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Disfungsi Ereksi PDF
Disfungsi Ereksi PDF
We’re born
together, grew
Erectile dysfunction (ED)
up together, but
- Persistent or recurrent inability to why you died
earlier? Huu
achieve or maintain an erection adequate
for sexual intercourse
- Most frequent sexual dysfunction in male
besides premature ejaculation
Wimpie Pangkahila - Center for Study of Anti-Aging Medicine, Department of Andrology and Sexology Wimpie Pangkahila - Center for Study of Anti-Aging Medicine, Department of Andrology and Sexology
Medical Faculty Udayana University - Indonesian Center for Anti-Aging Medicine Medical Faculty Udayana University - Indonesian Center for Anti-Aging Medicine
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Diagnosis:
Cause-result correlation
1.Sexual history.
• Erectile insufficiency
• Altered sexual desire? Female Male
• Nocturnal and morning erection Sexual Sexual
• Ejaculation, orgasm, genital pain DysfunctionD DysfunctionD
• Partner sexual function
• International Index of Erectile Function-
5 (IIEF-5)
Diagnosis: Diagnosis:
2. Medical history
• Lifestyle factors, smoking 3. Clinical examination
• Chronic medical illness
• Pelvic/perineal/penile trauma and a. General examination:
surgery, pelvic radiotherapy - Body configuration: fat distribution,
• Medications/recreational drug use gynaecomastia
• Neurological disease, endocrine - Degree of virilization: hair distribution,
disease muscle, skin
• Psychological state, psychiatric - Blood pressure, cardiovascular
problem - neurological
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4. Laboratory tests:
LFT, Lipid tests, Glucose.
Testosterone assay: low sexual desire
and diminished size testes.
5. Additional testing:
erectiometer, Doppler stethoscope,
Rigiscan
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However, make sure that the diagnosis is ED, At the beginning treatment of ED was
not sexual desire disorder considered as not ideal treatment
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Intracavernous injection
Ideal treatment
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250
200
♦Tadalafil is suited for use OD for ED therapy, 150
owing to its long half-life (17.5 hours)4
100
50
0
0 24 48 72 96 120 144 168
Time (hours)
1. Carson C et al. BJU Int 2004;93:1276-81. 3. Dunn M et al. Int J Impot Res 2007;19:119-23.
Wrishko R et al. J Sex Med 2009;6:2039-48.
2. Rajfer J et al. Int J Impot Res 2007;19:95-103. 4. Forgue S et al. Br J Clin Pharmacol
2006;61:280-8.
Tadalafil 10 mg OAD
22.8 22.8
endpoints *p<0.05 vs placebo
− IIEF EF 15.0
− SEP2 (insertion into vagina) Baseline
1. Porst H et al. Eur Urol 2006;50(2):351-359. 4. Porst H et al. J Sex Med 2008;5(9):2160-2169.
2. Rajfer J et al. Int J Impot Res 2007;19(1):95-103. 5. Brock GB et al. J Urol 2002:168(4):1332-1336. Porst H et al. Eur Urol 2006;50:351-359.
3. Hatzichristou D et al. Diabet Med 2008;25(2):138-146. 6. Carson CC et al. BJU Int 2004;93(9):1276-1281.
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Study 1 Additional Co-Primary Endpoints: SEP2 Study 1 Secondary Endpoint: Percentage of Men With
(Penetration) and SEP3 (Successful Intercourse) “No ED” at 12 Weeks (IIEF EF ≥26)
Placebo
Tadalafil 5 mg OAD Placebo
* * 100
Tadalafil 10 mg OAD Tadalafil 5 mg OAD
79.4% 81.2% * 90
Mean Per-Patient % “Yes”
* Tadalafil 10 mg OAD
72.8% 80
67.2% *p<0.05 vs placebo *p<0.001 vs placebo
% of Patients
70
* *
51.7% 60 52% 51%
50
36.7% 40
30
Baseline 20
8%
10
0
(n=52) (n=105) (n=103) (n=51) (n=105) (n=103) Placebo Tadalafil Tadalafil
(n=48) 5 mg OAD 10 mg OAD
(n=103) (n=101)
SEP2 SEP3
Patients with IIEF EF <26 at Baseline
SEP2=Sexual Encounter Profile Question 2: “Were you able to insert your penis into your partner’s vagina?”;
SEP3=Sexual Encounter Profile Question 3: “Did your erection last long enough to have successful intercourse?”
Porst H et al. Eur Urol 2006;50:351-359. Porst H et al. Eur Urol 2006;50:351-359.
90
Mean IIEF EF Domain Score
* *
*p<0.001 vs placebo 80 * *p<0.001 tadalafil vs placebo
* 20.8 70.7%
19.1 65.3% *
70
* 56.9%
60 51.1% 50.0%
14.6
50
40 31.3%
30
20 Baseline
10
0
(n=92) (n=92) (n=96)
Placebo Tadalafil
(n=93) 2.5 mg OAD SEP2 SEP3
(n=93) SEP2=Sexual Encounter Profile Question 2: “Were you able to insert your penis into your partner’s vagina?”;
IIEF EF=International Index of Erectile Function Erectile Function Domain SEP3=Sexual Encounter Profile Question 3: “Did your erection last long enough to have successful intercourse?”
Rajfer J et al. Int J Impot Res 2007;19:95-103. Rajfer J et al. Int J Impot Res 2007;19:95-103.
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* 21.1
19.2
14.9 15.3
1. Rajfer J et al. Int J Impot Res 2007;19:95-103. 1. Donatucci et al. Curr Med Res Opin 2008; 24:3383-3392. 3. Rajfer J et al. Int J Impot Res 2007;19:95-103.
2. Data on File, Lilly Research Laboraties. 2. Porst H et al. Eur Urol 2006;50:351-359 4. Carson et al. BJU Int 2004;93:1276-1281.
*p<0.001 vs placebo
* * *
* 75% 73% 80%
* *
65% 68%
62% *
* 58%
50% 50% 50%
Baseline
33% 31%
Baseline
(n=144) (n=92) (n=201) (n=638) (n=321) (n=1143) (n=144) (n=92) (n=201) (n=638) (n=321) (n=1143)
Once-Daily1 On-Demand4 Once-Daily1 On-Demand4
(one 12-2 and one 24-week3 study) (11 pooled 12-week studies) (one 12-2 and one 24-week3 study) (11 pooled 12-week studies)
SEP2=Sexual Encounter Profile Question 2: “Were you able to insert your penis into your partner’s vagina?” SEP3=Sexual Encounter Profile Question 3: “Did your erection last long enough to have successful intercourse?”
1. Donatucci et al. Curr Med Res Opin 2008; 24:3383-3392. 3. Rajfer J et al. Int J Impot Res 2007;19:95-103. 1. Donatucci et al. Curr Med Res Opin 2008; 24:3383-3392.
2. Porst H et al. Eur Urol 2006;50:351-359 4. Carson et al. BJU Int 2004;93:1276-1281. 2. Porst H et al. Eur Urol 2006;50:351-359
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4/2/2017
Wimpie Pangkahila - Center for Study of Anti-Aging Medicine, Department of Andrology and Sexology Wimpie Pangkahila - Center for Study of Anti-Aging Medicine, Department of Andrology and Sexology
Medical Faculty Udayana University - Indonesian Center for Anti-Aging Medicine Medical Faculty Udayana University - Indonesian Center for Anti-Aging Medicine
1. Nehra A. Mayo Clin Proc 2009 Feb;84(2):139-48. 3. Billups KL et al. Curr Urol Rep 2005;6(6):439- Hatzichristou D et al. Diabet Med 2008;25:138-146.
2. Angulo J et al. J Sex Med 2005;2(3):341-346. 444.
Once-Daily Tadalafil 2.5 mg and 5 mg in Diabetes: Once-Daily Tadalafil 2.5 mg and 5 mg in Diabetes
Additional Co-Primary Endpoints SEP2 and SEP3 Subgroup Analyses: IIEF EF by ED Severity
Placebo Placebo
Tadalafil 2.5 mg OAD 30 Tadalafil 2.5 mg OAD
Mean IIEF EF Domain Score
Baseline
(n=98) (n=97) (n=97) (n=33) (n=28) (n=27) (n=25) (n=26) (n=28) (n=40) (n=41) (n=42)
All Patients Mild ED Moderate ED Severe ED
Placebo Tadalafil Tadalafil Placebo Tadalafil Tadalafil (22-30) (17-21) (1-10)
(n=98) 2.5 mg OAD 5 mg OAD (n=95) 2.5 mg OAD 5 mg OAD
(n=97) (n=97) (n=96) (n=95) Baseline ED Severity (IIEF EF)
SEP2 SEP3
SEP2=Sexual Encounter Profile Question 2: “Were you able to insert your penis into your partner’s vagina?”;
SEP3=Sexual Encounter Profile Question
Wimpie Pangkahila 3:Study
- Center for “Did of
your erection
Anti-Aging last long
Medicine, enough of
Department to Andrology
have successful intercourse?”
and Sexology Wimpie Pangkahila - Center for Study of Anti-Aging Medicine, Department of Andrology and Sexology
Medical Faculty Udayana University - Indonesian Center for Anti-Aging Medicine Medical Faculty Udayana University - Indonesian Center for Anti-Aging Medicine
Hatzichristou D et al. Diabet Med 2008;25:138-146. Hatzichristou D et al. Diabet Med 2008;25:138-146.
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Nasopharyngitis 5% 6% 6%
Influenza 3% 5% 3%
Gastroenteritis, Viral 2% 3% 5% Once-Daily Tadalafil:
Back Pain
Upper Respiratory Tract Infection
3%
0
5%
3%
2%
4%
Longterm Effectiveness
Dyspepsia 1% 4% 1%
Nasal Congestion 0 0 4%
Gastroesophageal Reflux Disease 0 3% 2%
Myalgia 2% 4% 1%
Headache 3% 3% 1%
Hypertension 0 1% 3%
Bronchitis 3% 3% 0
Sinus Congestion 0 0 3%
Discontinuations Due to AE 2% 6% 4%
AE=Adverse Event; ED=Erectile
Wimpie PangkahilaDysfunction; TEAE=Treatment-Emergent
- Center for Study Adverse
of Anti-Aging Medicine, Department Events.and Sexology
of Andrology Wimpie Pangkahila - Center for Study of Anti-Aging Medicine, Department of Andrology and Sexology
Medical Faculty Udayana University - Indonesian Center for Anti-Aging Medicine Medical Faculty Udayana University - Indonesian Center for Anti-Aging Medicine
Rajfer J et al. Int J Impot Res 2007;19:95-103.
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