1822 ORAL TRAZODONE IS NOT EFFECTIVE FOR ERECTILE DYSFUNCTION 24. Bondil, P., L‘associatio Trazodone-Moxissylite par voie orale: Interet diagnostique et therapeutique dans l’impuissance a propos de 110 cas. Prog. Urol., 2: 1, 1992. 25. Yates, A. and Wolman, W.: Aphrodisiacs: myth and reality. Med. Aspects Hum. Sexuality, 67: 58, 1991. 26. Seagraves, R.: Effects of psychotropic drugs on human erection and ejaculation. Arch. Gen. Psychiat.. 46 275, 1989. EDITORIAL COMMENT Erectile dysfunction is a common problem in urological practice and treatment is constantly being refined with the desire to find an oral medication that effectively alleviates the problem, causes no side effects and is inexpensive. Trazodone has been touted as one of these potential drugs. Clinical trials with negative findings often do not generate the excitement of positive findings. However, the re- sults of a well designed study, regardless of whether it is positive or negative, deserve to be published and read. The authors have used a double-blinded, placebo controlled, cross- over study to assess the patient perceived effectiveness of 50 mg. trazodone versus placebo for treatment of erectile dysfunction. They found convincing evidence that trazodone had no benefit over placebo. However, several questions are raised. The study included a select population with presumed physiological erectile dysfunction. The authors did not state how many patients were excluded from this study but only that they excluded those with primary psychogenic erectile dysfunction, Could there have been a significant per- centage of patients who may have benefited from trazodone but who were excluded? Were these excluded patients more depressed than the study population and, therefore, more likely to respond to trazodone? Although a continuum exists between psychogenic and physiological erectile dysfunction as depicted in figure 2 in the article. patients with erectile dysfunction usually are not solely on either end. As cited in the article, a previous double-blind placebo controlled study in a nonselect population, 509 of whom had psychogenic impotence, showed that trazodone did not work (reference 13 in article). These findings suggest that trazodone has limited clinical efficacy in the treatment of erectile dysfunction secondary to any cause. However, given the safety and cost of trazodone (200 times less expensive than sildenafil), it may still be worth a brief trial in some patients who might otherwise benefit from its antidepressant or hypnotic effects. Toby Chai Department of Surgery Division of Urology Uniuersity of Maryland School of Medicine Baltimore, Maryland

EDITORIAL COMMENT

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1822 ORAL TRAZODONE IS NOT EFFECTIVE FOR ERECTILE DYSFUNCTION

24. Bondil, P., L‘associatio Trazodone-Moxissylite par voie orale: Interet diagnostique et therapeutique dans l’impuissance a propos de 110 cas. Prog. Urol., 2: 1, 1992.

25. Yates, A. and Wolman, W.: Aphrodisiacs: myth and reality. Med. Aspects Hum. Sexuality, 67: 58, 1991.

26. Seagraves, R.: Effects of psychotropic drugs on human erection and ejaculation. Arch. Gen. Psychiat.. 4 6 275, 1989.

EDITORIAL COMMENT

Erectile dysfunction is a common problem in urological practice and treatment is constantly being refined with the desire to find an oral medication that effectively alleviates the problem, causes no side effects and is inexpensive. Trazodone has been touted as one of these potential drugs. Clinical trials with negative findings often do not generate the excitement of positive findings. However, the re- sults of a well designed study, regardless of whether it is positive or negative, deserve to be published and read.

The authors have used a double-blinded, placebo controlled, cross- over study to assess the patient perceived effectiveness of 50 mg. trazodone versus placebo for treatment of erectile dysfunction. They found convincing evidence that trazodone had no benefit over placebo. However, several questions are raised. The study included a select population with presumed physiological erectile dysfunction.

The authors did not state how many patients were excluded from this study but only that they excluded those with primary psychogenic erectile dysfunction, Could there have been a significant per- centage of patients who may have benefited from trazodone but who were excluded? Were these excluded patients more depressed than the study population and, therefore, more likely to respond to trazodone? Although a continuum exists between psychogenic and physiological erectile dysfunction as depicted in figure 2 in the article. patients with erectile dysfunction usually are not solely on either end. As cited in the article, a previous double-blind placebo controlled study in a nonselect population, 509 of whom had psychogenic impotence, showed that trazodone did not work (reference 13 in article). These findings suggest that trazodone has limited clinical efficacy in the treatment of erectile dysfunction secondary to any cause. However, given the safety and cost of trazodone (200 times less expensive than sildenafil), it may still be worth a brief trial in some patients who might otherwise benefit from its antidepressant or hypnotic effects.

Toby Chai Department of Surgery Division of Urology Uniuersity of Maryland School of Medicine Baltimore, Maryland