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  • br Materials and methods br Results br Discussion For many

    2019-09-11


    Materials and methods
    Results
    Discussion For many years, oral PDE5-Is have been prescribed as an on-demand regimen for treating ED. Several studies have reported on the efficacy and safety of such a regimen, with an overall efficacy rate of 60–70% [21]. However, many patients complain of a lack of spontaneity and natural sexual function with on-demand regimens [22]. Planning sexual activity might be anxiety provoking for the man, his partner, and their relationship, causing the sexual encounter to become a stressful event. In 2007, the European Medicines Agency approved low-dose tadalafil to be used as once-daily therapy for ED [23]. Daily dosing or chronic administration of a PDE5-I provides a treatment alternative to on-demand PDE5-Is and more closely approximates natural sexual function [4]. Tadalafil (5mg) Protease Inhibitor Cocktail (EDTA-Free, 100X in DMSO) the only drug currently approved for daily administration in the treatment of ED. The favorable pharmacokinetic profile of tadalafil (5mg) achieves steady-state concentrations similar to the steady-state concentrations obtained with tadalafil (20mg twice per week) and avoids the risk of over- and underexposure [24]. Udenafil is a pyrazolopyrimidinone derivative with a molecular weight of 516.66. The pharmacokinetic profile of udenafil includes a time of maximal concentration of 1.0–1.5h and a T1/2 of 11–13h, which confers unique clinical properties (relatively rapid onset and a long duration of action) [9]. There are also small but well-established differences in selectivity of PDE enzymes. Whereas sildenafil has low PDE1 selectivity (selectivity ratio: 41), associated with vasodilation, flushing, and tachycardia, udenafil displayed higher selectivity (selectivity ratio: 1262) than sildenafil. In addition, with regard to PDE11, udenafil (selectivity ratio: 96) displayed much higher selectivity than tadalafil (selectivity ratio: 7.1) [25]. Although its function is not yet clear, PDE11 is widely distributed in skeletal muscle, testes, heart, prostate, kidney, liver, and pituitary [26]. Therefore, udenafil was found to be safe and well tolerated in human subjects. Compared with once-daily dosing of tadalafil for 12 wk, udenafil also resulted in similar changes in the IIEF-EFD score and in the rate of response to SEP questions 2 and 3 [5], [27]. In the present study, udenafil treatment improved the mean sexual desire domain score at 12 wk. In men treated with PDE5-Is, the improved erectile function and sexual relationship satisfaction resulted in improvement in confidence, which might increase sexual desire [28]. The adverse events associated with udenafil were similar to the adverse events commonly observed in other studies involving PDE5-Is. In the current study, the most frequently reported adverse events were flushing and headaches. Udenafil did not induce myalgias or abnormalities in color vision, which are profound side effects of tadalafil and sildenafil [29]. The number of patients who received once-daily dosing and experienced at least one adverse drug reaction was significantly less than the on-demand group [13]. Such observed data on adverse events for udenafil may be correlated with favorable pharmacokinetic profiles and the greater selectivity of udenafil for PDE5. A total of 79.9% of the patients had previous PDE5-I use before entering this study, which might have jeopardized the double-blind study design. The effect of daily administration of udenafil on PDE5-I–naive patients is needed in further study.
    Conclusions Udenafil in doses of 50 and 75mg administered once daily for 12 wk significantly improved erectile function among ED patients. The daily administration of udenafil (50mg) is a promising treatment option for patients with ED.
    R has a significant effect on patient\'s survival and quality of life. Over the last 2 decades, total mesorectal excision (TME) clearly improved local disease control and long-term oncologic outcomes of rectal cancer., In addition, the development of TME has helped surgeons to enhance nerve-sparing rectal cancer surgery. Given the complex nerve pathways located near the surgical plane of rectal cancer surgery, there is a substantial effect of rectal cancer surgery on sexual function. Although this sexual dysfunction is caused by various factors, the main reason is injury to the pelvic autonomic nerves during surgical resection. Functional changes after rectal cancer surgery have resulted in sexual dysfunction in 40–65% of patients., Fortunately, the rates of sexual dysfunction after rectal cancer surgery were reduced after TME was implemented. Nevertheless, sexual dysfunction is still reported at wide-ranging rates (10–50%) and it worsens patient quality of life., , , , Although sexual dysfunction is a well-known complication after rectal cancer surgery, few studies have addressed the treatment of this complication.