UROLOGY SALVAGE OF SILDENAFIL FAILURES FROM PRIMARY CARE PHYSICIANS
Sildenafil citrate is effective first line therapy for erectile dysfunction. Approximately 65 percent of initial prescriptions are not written by urologists, but by primary care physicians. In many of these patients sildenafil therapy is considered to fail and they are subsequently referred to urologists for alternative treatment. It is often thought that sildenafil was ineffective, when in actuality failure was due to inadequate patient education. We examined these so-called sildenafil failures and reeducated patients in a urology setting to determine how many failures could be converted to sildenafil responders. Of the 622 consecutive patients referred to a single urologist from primary care physicians with the diagnosis of erectile dysfunction between October 1999 and September 2001, 253 were considered sildenafil failures by the primary care physician. These patients were reeducated on correct sildenafil use with videotapes and instruction sheets. Patients were followed at 3-month intervals to determine long-term efficacy in sildenafil responders. Efficacy was measured using a sexual health questionnaire and a global assessment question. Ninety-eight of the original 253 sildenafil failures (38 percent) were converted to sildenafil responders. During extended followup, 89 percent of the salvaged responders continued to use the drug with good results for a long-term salvage rate of 31 percent. Sildenafil citrate is efficacious first line therapy for erectile dysfunction. Many factors determine drug efficacy, including age, vasculogenic risk factors, and the etiology and severity of underlying erectile dysfunction. A factor that has been difficult to quantitate is the success of medical counseling. We showed that the cause of many sildenafil failures is poor education. Many patients in whom sildenafil failed initially tried the drug only once and never noticed any sexual stimulation. Our study shows the profound positive impact of proper urological counseling on the outcome of sildenafil therapy.
Geoffrey N Sklar, Michael J Szostak*, Baltimore, MD
Additional resources on erectile dysfunction are available from MayoClinic.com:
http://www.mayoclinic.com/health/erectile-dysfunction/DS00162
