Zithromax: Stop the Infection and Enjoy Your Life

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This article is devoted to the drugs that are called Zithromax. It is one of the most effective antibiotics that deal with the problem of ear, skin, throat and sexually transmitted infection that is caused by bacteria. People are to react quickly when they notice some infection.  Experts say that when you put off the problem, it will bring a lot of complications that will be difficult or sometimes even impossible to cure. The main aim of this article is to give as much information about these drugs as possible: its nature, possible side effects and the way of its usage. We will also give you a hint where you can buy it.

Zithromax: What is That?

Zithromax, which can be known as azithromycin, is a drug that fights with infection in ears, on the skin, in the throat or that that can be transmitted by sexual intercourse. Its main aim is to reduce the amount of bacteria in the human body, but it has nothing to do with the viral infection. It is a perfect medicine for the following diseases:

  • Bronchitis
  • Pneumonia
  • Urethritis
  • Quinsy
  • Sore throat
  • Otitis
  • Scarlet fever
  • Dermatitis and other infections caused by bacteria.

Zithromax is not recommended to take without the consultation with the specialist. Only your doctor can decide what a permitted dosage for you is, the length of the medication and whether you need it or not. Don’t delay your visit to a doctor because infection is one of the most serious problems that spreads quickly and brings a lot of damage to your health.

How to Take Zithromax

It is very important to take drugs the way they are prescribed, so first consult your doctor. If you take more or less, the effect can be reduced to zero or you can even get poisoned. Zithromax can be produced as a suspension, capsules or pills. Generally, Zithromax does not depend on meals: you can take it before or after it, but , as a rule, all drugs are safer to take after meals because it is better for your stomach. There are still several recommendations on how to take Zithromax:

  • Suspension should be taken orally at once after you dissolve it in a 2 mm of water. It is better not to keep it longer than 12 hours.
  • Capsules are better to take one or two hours before or after meals.
  • Pills should be taken after meals and the dosage should be recommended by your doctor. It is also important to drink a full glass of water that will protect the stomach from harmful influence.
  • It is recommended to take the drugs until the disease disappears. The results can be seen but the illness can remain. That’s why it is important to see your doctor regularly.

The Most Widely Spread Zithromax Side Effects

There are Zithromax side effects which you should know. First of all, you should check whether you have allergy to some of the components or not. The most vivid signs of allergy are:

  • Heavy breath
  • Swelling throat
  • Swelling tongue
  • Skin rash

If you notice that something is wrong, you should consult your doctor. Other possible side effects are:

  • You can feel sick and dizzy
  • You may have stomach upset
  • Vomiting
  • There can be a headache and stomach pain
  • Sometimes you can feel exhausted, weak or have no appetite before having meals
  • Jaundice
  • There can be also not normal skin reaction (blistering, peeling, red skin, etc.)

This list is not complete because here you can see only the most common cases that were noticed by some patients. It is also essential to know that people are not to take Zithromax if they have problems with stomach or digestion, migraine or serious headaches, liver problems, kidney problems, heart problems or they have too sensitive skin that often reacts to different irritants. One thing that is important to know that it is difficult to find out whether Zithromax is harmful for children and pregnant women. So better see your doctor and ask if you are allowed to take it. Children whose age is less than 6 months should not take these drugs. While using Zithromax your skin can become too sensitive to abnormal sunshine or tanning beds rays. So you’d better to avoid them because you can easily get sunburnt.

Zithromax should be kept in dry and clean place protected from direct sunrays in room temperature.

Where can you Get Zithromax Online?

Zithromax is a widely spread antibiotic. You can buy it at any drug store or order it in the Internet. Canadian pharmacy is one of the most widely used online pharmacies that has excellent delivery system, acceptable prices and professional online 24/7 consultation. Its production is of high quality. So you can buy Zithromax Online here – www.mycanadianpharmacyrx.com/zithromax-azithromycin.html and even get discount in several months in case you buy all the medicine you need here.


Viagra Alternatives at Canadian Health and Care Mall Pharmacy: Kamagra, Cialis

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Erectile dysfunction, sometimes referred to as impotence, is a nightmare for many men, but it affects most of them sooner or later. There is nothing to be ashamed of because this medical condition is widespread and easy to treat, you only need to determine its underlying causes and effective meds. It’s all about your inability to keep or get an erection firm enough for having a sexual intercourse. Canadian Health and Care pharmacy www.acanadianhealthcaremall.com sells Viagra and its popular and more affordable alternatives to men who suffer from ED, and they all are of the best quality.

5 Factors That Cause ED

Viagra Alternatives at Canadian Health and Care Mall Pharmacy: Kamagra, Cialis

1. Endocrine problems. Your endocrine system produces hormones which are necessary to regulate sexual functions, and that’s why such diseases as diabetes can cause impotence.

2. Neurological disorders (spinal tumors, stroke, multiple sclerosis and others) increase the risk of having erectile dysfunction because they affect the ability of your brain to communicate with the sexual system, thus, preventing you from getting a firm erection.

3. Taking certain medications (beta-blockers, depressants, stimulants, synthetic hormones, alpha-adrenergic blockers) affects your blood flow and results in experiencing erectile difficulties, and that’s why you should never take them without the permission of your healthcare provider.

4. Heart conditions affect the ability to pump blood properly, so that they also may cause ED or impotence because you can’t get an erection without enough blood flow. For example, if you suffer from hypertension, high cholesterol levels and atherosclerosis, you have a higher risk for erectile dysfunction.

5. Emotional disorders and bad lifestyle habits. All men go through the excitement phase before achieving an erection, which is their emotional response. If you have emotional disorders, such as anxiety, fatigue or depression, it’s hard to be sexually excited.

How Does Cialis Work?

Cialis is a hot trend at the moment because of its unique effects and incredible characteristics that make it number one choice of many men who suffer from ED. This medication is a PDE5 inhibitor that helps to relax penis muscles and provides enough blood flow into it to achieve an erection. Its effects can last up to 36 hours, and you can take it with or without food only 20 minutes before a sexual intercourse. Other ED meds can’t boast the same effects, and that’s why Cialis is worth your attention and investment, so find out more about its extra benefits.

• Increasing Nitric Oxide levels in your blood, and this means that it flows much better, your oxygen delivery is improved, and your muscles receive more nutrients, thus, making you feel healthier.
• Lowering blood pressure (you shouldn’t take Cialis with other blood pressure meds, such as alpha-blockers and ACE inhibitors).
• Improving your enlarged prostate health by reducing inflammation.

Most Popular Generic Form of Viagra

Want to enjoy the benefits of this famous ED drug, but can’t afford paying its high price? The good news is that you can order Generic Viagra at our website and save money while solving your erectile problems. Kamagra uses the same Sildenafil citrate original formula, is manufactured in India and has GMP certificates. It works by inhibiting the enzyme responsible for having enough blood flow in your penis, thus, improving an erection. Keep in mind that this medication was developed as hypertension treatment, but now it’s used to solve erectile problems worldwide. Kamagra is available as blue diamond-shaped tablets that come in 1 or 4-pill packs, and its recommended dosage is 50 mg a day taken 1 hour before sex.

Generic Viagra, Kamagra, Cialis and other ed medications online at Canadian Health and Care Mall.


Antidiabetic effect of extracts of the seeds of Citrullus lanatus

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The current epidemic of diabetes mellitus (DM) in Africa, coupled with impinging poverty, clearly indicates the urgent need to develop new therapeutic drugs of cheaper and more available to face this growing health challenge. A number of plants products among which the protein-rich seeds including Citrullus lanatus, Telfairia occidentalis, Lagenaria siceraria, Cucumeropsis mannii and Cucurbita moschata are commonly used in traditional medicine with increasing acclaimed efficacy against DM (Teugwa et al., 2013). Diabetes mellitus is a major illness of the human race implicated with numerous clinical manifestations. It is a clinical syndrome characterized by chronic hyperglycemia (defects in insulin secretion, insulin action or both) resulting in aberration in carbohydrate, fat and protein metabolism. It has been reported that the chronic hyperglycemia of diabetes is associated with complications like renal failure, coronary artery disorder, neurological complications, cerebrovascular disease, blindness, and limb amputation, long term dysfunctions and failure of various organs and eventually premature death).

According to the World Health Organization (WHO) projections, the diabetes population is likely to increase to 300 million or more by the year 2025. The high cost of conventional drugs and their unavailability in many rural areas, coupled with their high incidence of side effects, posed a dare need for a change of the affair in case of modern medicine. Thus, the management of diabetes without any side effect is still a major challenge. According to the WHO, approximately 80% of the world’s population currently uses herbal medicines in healing different ailments. However, among the estimated 400,000 plant species, only 6% have been studied for biological activity, and about 15% have been investigated phytochemically. This shows a need for planned activity guided phyto-pharmacological evaluation of herbal drugs. The aim of this study was to phytochemically analyse and evaluate the antidiabetic activity of the seeds of Citrullus lanatus.


Plant material

Seeds of Citrullus lanatus were collected from Unguwar Rimi market, Kaduna north, Kaduna. The seeds were bench dried for eleven days and pulverized into coarse powder and kept in polythene bags at room temperature, ready for extraction.

Extraction of plant material

The dried pulverized seed (300g) was macerated with 1000 mls of petroleum ether (60-80 °C) for three days at room temperature and filtered and this was repeated twice. The combined filtrate was distilled using a rotary evaporator and then air-dried to obtain the petroleum ether extract. This procedure was repeated using ethanol on the residue of the seeds and after filtration the combined filtrate was then distilled to afford the ethanol extracts. Sildenafil Citrate in Discount Canadian Store. Watch on this website: mycanadianpharmacyrx.com.

Phytochemical screening

Phytochemical screening was carried out on the two extracts (petroleum ether and ethanol) of Citrullus lanatus peel using standard procedures and tests (Trease and Evans, 1989; Sofowora, 1993) to determine the presence of alkaloids, tannins, terpenoids, flavonoids, reducing sugar, anthraquinones, and saponins.

Pharmacological study


White albino mice (22-32g) of both sexes obtained from biochemistry department Kaduna state University, Kaduna were used for the experiment. The animals were kept under standard environmental conditions of temperature, relative humidity, and fed with standardized pellets and water ad libitum during the period in aluminum cages. The mice were fasted for 12hrs before experimentation but were allowed free access to water.

Experimental design

Hyperglycemia was induced by intraperitoneal injection of 150mg/kg body weight alloxan monohydrate, freshly dissolved in regular saline 0.9% physiological saline immediately before use, to overnight fasted albino mice. After 7 days, animals with fasting blood glucose level ≥126 mg/dl (≥7.0 mmol/dl) or more were considered diabetic and employed in the study. The mice were then grouped into 5 groups of five mice each as follows:

Group 1: Served as positive control and received glibenclamide (2 ml/kg body weight)
Group 2: Served as negative control receiving physiological saline (10 ml/kg)
Group 3: Received petroleum ether extract at 150 mg/kg body weight
Group 4: Received petroleum ether extract at 200 mg/kg
Group 5: Received petroleum ether extract at 250 mg/kg
Group 6: Received ethanol extract at 150 mg/kg body weight
Group 7: Received ethanol extract at 200 mg/kg Group 8: Received ethanol extract at 250 mg/kg

The animals were treated once with each dose and fasting blood glucose concentrations were measured at 0, 1, 3, 6 and 12 hours. Blood samples were taken by a snip-cut at the tip of the tail and blood sugar level was measured with a glucometer (a ONE TOUCH Ultra easy blood glucose monitoring system. Twitter Canadian Pharmacy – hot infortmation about sexual health, discounts in best Canadian Pharmacies.

Statistical Analysis

All the values of fasting blood glucose were expressed as mean ± SEM (n=5) and statistical significances between the treated and control groups (glibenclamide and physiological saline) were analyzed by means of Student’s t-test; P values <0.05 were considered significant.


Sigmoid perforation with retroperitoneal abscess and retroperitoneal air tracking into mediastinum

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What would be your next step in managing this patient?

What is the most likely source of mediastinal air? What is the diagnosis?

Pulmonary and Critical Care Pearls

Answers: Exploratory laparotomy; perforated viscus.

Diagnosis: Sigmoid perforation with retroperitoneal abscess and retroperitoneal air tracking into mediastinum.


Pneumomediastinum, or air in the mediastinum, was first described as a complication of trauma in 1819 by Laennec. Spontaneous pneumomediastinum as an entity was initially introduced into the medical literature in 1939 by Hamman, from which “Hamman sign” (air crepitus heard on auscultation with each heart beat) is derived. Pneumomediastinum is usually regarded as a benign, self-limited process that does not require medical intervention, although the etiology must be assessed to exclude rare life-threatening causes. Typical causes of pneumomediastinum are as follows:

1. Secondary to increased intrathoracic pressure, ie, Valsalva maneuver, strenuous exercise, weight lifting, vaginal delivery, and vomiting.
2. Sniffing cocaine or other Viagra pills Australia.
3. Barotrauma.
4. Status asthmaticus.

Unusual causes include arthroscopy, dental extraction, and adenotonsilectomy, scuba diving, trombone playing, and performing a maximal expiratory pressure maneuver.

Pneumomediastinum of a GI origin has been described in the medicalliterature. It can occur after GI instrumentation, endoscopy, endoscopic retrograde cholangiopancreatography, colonoscopy, or laparoscopic surgery. It may occur with or without evidence of perforation. In most cases, the condition is self-limited and resolves without surgical intervention, although a possible life-threatening etiology should be considered. A known life-threatening cause of pneumomediastinum is spontaneous esophageal rupture (Boerhaave’s syndrome). An esopha-gogram should, therefore, be included in the routine workup of pneumomediastinum and subcutaneous emphysema in the appropriate clinical setting.


Alcohol and Drugs: Disease Cannabis

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Ho w Does It Work?

Cannabis affects special areas of the brain called cannabinoid receptors, which are mainly found in areas of the brain that influence pleasure, thoughts, and sensory and time perception.

Cannabis gets into the bloodstream quickly after being taken and tends to build up in fatty tissues throughout the body. It is stored there and it can take several weeks for the body to eliminate it. This is why cannabis can sometimes be detected in urine up to 56 days after it has last been used.

What Are Its Effects?

Short-term use of cannabis can affect people in different ways. These can include a temporary ‘high’, a sense of relaxation or contentment (of being ‘stoned’), becoming more talkative and sometimes having a sense of time slowing down. Changes in awareness can make colours seem more intense and music sound better. Cravings for food (having the ‘munchies’) and hallucinations (when you see or hear something that isn’t there) may occur. Short-term memory, concentration and learning can be affected. Cannabis can also cause feelings of nausea, fatigue and loss of energy and can affect your coordination. The feelings are usually only temporary, although the drug can stay in the system for some weeks.

Long-term cannabis use can have a depressant effect, reducing motivation and leading to apathy. Short-term memory, concentration and learning can be affected. This can lead to poor performance at work or school.

Health Risks of Cannabis

Smoking cannabis damages your throat and lungs just like cigarettes do. It can cause hoarseness, a chronic cough and bronchitis as well as lung damage, including lung cancer. Indeed, smoking cannabis is thought to be even worse for your lungs than cigarettes. Cannabis can affect male fertility by leading to a decreased sperm count and reduced sperm mobility.

Mental health problems can include confusion, anxiety, panic, depression, paranoia and schizophrenia. Regular use of the drug increases the risk of developing a psychotic episode or long-term schizophrenia.


Speed (amphetamine) is a man-made stimulant that is usually swallowed in pill form. It can also be a powder that is dissolved in liquid for injection or drinking. Amphetamine is a stimulant, which quickens the heartbeat and can increase energy levels, making the user feel more confident. It can also cause anxiety, panic and paranoia, as well as impaired memory and concentration. The ‘come down’ period, when the effects wear off, can last for days, with users feeling very tired and depressed and having symptoms of anxiety and panic. Sleep disturbance is very common and can keep users awake for days afterwards.


The Heart and Erectile Dysfunction and New Zealand Viagra

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We will now get acquainted with one of the essential party guests, Mr. Heart. He is usually shy and a quiet achiever, just ticking away in the background although he is known to get a bit excited with some alcohol, exercise and of course, sex.

It may be getting clear by now that an erection is a cardiovascular event involving blood flow. Here is an interesting fact: your Dick is not a muscle but tissue that gets engorged with blood. You will And out all about this in Step 5. So, you can ignore all those peddlers selling elongation or strengthening your Dick’s muscle. The ultimate determinant of blood flow is of course the heart: Mr. Heart to you and me.

Your heart is basically a muscle pump that is controlled by electricity. It has two upper and two lower sections called chambers. The directional flow of blood between the chambers is directed by valves. Electrical charges contract the upper chambers and half a second later contract the lower chambers in synchrony. These time delayed synchronous contractions give it its pumping function New Zealand Viagra Shop. In simple terms, blood enters the upper chambers, and is pumped by the lower chambers to your lungs to pick up oxygen and to your body including your Dick. An erection is therefore totally dependent on allowing this pumped blood flow to engorge your Dick. So, we’d better get Mr. Heart onside. Because if Mr. Heart is not happy how can we party?

In fact, Mr. Heart and Mr. ED dislike each other so much, we now have a chicken and egg situation a heart condition will usually affect ED and now researchers have found ED to be a strong predictor of cardiovascular disease. According to a 2010 study in the Journal of the American Heart Association, men with ED were 1.6 times more likely to suffer from a serious cardiovascular problem such as a heart attack or stroke. It makes sense because the blood vessels in your Dick are a lot smaller than other parts of the body. For example, the main blood vessels in your heart are probably around 4mm, whereas they are probably around 1mm in your Dick. Therefore, any vascular issues are easier to develop in your Dick first For example for heart disease, research has shown that ED can precede heart disease by maybe three to five years. And this is not just for atherosclerosis (hardening of the arteries) but could also indicate other problems like high blood pressure, high cholesterol or, any other heart issues. So, the first instances of ED should be taken seriously for further investigation and this should be treated with urgency if you are under 40.

Some men are unlucky and suffer from genetic heart issues such as holes in the heart, valve problems and even with the timing of the electricity charges. These are clearly unfortunate situations where blood flows are affected and the heart issues have to be fixed first. But, for most men, heart issues will develop with age and lifestyle experience. With advancing age you need to get Mr Heart all the help he needs as anything that is good for him is bound to be good for your Dick getting erect. My Lifestyle and Nutrition advice in Step 6 is good for both. Let’s look at the most common developed condition affecting Mr Heart.


Breast Cancer in Men

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Breast cancer in men is uncommon. Less than 1 per cent of all breast cancers occur in men. Although men of all ages can be affected with the disease, the average age at diagnosis is between 60 and 70.

What Are the Risk Factors for Breast Cancer in Men?

Risk factors may include a family history of breast cancer in female relatives. Other factors may include radiation exposure and medical conditions associated with high oestrogen states, such as cirrhosis of the liver.

What Are the Symptoms of Breast Cancer in Men and How Is it Treated?

Every man may experience symptoms differently. Symptoms may include breast lumps, nipple inversion, a nipple discharge (sometimes bloody) or atypical pain or a pulling sensation in the breast. Keep in mind that these symptoms of breast cancer may resemble many other medical conditions. It is important to consult your doctor for advice. Overall survival rates are similar to that of women with breast cancer.

The main treatment Viagra Australia is surgical removal, and other treatment options include radiation therapy and chemotherapy.

Liver Cancer

Liver cancer is a rare cancer in men and usually involves a cancer elsewhere in the body spreading to the liver. The main cause of cancer originating in the liver itself is the hepatitis B virus infection, which is why vaccination against hepatitis B is so important for individuals at risk of contracting it. This virus spreads through contact with infected blood. Other infections that can cause liver cancer include hepatitis C, which is also spread via infected blood and other body fluids. Cirrhosis, usually but not always caused by excess alcohol, can also cause liver cancer. Some foodstuffs such as aflatoxin mould on peanuts, for example, can cause liver cancer.

Symptoms of Liver Cancer

Symptoms of liver cancer include yellow jaundice, loss of appetite, weight loss and pain or swelling in the upper abdomen.

Prevention of Liver Cancer

The best way to prevent liver cancer is to avoid hepatitis B or C infection. The most common form of hepatitis (hepatitis A) is not a risk factor for liver cancer. Hepatitis B and C are spread by contact with contaminated body fluids, most commonly blood or saliva. Practising safe sex, including the use of condoms, and avoiding sharing needles are important. There is a vaccine available to prevent hepatitis B. Unfortunately there is no vaccine available yet for the hepatitis C infection. You can also help prevent liver cancer by avoiding drinking excess alcohol, thereby preventing liver cirrhosis.

Treatment of Liver Cancer

Specific treatment for cancer will be determined by your doctors in consultation with you. Factors to be taken into consideration will include:

  • The extent of the cancer – how far it has spread
  • Your overall health, age and other medical conditions
  • Your tolerance for specific medications, procedures or therapies
  • Your ideas, concerns and expectations
  • Your opinions or preferences

Coping with Sperm Banking

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Local Research Ethics Committees’ approval was obtained.


Single interviews were undertaken that focused on the young men’s Vardenafil online pharmacy and parents’ retrospective perceptions of the content and style of communication within the family and with professionals surrounding the decision-making about, and management of, sperm storage following a diagnosis of cancer. A qualitative approach was used to allow respondents to raise issues pertinent to them. Prompts were made either for clarification or when respondents appeared to have completed their narrative. Towards the end, the researcher invited comment on areas not spontaneously covered using a topic guide. Permission was given for all interviews to be taped and transcribed.

Framework analysis was used to analyse the interview data. Two researchers, including the one who conducted the interviews, separately read and analysed the transcripts to identify themes, then a final framework was reached through discussion between the researchers. Respondents were sent summaries of the analysis before the full report was written in order to test the researchers’ interpretations against the research participants’ perceptions. Finally, findings from the interviews with professionals, the young men and their parents were compared.


Potential recruits who were under 18 (the age of consent in England) and post-Tanner Stage 22 at diagnosis were approached by paediatric oncology staff when they were not undergoing intensive treatment Cialis medstore online. Their involvement was discussed with their parents/carers where appropriate (and always if they were under 16). Parents were invited to be interviewed, with their sons’ permission.

Due to high levels of relapse in the potential sample, only nine young men were approached. Of these, seven young men and five sets of parents agreed to participate. Five young men were interviewed alone while two opted to have a parent present.

There was a diversity among the young men according to age (14 to 17 at diagnosis and 16 to 20 at interview); ethnicity (six White, one Asian); disability (one had a prior physical disability and at least one had learning difficulties); living situation (with a single parent, both parents, another family member and alone; and employment situation (in education, full time employment, unemployed/on sick leave) and cancer type. Two parents were lone parents; three were from twoparent families.

To maintain confidentiality, their situation is not generally referred to. The analysis did not reveal differences related to specific situations. Quotes are drawn from all respondents.


Data Supporting the Concept of Penile Rehabilitation

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In summary, as practicing physicians we appreciate that the consequences of ED are pro-found for many men. In a 55 year old men who was asymptomatic prior to his prostate biopsy, who had a mildly elevated PSA and ends up having a radical prostatectomy long-term ED is a major source of psychological distress in his life.

I believe that the above data shows that cavernosal smooth muscle alterations are common early after prostatectomy; that venous leak imparts a poor prognosis for recovery of natural and PDE5 inhibitor-assisted erections; that the animal evidence is robustly supportive of the concept that erectile function preservation can be achieved using PDE5 inhibitors; that there is a signal from human data that early erections after surgery and regular sildenafil citrate in Australia use is of some benefit to the recovery of erectile function. Despite this, there is yet to be conducted at large randomized controlled trial that definitively answers the role of injection therapy versus PDE5 inhibitors.

More recently, two other strategies have been explored for the purposes of penile rehabilitation postprostatectomy. Vacuum device therapy has been around for more than a century and has continued to assume a role in the management of men with erectile dysfunction treatment – look at here now. A number of centers have studied the role of vacuum device therapy for the preservation of penile length postprostatectomy as well as for rehabilitation.

It has been well documented that the pO2 and pCO2 levels in the cavernosal sinusoids following the application of a vacuum device remain in the venous range. Indeed the oxygen saturation is approximately 80%. If one believes that cavernosal oxygenation is critical to erectile tissue health and penile rehabilitation outcomes, this finding would undermine the role of vacuum device therapy as a rehabilitation strategy.

Raina et al. study 109 patients who were randomized to vacuum device use daily for 9 months versus observation. Thirty-two percent of patients in the vacuum device rehabilitation group versus 37% in the observation group had recovery of natural erections at 9 months after surgery. Seventy percent of the vacuum device patients and 29% of those not using vacuum device were able to have sexual intercourse at that time. Dalkin et al. studied 39 men with good preoperative erectile function who underwent nerve sparing radical prostatectomy. Stretched flaccid penile length was evaluated preoperatively and at 3-month postoperatively by a single examiner. The vacuum device was used daily starting the day after catheter removal and was continued for 90 days.

In men using the vacuum device on more than 50% of the possible days, only 3% had a decrease in stretched flaccid penile length of greater than 1 cm. Of the three men with poor vacuum device compliance 67% had a penile length reduction of more than 1 cm. Kohler et al. analyzed 28 men who were randomized to early vacuum device or a control group. The vacuum device group had therapy commenced 1 month after radical prostatectomy while the control group had vacuum therapy instituted 6 months after radical prostatectomy.


ED: Surgeon Factors

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Surgeon procedure volume and expertise are often cited as important factors for successful surgical outcomes. ED outcomes in regards to individual surgical volumes have been mixed. In a study of 1,778 prostatectomy patients operated upon by 14 different surgeons, patient age, the surgeon performing the RRP, and neurovascular bundle status, but not surgical volume were found to be significant predictors of erectile function adequate for penetrative relations recovery.

Number of Nerves Spared

Advances in prostatectomy surgical technique, the use of loupe magnification, and the understanding of cavernosal nerve anatomy have improved sexual function outcomes. Number of nerves spared has been a consistent predictor of erectile function postprostatectomy. Surgical margins required for cancer control has obvious implications on the ability to spare nerves. One of the original reports in 1991 stated that age, clinical and pathological stage, and the preservation of neurovascular bundles were significant factors in return of preoperative potency in 503 patients undergoing prostatectomy.

A recent review article summarizing ED patients after nerve sparing RRP of ³50 patients, ³1 year f/u, prospective interview or patient questionnaire outcomes, and erectile function defined as the ability to achieve unassisted intercourse with vaginal penetration showed erectile function as 31–86% for bilateral nerve sparing procedures, 13–56% for unilateral nerve sparing, and 0–17% in nonnerve sparing prostatectomies. Further stratification by age showed erectile function as 61–100% postprocedure for age <50 (for both unilateral and bilateral nerve sparing), 47–58% and 44–90% for unilateral and bilateral nerve sparing, respectively, for ages 50–70 and 0–51% for any nerve sparing procedure age >70.


The current literature on ED prevalence after CAP treatment is inconsistent, often poorly interpretable, and yield unacceptably disparate results. The wide range of ED prevalence rates indicates suboptimal study design and data acquisition, as biological variability alone is not likely to account for such drastically wide ED prevalence rates after CAP treatment. Study methodologies pertaining to internal and external validity of the data account for some of the ED data variability viagra online in Australia. Only through optimal ED quantification study can consistent, standardized outcomes be obtained to properly counsel patients and advance the field of study.