict of interest.
M Akcay1 and EC Serefoglu2 Faculty of Medicine, Department of Urology, Bezmialem Vakif University, Istanbul, Turkey and 2 Department of Urology, Medicana International Hospital, Ankara, Turkey E-mail: [email protected]
1
REFERENCES 1 Yang Y, Hu JL, Ma Y, Wang HX, Chen Z, Xia JG et al. Pharmaco-induced erections for penile color-duplex ultrasound: oral PDE-5 inhibitors or intracavernosal injection? Int J Impot Res 2012; 24: 191–195. 2 Ardicoglu A, Kocakoc E, Tuygun UO, Bozgeyik Z, Orhan I. Effectiveness of vardenafil versus papaverine in penile Doppler ultrasonography. Urol Int 2005; 75: 75–79. 3 Arslan D, Esen AA, Sec¸il M, Aslan G, Celebi I, Dicle O. A new method for the evaluation of erectile dysfunction: sildenafil plus Doppler ultrasonography. J Urol 2001; 166: 181–184. 4 Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F et al. Guidelines on male sexual dysfunction: Erectile dysfunction and premature ejaculation. Eur Urol 2010; 57: 804–814. 5 Kilic M, Serefoglu EC, Ozdemir AT, Balbay MD. The actual incidence of papaverineinduced priapism in patients with erectile dysfunction following penile colour Doppler ultrasonography. Andrologia 2010; 42: 1–4.
