Zülfü SERTKAYA, Abdullah AKKURT, Kemal ERTAŞ

Erektil disfonksiyon şikâyeti ile başvurup eşlik eden prematür ejakulasyonu olan heteroseksüel hastalarda günlük tadalafil ve sertralin kombinasyon tedavisinin etkinliği ve güvenilirliği

AMAÇ: Bu çalışmanın amacı, erektil disfonksiyon (ED) yakınmaları ile başvuran ve eşlik eden erken boşalma (PE) semptomları olan hastalarda üç aylık takipte günlük tadalafil 5 mg ve sertralin 50 mg tedavisinin etkinlik ve güvenilirliğini değerlendirmektir. GEREÇ ve YÖNTEMLER: Bu prospektif, gözlemsel tek kollu çalışma, Mart ve Eylül 2021 arasında ED’ve eşlik eden Yaşam Boyu / edinilmiş PE’den muzdarip hastalar arasında gerçekleştirildi. Hastalarda ED tanısı için Uluslararası Erektil Fonksiyon - Erektil Fonksiyon İndeksi’nin (IIEF-EF) Türkiye geçerliliği kul - lanıldı. Hastalar PE tanısı için Erken Boşalma Teşhis Aracı (PEDT) anketini doldurdu. Ek olarak, Erken Boşalma Profili (PEP) skoru dolduruldu. Tüm has- talardan ayrıntılı tıbbi öykü alındı ve tam bir fizik muayene yapıldı. Dört haf- talık takip sürecinden sonra hastalara günde 5 mg tadalafil ve sertralin 50 mg tablet verildi. Hastaların IELT süreleri 12 haftalık tedaviden sonra kaydedildi. Hastalara başlangıçta uygulanan PEP ve IIEF-EF anketleri tekrar dolduruldu. Ayrıca tedavi memnuniyeti açısından Global Impression of Change (GIC) an- keti uygulandı. BULGULAR: Çalışmaya toplam 71 hasta dahil edildi. Altmış üç hasta (%88,73) çalışmayı tamamladı. Üç aylık tadalafil 5 mg + sertralin 50 mg kombinasyon tedavisi sonucunda hastaların geometrik ortalama IELT, PEP indeks skorları ve alt grup skorlarında düzelme ile IIEF-EF skorlarında istatistiksel olarak anlamlı artış saptandı (p

Efficacy and safety of daily tadalafil and sertraline combination therapy in heterosexual patients presenting with erectile dysfunction and concomitant premature ejaculation

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of daily tadalafil 5 mg and sertraline 50 mg treatment in 3-month follow-up in patients presenting with erectile dysfunction (ED) complaints and accompanying premature ejaculation (PE) symptoms. MATERIAL and METHODS: This prospective, observational single-arm study was conducted between March and September 2021 among patients suffering from ED and concomitant Lifetime/acquired PE. The Turkish validity of the International Erectile Function-Erectile Function Index (IIEF-EF) was used for the diagnosis of ED in the patients. The patients filled the Premature Ejaculation Diagnostic Tool (PEDT) questionnaire for the diagnosis of PE. Additionally, the Premature Ejaculation Profile (PEP) score was filled. A detailed medical history was taken from all patients and a complete physical examination was performed. After a four- week follow-up period, patients were given 5 mg tadalafil and sertraline 50 mg tablets daily. The IELT durations of the patients were recorded after 12 weeks of treatment. Premature ejaculation profile and IIEF-EF questionnaires administered to the patients at the beginning were filled again. In addition, the Global Impression of Change (GIC) questionnaire was applied in terms of treatment satisfaction. RESULTS: A total of 71 patients were included in the study. Sixty-three patients completed the study (88.73%). As a result of 3-month daily tadalafil 5 mg + sertraline 50 mg combination therapy, the geometric mean IELT, PEP index scores and subgroup scores of the patients improved and a statistically significant increase in the IIEF-EF scores (p

PDF

___

1. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA. 1993;270:83–90. [CrossRef ]
2. Fugl-Meyer K, Fugl-Meyer AR. Sexual disabilities are not singularities. Int J Impot Res. 2002;14:487–93. [CrossRef ]
3. Porst H, Montorsi F, Rosen RC, Gaynor L, Grupe S, Alexander J. The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking. European urology. 2007;51:816–23; discussion 824. [CrossRef ]
4. Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G, et al. An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. J Sex Med. 2014;11:1423–41.
5. Waldinger MD. Lifelong premature ejaculation: from authority- based to evidence-based medicine. BJU Int. 2004;93:201–7. [CrossRef ]
6. Waldinger MD, Hengeveld MW, Zwinderman AH, Olivier B. An empirical operationalization study of DSM-IV diagnostic criteria for premature ejaculation. Int J Psychiatry Clin Pract. 1998;2:287– 93. [CrossRef ]
7. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, et al. An update of the International Society of Sexual Medicine’s Guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med. 2014;2:60–90. [CrossRef ]
8. Castiglione F, Albersen M, Hedlund P, Gratzke C, Salonia A, Giuliano F. Current pharmacological management of premature ejaculation: a systematic review and meta-analysis. Eur Urol. 2016;69:904–16. [CrossRef ]
9. Waldinger MD, Berendsen HH, Blok BF, Holstege G. Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: the involvement of the serotonergic system. Behav Brain Res. 1998;92:111–8. [CrossRef ]
10. Olivier B, van Oorschot R, Waldinger MD. Serotonin, serotonergic receptors, selective serotonin reuptake inhibitors and sexual behaviour. Int Clin Psychopharmacol. 1998;13:S9–14. [CrossRef ]
11. Mathers MJ, Klotz T, Roth S, Lümmen G, Sommer F. Safety and efficacy of vardenafil versus sertraline in the treatment of premature ejaculation: a randomised, prospective and crossover study. Andrologia. 2009;41:169–75. [CrossRef ]
12. Montague DK, Jarow J, Broderick GA, Dmochowski RR, Heaton JPW, Lue TF, et al. AUA guideline on the pharmacologic management of premature ejaculation. J Urol. 2004;172:290–4. [CrossRef ]
13. Bai Y, Pu C, Han P, Jinhong Li, Haichao Yuan, Yin Tang, et al. Selective serotonin reuptake inhibitors plus phosphodiesterase-5 inhibitors for premature ejaculation: a systematic review and meta- analysis. Urology. 2015;86:758–64. [CrossRef ]
14. Men C, Yu L, Yuan H, Cui Y. Efficacy and safety of phosphodiesterase type 5 inhibitors on primary premature ejaculation in men receiving selective serotonin reuptake inhibitors therapy: a systematic review and meta-analysis. Andrologia. 2016;48:978–85. [CrossRef ]
15. Tuken M, Culha MG, Serefoglu EC. Efficacy and safety of dapoxetine/sildenafil combination tablets in the treatment of men with premature ejaculation and concomitant erectile dysfunction- DAP-SPEED Study. Int J Impot Res. 2019;31:92–6. [CrossRef ]
16. Yalçınkaya, Fatih Rüştü, and Serdar Geyik. Sertleşme Sorunu Tedavisinde Tadalafil ve Trazodonun Birlikte Kullanımı. Ann Health Sci Res. 2018;7:26–8. https://dergipark.org.tr/tr/ download/article-file/2017124
17. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–30. [CrossRef ]
18. Serefoglu EC, Cimen HI, Ozdemir AT, Symonds T, Berktas M, Balbay MD. Turkish validation of the premature ejaculation diagnostic tool and its association with intravaginal ejaculatory latency time. Int J Impot Res. 2009;21:139–44. [CrossRef ]
19. Serefoglu EC, Yaman O, Cayan S, Asci R, Orhan I, Usta MF, et al. Prevalence of the complaint of ejaculating prematurely and the four premature ejaculation syndromes: results from the Turkish Society of Andrology Sexual Health Survey. J Sex Med. 2011;8:540–8. [CrossRef]
20. McMahon CG, McMahon CN, Leow LJ, Winestock CG. Efficacy of type-5 phosphodiesterase inhibitors in the drug treatment of premature ejaculation: a systematic review. BJU Int. 2006;98:259– 72. [CrossRef ]
21. Akgül T, Karakan T, Ayyildiz A, Germiyanoğlu C. Comparison of sertraline and citalopram for treatment of premature ejaculation. Urol J. 2008;5:41–5. https://journals.sbmu.ac.ir/urolj/index.php/ uj/article/view/71/69
22. Wang WF, Wang Y, Minhas S, Ralph DJ. Can sildenafil treat primary premature ejaculation? A prospective clinical study. Int J Urol. 2007;14:331–5. [CrossRef ]