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CLICK HERE FOR DETAILS Do you have Erectile Dysfunction? viagra without prescription Related Health News Vascular disease: Vascular diseases are those that affect the blood vessels. These diseases include atherosclerosis (hardening of the arteries), hypertension, and high cholesterol. These diseases, which account for 70% of physically-related causes of ED, all restrict blood flow to the heart, the brain and, in the case of ED, the penis. Several other, more invasive options exist for patients who do not respond to PDE-5 inhibitor therapy or in whom it is contraindicated. Alprostadil (prostaglandin E1) causes smooth-muscle relaxation and subsequent vasodilation by acting on adenylate cyclase to increase the intracellular cyclic adenosine monophosphate (cAMP) concentration. Prostaglandin E1 may be administered intraurethrally, where it is absorbed and transported throughout the erectile bodies. The reported efficacy of intraurethral alprostadil therapy is variable. Padma-Nathan and colleagues59 reported a response rate of 65.9%. Fulgham and associates60 noted improvement in 30% of patients; however, this study has been criticized for inadequate dose titration.61 The most common side effect of intraurethral alprostadil therapy is local penile pain caused by drug-mediated sensitization of nerve fibres.60 |