Resumption of spontaneous erections in selected patients affected by erectile dysfunction and various degrees of carotid wall alteration: Role of tadalafil

Objective: To evaluate the possible improvement of sexual activity following a non on-demand administration of a long half-life selective inhibitor of phosphodiesterase type 5 (PDE-5) in elderly patients without major cardiovascular risk factors. Methods: Sixty subjects with erectile dysfunction (ED) aged 60-70 years and 30 control patients aged 18-40 years, affected by psychogenic ED, were studied. All underwent routine and hormonal blood tests, Nocturnal Penile Tumescence Rigidity Monitoring test (NPTRM), ultrasonographyc evaluation of common carotid artery intimamedia thickness (IMT) and penile colour Doppler ultrasonography (P-CDU). All patients underwent therapy with tadalafil 20 mg in alternative days, non on-demand, at 5.00 p.m., for three consecutive months. IIEF-5, NPTRM test and P-CDU were re-evaluated one month after the end of the therapy. Results: Among elderly subjects 20 (33%) had normal carotid IMT (< 0.9 mm), 15 (25%) minimal increase of carotid thickness (IMT = 0.9-1.2 mm) and 25 (42%) one or more carotid plaques (IMT > 1.3 mm). NPTRM and PCDU parameters were inversely related to different degrees of carotid wall alteration and showed a significant improvement respect to pre-treatment only in patients without atherosclerotic plaques. Also IIEF-5 showed significant improvements only in patients without atherosclerotic plaques. Conclusions: In elderly subjects with slight or no signs of vascular disease at the carotid level, chronic and non on-demand treatment with tadalafil can induce spontaneous resumption of erections, probably through the improvement of endothelial function, but direct evidences to confirm this hypothesis are required. (c) 2005 Elsevier B.V. All rights reserved.