Efficacy, safety and predictive factors of therapeutic success with sildenafil for erectile dysfunction in patients with different spinal cord injuries

Study design: Multicenter, open, prospective, before-after study. Objective: To assess the efficacy and safety of sildenafil therapy for erec tile dysfunction in patients with spinal cord injury, and the association b etween the response to sildenafil and factors such as causes and levels of spinal cord injury, grade of ASIA deficit, time since injury, orgasmic perc eption, and degree of baseline erection. Setting: Homes of outpatients of 16 spinal cord injury units in Spain. Method: One hundred and seventy patients with erectile dysfunction secondar y to spinal cord injury, from whom baseline data were collected on their se xual function, and who started treatment with sildenafil 50 mg. An efficacy assessment was made by the patient and his partner, and the score of the I nternational Index of Erectile Function (IIEF) was recorded. Results: It was reported by 88.2% of the patients and 85.3% of their partne rs that treatment with sildenafil had improved their erections, regardless of the baseline characteristics of the spinal cord injury and erectile func tion. In responders, this improvement was confirmed by an increase from 12. 5 to 24.8 points (P < 0.001) of the Erectile Function Domain of IIEF. A sig nificant improvement was also seen in patients' satisfaction with sexual ac tivity and general satisfaction derived from sexual life. Preservation of o rgasmic perception and a baseline degree of erection of 3 or 4 (P = 0.006) were predictors of therapeutic success. No serious adverse events occurred. Conclusion: Sildenafil is an effective, well-tolerated treatment for erecti le dysfunction caused by spinal cord injury, regardless of the cause, neuro logical level, ASIA grade, and time since injury. Sponsorship: Spanish Society of Paraplegia.