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Przydacz M, Rajwa P, De Cillis S, Guillot-Tantay C, Herve F, Tienza Fernandez A, Tutolo M, Culha MG, Geretto P, Shenhar C, Miszczyk M, Chlosta P, Phe V, Osman N. Lower Urinary Tract Symptoms Correlate with Erectile Dysfunction and Premature Ejaculation but Not with Men's Sexual Activity: Results from a Large Population-Representative Study. Healthcare (Basel) 2024; 12:1408. [PMID: 39057551 PMCID: PMC11276619 DOI: 10.3390/healthcare12141408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) contribute to erectile dysfunction (ED) and premature ejaculation (PE). However, only a few studies have been conducted with representative groups of men that had well-balanced demographic characteristics. Thus, we aimed to confirm the effect of LUTS on ED and PE and to analyze the association between LUTS and men's sexual activity in a large representative cohort. In addition, we evaluated the sex-specific and overall quality of life of men who had LUTS with either ED or PE. METHODS We used the latest census and estimated the sample size to build a group of men representative of the population. LUTS, ED, and PE were evaluated with reliable instruments. Regression models were used to analyze the data. RESULTS All included men were representative in relation to their age and residential location (n = 3001). ED and PE were more common in men who reported LUTS compared with men who did not have LUTS (p < 0.001). Age, comorbidity, and lifestyle did not affect the negative effect of LUTS on ED or PE (regression coefficients of 0.159 and 0.528 for ED and PE, respectively, p < 0.001). However, regression models did not validate the impact of LUTS on sexual activity, defined by intercourse frequency and number of sexual partners (odds ratio of 0.981, CI 0.961-1.001, p = 0.061). Nevertheless, men with LUTS and either ED or PE had worse quality of sexual life and general quality of life compared with the remaining respondents. CONCLUSION LUTS worsened ED and PE but had no impact on men's sexual activity. Our findings confirm the recommendations to assess for LUTS in men reporting ED or PE. CLINICAL TRIAL REGISTRATION The study was registered with ClinicalTrials.gov (NCT05462171).
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Affiliation(s)
- Mikolaj Przydacz
- Department of Urology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Pawel Rajwa
- Department of Urology, Medical University of Silesia, 41-808 Zabrze, Poland
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
| | - Sabrina De Cillis
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, 10124 Orbassano, Italy
| | | | - Francois Herve
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, 9000 Ghent, Belgium
| | - Antonio Tienza Fernandez
- Department of Urology, Son Espases University Hospital, Health Research Institute of the Balearic Islands, 07120 Palma, Spain;
| | - Manuela Tutolo
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Mehmet Gokhan Culha
- Department of Urology, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, 34668 Istanbul, Turkey
| | - Paolo Geretto
- Division of Neuro-Urology, Department of Surgical Sciences, CTO Hospital, Citta della Salute e della Scienza, 10126 Turin, Italy
| | - Chen Shenhar
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Marcin Miszczyk
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
- Collegium Medicum Faculty of Medicine, WSB University, 41-300 Dabrowa Gornicza, Poland
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Veronique Phe
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Tenon Academic Hospital, Sorbonne University, 75020 Paris, France
| | - Nadir Osman
- Department of Urology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
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Song Y, Mao C, Zhong Q, Zhang R, Jiang D, Sun X. Role of hydrogen sulfide in the male reproductive system. Front Endocrinol (Lausanne) 2024; 15:1377090. [PMID: 38883604 PMCID: PMC11177757 DOI: 10.3389/fendo.2024.1377090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
As an important gas signaling molecule, hydrogen sulfide (H2S) affects multiple organ systems, including the nervous, cardiovascular, digestive, and genitourinary, reproductive systems. In particular, H2S not only regulates female reproductive function but also holds great promise in the treatment of male reproductive diseases and disorders, such as erectile dysfunction, prostate cancer, varicocele, and infertility. In this review, we summarize the relationship between H2S and male reproductive organs, including the penis, testis, prostate, vas deferens, and epididymis. As lower urinary tract symptoms have a significant impact on penile erection disorders, we also address the potential ameliorative effects of H2S in erectile dysfunction resulting from bladder disease. Additionally, we discuss the regulatory role of H2S in cavernous smooth muscle relaxation, which involves the NO/cGMP pathway, the RhoA/Rho-kinase pathway, and K+ channel activation. Recently, various compounds that can alleviate erectile dysfunction have been reported to be at least partly dependent on H2S. Therefore, understanding the role of H2S in the male reproductive system may help develop novel strategies for the clinical treatment of male reproductive system diseases.
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Affiliation(s)
- Yunjia Song
- Department of Pharmacology, School of Basic Medical Sciences, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Caiyun Mao
- Department of Pharmacology, School of Basic Medical Sciences, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Qing Zhong
- Department of Pharmacology, School of Basic Medical Sciences, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Rong Zhang
- Department of Pharmacology, School of Basic Medical Sciences, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Deyou Jiang
- Department of Typhoid, School of Basic Medical Sciences, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xutao Sun
- Department of Synopsis of the Golden Chamber, School of Basic Medical Sciences, Heilongjiang University of Chinese Medicine, Harbin, China
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Bai J, Gu L, Chen Y, Liu X, Yang J, Li M, Dong X, Yang S, Huang B, Wang T, Jin L, Liu J, Wang S. Evaluation of psychological stress, cortisol awakening response, and heart rate variability in patients with chronic prostatitis/chronic pelvic pain syndrome complicated by lower urinary tract symptoms and erectile dysfunction. Front Psychol 2022; 13:903250. [PMID: 36405196 PMCID: PMC9674019 DOI: 10.3389/fpsyg.2022.903250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/28/2022] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Mental stress and imbalance of its two neural stress systems, the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis, are associated with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and erectile dysfunction (ED). However, the comprehensive analyses of psychological stress and stress systems are under-investigated, particularly in CP/CPPS patients complicated by lower urinary tract symptoms (LUTS) and ED. MATERIALS AND METHODS Participants were 95 patients in CP/CPPS+ED group, 290 patients in CP/CPPS group, 124 patients in ED group and 52 healthy men in control group. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Index of Erectile Function-5 (IIEF-5) and the International Prostate Symptom Score (IPSS) were used for assessing the disease severity of CP/CPPS, LUTS and ED. Psychometric self-report questionnaires including the Beck Anxiety Inventory (BAI), Perceived Stress Scale (PSS), Type A Personality Test (TAPT) and Symptom Checklist 90 (SCL-90) were completed for distress from physical symptoms. Twenty-five subjects per group were randomly selected for further investigating the changes of the HPA axis and ANS. Saliva samples were taken on 3 consecutive days at 8 specific times with strict reference to time of morning awakening for evaluation of free cortisol. Heart rate variability (HRV) as marker of the ANS was measured using 24 h electrocardiography, and time-and frequency-domain variables were analyzed. RESULTS The BAI and SCL-90 scores were significantly higher in the CP/CPPS+ED, CP/CPPS and ED groups compared with the control group (p < 0.01). The PSS scores of both groups with ED were significantly higher than the control group (p < 0.01). Compared with the CP/CPPS group, the differences of PSS, SCL-90 and TAPT scores were statistically significant in CP/CPPS+ED patients (p < 0.01). The IPSS scores were shown to have significantly positive correlations with BAI (r = 0.32, p < 0.0001), PSS (r = 0.18, p < 0.01) and SCL-90 (r = 0.19, p < 0.01) in the CP/CPPS patients. However, in all subjects, the IIEF-5 scores were shown to have significantly negative correlations with BAI (r = -0.17,p < 0.001), PSS (r = -0.25,p < 0.0001), SCL-90 (r = -0.20,p < 0.001) and quality of life score in NIH-CPSI (r = -0.14,p = 0.0075). Cortisol awakening response (CAR) parameters and diurnal cortisol levels did not significantly vary between the four groups. Time-dependent parameters of HRV also did not differ significantly across groups. In the frequency domain analysis, low frequency (LF) was significantly lower in ED patients when compared with CP/CPPS+ED patients (p = 0.044) and healthy controls (p = 0.005), high frequency (HF) power was significantly higher in healthy controls compared to patients with ED (p < 0.001), CP/CPPS (p < 0.001) and CP/CPPS+ED (p < 0.001), and the CP/CPPS+ED group had significantly higher LF/HF ratio than the control group (p = 0.001). CONCLUSION CP/CPPS and ED patients score exceedingly high on most psychosocial variables. The symptom scores of LUTS and ED positively correlate with the severity of psychological stress. Our findings also suggest that the ANS sympathovagal imbalance is associated with ED and LUTS in CP/CPPS, whereas HPA axis activity is not.
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Affiliation(s)
- Jian Bai
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Longjie Gu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinwei Chen
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingchao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiyuan Dong
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shulin Yang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Huang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yang H, Breyer BN, Rimm EB, Giovannucci E, Loeb S, Kenfield SA, Bauer SR. Plant-based diet index and erectile dysfunction in the Health Professionals Follow-Up Study. BJU Int 2022; 130:514-521. [PMID: 35484829 PMCID: PMC9474604 DOI: 10.1111/bju.15765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the longitudinal association between plant-based diet index (PDI) score and incident erectile dysfunction (ED). MATERIALS AND METHODS We conducted a prospective analysis of 21 942 men aged 40 to 75 years who were enrolled in the Health Professionals Follow-Up Study. ED was assessed with questionnaires every 4 years starting in 2000. Dietary data were collected via validated food frequency questionnaires completed every 4 years and were used to calculate total PDI scores, as well as healthy (hPDI) and unhealthy (uPDI) subscores. Multivariable Cox proportional hazards models were used to compute hazard ratios (HRs) for incident ED. All models were stratified by age (<60, 60 to <70, ≥70 years). RESULTS Among men aged 60 to <70 years, hPDI was inversely associated with incident ED. Those in the highest quintile of hPDI in that age group had an 18% lower risk of ED (HR 0.82, 95% confidence interval (CI) 0.73-0.91; P-trend <0.001) compared to those in the lowest quintile. Conversely, uPDI was positively associated with ED in men aged <60 years (HR 1.27, 95% CI 1.01-1.60; P-trend = 0.02). CONCLUSIONS Encouraging a healthy plant-based diet may be an environmentally sustainable intervention for men interested in maintaining erectile function.
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Affiliation(s)
| | | | - Eric B. Rimm
- Departments of Nutrition & Epidemiology, Harvard T.H. Chan School of Public Health
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital
| | - Edward Giovannucci
- Departments of Nutrition & Epidemiology, Harvard T.H. Chan School of Public Health
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital
| | - Stacy Loeb
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs
| | - Stacey A. Kenfield
- Department of Urology, UCSF
- Department of Epidemiology & Biostatistics, UCSF
| | - Scott R. Bauer
- Department of Urology, UCSF
- Division of General Internal Medicine, Department of Medicine, UCSF
- San Francisco Veterans Affairs Healthcare System
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Song G, Wang M, Chen B, Long G, Li H, Li R, Liu Z, Wei C, Wang T, Wang S, Liu J, Zhang Y, Liu X. Lower Urinary Tract Symptoms and Sexual Dysfunction in Male: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:653510. [PMID: 34124091 PMCID: PMC8193225 DOI: 10.3389/fmed.2021.653510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/10/2021] [Indexed: 01/10/2023] Open
Abstract
Background: An association between lower urinary tract symptoms (LUTS) and risk of sexual dysfunction in male remains controversial in recent decades. Materials and Methods: PubMed and Web of Science were searched up to October 28, 2020, for articles reporting the prevalence of sexual dysfunction in men with LUTS. The main outcomes were results from sexual dysfunction assessments. Pooled odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) were calculated. The quality assessment of the included studies was performed by using The Newcastle-Ottawa Scale (NOS) or JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Results: A total of 24 full-manuscript papers met the inclusion criteria. The pooled OR for 21 studies suggested that patients with severer LUTS had a higher risk of sexual dysfunction (OR = 3.31, 95% CI: 2.43 to 4.49, p < 0.001, I 2 = 90%). A significant decrease in scores of assessment tools for sexual dysfunction was observed in the patients with higher severity of LUTS compared with those patients with lower severity (WMD = -5.49, 95%CI: -7.25 to -3.27, P < 0.001, I 2 = 96%). Similar outcomes were also found in subgroup analyses. In a detailed analysis of specific sexual function domains, the severity of LUTS was associated with erectile dysfunction, intercourse satisfaction, and overall satisfaction, except for sexual desire. Conclusion: The study demonstrates an association between exposure of lower urinary tract symptoms and risk of sexual dysfunction in male. Assessment of sexual function is necessary for patients with lower urinary tract symptoms. Systematic Review Registration: http://www.crd.york.ac.uk/prospero, identifier: CRD42020208747.
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Affiliation(s)
- Guoda Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Second Clinical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Wang
- Department of Emergency and Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingliang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Second Clinical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gongwei Long
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Second Clinical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuo Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Wei
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Geriatric, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Gul A, Coban S, Turkoglu AR, Guzelsoy M, Ozturk M, Kankilic NA. Comparative efficacy and safety profile of 4 vs 8 mg of silodosin once daily usage in patients with benign prostatic hyperplasia-related lower urinary tract symptoms divided into subgroups according to International Prostate Symptom Score severity. Prostate Int 2021; 8:152-157. [PMID: 33425792 PMCID: PMC7767940 DOI: 10.1016/j.prnil.2020.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/11/2020] [Accepted: 04/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of this study was to compare once daily (QD) usage of 4 and 8 mg of silodosin in patients divided as those with moderate and with severe lower urinary tract symptoms (LUTSs) according to International Prostate Symptom Score (IPSS) categories in terms of effectiveness and adverse events. Methods A total of 234 patients aged ≥ 40 years were evaluated prospectively. All participants were divided firstly into two groups according to their IPSS severity as moderate and severe. They were further allocated to receive 4 mg of silodosin and 8 mg of silodosin QD. Demographic features and laboratory tests were recorded. The patients were questioned with International Index of Erectile Function-5 and IPSS along with quality of life index. Uroflowmetric measurements were applied to the patients. All tests and measurements were repeated at the 3rd month, and changes from pretreatment to posttreatment were analyzed by SPSS 21.0 Program. The statistical significance level was set at p < 0.05. Results Both treatments provided benefit in patients with both moderate and severe LUTSs. While results did not differ among 4 mg and 8 mg of silodosin in patients with moderate LUTSs, 8 mg of silodosin was significantly better than 4mg in those with severe LUTSs in terms of improvement of the total IPSS, IPSS voiding subtotal score, and quality of life score (p = 0.015, 0.030, <0.001, respectively). Both treatments did not affect erectile functions. Adverse events were seen more frequently in patients receiving 8 mg of silodosin than those treated with 4 mg of silodosin (p = 0.024). Conclusion Our study revealed that 4 mg of silodosin QD was as effective as 8 mg of silodosin QD in patients with moderate LUTSs but not with severe LUTSs. It can be inferred from this study that prescription of 4 and 8 mg of silodosin may be chosen to treat the patients with moderate and severe LUTSs due to benign prostatic heperplasia, respectively.
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Affiliation(s)
- Abdullah Gul
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Urology, Bursa, Turkey
- Corresponding author. Bursa Training and Research Hospital, Floor:2, Bursa, 16310, Turkey.
| | - Soner Coban
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Urology, Bursa, Turkey
| | - Ali Riza Turkoglu
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Urology, Bursa, Turkey
| | - Muhammet Guzelsoy
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Urology, Bursa, Turkey
| | - Murat Ozturk
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Urology, Bursa, Turkey
| | - Nazim Abdulkadir Kankilic
- University of Health Sciences, Van Education and Research Hospital, Department of Urology, Van, Turkey
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Lombardo R, Tema G, De Nunzio C. Phosphodiesterases 5 Inhibitors and Erectile Dysfunction Recovery after Pelvic Surgery: Future Perspectives for New Drugs and New Formulations. Curr Drug Targets 2020; 22:31-37. [PMID: 32981502 DOI: 10.2174/1389450121666200925145347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/25/2020] [Accepted: 07/13/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Phosphodiesterase 5 inhibitors (PDE5I) represent the first-line treatment in the management of post-operative erectile dysfunction (ED) after pelvic oncological surgery. The aim of our study is to evaluate the available evidence on the efficacy of PDE5Is, including new formulations and penile rehabilitation post-pelvic surgery. EVIDENCE ACQUISITION A systematic review of the literature was performed until May 2020. The following databases were searched: Scopus, Medline and Web of Science. The MeSH search was conducted by combining the following terms: 'erectile dysfunction', 'radical prostatectomy' 'pelvic' 'bladder' 'phosphodiesterase' inhibitors' 'avanafil' 'sildenafil' 'tadalafil' 'lodenafil' 'mirodenafil' 'udenafil' 'vardenafil' 'sublingual' 'orodispersible' 'penile' 'rehabilitation'. EVIDENCE SYNTHESIS Sildenafil, Tadalafil, vardenafil and Avanafil improve EF compared with placebo in men with all levels of ED severity after radical prostatectomy with good tolerability. No specific recommendations can be suggested regarding the superiority of a drug over the other. The optimal dose, continuous vs. on-demand and duration of treatment, is still under investigation. In vitro and preclinical studies suggest the possible role for lodenafil, mirodenafil and oro-dispersible formulations in patients undergoing oncological pelvic surgery. Few studies demonstrated the efficacy of udenafil in improving ED after rectal surgery or radical prostatectomy. Complete recovery of EF after surgery is still an unmet need in the field of penile rehabilitation after pelvic surgery. CONCLUSION PDE5Is have a crucial role in the management of post pelvic surgery of ED. New drugs and new formulations have shown excellent results in patients with ED; however, data in patients after surgery is still scarce. Further well designed RCT should clarify the role of these new compounds and oro-dispersible formulations in the management of ED in patients undergoing pelvic surgery.
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Affiliation(s)
- Riccardo Lombardo
- Ospedale Sant'Andrea, Department of Urology 'Sapienza' Univeristy of Rome, Rome, Italy
| | - Giorgia Tema
- Ospedale Sant'Andrea, Department of Urology 'Sapienza' Univeristy of Rome, Rome, Italy
| | - Cosimo De Nunzio
- Ospedale Sant'Andrea, Department of Urology 'Sapienza' Univeristy of Rome, Rome, Italy
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Qiangzhao L, Xiaofeng Z, Fenghai Z, Qiong L, Fa Z, Bohong G, Xinsheng X. Efficacy and tolerability of combination therapy with alpha-blockers and phosphodiesterase-5 inhibitors compared with monotherapy for lower urinary tract symptoms: Protocol for a systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e22834. [PMID: 33120811 PMCID: PMC7581165 DOI: 10.1097/md.0000000000022834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/26/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study aimed to compare the efficacy and safety of combination therapy consisting of α-blockers and different phosphodiesterase type 5 inhibitors for lower urinary tract symptoms (LUTS) by performing a network meta-analysis. METHOD Relevant articles were retrieved from the Cochrane Library, PubMed, and EMBASE databases. Bayesian network meta-analyses were performed with a random-effect model to compare the efficacy and safety of combination therapy with α-blockers and phosphodiesterase-5 inhibitors for LUTS. The odds ratio (OR), mean difference (MD) and surface under the cumulative ranking curve (SUCRA) were calculated with the GeMTC R package. RESULTS Twenty randomized trials with 4131 patients were included in this network meta-analysis. Based on the SUCRA values, vardenafil (10 mg) combined with α-blockers ranked first, first and sixth; sildenafil (25 mg) combined with α-blockers ranked second, third and first; and tadalafil (20 mg) combined with α-blockers ranked third, second and fourth in IPSS, post void residual, and maximum flow rate, respectively. CONCLUSIONS Combination therapy with α-blockers and phosphodiesterase-5 inhibitors was effective and well tolerated for LUTS. For men who prioritize high efficacy, vardenafil (10 mg) combined with α-blockers seems to be the treatment of choice. For men wishing to optimize minimally invasive treatment, sildenafil (25 mg) and tadalafil (20 mg) combined with α-blockers appears to have a possible advantage in terms of avoiding adverse effects.
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Affiliation(s)
| | | | - Zhou Fenghai
- Department of Urology, Gansu Provincial Hospital
| | - Lian Qiong
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, Gansu, P.R. China
| | - Zhang Fa
- Department of Urology, Gansu Provincial Hospital
| | - Guo Bohong
- Department of Urology, Gansu Provincial Hospital
| | - Xi Xinsheng
- Department of Urology, Gansu Provincial Hospital
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Biers S, Walton T, Belal M, Keeley FX, Alnajjar HM, Muneer A. Urology highlights 2017 to 2018. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415819887050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The final clinical session of the British Association of Urological Surgeons (BAUS) annual meeting is the Updates and Highlights session, where the most important advances in the main urological sub-specialities are summarised and presented by sub-specialist experts representing each BAUS section. The aim of the session is to disseminate knowledge on the latest research, new guidelines and changes to general and specialist clinical practice. This paper covers contemporary urological advances as presented at the Liverpool BAUS meeting in June 2018.
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Affiliation(s)
- Suzanne Biers
- Urology Department, Addenbrooke’s Hospital, Cambridge, UK
| | - Tom Walton
- Urology Department, Nottingham City Hospital, UK
| | - Mohammed Belal
- Urology Department, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | - Asif Muneer
- Division of Surgery and Interventional Science UCL, NIHR Biomedical Research Centre University College London Hospitals, UK
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Choi WS, Song WH, Park J, Yoo S, Son H. Relationship between each IPSS item score and erectile dysfunction in the Korean Internet Sexuality Survey (KISS): do men with weak streams have low sexual function? World J Urol 2020; 38:3219-3226. [DOI: 10.1007/s00345-020-03128-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/04/2020] [Indexed: 02/01/2023] Open
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Wang Z, Zhang J, Zhang H, Liu S, Sun D, Hu L, Fu Q, Zhang K. Impact on sexual function of plasma button transurethral vapour enucleation versus plasmakinetic resection of the large prostate >90 ml: Results of a prospective, randomized trial. Andrologia 2019; 52:e13390. [PMID: 31773765 DOI: 10.1111/and.13390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 12/31/2022] Open
Abstract
To compare the impact of plasma button transurethral vapour enucleation of the prostate (PVEP) and plasmakinetic resection of the prostate (PKRP) on lower urinary tract symptoms and sexual function in patients with benign prostatic enlargement (BPE) >90 ml. Between July 2017 and August 2018, 101 patients with symptomatic BPE were randomly, prospectively assigned to either PKRP or PVEP in our department. The clinical characteristics and sexual function were evaluated before and after surgery. Post-void residual volume, IPSS and QoL were all significantly decreased compared with baseline data in each group, while Qmax was significantly increased. The IIEF-5 score showed a slight but nonsignificant increase in both groups at 3 and 6 months after surgery, and there was no significant difference between the two groups. The post-operative rate of reduced ejaculate volume was significantly higher than the pre-operative rate in PKRP group, while there was no significant difference in PVEP group. PVEP had an attenuated effect on no ejaculate compared with PRKP, and they both had a significantly negative effect on no ejaculate. PVEP is an effective and minimally invasive procedure for large prostate. Compared with PKRP, PVEP has no effect on erectile dysfunction and has a lower negative impact on ejaculation.
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Affiliation(s)
- Zhenqing Wang
- Department of Urology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Jing Zhang
- Department of Nephrology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Hui Zhang
- Department of Urology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Shuai Liu
- Department of Urology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Dingqi Sun
- Department of Urology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Liangliang Hu
- Department of Urology, Shandong Zaozhuang Municipal Hospital, Zaozhuang, Shandong, China
| | - Qiang Fu
- Department of Urology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Keqin Zhang
- Department of Urology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
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