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Penile arterial bypass surgery is appropriate in only a select group of patients (men under 35 years of age who have no generalized vascular disease and in whom an isolated injury has obstructed blood flow). Penile implants are available for patients who have not responded to more conservative treatment. This procedure is invasive, irreversible and subject to complications such as infection, erosion and mechanical failure. There is, however, a high rate of patient and partner satisfaction.63 But Cialis "was found to improve exercise capacity, health-related quality of life, delay time to clinical worsening, and improve hemodynamic [blood-linked] parameters of disease severity," said lead researcher Dr. Robyn J. Barst, a professor of pediatrics at Columbia University College of Physicians & Surgeons in New York City. The drug was also well-tolerated, she added. THURSDAY, Oct. 22 (HealthDay News) -- Doctors should prescribe oral phosphodiesterase type 5 (PDE-5) inhibitor drugs, such as Viagra, Cialis and Levitra, for men with erectile dysfunction, unless the patient is on nitrate therapy, according to a clinical practice guideline issued by the American College of Physicians. All 3 of the PDE-5 inhibitors are metabolized by the cytochrome P-450 3A4 enzyme. Sildenafil and vardenafil share similar pharmacokinetic properties (Table 2). Both have been shown in clinical trials to improve the ability to attain and maintain erections when taken 1 hour before sexual activity (Table 3). Since sildenafil was introduced, extensive clinical experience has been gained with prescriptions of it to more than 20 million patients. Vardenafil has distinguished itself by demonstrating efficacy in patients who have previously undergone radical prostatectomy for localized prostate cancer (a group that had been difficult to treat because of nerve and vascular injury secondary to surgery) and in patients with diabetes.34,35 "In some cases producing counterfeit medicine can be ten times as profitable per kilogram as heroin, yet in the UK someone can face greater legal sanctions if they produce a counterfeit T-shirt. "There is an association, but we don't know which one comes first," said study author Dr. Xiang Gao, an instructor in medicine at Harvard University School of Public Health. If researchers do discover how they're connected, it could lead to more effective treatments, he said. The use of oral therapy has long been preferred over invasive procedures such as injection therapy for erectile dysfunction. We review the pharmacology, efficacy and side effects of the newest agents available for oral therapy: the PDE-5 inhibitors sildenafil, vardenafil and tadalafil. These drugs should be kept in its original container and out of reach of children. Store them away from excess heat and moisture (not in the bathroom). Discard any medication that has expired or is no longer needed. This agent, which is available in 5-mg, 10-mg, and 20-mg doses, became available in 2003. These lower doses are effective because this agent has a 9-fold increase in selectivity for the specific receptor responsible for NO release in the penis. This agent can act within 20 minutes. Vardenafil has similar efficacy, side effects, and limitations as sildenafil but may be less bothered by food. Vorona said another sleep disorder -- sleep apnea -- also has been linked to erectile dysfunction. 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