Browsing by Author "Pereira, Nuno Monteiro"
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- Adherence to phosphodiesterase type 5 Inhibitors in the treatment of frectile dysfunction in long-term users: How Do Men Use the Inhibitors?Publication . Carvalheira, Ana Alexandra; Forjaz, Vera; Pereira, Nuno MonteiroThe high effectiveness of phosphodiesterase type 5 inhibitors (PDE5-i) in the treatment of erectile dysfunction (ED) has been demonstrated. However, previous research shows that PDE5-i treatments have high discontinuation rates.
- Dropout in the treatment of erectile dysfunction with PDE5: A study on predictors and a qualitative analysis of reasons for discontinuationPublication . Carvalheira, Ana Alexandra; Pereira, Nuno Monteiro; Maroco, João; Forjaz, VeraPhosphodiesterase type 5 inhibitors (PDE5) are currently the first line treatment for erectile dysfunction (ED). However, previous research shows that PDE5 treatments have high discontinuation rates. Understanding the reasons for discontinuing PDE5 will be necessary to optimize the response to treatment. Aim. The main goals were: (i) to analyze discontinuation rate of PDE5; (ii) to identify the discontinuation predictors; and (iii) to study the reasons for discontinuation using a qualitative methodology. Main Outcome Measures. The PDE5 discontinuation rates, predictors, and reasons for discontinuation treatment. Methods. A total of 327 men with clinical diagnosis for ED who had been treated with PDE5 were successfully interviewed by telephone, after giving their informed consent by snail mail. Telephone interviews, concerning their ongoing treatment, were carried out using a standardized questionnaire form with quantitative and qualitative items. Participation rate was 71.8%. Results. Of the total sample, 160 men (48.9%) had discontinued PDE5 treatment. The discontinuation rate was higher among men with diabetes (73%) and in iatrogenic group (65%), and lower in venogenic etiology (38.7%).We differentiated three groups of men who discontinued treatment (i) during the first 3 months (55.1%); (ii) between 4 and 12 months (26.9%); and (iii) after a period of 12 months (18%). Qualitative analyses revealed diverse reasons for discontinuation: non-effectiveness of PDE5 (36.8%), psychological factors (e.g., anxiety, negative emotions, fears, concerns, dysfunctional beliefs) (17.5%), erection recovery (14.4%), and concerns about the cardiovascular safety of PDE5 (8.7%) were the most common. Older men and men whose partners were involved in the treatment, were less likely to discontinue treatment. Conclusion. Half the subjects discontinued medication. Mostly, there was a combination of factors that led to discontinuation: non-effectiveness and psychosocial factors appear to be the main reasons. Addressing those factors will allow following up with appropriate focus on relevant topics in order to improve compliance.
- Why are men satisfied or dissatisfied with penile implants? A mixed method study on satisfaction with penile prosthesis implantationPublication . Carvalheira, Ana Alexandra; Santana, Rita; Pereira, Nuno MonteiroIntroduction. Studies have demonstrated high levels of satisfaction with penile prosthesis implantation (PPI).However, qualitative research exploring the experience of PPI through men’s narratives is scarce.Aim. The main goals were to analyze (i) the level of sexual satisfaction (quantitatively), and (ii) the reasons forsatisfaction and/or dissatisfaction with PPI (qualitatively).Method. Participants were 47 men with erectile dysfunction who underwent surgery between 2003 and 2012, placedby a single surgeon. Structured telephone interviews were carried out.Main Outcome Measures. Satisfaction with PPI was a qualitative and quantitative measure assessed through thefollowing four items: (i) “Would you repeat the PPI surgery?”; (ii) “Would you recommend the PPI surgery?”; (iii)“How satisfied are you with the PP?”; and (iv) “Could you explain the motives of your satisfaction/dissatisfaction?”.Results. The majority of men (79%) reported to be satisfied with PPI. Content analysis revealed four main themesfor men’s satisfaction with the PPI: (i) psychological factors were reported 54 times (n = 54) and included positiveemotions, self-esteem, confidence, enhancement of male identity, major live change, and self-image; (ii) improve-ment of sexual function was reported 54 times (n = 54) and referred to achievement of vaginal penetration, increaseof sexual desire, sexual satisfaction, penis size, and improvement of erectile function; (iii) relationship factors werereported 11 times (n = 11) and referred to relationship improvement and the possibility of giving pleasure to thepartner; and (iv) improvement in urinary function (n = 3).Conclusions. The level of satisfaction with the implementation of penile prostheses is very high, therefore consti-tuting a treatment for erectile dysfunction with a positive impact on the experience of men at sexual, psychologicaland relational level.