DISSATISFACTION WITH THE PDE5 INHIBITORS TREATMENT FOR ERECTILE DYSFUNCTION: THE SALVAGE OF THE NON-RESPONSIVE PATIENTS.

Nogueira Jr, JS⁽¹⁾; Awad, MC⁽¹⁾; da Silva, EA⁽¹⁾; Schiavini, JL⁽¹⁾; Araújo, AC⁽¹⁾; Damião, R⁽¹⁾

⁽¹⁾Service of Urology. Rio de Janeiro State University. Rio de Janeiro. Brazil.

INTRODUCTION: Phosphodiesterase type 5 inhibitors (iPDE5) are effective treatment for erectile dysfunction (ED). Although the incidence of dissatisfaction with the ED treatment is unknown, the incidence of iPDE5 non-responsive patients ranges from 10% to 40%. We aimed to evaluate patients who referred dissatisfaction with the iPDE5 treatment.
MATERIAL AND METHODS: We reviewed charts from 156 patients, from January 2002 to May 2007, who referred dissatisfaction with the use of iPDE5 for the ED treatment. The patients’ mean age was 52.0 ± 9.3 years (from 39 to 74 years). The clinical management was in accordance with the guidelines of the Brazilian Society of Urology for ED. After the prescription of the iPDE5, patients’ satisfaction was evaluated after 4 weeks by an open questionnaire and erectile function was assessed by quality of erection questionnaire (QEQ).
RESULTS: Sixty-nine (44.2%) patients considered the treatment expensive and costly medication was the most common cause of dissatisfaction. Only 11 (7.1%) patients referred side effects and 10 (6.5%) discontinued treatment due to anecdotic fear of the medication. Forty-two percent (66/156) were considered non-responsive to the treatment. Seventy-one percent (61/90) of the dissatisfied patients discontinued follow up due to cost, side effect and fear. Regarding non-responsive patients, 40 (60.6%) became completely responsive to iPDE5 after dose adjustment (31.8%), reassurance of the iPDE5 pharmacological properties (19.7%), association of androgen replacement therapy (7.6%) and hyperglycemia control (1.5%). While 21.2% (14/66) of the patients undergone penile prosthesis implantation, 18.2% (12/66) refused other treatment.
CONCLUSION: Dissatisfied patients with the iPDE5 treatment for ED must be considered at risk for abandoning follow up. Cost of iPDE5 treatment is an important cause of dissatisfaction in Brazilian patients. The majority of iPDE5 non-responsive patients can be salvaged by simple procedures.