[Metabolic syndrome and erectile dysfunction. Epidemiologic associations and pathogenetic links]

[Primary and secondary prevention of erectile dysfunction]

Erectile dysfunction has an incidence of up to 75% in men aged 80, thus making primary prevention really important. Aetiologically multiple reasons are responsible for erectile dysfunction; therefore, recommendations for primary prevention contain different parts. The first one is to maintain a healthy arterial system and prevent atherosclerosis. Besides that diabetes, neurogenic disturbances or mental distress should be avoided. Physical activity, balanced nutrition, nonsmoking, unsaturated fatty acids and moderate alcohol consumption are preventive. Regular erections cause oxygenation of the cavernous body and prevent fibrosis which could lead to an insufficient occlusion of the cavernous veins. If the patient already suffers from coronary heart disease or diabetes, blood pressure, pulse, blood lipids and blood sugar should be as normal as possible. Erectile dysfunction might be the primary symptom of coronary heart disease; therefore, consideration should be given to a cardiac examination in the diagnostic setting.

[Why and how to explore erectile function in patient with cardiovascular risk?]

Erectile dysfunction (ED) is a frequent disorder, which can be the first symptom of an underlying pathology such as cardiovascular diseases. Doctors should have a good understanding of erectile dysfunction and must be aware of the importance of detecting and investigating any erectile disorders. Detection of an erectile dysfunction induces to search underlying cardiovascular diseases, but also urinary symptoms, hormonal deprivation, mood and relational alterations and iatrogenous complications. Determination of erectile disorders therefore represents an excellent opportunity to conduct a work-up of this symptom, as an integral part of health policy.

[Is rehabilitation of erectile function following pelvic surgery reasonable? Review of the literature: from sports to PDE5 inhibitors]

Increasingly, urologists are seeing patients with erectile dysfunction after pelvic operations. In most cases, radical prostatectomy is the cause. Even when a nerve-sparing procedure is performed, approximately 50% of the patients suffer from erectile dysfunction. This report discusses the causes and theoretical therapies, including lifestyle changes, strategies for neuroregeneration and the associated prevention of apoptosis of the smooth muscle of the corpus cavernosum and improvement of the corpora cavernosa by increased oxygenation. According to the international literature, many of these agents and lifestyle modifications display promise for treating impotence. Early treatment for patients recovering from pelvic operations seems to be reasonable. It is assumed that the natural recovery of erections may take as long as 18 to 24 months postsurgery or even longer; however, treatment modalities may reduce the time to erectile recovery.

[Lifestyle, erectile dysfunction, hormones and metabolic syndrome. Opportunities for gender-specific prevention for men]

German men tend to be less health conscious and show less of an interest in preventative behaviours. However, urological symptoms can provide the grounds for a doctor's visit and conversation. Modifiable lifestyle factors such as obesity, lack of exercise and smoking play a role in the development, progression or remission not only of erectile dysfunction (ED), but also in cardiovascular disease and the metabolic syndrome. Moreover, age-related testosterone deficiency can negatively impact the overall health as well as the sexual function of men. Recommendations to alter behaviours in the context of ED management and, if necessary, testosterone replacement, provide the urologist with the opportunity for broad gender-specific prevention for his male patients.