Investigation of the Effect of the Atherogenic Index on the Therapeutic Response to Tadalafil in Patients With Vascular Erectile Dysfunction
Conditions: Erectile Dysfunction Vascular Erectile Dysfunction Atherogenic Dyslipidemia
Sponsor: Taksim Egitim ve Arastirma Hastanesi

Clinical Study Patient Data Form
Official Title: Investigation of the Effect of the Atherogenic Index of Plasma on the Therapeutic
Response to Tadalafil in Patients With Vascular Erectile Dysfunction
NCT Number: NCT: To Be Assigned
Document Date: 10 May 2025
Patient Information
Patient Name / Age:
National ID Number:
Admission Number:
Phone:
Height / Weight:
Smoking / Alcohol:
Laboratory Values
HbA1c:
Total Cholesterol:
HDL:
LDL:
Triglycerides:
LH:
Prolactin:
E2:
Testosterone:
Known Comorbidities
Lipid Disorder:
Diabetes Mellitus:
Hypertension:
Malignancy:
Other:
Physical Examination Findings:

Previous Surgeries:
Regular Medications:
IIEF Score Before Treatment:
IIEF Score After Treatment:
IIEF Questionnaire (Last 4 Weeks)
How often were you able to achieve an erection during sexual activity?
When you had erections with sexual stimulation, how often were they hard enough for penetration?
During sexual intercourse attempts, how often were you able to penetrate your partner?
During sexual intercourse, how often were you able to maintain your erection?
During sexual intercourse, how difficult was it to maintain your erection to completion?
How would you rate your confidence in getting and maintaining an erection?
TOTAL SCORE: