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Abstract Introduction Erectile dysfunction is a condition that affects many men worldwide, significantly impacting their quality of life. PDE5 inhibitors (PDE5i) are commonly prescribed medications for treating this condition, but some patients do not adequately respond to these treatments Objective This study aims to evaluate the efficacy and safety of a combination of long-acting and short-acting PDE5 inhibitors in non-responding patients Methods The study was conducted on 40 men with erectile dysfunction refractory to PDE5 inhibitors. Participants were evaluated using questionnaires, clinical examinations, and paraclinical tests. All patients received a combination treatment of daily 5 mg tadalafil and 100 mg sildenafil on-demand, one hour before sexual intercourse. Patients were followed up for 12 weeks, and the results were assessed using questionnaires and recording of side effects. Results The average age of the participants was 47.4 years. The main etiologies of erectile dysfunction were vascular, psychogenic, age-related, or neurological. After 6 weeks of treatment, a statistically significant improvement was observed in erectile function scores (SHIM) and erectile rigidity scores (EHS). This improvement was maintained until the 12th week, although not significantly. Side effects were generally minor and well-tolerated. Conclusions The combination of long-acting and short-acting PDE5 inhibitors proved to be effective and safe in non-responding patients to PDE5 inhibitors. This therapeutic approach offers a promising alternative before resorting to other more invasive options, such as prostaglandins or penile prosthesis. The combined use of these two types of inhibitors improves erectile function while minimizing undesirable side effects. Further studies could explore the addition of vacuum devices, shockwave therapy, or platelet-rich plasma injections to optimize outcomes. Overall, this study provides valuable insights for urologists in the treatment of non-responding patients to a single type of PDE5 inhibitor, opening up new therapeutic perspectives. Disclosure No.
Mounir et al. (Fri,) studied this question.