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The Number One Erectile Dysfunction Centre


Evenings 5-9 on Tues and Thursday and Saturdays with Drs Michaela Schuhwerk, Johann Carinus, Leon Stehle and Reval Sukkhu

1st Consultation - Erectile Dysfunction

You complete a 15 minute questionnaire with the doctor, have a 60 minute physical examination and blood tests.

Total Cost £295.

Bloods tests included in the above price are:

  • Full biochemistry plus Haematology
  • Testosterone
  • Sex hormone Binding Globulin
  • Prolactin

2nd Consultation - Erectile Dysfunction

30 minutes review £92.40

A prescription for medication is given at no extra charge for the prescription but you do need to pay the Pharmacist the cost of any medication.

3rd Consultation - Erectile Dysfunction

30 minutes review £92.40

A prescription for medication is given at no extra charge for the prescription but you do need to pay the Pharmacist the cost of any medication.

 
1. Current Situation
  • Erectile dysfunction (ED) is very common. In the UK, one man in 10 aged over 21 years will suffer from ED at some stage in his life (Expert Opin Pharmacother 2004; 5:2,241).
  • It has been estimated that 70 per cent of ED remains undiagnosed (Urol Clin North Am 2001; 28:249)
  • The fairly recent advent of oral medication for ED has raised its profile considerably for both doctors and patients.         
  • However, only about half of patients report their symptoms of ED to their GP (Curr Med Res Opin 2004; 20:607).
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2. What is the evidence?
  • The oral phosphodiesterase-5 (PDE-5) inhibitors have become the treatment of choice for most patients, because they are more convenient than injections or vacuum devices.
  • Sildenafil is probably one of the most investigated drugs of all time.                
  • A meta-analysis if 27 sildenafil trials, involving nearly 7,000 men, showed a large and statistically significant improvement in erectile function, compared with placebo (Arch Intern Med 2002; 162:1,349).
  • About 80 per cent of men have been shown to report improved erections with PDE-5 inhibitors in a randomised controlled trial (J Urol 2002; 168:1,332).
  • All three erectile dysfunction drugs are well-tolerated drugs, causing few side effects.
  • The rates of MI for patients taking PDE-5 inhibitors is very low. A meta-analysis found that 0.8 per cent of men taking sildenafil reported angina, compared to 0.5 per cent for placebo and the rate of MI was 0.1 per cent versus 0.2 per cent respectively (Arch Intern Med 2002; 162:1,349).
  • The rate of MI among patients taking tadalafil has been shown to be 0.43 per 100 patient-years; this was actually less than that reported in placebo-treated patients (Am J Cardiol 2003;92:37M).
  • Pooled analysis of five trials involving verdenafil showed no increased risk in serious cardiovascular events for patients taking the drug (Int J Import Res 2002; 14 (Suppl): P092).
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3. Primary care implication
  • PDE-5 inhibitors are, generally, less successful in treating patients with diabetes mellitus.
  • Virtually all patients now chose oral medication as first-line treatment for ED.
  • Tadalafil has a much longer duration of action than the other drugs. In addition, its absorption is unaffected by fatty foods.
 
4. Available guidelines/further reading
 
UK management guidelines for erectile dysfunction, Erectile Dysfunction Alliance. London: RSM Press, 19
 
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5. Useful websites
 
Sexual Dysfunction Association http://www.sda.uk.net/