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Eli Lilly's erectile dysfunction drug Cialis shows signs of reversing heart failure in sheep.

Eli Lilly’s Cialis (tadalafil) is best known as an erectile dysfunction (ED) therapy.

But University of

Manchester

Then the scientists developing Viagra discovered the drug relieved ED. “We do have limited evidence from human trials and epidemiological studies that show Tadalafil can be effective in treating heart failure,” said the study’s lead author, Andrew Trafford, in a statement.

“This study provides further confirmation, adds mechanistic details and demonstrates that Tadalafil could now be a possible therapy for heart failure.” It’s possible that patients taking Cialis for ED have already unknowingly benefited from the drug’s protective effect on the heart, he added. Heart failure is characterized by the heart’s inability to pump enough blood to meet the body’s needs, which can lead to fluid accumulation in the lungs and cause the feeling of being short of breath. Trafford’s team used sheep to study the effects of PDE5 inhibition because their hearts are similar to human hearts. After inducing heart failure in the animals, the team administered Cialis at a dose similar to what’s used to treat ED in people.

They observed that Cialis restored the heart’s ability to respond to adrenaline—and that improved its ability to pump blood.

Most heart failure medications can slow the progression of the disease and lower the probability of deadly cardiac events.

But actually reversing heart failure is difficult, especially without surgery or the assistance of medical devices. Various groups of scientists are exploring methods for reversing heart failure with drugs.

A team at

Imperial

But the University of Manchester researchers believe the best strategy may be to return to the original goal in PDE5 inhibition. “We seem to have gone full-circle, with findings from recent studies suggesting that [ED drugs] may be effective in the treatment of some forms of heart disease—in this case, heart failure,” said Metin Avkiran, associate medical director of the British Heart Foundation, which funded the study.

"The evidence from this study, that a Viagra-like drug could reverse heart failure, should encourage further research in humans to determine if such drugs may help to save and improve lives.” Erections after prostatectomy surgery: does Viagra still work? In this blog for a non-medical audience, Alastair Lamb, Senior Fellow in Robotic surgery and Consultant Urologist at Oxford University Hospitals, and Altan Omer, Pelvic GU-Oncology fellow, look at the evidence for use of PDE5 inhibitors (Viagra, Cialis & Levitra) for penile rehabilitation after prostate cancer surgery. Some 6,500 radical prostatectomies are performed every year in the UK (British Association A relationship

between

In a positive association, one quantity increases as the other one increases (as with smoking walgreens sildenafil price and lung cancer).

In a negative association, an increase in one quantity corresponds to a decrease in the other.

Association does not necessarily mean that one thing causes the other.

While approximately half of these men have pre-existing erectile dysfunction, over 50% of the other half can expect to lose natural erections after prostatectomy surgery, especially if their cancers are locally advanced and require wide clearance to ensure removal of the whole tumour. There’s pretty good evidence to show that men can continue to recover erectile function up to two years after prostatectomy surgery (Montorsi et al., 2014), which we believe is partly because it takes time for the bruising and scar tissue after surgery to settle down.

But if spontaneous erections do not recover by this point then it is unlikely that they will do so thereafter.

Conversely, there is good evidence that drugs such as Viagra can be

used

The question therefore remains as to whether longer term recovery of spontaneous erections can be assisted by such devices and particularly by the use of PDE5 inhibitors. This is a process generally known as “penile rehabilitation”. The concept is that men need to ‘use’ their penises in order to speed up recovery of the blood vessels and nerves that are essential for erections, indeed that lack of use may inhibit recovery. This Cochrane review pulled together randomised trials testing the effect of PDE5i on erectile function after radical prostatectomy (Philippou et al., 2018). There were eight randomised Randomization is the process of randomly dividing into groups the people taking part in a trial. One group (the intervention group) will be given the intervention being tested (for example a drug, surgery, or exercise) and compared with a group which does not receive the intervention (the control group).

trials Clinical trials are research studies involving people who use prescription generic viagra healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used.

No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known.

including 1699 men and the drugs used were either Viagra (sildenafil), Cialis (tadalafil) or Levitra (vardenafil). The review found no evidence to support penile rehabilitation, defined as an improvement in erectile function, off drug, at the end of the period of follow up (one to two years) compared to a control group who had not received any drug.

The authors did note however that the quality of evidence The certainty (or quality) of evidence is the extent to which we can be confident that what the research tells us about a particular treatment effect is likely to be accurate. Concerns about factors such as bias can reduce the certainty of the evidence. Evidence may be of high certainty; moderate certainty; low certainty or very-low certainty.

Cochrane has adopted the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) for assessing certainty (or quality) of evidence. Find out more here: https://training.cochrane.org/grade-approach was poor, mainly because of a lack predefined outcomes Outcomes are measures of health (for example quality of life, pain, blood sugar levels) that can be used to assess the effectiveness and safety of a treatment or other intervention (for example a drug, surgery, or exercise). In research, the outcomes considered most important are ‘primary outcomes’ and those considered less important are ‘secondary outcomes’.

and inconsistency in reporting standards (varying definitions of potency, different follow-up durations, multiple modes of assessment including both physician and patient-reported outcomes etc).

All men in these studies had some form of nerve-sparing performed during their surgery so this review was not able to assess the effect of nerve-sparing on subsequent recovery of erections as there was no control group to compare to.

Previous studies have convincingly demonstrated the critical nature of nerve-sparing (Patel et al., 2011). The decision to undertake nerve-sparing is made in advance by the surgeon and depends on the extent of cancer. Robotic surgery has allowed more precise and meticulous surgical dissection of the surrounding layers of the prostate.

Indeed, 80% of UK prostatectomies are now completed with a da Vinci robot, the remainder split evenly between laparoscopic and open surgery. The outer layers of the prostate are a bit like an onion with several layers.

The layer containing the nerves is like the brown skin on the onion and the surgeon can choose to cut walgreens viagra connect inside this layer to leave the brown skin (or nerve layer) in place.

The outer layers of the prostate are a bit like an onion with several layers.

The layer containing the nerves is like the brown skin on the onion and the surgeon can choose to cut inside this layer to leave the brown skin (or nerve layer) in place. However, when there is a lot of cancer there is a real possibility of leaving some cancer cells behind if this close approach is taken, and so the surgeon instead chooses intentionally to take this outer layer with the prostate – the brown skin stays on the onion. So, while it may increase the risk A way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people.

It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%).

This measure is good no matter the incidence of events i.e. of prostate tissue being left behind (which incidentally, is one of the reasons why the PSA may remain high post-operatively), sparing the nerves is a critical step for preservation of erectile function, and men who undergo an intentional non-nerve-sparing procedure should always be warned of

the

meet

Join in the conversation on Twitter with @CochraneUK or leave a comment on the blog.

Alastair Lamb and Altan Omer have nothing to disclose. Omer MD FEBU is a Pelvic Uro-Oncology and

Robotic

Mr Alastair D Lamb, MA(Oxon), MBChB, PhD(Cantab), FRCS(Urol) is a Cancer Research UK Clinician Scientist, Senior Fellow in Robotic Surgery and Honorary Consultant Urologist at the Nuffield Department of Surgery, University of Oxford and Oxford University Hospitals NHS Foundation Trust, UK. My clinical focus is to deliver excellent and timely prostate cancer care to men referred to our team from the Oxford regional area, focussing on state-of-the-art diagnostics with multiparametric MRI and targeted transperineal biopsies, followed by robotic-radical prostatectomy (RARP) or indeed active surveillance where appropriate. I have a particular interest in pushing the boundaries of minimal access surgery (MIS), for example to performing cytoreductive radical prostectomy in locally advanced or metastatic disease and RARP in fit, older men where such approaches are deemed safe and evidence-based.

My research goal is to provide a robust molecular platform for accurate decision-making in early stage prostate cancer.

Erections after prostatectomy surgery: does Viagra still work?

I had prostate surgery it have been about six weeks no action with my love making .so I tired tadalafil 20 mg did not for me.so I tried 40 mg nothing . For me it will be two years in May for my prostate surgery removal so I tired the penis pump viagra and no action in the bedroom and my age 52.

I’ve tried All the injections but the erection is only 70%,I’ve also tried viagra 100mg abit better but again only 80%.Is it dangerous to take a double dosage.

Mr Lamb, I am now 68 and had nerve sparing laparoscopic prostatectomy in 2006 and have managed reasonable erections on sildenafil although not every time and the frequency of success has reduced markedly over the last few months.

I had no ED issues before my RP and am a slim, fit, non smoker with lowish blood pressure and not on any medication.

Is it just my age or as my wife suggests it may be partly in my mind and if so do you think therapy might help. My husband is 75, and had prostate surgery, due to cancer, in March 2018. He works out of town most of the time, so we have not had a good chance to try the remedies for ED. He also had open heart surgery several years ago, and his heart doctor has been reluctant to prescribe Viagra, or some similar drug.

Is there anything that you might suggest that might help him when he is not home? There is some response, even at this late date after prostate surgery, when he is home, but he needs something to try in the meantime.

Is Viagra safe in low doses, to help stimulate him?

A viberator seems to help some enlargement and maybe some blood flow. I had a radical prostatectomy on October 31st, (for Halloween I was dressed as a hospital patient with nurses, IV’s and real blood), Sorry,…maybe a bit too graphic ?? Question; it is now 4 weeks since I had this procedure, so,….

Is it too soon to start with any kind of ED meds to “wake up” the sleeping giant??? Hello Tom, blog author and urologist Alastair Lamb has posted a reply to another comment here (by Susan) which may be helpful to you, as he talks about the timing and purpose of taking ED drugs after prostatectomy. Best wishes, Sarah Chapman [Editor] My husband (52, fit, healthy, normal sexual function before surgery) has just had a radical nerve preserving surgery and was told to start on viagra straight away.

We tried it 3 days after having the catheter, blood drain and stitches out (open surgery) and it failed. I feel it was too soon to try after having all these tubes removed but the surgeon had stressed the importance of getting things moving again straight away. How long should we leave it before trying viagra again?

I’m really glad that your husband has got through his surgery well.

As you say, it can seem quite early to start taking viagra so soon after a major operation. However, there is a bit of evidence emerging (not strong as yet) that starting viagra early, or even before surgery, can help.

The message is a little mixed as, from the Cochrane Review we commented on above, the concept of “penile rehabilitation” has essentially been debunked. However, it may be that starting the drug very early catches the vessel and nerve changes at just the right time.

It should be emphasised that the purpose of taking viagra this early is not to give immediate erections, but rather to improve future erections in the weeks and months to follow.

Tadalafil is probably the best PDE5 inhibitor to take for this purpose because of it’s longer half-life, but it is still rather expensive and so, as outlined above, I tend to give my patients a quarter dose (25mg) of sildenafil (viagra) daily which, when prescribed “privately”, can be paid for over the pharmacy counter and is almost as cheap as paracetamol.

I have not been part of any survey and had my prostate removed one year ago using the Da Vinci robot.

I am still clear with no follow up radiation or hormone treatment. After not getting on with muse or the cream variant of the same drug I took it upon myself to buy some Viagra over the counter as I had seen some evidence of activity.

To cut a long story short the Viagra helped but I didn’t get a full erection. I told my post surgical team and they are now trying me on Cialis. Most recently I have tried the 20mg dose less frequently and results within a few hours seem further improved. Mr Lamb, it’s very impressive that you’ve attended Mani Menon’s recent presentation at AUA19 on 5 May of the Menon Precision Prostatectomy technique, aimed at reducing ED. Plainly, one should not just MRI the area of the PZ to be left in situ, but also biopsy it too.

Yes, there is a risk that the sliver of PZ which is left in situ may generate CaP. But in any event, even if you did a full RARP, traditional or Retzius-sparing, my understanding is that the patient will still be taking some risk of biochemical reoccurrence in some circumstances, even if there are “clear” margins at the finish of the operation.

It seems to me that it is for the patient to choose what level of risk he’d prefer – and whether he’s willing to take some CaP risk to have a better chance of continued normal erectile function, given that he is, as I understand it, already taking at least some risk of biochemical reoccurrence anyway.

So it seems to me that surgeons, in principle, ought to be prepared to have the technical capacity to “do it the patient’s way” provided that the patient understands and signs up to any extra risk, rather than the surgeon saying ab initio that no sliver at all of PZ can be left and imposing a decision on the patient of greater ED risk when the patient might prefer a better chance of erectile function and be willing to tradeoff some CaP risk, at least if it is found that there is negative MRI report AND a negative biopsy in the area.

Someone needs spend a little time with Menon in the USA and bring the learning over the Atlantic because there are lots of men who’d prefer to have this chance if MPPs can be done in a way that makes sense. yes it does work, viagra should be first consulted by the doctor in this case before consumption.

Mr Lamb, What do you think of the Menon precision prostatectomy technique described by Dr Mani Menon in the link below: early results on the first 50 patients are said to yield a much higher recovery of erectile function (said to be about 95%) compared to the usual robot assisted radical prostatectomy, whether retzius sparing or traditional? Of course, one could not apply the MPP technique to every case (eg where cancer has invaded the cap of the prostate); but one would think that there must be a significant subset of patients

for

http://manimenon.com/menon-precision-prostatectomy/ Thank you for your comment Ian.

Mani Menon is a legend in our field and I want to learn everything I can from him! However, I do have reservations about his proposed technique, just as I have reservations about

any

Instead I think we should put our efforts and fundraising into basic scientific endeavour to identify such “lethal clones” in the prostate (http://www.nds.ox.ac.uk/team/alastair-lamb).

I am also very encouraged by the potential of “retzius-sparing” prostatectomy techniques, using both posterior and anterior approaches, pfizer generic viagra price early results of which seem to offer very promising erectile function and continence results without compromising radical treatment (several abstracts to be presented this year at EAU19 and AUA19 https://eaucongress.uroweb.org/scientific-programme/. It’s also available as PRN does of 10mg and 20mg as well as daily doses of 2.5mg and 5mg. The long half-life isn’t the reason it’s given daily!

Erectile

dysfunction

Men who have diabetes are thought to develop erectile dysfunction between 10 and 15 years earlier than men who do not suffer from the disease. Over the age of 70, there is a 95% likelihood of facing difficulties with erectile function. What causes erectile dysfunction amongst diabetics?

Causes of ED are extremely complex, and are based around changes that occur to the body over time affecting nerve, muscle and blood vessel functions.

In order to obtain an erection, men need to have healthy blood vessels, nerves, male hormones and a desire to have sex. Without blood vessels and nerves that control erection, ED can still occur despite a desire to have sex and normal male hormones. Many other factors bear on erectile dysfunction amongst diabetic men.

Being overweight Smoking Taking too little exercise and other lifestyle factors. Surgery can damage nerves and arteries linked to the penis, as can some injuries.

Many common medications (including antidepressants and blood pressure drugs) can produce ED.

Psychological factors also have an enormous influence. Anxiety, guilt, depression, low self-esteem and paranoia about sexual failure are estimated to cause between 10% and 20% of ED cases.

Erectile dysfunction is diagnosed using

several

Patient history often informs the degree and nature of the ED.

Medical and sexual past often has an influence, as does prescription or illegal drug use. ED patients may be physically examined, and bodily features can give clues to the cause. Laboratory tests can also be key for diagnosing ED.

Further tests

such