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Generic Cialis Online: The drug Cialis 5 mg in modern urological practice. Breast Cancer Satellite Symposium 34 of December 18, 2013

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Generic Cialis Online: The drug Cialis 5 mg in modern urological practice. Breast Cancer Satellite Symposium 34 of December 18, 2013

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The drug Cialis 5 mg in modern urological practice. Satellite Symposium | | “Breast Cancer” №34 from 12/18/2013

On November 6, 2013, in the framework of the XIII Congress of the Russian Society of Urology, a satellite company symposium was held «Eli lilly» in the form of a scientific duel between the leading Russian urologists «Professors VS Professors»

Debate topic:

“The drug Cialis 5 mg in modern urological practice”

The debate was opened by an associate professor at the Department of Urology, Moscow State Medical University, Ph.D. P.I. Rasner

P.I. Rasner spoke about the epidemiology of erectile dysfunction (ED), based on data from various studies. One of them, conducted in 2011 in the United States, was a large-scale 45-minute survey, in which 123,163 adult respondents took part, 75,000 of whom completed it. This survey showed that ED is present in 24.6% of men surveyed (mean age is 60 years), and ED with symptoms of the lower urinary tract (LUTS) was detected in 4.9% of respondents (mean age 68 years). Interestingly, 66% of respondents told doctors about their problems, which, according to P.I. Rasner is still an unattainable indicator for Russia, and 23% received drugs for the treatment of ED.

As a result of the European MSAM-7 study, which was attended by more than 14,000 men 50–80 years old in 7 countries (Russia was not included in this study), it was revealed that men of this age also need effective therapy for ED. Thus, the average number of sexual acts in men is 70–80 years old – 3 times a month. The speaker pointed out that these figures are of great interest: “Sexual contacts almost once a week for an 80-year-old man are somewhat unexpected data.” At the same time, sexual activity was absolutely clearly associated with the severity of LUTS: the more symptoms were expressed, the lower the activity was.

Even more intriguing data was obtained in a large Asian study that was divided by country. It turned out that on average in Asia, slightly less sexually active than in Europe, but not in all countries, sexual activity is the same in the respective age categories. In Japan, for example, 44% of men are sexually active and over the age of 80, which cannot be said of other countries.

Another interesting fact for urologists was named: many studies have shown that men who initially attracted their sexual partners to the treatment were much more motivated. And they were absolutely satisfied that they shared this problem with their partner.

Chief Urologist of the Ministry of Health of the Russian Federation, Professor, Head. Department of Urology, Moscow State Medical University, MD. D.Yu. Pushkar summarized and summarized the data given in the studies. He said that, despite the insufficient amount of Russian research in this area, by and large, all patients – in France, Japan, Italy and Russia – are no different. And, in principle, all these studies can be transferred to our country. The professor asked his colleagues to pay attention to how quickly the patient of the urologist changes in the modern world: “What is today called erectile dysfunction was not considered 10-20 years ago. Today, the evolution of patients is very fast. Yesterday, this patient would undergo a transurethral resection, the day before yesterday he would undergo an extensive operation, today he is being observed and is ready to be observed. Moreover, he chooses an observation, and I have no right to offer him an operation according to such indications, according to which they would have done it yesterday. And the testimony today is different, and the patients are more literate – they listen to their urination completely differently. But the therapy is changing: not so long ago there was no magic pill we are talking about today. Also, there was not this unique dosage – 5 mg, which is the only one for daily use among type 5 phosphodiesterase inhibitors (iFDE-5), but at the same time shows high efficiency compared with the use of iFDE-5 on demand. ”

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In his speech, prof. D.Yu. Pushkar raised another important question that no one has ever investigated the quality of urination in men who take a sufficient amount of fluid. It is known that for the prevention of urolithiasis, bone and joint disorders, cardiovascular pathology, it is necessary to use 11 glasses of water daily. Most men, incl. surveyed, do not get this amount of fluid. What data can give research conducted with this factor? Indeed, many urinary disorders may not be detected until there are conditions for their detection.

Further, the question was raised of the risk factors of the early finals of the sexual life of Russian men. The data of a domestic study were presented, which showed that the age of sexual interruption for men in Russia is on average 45–60 years. 37% of the interviewed men stopped their sexual life before the age of 60, and this was done on the initiative of the men themselves in 70% of cases. The risk factors are evident: 63% consume alcohol, 50% smoke, most have an increased body mass index.

D.Yu. Pushkar pointed out that today the symposium discusses the rare case when doctors can meet the expectations of patients. A small dosage of Cialis 5 mg with the possibility of daily use – as the speaker said – turned the ideas of urologists about the formula for the treatment of ED.

Professor, Department of Urology, First Moscow State Medical University named after I.M. Sechenov, MD A.Z. Vinarov cited data on various representatives of the iFDE-5 group: in addition to tadalafil, there are other, and more studied, drugs. The most studied drug used in the treatment of ED is sildenafil; for him by the number of studies is tadalafil. According to the recommendations of the European Association of Urology (EAU), currently there is no information indicating that patients prefer sildenafil, tadalafil or vardenafil. Today, the choice of the drug depends on the frequency of sexual contacts, the patient’s own experience. Therefore, the patient should be aware of the fact that there are drugs of short and long-acting, should know their disadvantages and advantages.

Associate Professor, Department of Urology, First Moscow State Medical University named after I.M. Sechenov, MD N.D. Akhvlediani contrasted data prof. A.Z. Vinarov the following facts:

“If you and I compare Cialis 5 mg and Cialis 20 mg,” he began, “you can definitely say that these are different drugs with a different philosophy of use. If you try to apply Cialis 20 mg in a sexually active patient, then, based on the instructions, we can prescribe it only every other day. It is known that it is valid for 36 hours. Thus, an 8-hour interval appears when the patient does not have the effect of iFDE-5, and he can get into an unpleasant situation, forgetting about it, hoping for the effect of the drug. This is excluded when using Cialis 5 mg, because the concentration of this drug due to daily use does not change constantly, and the effectiveness does not fall.

We have to admit that there are objective research data: using inhibitors more often, for example, daily, like Cialis 5 mg, we have the best result in the frequency of spontaneous night or morning erections. This is a comparison with Cialis 20 mg and sildenafil. The pattern is as follows: the more often a patient takes an inhibitor, the better the effect. In addition, we must recognize, based on the data of long-term serious studies, that with daily intake of almost 60% of men, full erectile function normalized, ie they have no signs of illness, and they feel healthy. Interestingly, after 2 years of use, this indicator practically does not change. This suggests that there is no tachyphylaxis.

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The psychological status of patients taking tadalafil 5 mg, cialis 20 mg and sildenafil is different. The data of a large-scale study are such that patients who take iFDE-5 – Cialis 5 mg – daily, are less concerned about the time of action of the drug, the rate of onset of the effect, the spontaneity of sexual activity. The patient does not think about whether the tablet he takes will work. This cannot be said about the action of iFDE-5 on demand – sildenafil.

Generic Cialis Online: The drug Cialis 5 mg in modern urological practice. Breast Cancer Satellite Symposium 34 of December 18, 2013

What are the reasons for the greater efficacy of tadalafil 5 mg for daily use compared with the prescription of iFDE-5 on demand? First, in these patients the morning erection is restored, it occurs more often. And the man at the same time again feels healthy. Secondly, such a drug is easier to use. After all, many patients incorrectly take iFDE-5. Because you can forget how long before intercourse you need to take medicine, because some of these drugs are titrated, i.e. It is necessary to choose the dosage. Thirdly, there is no concern about the duration of the effect of the drug and the rate of onset of the effect. And the most convincing data (this work has not yet been published) is a comparison of the effectiveness of tadalafil 5 mg, tadalafil 20 mg and placebo in the most severe patients with radical prostatectomy, of course, nerve-saving.

With a long follow-up period of 13.5 months, the most effective results were shown by prolonged iFDE-5 compared to placebo, but Cialis has the best result of 5 mg: the only reliable indicator of the relative probability of restoring erection. “

Professor A.Z. Vinar:

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“You know that now iFDE-5 is included in the recommendations of the EAU as drugs that can be used in patients with urination disorders. And it has long been known that sildenafil improves the symptoms of impaired urination. In 2013, recommendations appeared in the journal European Urology, which indicated that iFDE-5 reduces the severity of moderate and severe accumulative and excretory symptoms of impaired urination in men with or without ED. But only tadalafil 5 mg is registered for the treatment of men with symptoms of impaired urination in Europe. ”

Associate Professor N.D. Akhvlediani:

“We understand that permanent effects, long-term inhibition of phosphodiesterase-5, are necessary for the treatment of urination disorders. In Europe and other countries, iFDE-5 is registered both for the treatment of erectile dysfunction and for symptoms of urinary disturbance.

Tadalafil in this sense – the leader. 111 publications mentioning tadalafil used in the treatment of symptoms of impaired urination. The second place, oddly enough, was taken by the short-acting drug sildenafil. But this is the first drug from the iFDE-5 group, and these studies were started from it. But should it be used in the treatment of patients? “

Professor A. Z. Vinarov summed up:

“PDE-5 inhibitors and, in particular, tadalafil, can be equally effective in patients with ED and urinary disorders, and in patients with urinary disorders, but without impairment of erectile function.”

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Associate Professor of the Department of Urology, Moscow State Medical University, Ph.D. A.V. Go­Thieves raised another important topic – the daily use of iFDE-5 for the treatment of benign prostatic hyperplasia (BPH).

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“What do we know about the standard treatment for BPH? We know that α-blockers are the standard treatment for BPH, because they act quickly, they are effective, they have a low incidence and severity of side effects. We know that they reduce I-PSS in patients with treatment by about 30–40% and increase the maximum urinary rate by about 25%. They can be prescribed to a patient with BPH at any age. Recently we have been talking about the importance of the selectivity of these drugs. On the one hand, we understand that the higher the selectivity, the better it would seem. However, the more selective drugs are characterized by the presence of such a criterion as retrograde ejaculation.

When we talk about this with patients, we explain to them in advance that modern selective drugs can cause this condition. Patients seem to agree to such conditions. But quite often, using this therapy, they return to us with complaints about exactly what they were warned about.

Now let’s talk about the group of drugs that we know well: about iFDE-5. They are the only group of drugs that prevent the symptoms of BPH and also effectively reduce I-PSS, effectively reducing prostate volume by about 18–25% when used for 2–4 years. We remember that the greater the volume of the prostate gland in patients, the more pronounced is the effect of the treatment of iFDE-5. These drugs are necessary and important in modern combinations. Now there are drugs that combine α-blockers with iFDE-5. We are talking about the fact that today other patients come to our reception who, thanks to the Internet, have an idea of ​​what kind of treatment they want to receive. There are more and more such patients. These are the patients with whom we can discuss new therapeutic options for BPH. ”

Professor of the Department of Urology and Surgical Andrology, RMAPO, MD. E.I. Veliyev spoke about a study comparing the effectiveness of tadalafil 5 mg with placebo:

“Half of the patients had successful intercourse from the 2nd day of therapy. Further, the number of such attempts increased. Tadalafil 5 mg was studied with long-term use – over 12 months. The conclusions are as follows: the dose is small, it acts quickly and works well. ”

Further, E.I. Veliyev briefly focused on the effect of tadalafil on LUTS:

“When we talk about the effects of Cialis 5 mg with continuous use, we mean the effects associated with LUTS, and with the severity of ED. These studies, in which patients were divided into 3 groups – with unexpressed ED, with moderate and severe ED, show that tadalafil 5 mg with continuous use showed an improvement in the I-PSS scale. To date, we know several treatments for BPH and LUTS. We are accustomed to divide our patients into several groups: these are patients who can use monotherapy and who are recommended to use combination therapy. We say, as a rule, that in those patients for whom combination therapy is recommended, progressive BPH occurs. Regardless of the progression of BPH, Cialis 5 mg is effective. Where ED is associated with LUTS, tadalafil 5 mg shows efficacy everywhere, regardless of the severity of its manifestation. Tadalafil 5 mg improves LUTS, with any degree of ED in a patient. “

Prof. EI Veliyev, summing up the debate, said that two problems can really have one solution for a group of patients that was mentioned today: ED and urination disorders in BPH. And this number of patients may be more than 70%.

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