• 
• 
• 
• 
• 
• 
• 

• 
• 
• 
• 

• 
• 
• 

• 
• 
• 
• 
• 

Gruenwald I, Shenfeld O, Chen J, Raviv G, Richter S, Cohen A, Vardi Y. Positive Effect of Counseling and Dose Adjustment in Patients with Erectile Dysfunction who Failed Treatment with Sildenafil. Eur Urol 2006;50:134-140.

This study answers a very pertinent question whether counselling and maximal dosing of PDE5-I (only Sildenafil failures were considered) achieves better treatment compliance and improvement in treatment outcome in patients with ED who stop using the PDE5I due to subjective failure.

An explicit explanation about the nature and action of the drug was given to the 220 recruits (27–88 yrs).  Instructions on drug use were provided during each visit in which four 100 mg Sildenafil tablets were provided. Treatment outcomes were assessed by the IIEF questionnaire after taking 4 and 8 tablets.

A significant increase in IIEF erectile function domain scores (EFDS) between visits 1, 2 and 3 was observed with 23.6% of the study patients achieving normal erectile function at the end of the study. The parameters of age and initial severity of ED most influenced treatment success.

The authors conclude that counselling and dose adjustment were directly influential in achieving an excellent response to a second trial of sildenafil in patients with ED who had previously failed treatment with the drug, and obviated their needing to seek more invasive measures.