A Comprehensive Approach in the Treatment of Erectile Dysfunction in Obesity Patients


Yurii Gurzhenko


As early as in the middle of the twentieth century, obesity became one of the most important medical and social problems in the world, especially among the population of developed countries due to its high prevalence and the enormous cost of overcoming its consequences. One of the complications of obesity is sexual dysfunction in men.

The objective: to evaluate the effectiveness of udenafil in the form of 200 mg tablets in the treatment of erectile dysfunction in obese patients.

Materials and methods. The clinical efficacy of udenafil PDE-5 inhibitor in 125 patients with ED and obesity was studied. The mean age of the patients was 47.4±6.7 years.

When dividing patients into groups in order to objectively assess the results of different types of therapy, the groups were homogeneous in age, severity of obesity and ED, and then randomized patients into groups.

Group I included 37 patients with ED and obesity who received therapy to normalize erectile function (healthy lifestyle, modification of individual risk factors, local negative pressure therapy, phosphodiesterase type 5 inhibitor udenafil) and obesity treatment aimed at weight loss; diet therapy, physical therapy, pharmacotherapy according to the indications, adequate level of physical activity). Group II – 56 patients with ED and obesity who received similar therapy to normalize erections. Group III 32 patients with ED and obesity treated with obesity without the use of phosphodiesterase type 5 inhibitors. The follow-up was 12 weeks.

Criteria for assessing the clinical effectiveness of treatment: the dynamics of the International Erectile Function Index (ICEF). The diagnosis of ED was established by the total of points in the answers to questions 1–5, 15; which is 26 or less. The severity was assessed as severe – 1–10 points, moderate – 11–16 points, mild – 17–25 points; assessment of changes in cavernous hemodynamics according to Doppler data of cavernous vessels; assessment of body mass index and waist circumference; dynamics of lipid parameters (total cholesterol, triglycerides and atherogenic factor); dynamics of hormonal background indicators (testosterone, estradiol, LH, FSH, prolactin); Characteristics of the rate of onset of the effect of maximum erection and duration of action of udenafil.

Statistical data processing was performed using the application package Statistica for Windows v. 6.0.

Results. After 3 months, the following results were obtained. In group I, the average total ICEF score (questions 1–5, 15) increased from 17.3±3.8 to 26.7±5.3 points, ie 1.54 times (p<0.05). In group II – increased 1.33 times – from 16.4±3.2 to 21.8±4.6 points (p<0.05). In the third group – increased from 15.8±2.7 to 17.9±3.8 points, ie 1.13 times (p>0.05). BMI decreased in group I from 38.7±4.7 kg/m2 to 35.3±3.8 kg/m2 (p>0.05); in the second group of patients – from 36.4±4.3 kg/m2 to 35.0±3.9 kg/m2 (p>0.05); in group III BMI also did not undergo significant changes. (decrease from 36.4±4.3 kg/m2 to 32.4±3.4 kg/m2) (p>0.05)

As a result of treatment, the indicators of total cholesterol, triglycerides, atherogenic coefficient and HDL levels improved, especially in patients of groups I and III, but they did not acquire signs of reliability. The increase in testosterone levels also did not achieve a statistically significant difference. In the study of cavernous blood flow, peak systolic velocity increased from 24.3±2.2 cm/s to 32.3±2.6 cm/s in the penis during erection (1.5-fold increase) in patients of the first group. p<0.05). In patients of the second and third groups, respectively, from 21.7±2.5 cm/s to 28.8±2.8 cm/s (p<0.05) and from 23.2±2.2 cm/s to 24,3±2.1 cm/s (p>0.05).

Conclusions. According to the patients from the first and second groups taking udenafil, 74 (79.6%) of 93 patients rated the effectiveness of the drug as «excellent», 12 (12.9%) of 93 patients as «good», 4 (4.3%) as «satisfactory». The final evaluation of the effectiveness of therapy revealed «excellent» and «good» results in 95.7% of patients.

Changes of indicators such as BMI, total cholesterol, triglycerides and atherogenic factor, testosterone levels, did not achieve a statistically significant difference because the observation period was too short.

Udenafil can be considered a first-line drug in the treatment of erectile dysfunction in obese patients.


How to Cite
Gurzhenko, Y. (2021). A Comprehensive Approach in the Treatment of Erectile Dysfunction in Obesity Patients. Health of Man, (4), 57–71. https://doi.org/10.30841/2307-5090.4.2021.252398
Sexology and andrology
Author Biography

Yurii Gurzhenko, Acad. O. F. Vozianov Institute of Urology NAMS of Ukraine

Yurii M. Gurzhenko,

Department of Sexopathology and Andrology


Dedov II, Mel’nichenko GA, Shestakova MV, Troshina YeA, Mazurina NV, Shestakova YeA. National clinical guidelines for the treatment of morbid obesity in adults. 3rd revision. Moscow; 2018. 18 p.

Всемирная организация здравоохранения. Ожирение и избыточный вес [Интернет]. ВОЗ; 2021. Доступно на: http://www.who.int/mediacentre/factsheets/fs311/ru/.

World Health Organization. Geneva: WHO. Available from: http://www.who.int/.

Caballero B. The global epidemic of obesity: an overview. Epidemiol Rev 2007;29:1-5. doi: 10.1093/epirev/mxm012.

Heymsfield S.B, Segal K.R, Haupman J, Lucas CP, Boldrin MN, Rissanen A, et al. Effects of weight loss with orlistat on glucose tolerance and progression to type 2 diabetes in obese adults. Arch Intern Med. 2000;5(8):1321-6. doi: 10.1001/archinte.160.9.1321.

International Association for the Study of Obesity. International Obesity Taskforce prevalence data: global obesity prevalence in adults. London: International Association for the Study of Obesity; 2005. p. 9.

Melnichenko GA, Romantsova TI, Dedova II, editors. Obesity: epidemiology, classification, pathogenesis, clinical symptoms and diagnosis. Obesity: ethology, pathogenesis, clinical aspects. Moscow: Medical Information Agency; 2004, p. 16-42.

World Health Organization. Obesity: Preventing and Managing the Global Epidemic. World Health Organization: 2000.30. Wilding JPH. Treatment strategies for obesity. Obesity Reviews. 2007;8(s1):137-44.

Russian Association of Endocrinologists. Clinical guidelines Obesity. Moscow: Russian Association of Endocrinologists; 2019. p. 43.

Shlyakhto YeV, Neugoda SV, Konrady AA. Diagnostics, treatment, prevention of obesity and associated diseases (national clinical guidelines). Saint Petersburg; 2017. 64 p.

Cavill N, Kahlmeier S, Racioppi F, editors. Physical activity and health in Europe: case for action [Internet]. Geneva: WHO; 2006. 46 p. Available from: https://www.euro.who.int/data/assets/pdf_file/0011/87545/E89490.pdf.

Eganyan RА, Kalinin AM, editors. Manual for doctors School of health. Overweight and obesity. Moscow; 2010. p. 47.

Hamidov SI, Shatylko TV, Hasanov NG, Naumov NP. The use of tadalafil on demand for erectile dysfunction in special categories of patients // Andrology and genital surgery. 2018;19(4):15-20.

Ghosh A, Gao L, Thakur A, Siu PM, Lai CWK. Role of free fatty acids in endothelial dysfunction. J Biomed Sci. 2017;24(1):50. doi: 10.1186/s12929-017-0357-5.

De Souza ILL, Barros BC, De Oliveira GA, Queiroga FR, Toscano LT, Silva AS, et al. Hypercaloric Diet Establishes Erectile Dysfunction in Rat: Mechanisms Underlying the Endothelial Damage. Front Physiol. 2017;8:760. doi: 10.3389/fphys.2017.00760.

Kim JE, Kim YW, Lee IK, Kim J-Y, Kang YJ, Park S-Y. AMP-activated protein kinase activation by 5-aminoimidazole-4-carboxamide-1-beta-D-ribofuranoside (AICAR) inhibits palmitate-induced endothelial cell apoptosis through reactive oxygen species suppression. J Pharmacol Sci. 2008;106(3):394-403. doi: 10.1254/jphs.fp0071857.

Ryu SY, Choi YJ, Park SY, Kim JY, Kim YD, Kim YW. Udenafil, a Phosphodiesterase 5 Inhibitor, Reduces Body Weight in High-Fat-Fed Mice. World J Mens Health. 2018;36(1):41-9. doi: 10.5534/wjmh.17028.

Li S, Xu J, Yao W, Li H, Liu Q, Xiao F, et al. Sevoflurane pretreatment attenuates TNF-alpha-induced human endothelial cell dysfunction through activating eNOS/NO pathway. Biochem Biophys Res Commun. 2015;460(3):879-86. doi: 10.1016/j.bbrc.2015.03.126.

Hafez G, Gonulalan U, Kosan M, Arioglu E, Ozturk B, Cetinkaya M, et al. Acetylsalicylic acid protects erectile function in diabetic rats. Androl. 2014;46(9):997-1003. doi: 10.1111/and.12187.

Bayraktar Z, Albayrak S. Antiplatelet (aspirin) therapy as a new option in the treatment of vasculogenic erectile dysfunction: a prospective randomized double-blind placebo-controlled study. Int Urol Nephrol. 2018;50(3):411-8. doi: 10.1007/s11255-018-1786-0.

Kaya E, Sikka SC, Gur S. A comprehensive review of metabolic syndrome affecting erectile dysfunction. J Sex Med. 2015;12(4):856-875. doi: 10.1111/jsm.12828.

Patel JP, Lee EH, Mena CI, Walker CN. Effects of metformin on endothelial health and erectile dysfunction. Transl Androl Urol. 2017;6(3):556-65. doi: 10.21037/tau.2017.03.52.

Corona G, Rastrelli G, Monami M, Luconi M, Lucchese M, Facchiano E, et al. Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis. Eur J Endocrinol. 2013;168(6):829-43. doi: 10.1530/EJE-12-0955.

Hofstra J, Loves S, Van Wageningen B, Ruinemans-Koerts J, Jansen I, De Boer H. High prevalence of hypogonadotropic hypogonadism in men referred for obesity treatment. Neth J Med. 2008;66(3):103-9.

Saboor Aftab SA, Kumar S, Barber TM. The role of obesity and type 2 diabetes mellitus in the development of male obesity-associated secondary hypogonadism. Clin Endocrinol (Oxf). 2013;78(3):330-7. doi: 10.1111/cen.12092.

Wagner IV, Kloting N, Atanassova N, Savchuk I, Spröte C, Kiess W et al. Prepubertal onset of obesity negatively impacts on testicular steroidogenesis in rats. Mol Cell Endocrinol. 2016;437:154-62. doi: 10.1016/j.mce.2016.08.027.

Kapoor MS, Khan SA, Gupta SK, Choudhary R, Bodakhe SH. Animal models of erectile dysfunction. J Pharmacol Toxicol Methods. 2015;76:43-54. doi: 10.1016/j.vascn.2015.07.013.

Vozianov OF, Gorpinchenko II. Experience of Viagra in Ukraine. Sexol Androl. 2000;(5):3-5.

Gorpinchenko I. Erectile dysfunction: diagnosis and modern methods of treatment. Men’s health. 2002;(1):9-11.

Gorpinchenko II, Miroshnikov Ya. O. Erectile dysfunction. Lviv: Medicine to light; 2019. 432 p.

Buva J. Treatment with sildenafil, four years of experience. Men’s health. 2002;(2):11-3.

Bell AS, Palmer MJ. Novel phosphodiesterase type 5 modulators: a patent survey (2008–2010). Expert Opin Ther Pat. 2011;21(10):1631-41. doi: 10.1517/13543776.2011.614435.

Yuan J, Zhang R, Yang Z, Lee J, Liu YL, Tian JH et al. Comparative effectiveness and safety of oral phosphodiesterase type 5 inhibitors for erectile dysfunction: a systematic review and network meta-analysis. Eur Urol. 2013;63(5):902-12. doi: 10.1016/j.eururo.2013.01.012.

Glina S, Toscano I, Gomatzky C, De Góes PM, Júnior AN, De Almeida Claro JF, et al. Efficacy and tolerability of lodenafil carbonate for oral therapy in erectile dysfunction: a phase II clinical trial. J Sex Med. 2009;6(2):553-7. doi: 10.1111/j.1743-6109.2008.01079.x.

Glina S, Fonseca GN, Bertero EB, Damião R, Rocha LCA, Jardim CRF, et al. Efficacy and tolerability of lodenafil carbonate for oral therapy of erectile dysfunction: a phase III clinical trial. J Sex Med. 2010;7(5):1928-36. doi: 10.1111/j.1743-6109.2010.01711.x.

Hatzimouratidis K, Hatzichristou DG. Looking to the future for erectile dysfunction therapies. Drugs. 2008;68(2):231-50. doi: 10.2165/00003495-200868020-00006.

Doh H, Shin CY, Son M, Yoo M, Kim SH, Kim WB. Mechanism of erectogenic effect of the selective phosphodiesterase type 5 inhibitor, DA-8159. Arch Pharm Res. 2002;25(6):873-8. doi: 10.1007/BF02977007.

Paick JS, Kim SW, Yang DY, Kim JJ, Lee SW, Ahn TY, et al. The efficacy and safety of udenafil, a new selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction. J Sex Med. 2008;5(4):946-53. doi: 10.1111/j.1743-6109.2007.00723.x.

Park HJ, Park JK, Park K, Min K, Park NC. Efficacy of udenafil for the treatment of erectile dysfunction up to 12 hours after dosing: a randomized placebo-controlled trial. J Sex Med. 2010;7(6):2209-16. doi: 10.1111/j.1743-6109.2010.01817.x

Moon DG, Yang DY, Lee CH, Ahn TY, Min KS, Park K, et al. A therapeutic confirmatory study to assess the safety and efficacy of Zydena (udenafil) for the treatment of erectile dysfunction in male patients with diabetes mellitus. J Sex Med. 2011;8(7):2048-61. doi: 10.1111/j.1743-6109.2011.02268.x.

Chung BH, Lee JY, Lee SH, Yoo SJ, Lee SW, Oh CY. Safety and efficacy of the simultaneous administration of udenafil and an alpha-blocker in men with erectile dysfunction concomitant with BPH/LUTS. Int J Impot Res. 2009;21(2):122-8. doi: 10.1038/ijir.2009.2.

Zhao C, Kim SW, Yang DY, Kim JJ, Park NC, Lee SW et al. Efficacy and safety of once-daily dosing of udenafil in the treatment of erectile dysfunction: results of a multicenter, randomized, double-blind, placebo-controlled trial. Eur Urol. 2011;60(2):380-7. doi: 10.1016/j.eururo.2011.03.025.

Paick JS, Kim SW, Park YK, Hyun JS, Park NC, Lee SW, et al. The efficacy and safety of udenafil [Zydena] for the treatment of erectile dysfunction in hypertensive men taking concomitant antihypertensive agents. J Sex Med. 2009;6(11):3166-76. doi: 10.1111/j.1743-6109.2009.01456.x.

Ortaç M, Çayan SÇ, Çalişkan MK, Yaman MÖ, Okutucu TM, Semerci MB, et al. Efficacy and tolerability of udenafil in Turkish men with erectile dysfunction of psychogenic and organic aetiology: a randomized, double-blind, placebo-controlled study. Andrology. 2013;1(4):549-55.

Kim BH, Lim HS, Chung JY, Kim J-R, Lim KS, Sohn D-R, et al. Safety, tolerability and pharmacokinetics of udenafil, a novel PDE-5 inhibitor, in healthy young Korean subjects. Br J Clin Pharmacol. 2008;65(6):848-54. doi: 10.1111/j.1365-2125.2008.03107.x.

Shim HJ, Kim YC, Park KJ, Kwo Jong WN, Ki Won BM, Lee MG Pharmacokinetics of DA-8159, a new erectogenic, after intravenous and oral administration to rats: hepatic and intestinal first-pass effects. J Pharm Sci. 2003;92(11):2185-95. doi: 10.1002/jps.10482.

Walker DK, Ackland MJ, James GC, Rance DJ, Wastall P, Wright PA. Pharmacokinetics and metabolism of sildenafil in mouse, rat, rabbit, dog and man. Xenobiotica. 1999;29(3):297-310. doi: 10.1080/004982599238687.

Wallis RM, Corbin JD, Francis SH, Ellis P. Tissue distribution of phosphodiesterase families and the effect of sildenafil on tissue cyclic nucleotides, platelet function, and the contractile responses of trabeculae carneae and aortic rings in vitro. Am J Cardiol. 1999;83(5A):3-12. doi: 10.1016/s0002-9149(99) 00042-9.

Francis SH, Turko IV, Corbin JD. Cyclic nucleotide phosphodiesterases: relating structure and function. Prog Nucleic Acid Res Mol Biol. 2001;65:1-52. doi: 10.1016/s0079-6603(00)65001-8.

European Associacion of Urology. Guidelines: 2017 ed [Internet]. EAU; 2017. 413 p. Available from: https://uroweb.org/wp-content/uploads/Guidelines_WebVersion_Complete-1.pdf.