Aversa.2_EU Urological Review 18/03/2010 10:39 Page 82
Erectile Dysfunction
effect on endothelial function via decreasing plasma levels of endothelial function and promoting general wellbeing and sexual
surrogate markers, i.e. endothelin, CRP and vascular cell adhesion health. It is important to remember also that adequate plasmatic
molecule (VCAM). In this study, the authors added another possible T concentrations are crucial for the regulation of correct endothelial
mechanism underlying penile rehabilitation: improvement of morning function and expression of the penile PDE5 isoenzyme. Daily PDE5-i
erections, which may provide better end-organ oxygenation, administration improves endothelial function and may represent a
especially in a diabetic population. This latter aspect was confirmed in ‘salvage’ therapy, especially in difficult-to-treat ED. Although the
another study carried out in male sclerodermic patients with ED. In safety of this class of agents has been indisputably established for the
that study, besides improvement in penile vascular circulation, daily treatment of ED on an on-demand basis, there remains a paucity
tadalafil led to a marked reduction of entothelin-1 plasma levels as of data on the long-term endothelial effects and possible hormonal
well as resumption of morning erections after 12 weeks of side effects of daily use. These data support the need for many
treatment.
63
Although this appears to be a fascinating hypothesis that patients with ED to continue therapy for successful sexual
opens new treatment perspectives, it is our opinion that larger studies performance and endothelial rehabilitative benefits, especially when
are needed in order to assess the possible clinical implications of co-morbidities are present, i.e. post-radical prostatectomy, MeS,
chronic therapy with PDE5-i on both cardioprotection and endothelial diabetes, CVD and chronic arthritis. n
rehabilitation in patients with co-morbidities.
Antonio Aversa is a Senior Researcher in the
As regards hormonal steroid patterns, there are several studies
Department of Medical Pathophysiology at the
indicating that resumption of sexual function with different therapies
University of Rome ‘La Sapienza’. He is a member of the
is able to increase T levels.
64
However, Greco and co-workers
Scientific Committee of the Italian Society of Andrology
and the Italian Society of Endocrinology. Dr Aversa is
disporved such results by demonstrating that after long-term tadalafil
also a member of the Editorial Board of various
treatment (12 months, with a mean of three tablets consumed per
scientific journals, and serves as a reviewer in leading
week), an increase in the T:estradiol ratio occurred through a
internal medicine, endocrinology, urology and sexology
peer-reviewed journals. He has published over 70
reduction of estradiol levels, thus hypothesising a direct interplay
papers in international journals (over 180 full texts including proceedings and chapters
between chronic tadalafil administration and aromatase activity.
65
in books), with his main interests being endocrinology (sexual dysfunctions, male
The clinical impact of this newest action on male osteoporosis and
ageing) and internal medicine (endothelial dysfunction, osteoporosis, obesity). 
breast and prostate cancers is under investigation.
Andrea Lenzi is a Professor of Endocrinology and Chairman of the Department of
Medical Pathophysiology at the University of Rome ‘La Sapienza’, and Chief of the Unit
Conclusions
of Andrology, Reproductive Medicine and Endocrine Diagnosis at the University
Diagnosing EDys and vascular ED is mandatory for early detection
Hospital. He is Secretary General of the Executive Committee of the European
Academy of Andrology and President of the Italian Society of Andrology and Medical
of systemic disease undermining men’s health. Furthermore,
Sexology. Professor Lenzi has published over 150 papers in international journals (over
modification of reversible causes, i.e. inadequate lifestyle, cigarette
500 full texts including proceedings and chapters in books) on the subjects of clinical
smoking, alcohol or recreational drug abuse, hyperglycaemia and
andrology, infertility, hypogonadism and erectile dysfunction.
hypertension, still represents the first approach to improving
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