Vardenaftl has been shown to inhibit the phosphodiesterase enzyme 10 times stronger than sildenafil. Vardenafil is more specific for the phosphodiesterase type 5 enzyme and inhibits the phosphodiesterase type 6 enzyme less than sildenafil. Vardenafil is absorbed faster than sildenafil and reaches the maximum level in the blood in 0.7-0.9 hours. Vardenafil used in doses of 5,10 and 20 mg has success rates of up to 80%. It gives the impression that it is superior to other PDE5 inhibitors in patients with diabetes mellitus and patients who have undergone surgery for prostate cancer.
Tadalafil also acts by inhibiting the phosphodiesterase type 5 enzyme. Its structure is different from other group members. Tadalafil. It is absorbed more slowly than sildenafil and vardenafil. The maximum blood level is reached in 2 hours. In addition, the half-life of tadalafil (the time required for the blood level to decrease by half) is longer than its competitors (17.5 hours). Thus, tadalafil provides efficacy for 36 hours. Tadalafil’s activity for 36 hours has led to the drug being named “weekend drug”. Tadalafil absorption is not affected by age, alcohol consumption or meals. Tadalafil is used in doses of 5, 10 and 20 mg.
Clinical studies and experience have shown that phosphodiesterase inhibitors are safe drugs. Due to the dilation of the blood vessels, complaints such as headache, hot flushes or a feeling of fullness in the nose may occur. Problems with vision may occur. This effect is due to inhibition of phosphodiesterase type 6 enzyme. In studies with tadalafil, adverse side effects such as back pain and myalgia were observed in approximately 15% of patients rather than visual complaints. Phosphodiesterase inhibitors do not increase the risk of heart disease events. These drugs should never be used with nitrates.
The compression band at the free end of the cylinder is placed on the root of the hardened penis. Thus, the continuation of the hardness level is ensured. The roller is separated from the penis. The compression band can stay on the penis for half an hour. It continues to harden until the tape is removed. This technique can be learned easily, and many people have had successful results with treatment.
Vasodilators are injected into the corpora cavernosa with the help of a thin needle. These drugs act by loosening the penile tissue and widening the veins. Thus, the amount of blood reaching the erection rings increases and hardening occurs. Intra-penile injection is applied to the patient group in whom oral medications have been tried and failed. This technique can be easily learned by the patient for home use. The appropriate dose is determined individually for each patient. The patient self-injects 0–15 minutes before sexual intercourse, and as a result of the appropriate dose adjustment, an erection is provided for about half an hour. Medicines injected into the penis are usually combined with each other. Papaverine / phentolamine. Papaverine / phentolamine / PgEl and PgEI are combinations used in phentolamine therapy. Vasodilation drugs can also be used to measure the response of the penis to these drugs. In patients who have intra-penile injection, pain may occur during erection and scar tissue may develop in the penis in long-term use. Therefore, the patient should be checked periodically by urologists.
The penile prosthesis consists of two synthetic cylinders placed in the penis by surgical intervention. The prosthesis does not affect urination and sexual functions such as ejaculation and orgasm. 2 types of prostheses are used. A malleable, semi-rigid prosthesis and inflatable prosthesis. Inflatable prostheses contain a pump and a reservoir in addition to the cylinders in the penis. Fluid is pumped from the reservoirs into the cylinders so that the penis becomes hard. By pressing a button on the base of the pump, the fluid collected in the cylinders returns to the reservoir and the penis softens. Inflatable prostheses have higher damage rates and provide a more natural appearance. Penile prostheses are rather applied to the patient group who cannot benefit from the treatment methods listed above. This group consists of patients with uncontrolled diabetes, patients who have undergone surgery or radiotherapy with the diagnosis of prostate cancer or bladder cancer. Penile prosthesis implantation in this group of patients has resulted in patient satisfaction rates of up to 90%.
In this treatment, it is aimed to increase blood flow and blood pressure in the penis. It is especially applied in young patients who have had an accident that will prevent normal blood flow. This method of treatment is based on directing a healthy artery to the penis. It is used in a very limited number of cases today.
In this treatment method, alprostadil is applied to the urinary tract by placing a small plastic cylinder from the tip of the penis. Enough active substance to achieve hardening reaches the penile tissue. It is applied 10-15 minutes before sexual intercourse and provides success in 43% of patients. May cause temporary burning sensation in the urinary tract.
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