A 70-year-old male with a history of diabetes, hyperlipidaemia and hypertension managed with atenolol presented to his family physician with lower urinary tract symptoms (LUTS). He was prescribed terazosin. Over the course of a year he noticed worsening erectile dysfunction (ED) with difficulty maintaining a hard erection until orgasm.
Erectile dysfunction (ED) is a common condition defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance.1 It is one of the most common complaints in men’s sexual medicine, affecting both physical and psychosocial health and having a significant impact on the patient and partner’s quality of life.1 Moreover, ED is commonly associated with other comorbid conditions, including hypertension, dyslipidaemia and diabetes mellitus.1
Evaluation of ED should include a detailed medical and sexual history of the patient. 1 A discussion of the patient and partner’s preference and treatment goals is essential to better tailor treatment and improve patient satisfaction and adherence to treatment.2 Lifestyle modification and management of risk factors should precede pharmacotherapy, while first-line treatment with oral phosphodiesterase type 5 inhibitors (PDE5i) is well established for the management of patients with ED.1
Use of phosphodiesterase-5 (PDE5) inhibitors
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long-term adverse outcomes, including mortality and heart failure
hospitalization, in a dose-dependent fashion, according to a Swedish study.
Erectile dysfunction may potentially be associated with gout, a new systematic report and meta-analysis reveals. However, the low quality and high degree of heterogeneity among the studies included reduce the certainty of this conclusion.
Metronomic cyclophosphamide is modestly effective, and may be a safe and non-expensive treatment alternative in hormone-naïve patients with non-metastatic biochemical recurrent prostate cancer, as stated in a prospective single-arm open-label phase II study.