We undertook a prospective pilot study in a small cohort of patients with renal replacement therapy to determine the cause of ED and evaluate the role of testosterone replacement therapy and sildenafil.
We investigated 12 patients who presented with ED for hypogonadism and cavernosal insufficiency. We assessed sexual performance before and after treatment by a questionnaire method based on the modified IIEF and NIH rating. Patients received 250 mg intramuscular monthly injections of testosterone cypionate and 50-100 mg sildenafil orally once or twice weekly for 12 months. Therapeutic response was considered acceptable if the patient could maintain an erection adequate for successful sexual intercourse and had a marked improvement in the overall sexual performance.
Before treatment, all patients had severe ED with a low IIEF score, while 11 also had diminished libido. Eleven patients had decreased testicular volume, and six had elevated follicle-stimulating hormone levels suggestive of germ cell damage. All patients had an excellent response to the therapeutic trial of testosterone and sildenafil.
The study concluded that testosterone and sildenafil therapy might indicate those with cavernosal arterial insufficiency and reproductive hormone abnormalities. Further longer-term data are needed to determine the safety and efficacy of this novel regimen.