Tez boşalmalı olgularda fosfodiesteraz tip 5 inhibitörlerinin sertleşme ve boşalma sürecine etkileri: Çift-kör, plasebo kontrollü laboratuar çalışması

Abstract

Amaç: Primer tez bosalmalı (TB) hastalarda fosfodiesteraz tip 5 (PDE5)inhibitörlerinin uyarı ile bosalma süresi ve sertlesme parametreleri üzerine etkilerininlaboratuar sartlarında degerlendirilmesi.Hastalar ve yöntem: Primer TB'lı 80 olguda çift-kör, plasebo kontrollülaboratuar çalısması gerçeklestirildi.Çalısmaya alınan tüm olgular, TB sorgulamasıyla, yanı sıra uluslararasıerektil islev sorgulaması (IIEF), Amerikan ulusal saglık enstitüsü (NIH) prostatitsorgulaması ve uluslararası prostat semptom skoru (IPSS) sorgulaması iledegerlendirildi.Olgular plasebo ve PDE5 inhibitörlerini alır almaz gerçek zamanlı peniltümesans ve sertlik ölçümü baslatıldı. Görsel ve sesli cinsel uyarı (GSCU) 90 dakikasonra baslatıldı. Hasta GSCU'nun sekizinci dakikasında vibrasyonla cinsel uyarıyabasladı ve bosalma gerçeklesinceye kadar devam etti. Bosalma sonrası GSCUdurduruldu. Uyarı ile bosalma süresi kronometre ile ölçüldü. Monitorizasyona sonkaydedilen uç veya kök sertliginden sonra 20 dakika daha devam edildi.

Objectives: To evaluate the effects of fosfodiesterase type 5 (PDE5)inhibitors on ejaculation latency and rigidity parameters of patients with rapidejaculation in a laboratory setting.Patients and Methods: Double-blind, placebo controlled laboratory studywas performed with 80 males with lifelong rapid ejaculation.All patients were evaluated with premature ejaculation questionnaire,International Index of Erectile Function (IIEF) questionnaire, NIH questionnaire forprostatitis, and IPSS questionnaire for urinary obstruction.As the subjects ingested the placebo or PDE5 inhibitors, real time peniletumescence and rigidity monitoring began. Audiovisual sexual stimulation (AVSS)was performed 90 minutes later. The patients began vibratory stimulation at 8 thminute of AVSS till ejaculation. Following ejaculation AVSS was stopped. Theejaculation latency time was measured by chronometer. The monitorisation wascontinued for 20 minutes after the last recorded tip or base rigidity.After the tests, all patients underwent side effect qestionnaire and satisfactionquestionnaire. Results were compared using Man Whitney U, chi square, student t,variance analysis, and Kruskall Wallis tests.Results: In placebo, sildenafil, and vardenafil groups 16 per each group andin tadalafil group 15 patients had evaluable parameters. Mean age, length, body massindex, and duration of rapid ejaculation did not show any significant differencebetween these groups. The ejaculation latency time of patients who received placebowas 51,9±29,5 (mean ± SD) seconds, this time 91,9±117,8 seconds for sildenafil,90,5±96,6 seconds for tadalafil and 99,1±62,6 seconds for vardenafil. Whencompared with placebo group it was statistically significant only in patients receivingvardenafil. Although time to first measured tip or base rigidities were shorter whenthe patients received PDE5 inhibitors, these differences were statistically significantonly in patients who received sildenafil or vardenafil. When compared with placebotime to last recorded tip or base rigidities were also longer in PDE5 groups, and thedifferences were significant. There were more side effects in PDE5 groups. All theside effects were mild to moderate in severity. When ejaculation latency times duringtests were compared with subjective ejaculation latency times of patients, it waslonger in PDE5 groups and also these differences were statistically significant.Conclusion: In this laboratory setting, PDE5 inhibitors prolonged ejaculationlatency time. Also the benefical effects of PDE5 inhibitors were demonstrated onerection parameters. This laboratory setting might be used to evaluate the effects ofdrugs for rapid ejaculation.Keywords: Rapid ejaculation, phosphodiesterase type 5 inhibitors, sildenafil,tadalafil, vardenafil, audiovisual sexual stimulation, vibratory stimulation.