What to learn about sildenafil in the treatment of erectile dysfunction from 3-year clinical experience

We retrospectively assessed the clinical uses and results of sildenafil in the treatment of erectile dysfunction (ED) in daily clinical practice from a cohort of 1658 subjects at a multispecialty medical center from 1999 to 2001 through a chart review, mailed questionnaire and telephone interview. The overall follow-up rate was 77.8% (1290/1658). The mean age was 63.8 y and ED duration was 3.4 y, and 44.6% of them had one or more concomitant conditions. The mean score of the International Index of Erectile Function erectile function domain was 12.7 in 314 nonselective subjects, and 75% of them had moderate to severe ED. The average number of purchase-visits and tablets of sildenafil purchased was 2.27 and 10.8 per person, respectively, and the prescription refill rate was 58.6%. Urology accounts for 91.4% of the specialties of prescribers. The response rate was 72.0%, which was significantly lower in subjects with diabetes, ischemic heart disease and following radical pelvic surgery than those without. Subjects with psychogenic etiology had the highest response rate, while those following radical pelvic surgery the lowest. Of the nonresponders, 67% did not try the maximum dose of 100 mg and 71.1% bought no more than four tablets. Adverse events were reported in 20.1% of the subjects. No one discontinued the treatment because of the adverse events. Mortality occurred in 17 subjects and none was considered related to sildenafil use. In conclusion, sildenafil was effective and safe in the treatment of ED in clinical practice. Compared with clinical trials or prospective clinical practice based studies, lack of dose titration, less follow-up visits and inadequate attempts before giving up were the main shortfalls in daily practice.