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Slowikowska-Hilczer J, Walczak-Jedrzejowska R, Adamczewska D, Byczkiewicz P, Marchlewska K, Katarzynska J, Gebicki J. A New Approach to the Assessment of Erectile Dysfunction Based on Vasomotion Monitored by the Flow-Mediated Skin Fluorescence (FMSF) Technique-A Preliminary Study. J Clin Med 2024; 13:3210. [PMID: 38892921 PMCID: PMC11173337 DOI: 10.3390/jcm13113210] [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: 03/30/2024] [Revised: 04/29/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Erectile dysfunction (ED) most often has vascular etiology and usually is the earliest symptom of vascular dysfunction. The aim of this study was to evaluate vascular dysfunction with the use of the Flow-Mediated Skin Fluorescence (FMSF) technique in men with and without ED. Methods: Included were 39 men (median age 53) with ED and 40 men (median age 41.5) without ED. Medical interview, physical examination, and anthropometrical measurements were performed for all participants. The serum total testosterone, LH, and SHBG determinations were performed in patients with ED, and the Free Testosterone Index (FTI) was calculated. The FMSF technique was used to measure the microcirculatory oscillations at the baseline and to determine the flowmotion (FM) and vasomotion (VM) parameters. The Normoxia Oscillatory Index (NOI) was calculated, which represents the contribution of the endothelial (ENDO) and neurogenic (NEURO) oscillations relative to all oscillations detected at low-frequency intervals (<0.15 Hz): NOI = (ENDO + NEURO)/(ENDO + NEURO + VM). Results: In men with ED were found significantly lower FM and VM parameters, but the NOI was significantly higher in comparison to men without ED. VM and FM correlated significantly positively with erectile function, orgasmic function, and general sexual satisfaction in the whole group and the FTI in the ED group. The thresholds of 53.5 FM (AUC = 0.7) and 8.4 VM (AUC = 0.7) were predictive values for discriminating men with ED. Conclusions: It was shown that the FMSF diagnostic technique may be helpful in the early diagnosis of microcirculation dysfunction due to impaired vasomotion caused by decreased testosterone activity.
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Affiliation(s)
- Jolanta Slowikowska-Hilczer
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | - Renata Walczak-Jedrzejowska
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | - Daria Adamczewska
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | - Piotr Byczkiewicz
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | - Katarzyna Marchlewska
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | | | - Jerzy Gebicki
- Angionica Ltd., 90-924 Lodz, Poland; (J.K.); (J.G.)
- Institute of Applied Radiation Chemistry, Lodz University of Technology, 90-924 Lodz, Poland
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Guo L, Nan Y, Yao L. Association between atherogenic indexes and erectile dysfunction: a cross-sectional analysis of the National Health and Nutrition Examination Survey 2001-2004. Int Urol Nephrol 2024:10.1007/s11255-024-04050-4. [PMID: 38625648 DOI: 10.1007/s11255-024-04050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE Elevated blood lipids are considered a risk factor for atherosclerosis, which can lead to erectile dysfunction. This study aimed to explore the relationship between the atherogenic index of plasma (AIP), atherogenic coefficient (AC), Castelli's risk index-I (CRI-I), Castelli's risk index-II (CRI-II), and erectile dysfunction. METHODS Based on the National Health and Nutrition Examination Survey (NHANES) data from 2001-2004, multivariable-adjusted logistic regression models were used to evaluate the association between AIP, AC, CRI-I, and CRI-II with ED. Smooth curve fitting was employed to assess the linear association. RESULTS A total of 1806 male participants with complete data were enrolled in the study. In Model 1, those in the highest tertile of AIP had a 49% increased risk of ED compared to the lowest tertile (OR 1.49; 95% CI 1.15-1.91 p = 0.0021). After adjusting for the variables of age, race, education, body mass index, and poverty income ratio (PIR), significant positive correlations were found between ED and AIP, with each 1-unit increase in AIP associated with a 65% increase in the risk of developing ED (OR 1.65; 95% CI 1.03-2.64 p = 0.0361). CONCLUSIONS AIP is positively associated with the development of ED in US adults. More prospective cohort studies are needed to confirm the link between AIP and ED.
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Affiliation(s)
- Lange Guo
- Department of Urology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yukui Nan
- Department of Urology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Lizhong Yao
- Department of Urology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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Cripps SM, Marshall SA, Mattiske DM, Ingham RY, Pask AJ. Estrogenic endocrine disruptor exposure directly impacts erectile function. Commun Biol 2024; 7:403. [PMID: 38565966 PMCID: PMC10987563 DOI: 10.1038/s42003-024-06048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
Erectile dysfunction (ED) is an extremely prevalent condition which significantly impacts quality of life. The rapid increase of ED in recent decades suggests the existence of unidentified environmental risk factors contributing to this condition. Endocrine Disrupting Chemicals (EDCs) are one likely candidate, given that development and function of the erectile tissues are hormonally dependent. We use the estrogenic-EDC diethylstilbestrol (DES) to model how widespread estrogenic-EDC exposure may impact erectile function in humans. Here we show that male mice chronically exposed to DES exhibit abnormal contractility of the erectile tissue, indicative of ED. The treatment did not affect systemic testosterone production yet significantly increased estrogen receptor α (Esr1) expression in the primary erectile tissue, suggesting EDCs directly impact erectile function. In response, we isolated the erectile tissue from mice and briefly incubated them with the estrogenic-EDCs DES or genistein (a phytoestrogen). These acute-direct exposures similarly caused a significant reduction in erectile tissue contractility, again indicative of ED. Overall, these findings demonstrate a direct link between estrogenic EDCs and erectile dysfunction and show that both chronic and acute estrogenic exposures are likely risk factors for this condition.
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Affiliation(s)
- Samuel M Cripps
- School of BioSciences, The University of Melbourne, Melbourne, Australia
| | - Sarah A Marshall
- The Ritchie Centre, Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - Deidre M Mattiske
- School of BioSciences, The University of Melbourne, Melbourne, Australia
| | - Rachel Y Ingham
- School of BioSciences, The University of Melbourne, Melbourne, Australia
| | - Andrew J Pask
- School of BioSciences, The University of Melbourne, Melbourne, Australia.
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Huang K, Yin S, Xiao Y, Wang J, Cui J, Wang J, Bai Y. Sexual dysfunction in patients with diabetes: association between remnant cholesterol and erectile dysfunction. Lipids Health Dis 2024; 23:55. [PMID: 38388371 PMCID: PMC10882869 DOI: 10.1186/s12944-024-02046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Erectile dysfunction (ED) is closely associated with dyslipidemia; however, it is yet unknown how ED and remnant cholesterol (RC) are related. As such, this research sought to explore the correlation between RC and ED among individuals with diagnosed with diabetes. METHODS This cross-sectional study used information from 215 males from National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004. RC was calculated as follows: the values of high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) were subtracted from the total cholesterol (TC) value, while ED diagnoses were based on self-reports. Weighted logistic regression analyses using both univariate and multivariate approaches were conducted to assess the correlation between RC and ED. RESULTS After comprehensive adjustment, multivariable logistic regression models revealed a strong correlation between RC and ED in subjects with diabetes (with an odds ratio (OR) of 7.49 and a 95% confidence interval (CI) of 1.98-28.37; P = 0.004). On categorizing RC into 3 grades (T1-T3), the OR corresponding to higher RC grade increased. Despite the results not reaching statistical significance upon categorization, a consistent and statistically significant trend (P for trend < 0.05) was observed. CONCLUSION This study indicated a correlation between increased RC levels and a higher prevalence of ED in diabetic males. RC may serve as a promising predictor of ED in individuals with diabetes. However, additional studies are required to confirm these findings.
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Affiliation(s)
- Ke Huang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Shan Yin
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yunfei Xiao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jiahao Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jianwei Cui
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jia Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Yunjin Bai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
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Sambel M, Erdogan A, Caglayan V, Avci S, Kilic S, Yildiz HE, Keskin E. Can atherogenic indices and the triglyceride-glucose index be used to predict erectile dysfunction? Sex Med 2023; 11:qfad069. [PMID: 38250336 PMCID: PMC10799712 DOI: 10.1093/sexmed/qfad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 01/23/2024] Open
Abstract
Background Atherosclerosis and insulin resistance play an important role in the development of erectile dysfunction (ED), and few studies have comprehensively evaluated more specific indicators like atherogenic indices and the triglyceride-glucose (TyG) index in the assessment of ED. Aim This study aimed to reveal the role of atherogenic indices (atherogenic index of plasma [AIP], Castelli risk index-1/2 [CRI-1/2], and atherogenic coefficient [AC]) based on plasma lipid ratios, which have been used as more sensitive indicators of atherosclerosis in recent years, and the TyG index, a practical indicator of insulin resistance, in predicting vasculogenic ED. Methods The study included a total of 199 patients who met the inclusion criteria and a total of 51 control subjects without ED complaints according to the International Index of Erectile Function (IIEF-5) scores (>21) between May 2021 and October 2022. For all participants, the demographic and biochemical parameters were evaluated, and atherogenic indices, namely CRI-1 (total cholesterol/high-density lipoprotein [HDL]), CRI-2 (LDL/HDL) AIP [log10(triglycerides/HDL)], and AC (non-HDL/HDL), as well as the TyG index [Ln {fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2}] were calculated. Outcomes The TyG index, which is an indicator of insulin resistance, and atherogenic indices such as CRI-1, AIP, and AC were significantly associated with ED, and especially AIP and the TyG index seem to be more important in the evaluation of ED. Results According to the univariate analysis, the patient group had significantly higher CRI-1 (5.3 ± 1.4 vs 4.7 ± 1.3; P = .005), AIP (0.31 ± 0.26 vs 0.13 ± 0.2; P < .001), AC (4.1 ± 1.4 vs 3.70 ± 1.2; P = .026), and TyG (9.16 ± 0.71 vs 8.77 ± 0.52; P < .001) values compared with the control group. In the correlation analysis, a significant negative correlation was found between the AIP and TyG index and the IIEF-5 scores (r2 = 0.120, P < .001 between AIP and IIEF-5; r2 = 0.091, P < .001 between TyG index and IIEF-5). The multivariate analysis revealed AIP and the TyG index as independent predictive factors for ED. Clinical Implications The use of atherogenic indices and TyG index in daily urology practice can help physicians in the diagnosis and follow-up of ED. Strengths and Limitations The lack of sex hormone-binding globulin and free testosterone levels represents a limitation of our study. Another limitation is that the severity of ED was determined using the IIEF-5 scores, rather than a more objective method, such as penile artery ultrasound. Conclusion Atherogenic indices and the TyG index can be used as inexpensive and practical markers to predict the severity of arteriogenic ED.
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Affiliation(s)
- Murat Sambel
- Department of Urology, Antalya Training and Research Hospital, Varlik 07100, Antalya, Turkey
| | - Abdullah Erdogan
- Department of Urology, Bursa City Hospital, Nilufer 16110, Bursa, Turkey
| | - Volkan Caglayan
- Department of Urology, Bursa City Hospital, Nilufer 16110, Bursa, Turkey
| | - Sinan Avci
- Department of Urology, Bursa City Hospital, Nilufer 16110, Bursa, Turkey
| | - Sahin Kilic
- Department of Urology, Antalya Training and Research Hospital, Varlik 07100, Antalya, Turkey
| | | | - Ercument Keskin
- Department of Urology, Mengucek Gazi Education and Research Hospital, Erzincan Binali Yildirim University, 24002, Erzincan, Turkey
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Bertini A, Pozzi E, Fallara G, Lanzaro F, Candela L, Costa A, Corsini C, Cilio S, Belladelli F, Capogrosso P, d'Arma A, Montorsi F, Salonia A. The atherosclerotic cardiovascular disease risk score is a reliable tool to identify patients with arteriogenic erectile dysfunction. Andrology 2023; 11:1451-1459. [PMID: 37017212 DOI: 10.1111/andr.13437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND The atherosclerotic cardiovascular disease risk score is a validated algorithm predicting an individual's 10-year risk of developing acute cardiovascular events (cardiovascular disease). Patients who suffer from arteriogenic erectile dysfunction are susceptible to developing cardiovascular disease in the future. OBJECTIVES To apply the atherosclerotic cardiovascular disease score at a homogenous cohort of men with erectile dysfunction undergoing a dynamic penile colour Doppler duplex ultrasound and explore its predictive ability to identify patients with vasculogenic erectile dysfunction at colour Doppler duplex ultrasound. MATERIALS AND METHODS Complete data of 219 patients undergoing colour Doppler duplex ultrasound were analysed. All patients completed the International Index of Erectile Function. The atherosclerotic cardiovascular disease score and Charlson comorbidity index were applied to the entire cohort. Patients were divided into those with normal vs. pathological parameters at colour Doppler duplex ultrasound. Descriptive statistics were used to explore differences between the two groups. Logistic regression models tested the potential role of atherosclerotic cardiovascular disease to predict arteriogenic and/or venogenic erectile dysfunction. Local polynomial smoothing models graphically displayed the probability of pathological colour Doppler duplex ultrasound parameters at different atherosclerotic cardiovascular disease scores. RESULTS Overall, arteriogenic erectile dysfunction and venous leakage were diagnosed in 88 (40.2%) and 28 (12.8%) patients respectively. The median (interquartile range) atherosclerotic cardiovascular disease score was 7.7 (3.9-14). Patients with pathologic colour Doppler duplex ultrasound were older (59 vs. 54 years, p < 0.001), had higher Body Mass Index (26.5 vs. 25.6 kg/m2 , p = 0.04), more comorbidities (Charlson comorbidity index ≥ 1) (76.5% vs. 54.4%, p = 0.002) and higher median atherosclerotic cardiovascular disease scores (9.95 vs. 7, p = 0.005), respectively. At logistic regression analysis, a higher atherosclerotic cardiovascular disease risk score was independently associated with arteriogenic erectile dysfunction at colour Doppler duplex ultrasound (odds ratio: 1.03, 95% confidence interval: 1.01-1.08, p = 0.02) after adjusting for Body Mass Index, physical activity, alcohol consumption and severe erectile dysfunction. DISCUSSION As vasculogenic erectile dysfunction may precede by some years the onset of acute cardiovascular diseases, the rigorous identification of patients with deficient cavernosal arterial blood flow, would definitely allow the implementation of earlier and more effective cardiovascular prevention strategies in men with erectile dysfunction. CONCLUSIONS The atherosclerotic cardiovascular disease risk score represents a reliable tool to identify patients with arteriogenic erectile dysfunction in everyday clinical practice.
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Affiliation(s)
- Alessandro Bertini
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Lanzaro
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Candela
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Costa
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Christian Corsini
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Cilio
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital - ASST Sette Laghi, Varese, Italy
| | - Alessia d'Arma
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Yannas D, Zago E, Cavallini E, Todisco T, Vignozzi L, Corona G, Maggi M, Rastrelli G. Education degree predicts cardiovascular outcomes in men suffering from erectile dysfunction. Andrology 2023; 11:1086-1095. [PMID: 36642862 DOI: 10.1111/andr.13389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/15/2022] [Accepted: 01/11/2023] [Indexed: 01/17/2023]
Abstract
BACKGROUND The level of education has been recognized as a cardiovascular risk factor; nevertheless, it is often neglected in cardiovascular risk prediction. OBJECTIVES To evaluate the psychobiological correlates of the level of education and if it could predict incident major adverse cardiovascular events in men consulting for erectile dysfunction. METHODS Total 3733 men (49.8 ± 13.7 years old) attending an andrology outpatient clinic for erectile dysfunction were studied. Sexual and psychological symptoms, hormonal and metabolic, as well as instrumental (penile color Doppler ultrasound) parameters were evaluated according to the education level (university, upper secondary, lower secondary, and primary degree). For a subset of 956 patients, data on incident major adverse cardiovascular events were retrospectively collected for 3.9 ± 2.4 years. RESULTS As compared with men with university degree, those with a lower education had an increased frequency of moderate-severe erectile dysfunction (odds ratio = 1.21 [0.99;1.48], 1.41 [1.14;1.73], 1.70 [1.26;2.30] for upper secondary, lower secondary, and primary school, respectively) and reduced flaccid peak systolic velocity at penile color Doppler ultrasound. Men with a lower level of education tend to suffer from metabolic syndrome (odds ratio = 1.38 [1.06;1.79], 1.73 [1.34;2.24], 1.72 [1.24;2.37] for upper secondary, lower secondary, and primary school, respectively) and were more likely to have history of previous cardiovascular events. In the longitudinal study, men with a higher level of education had a significantly lower incidence of major adverse cardiovascular events. The role of higher education as an independent predictor of major adverse cardiovascular events was established by multivariable Cox regressions (hazard ratio = 2.14 [1.24-3.69]). DISCUSSION In erectile dysfunction subjects, lower level of education is associated with a more severely impaired erectile function with atherogenic pathogenesis and with a worse cardio-metabolic profile. In addition, a lower level of education predicts forthcoming major adverse cardiovascular events. Therefore, education level should be considered as a costless but valuable information in the assessment of cardiovascular risk in patients with erectile dysfunction.
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Affiliation(s)
- Dimitri Yannas
- Andrology, Women's Endocrinology and Gender Incongruence Unit - Careggi Teaching Hospital, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Elena Zago
- Andrology, Women's Endocrinology and Gender Incongruence Unit - Careggi Teaching Hospital, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Elena Cavallini
- Andrology, Women's Endocrinology and Gender Incongruence Unit - Careggi Teaching Hospital, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Tommaso Todisco
- Andrology, Women's Endocrinology and Gender Incongruence Unit - Careggi Teaching Hospital, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit - Careggi Teaching Hospital, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
- Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy
| | | | - Mario Maggi
- Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy
- Endocrinology Unit - Careggi Teaching Hospital, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Giulia Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit - Careggi Teaching Hospital, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Feng X, Mei Y, Xie P, Xing Z, Wang X, Cui L, Xu R. Serum folic acid: an effective indicator for arteriogenic erectile dysfunction. Front Endocrinol (Lausanne) 2023; 14:1080188. [PMID: 37554765 PMCID: PMC10405823 DOI: 10.3389/fendo.2023.1080188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/30/2023] [Indexed: 08/10/2023] Open
Abstract
Background The present study is the first to explore the correlation between serum folic acid (FA) level and penile arterial peak systolic velocity (PSV) as measured via penile color Doppler ultrasonography (PDU), which directly reflects endothelial function in the penile artery. Materials and methods A total of 244 consecutive erectile dysfunction (ED) patients and 72 healthy controls, recruited from the Andrology department and the Healthy Physical Examination Center of our hospital, respectively, from June 2020 to April 2022, were included in the study. Serum FA was measured in ED patients and healthy controls, and PDU examinations were conducted for all eligible ED patients. The Pearson method was used to evaluate the correlation between FA levels and PDU parameters in ED patients. A receiver operating characteristic (ROC) curve analysis was also performed to calculate the sensitivity and specificity of these parameters for prediction of arteriogenic ED. Results After the PDU test, the average serum FA level among patients diagnosed with arteriogenic ED was 8.08 ± 2.64 ng/ml, lower than the average of 10.78 ± 2.87 ng/ml among healthy controls. There were no statistically significant inter-group differences on any basic parameters, including age, body mass index, fasting blood glucose, total cholesterol, and triglyceride. For further analysis, we divided the arteriogenic ED group into three subgroups by PSV range to compare serum FA levels among these subgroups. The mean FA levels in each of these groups were 5.97 ± 1.51ng/ml, and 8.21 ± 2.37ng/ml, and 10.55 ± 2.56ng/ml, while the corresponding PSV values were 15.75 ± 2.39cm/s, 23.53 ± 2.19cm/s, and 32.72 ± 1.64cm/s. Overall, a positive correlation between PSV and FA level was found among patients with arteriogenic ED (r=0.605, P<0.001). Furthermore, when FA level was used, with a cut-off value of 10.045 ng/ml, as a criterion to distinguish patients with arteriogenic ED from healthy controls, the area under the curve (AUC) was 0.772 (95% confidential interval: [0.696, 0.848]), for a sensitivity of 0.611 and specificity of 0.824. Conclusion Serum FA level is positively correlated with PSV in ED patients, and has the ability to distinguish patients with arteriogenic ED from healthy controls. Taking these findings together, FA deficiency should be regarded as an independent risk factor for arteriogenic ED.
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Affiliation(s)
- Xingliang Feng
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Department of Urology, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Yangyang Mei
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Pinpeng Xie
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Hefei, China
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhaoyu Xing
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Department of Urology, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Xiaogang Wang
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Department of Urology, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Li Cui
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Department of Urology, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Renfang Xu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Department of Urology, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
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9
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Feng X, Mei Y, Wang X, Cui L, Xu R. Association between neutrophil to lymphocyte ratio and erectile dysfunction among US males: a population-based cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1192113. [PMID: 37424870 PMCID: PMC10326541 DOI: 10.3389/fendo.2023.1192113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Objective The purpose of the study was to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR) and erectile dysfunction (ED) in adult American males using a large database. Methods We adopted a series of statistical analyses of the relationship between NLR indices and ED prevalence among participants in the 2001-2004 National Health and Nutrition Examination Survey (NHANES) database using the R software. Results The study included a total of 3012 participants, of whom 570 (18.9%) presented with ED. NLR levels were 2.13 (95% CI: 2.08,2.17) in those without ED and 2.36 (95% CI: 2.27,2.45) in those with ED. After adjusting for confounding variables, NLR levels were higher in patients with ED, (β, 1.21, 95% CI, 1.09-1.34, P < 0.001). In addition, a U-shaped relationship between NLR and ED was observed after controlling for all confounders. A more significant correlation (β, 1.35, 95% CI, 1.19 to 1.53, P < 0.001) existed to the right of the inflection point (1.52). Conclusion The results of the large cross-sectional study showed a statistically significant association between the occurrence of ED and NLR, a simple, inexpensive, and readily available parameter of inflammation, in US adults. Further studies are still needed in the future to validate and replicate our findings and to investigate the specific mechanisms involved.
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Affiliation(s)
- Xingliang Feng
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Department of Urology, First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Yangyang Mei
- Department of Urology, Jiangyin People’s Hospital of Jiangsu Province, Jiangyin, China
| | - Xiaogang Wang
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Department of Urology, First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Li Cui
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Department of Urology, First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Renfang Xu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Department of Urology, First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
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10
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Puṣcaṣu CM, Tecău AS, Nemet GC. Ranking of cardiovascular risk factors in Romania- regional epidemiological approach. BALNEO AND PRM RESEARCH JOURNAL 2023. [DOI: 10.12680/balneo.2023.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
An extensive epidemiological investigation was applied regarding the risk factors, to a cohort of patients with pre-existing heart disease, hospitalized for tertiary prophylaxis in a rehabilitation hospital. The group of 499 patients from all regions of the country respected the proportions of gender and environment of origin for the general population of Romania and was adjusted according to regional proportions.
The ranking of risk factors and protection factors present in the studied population was made, at the level of each of the 8 regions of the country and for the whole country consolidated. The profile of the cardiovascular patient was identified. We used risk factors for population characterization, not for aggregation into tools for assessing total cardiovascular risk (as is the trend in large cohort studies since Framingham)
The data processing was done to be able to develop prevention strategies in the interest of the specific individual, not to standardize population characteristics and translate them to the individual thus decreasing their appropriateness.
Keywords: 1 cardiovascular risk-factors, 2 cardiovascular diseases prevention , 3 cardiovascular rehabilitation.
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Affiliation(s)
| | - Alina-Simona Tecău
- “Transilvania” University of Brasov,Faculty of Economics and Business Administration, Braṣov, Romania
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11
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Wang M, Dai Y, Jiang H, Sansone A, Jannini EA, Zhang X. Application of dual-energy CT angiography in diagnosis of arterial erectile dysfunction: new scanning technology, new scanning area. Aging Male 2022; 25:257-265. [PMID: 36102620 DOI: 10.1080/13685538.2022.2121815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To explore the value of dual-energy computed tomography (DE-CT) angiography in diagnosis of arteriogenic erectile dysfunction (ED) patients and feasibility of new scanning area that excludes the testis. MATERIALS AND METHODS Ninety-three patients suspected of suffering arterial ED and 40 health volunteers underwent penile duplex Doppler ultrasound and DE-CT angiography (DE-CTA). The scanning range of DE-CTA covered whole arterial system of pelvis and testis was excluded. Two blinded investigators independently evaluated the arterial system that supplies the penis. RESULTS Finally, 1596 segments were evaluated and 470 segments were judged to be abnormal. The distribution was: 2 (0.4%) in common iliac artery, 7 (1.5%) in internal iliac artery, 82 (17.5%) in internal pudendal artery, 89 (18.9%) in penile artery, 120 (25.5%) in dorsal artery, and 170 (36.2%) in cavernosal artery. The specificity, sensitivity, positive predictive value, and negative predictive value of DE-CTA in diagnostic were 86.02%, 87.50%, 94.12%, and 72.92%. Besides, the new scan area allowed for effective evaluation of the arteries while excluding the testis. CONCLUSION DE-CTA can provide unbiased, safe evaluation of the vascular status of the penile bed in patients with ED.
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Affiliation(s)
- Ming Wang
- Department of Urology, First affiliated hospital of Anhui medical university, Hefei, China
| | - Yutian Dai
- Department of Andrology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Hui Jiang
- Department of Andrology, Peking University Third Hospital, Beijing, China
| | - Andrea Sansone
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emmanuele A Jannini
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Xiansheng Zhang
- Department of Urology, First affiliated hospital of Anhui medical university, Hefei, China
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12
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Cipriani S, Simon JA. Sexual Dysfunction as a Harbinger of Cardiovascular Disease in Postmenopausal Women: How Far Are We? J Sex Med 2022; 19:1321-1332. [DOI: 10.1016/j.jsxm.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 10/17/2022]
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13
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Liu G, Zhang Y, Zhang W, Wu X, Huang H, Jiang H, Zhang X. Significance of detailed hematological parameters as markers of arteriogenic erectile dysfunction. Andrology 2022; 10:1556-1566. [DOI: 10.1111/andr.13283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/25/2022] [Accepted: 08/23/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Guodong Liu
- Department of Urology the First Affiliated Hospital of Anhui Medical University Anhui province China
- Institute of Urology the First Affiliated Hospital of Anhui Medical University Anhui province China
- Anhui Province Key Laboratory of Genitourinary Diseases Anhui Medical University Anhui province China
| | - Yuyang Zhang
- Department of Urology the First Affiliated Hospital of Anhui Medical University Anhui province China
- Institute of Urology the First Affiliated Hospital of Anhui Medical University Anhui province China
- Anhui Province Key Laboratory of Genitourinary Diseases Anhui Medical University Anhui province China
| | - Wei Zhang
- Department of Urology the First Affiliated Hospital of Anhui Medical University Anhui province China
- Institute of Urology the First Affiliated Hospital of Anhui Medical University Anhui province China
- Anhui Province Key Laboratory of Genitourinary Diseases Anhui Medical University Anhui province China
| | - Xu Wu
- Department of Urology the First Affiliated Hospital of Anhui Medical University Anhui province China
- Institute of Urology the First Affiliated Hospital of Anhui Medical University Anhui province China
- Anhui Province Key Laboratory of Genitourinary Diseases Anhui Medical University Anhui province China
| | - Houbao Huang
- Department of Urology The First Affiliated Hospital of Wannan Medical College Anhui province China
| | - Hui Jiang
- The department of Urology Peking University Third Hospital Beijing China
| | - Xiansheng Zhang
- Department of Urology the First Affiliated Hospital of Anhui Medical University Anhui province China
- Institute of Urology the First Affiliated Hospital of Anhui Medical University Anhui province China
- Anhui Province Key Laboratory of Genitourinary Diseases Anhui Medical University Anhui province China
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14
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Wu X, Zhang Y, Zhang W, Liu G, Jiang H, Huang H, Zhang X. The relationship between serum 25‐hydroxy vitamin D and arteriogenic erectile dysfunction. Andrologia 2022; 54:e14568. [DOI: 10.1111/and.14568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Xu Wu
- Department of Urology the First Affiliated Hospital of Anhui Medical University Anhui China
| | - Yuyang Zhang
- Department of Urology the First Affiliated Hospital of Anhui Medical University Anhui China
| | - Wei Zhang
- Department of Urology the First Affiliated Hospital of Anhui Medical University Anhui China
| | - Guodong Liu
- Department of Urology the First Affiliated Hospital of Anhui Medical University Anhui China
| | - Hui Jiang
- Department of Urology Peking University First Hospital Beijing China
| | - Houbao Huang
- Department of Urology The first Affiliated Hospital of Wannan Medical College Wuhu China
| | - Xiansheng Zhang
- Department of Urology the First Affiliated Hospital of Anhui Medical University Anhui China
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15
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Zhang W, Zhang Y, Liu G, Wu X, Huang H, Jiang H, Zhang X. An objective correlation of specific haematological parameters with ED severity. Andrologia 2022; 54:e14448. [PMID: 35894065 DOI: 10.1111/and.14448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/05/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022] Open
Abstract
This study aims to investigate the role of nocturnal penile tumescence and rigidity (NPTR) and laboratory features in patients with mild, moderate and severe ED and then explored the correlation between ED severity with certain blood count parameters such as WBC and NLR. A total of 86 ED patients (age 29.8 ± 7.09 years) were enrolled. Classification of ED severity according to IIEF-5 scores was as follows: mild ED, 43.02% (37/86); moderate ED, 27.91% (24/86) and severe ED, 29.07% (25/86). Patients with moderate and severe ED had declined IIEF-5 scores and increased GAD-7 and PHQ-9 scores compared with mild ED. The mean NLR value of the mild, moderate and severe ED groups was 1.43 ± 0.39, 1.74 ± 0.45 and 2.0 ± 0.58, respectively. Stratification analysis according to NPTR results indicated that there was a significant difference in WBC and NLR between the two groups. Patients with abnormal NPTR had increased WBC and NLR levels compared with the normal groups. Multivariate logistic regression analysis suggested that severe ED (OR [95% CI]: 5.736 [1.248-26.354]), WBC (OR [95% CI]: 1.676 [1.094-2.567]) and NLR (OR [95% CI]: 5.595 [1.478-21.178]) were identified as independent risk factors for severe ED (abnormal NPTR results). In conclusion, this study indicates a significant difference in NLR, PLR, PDW, MPV and HDL between the mild, moderate and severe ED groups. The WBC and NLR are significantly increased in patients with severe ED (abnormal NPTR results) and it can be available as a quick, easy and cheap investigation compared with the RigiScan to evaluate the severity of ED with good sensitivity and specificity, which is important for the diagnosis and evaluation of ED.
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Affiliation(s)
- Wei Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuyang Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guodong Liu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xu Wu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Houbao Huang
- Department of Urology, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Hui Jiang
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Xiansheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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16
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17
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Wu X, Liu G, Zhang Y, Zhang W, Dai Y, Jiang H, Zhang X. The association between uric acid and erectile dysfunction: A systematic review and Meta-analysis. Andrologia 2021; 54:e14319. [PMID: 34796510 DOI: 10.1111/and.14319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022] Open
Abstract
The main purpose of this systematic review and meta-analysis was to explore the association between uric acid (UA) and erectile dysfunction (ED). Databases including PubMed, Cochrane Library and Web of Science were retrieved to identify studies published in English up to 31 June 2021. We preregistered this meta-analysis in the PROSPERO (registration number CRD42021267035). Two independent authors extracted the relevant data from all enrolled articles. We evaluated the quality of enrolled studies using the Newcastle-Ottawa Scale (NOS). The standardized mean difference (SMD), as well as the corresponding 95% confidence intervals (95% CIs), was used to assess the difference between ED patients and healthy subjects. A total of five studies were enrolled for our meta-analysis to explore the association of UA with ED. The pooled SMD of the UA level difference between ED patients and healthy subjects was 0.42 (95% CI:0.09, 0.74, p < 0.001). There were no individual data that significantly influenced the pooled SMDs in the sensitivity analysis. There was no evidence of publication bias. This novel meta-analysis confirmed that UA was an independent risk factor for ED, which suggested that the erectile function of patients with elevated uric acid should be evaluated by clinicians.
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Affiliation(s)
- Xu Wu
- The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guodong Liu
- The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuyang Zhang
- The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Zhang
- The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yutian Dai
- The Department of Andrology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hui Jiang
- The Department of Urology, Peking University Third Hospital, Beijing, China
| | - Xiansheng Zhang
- The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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18
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Abstract
The science of penile erection, including recent advances in its molecular physiology and neuroanatomic pathways, is described. The pathophysiology of erectile dysfunction is presented, acknowledging associated disease states, and accordingly follows a practical classification scheme: vasculogenic, neurogenic, endocrine, and psychogenic.
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Affiliation(s)
- Susan M MacDonald
- Division of Urology, Penn State Health Milton S. Hershey Medical Center, Mail Code H055, 500 University Drive, Hershey, PA 17033, USA.
| | - Arthur L Burnett
- James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, 600 North Wolfe Street, Marburg 407, Baltimore, MD 21287, USA
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19
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol 2021; 29:5-115. [PMID: 34558602 DOI: 10.1093/eurjpc/zwab154] [Citation(s) in RCA: 211] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA).,International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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20
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42:3227-3337. [PMID: 34458905 DOI: 10.1093/eurheartj/ehab484] [Citation(s) in RCA: 2310] [Impact Index Per Article: 770.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA)
- International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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21
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Alwani M, Yassin A, Talib R, Al-Qudimat A, Aboumarzouk O, Al-Zoubi RM, Saad F, Haider KS, Al Ansari A. Cardiovascular Disease, Hypogonadism and Erectile Dysfunction: Early Detection, Prevention and the Positive Effects of Long-Term Testosterone Treatment: Prospective Observational, Real-Life Data. Vasc Health Risk Manag 2021; 17:497-508. [PMID: 34465997 PMCID: PMC8403087 DOI: 10.2147/vhrm.s309714] [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: 04/18/2021] [Accepted: 07/30/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose Erectile dysfunction (ED) is associated with testosterone deficiency and is a symptom of functional hypogonadism. A correlation between ED and cardiovascular disease (CVD) has been recognized, and ED has been proposed as an early marker of CVD. However, the relationship between ED and CVD risk in hypogonadism requires clarification and whether testosterone therapy (TTh) can be a beneficial treatment strategy, but long-term data are limited. This study investigates long-term TTh in men with hypogonadism and ED with a history of CVD. Methods Seventy-seven patients with a history of CVD and diagnosed with functional hypogonadism and erectile dysfunction (erectile function domain score <21 on the International Index of Erectile Function questionnaire (IIEF questions 1–5)) were enrolled and TTh effects on anthropometric and metabolic parameters investigated for a maximum duration of 12 years. All men received long-acting injections of testosterone undecanoate at 3-monthly intervals. Eight-year data were analysed. Data collection registry started in November 2004 till January 2015. Results In hypogonadal men receiving TTh, IIEF increased by 5.4 (p<0.001). Total weight loss was 23.6 ± 0.6 kg after 8 years. HbA1c had declined by an average of 2.0% (P<0.0001). Total cholesterol levels significantly declined following TTh after only 1 year (P<0.0001), and HDL increased from 1.6±0.5 at baseline to 2±0.5 mmol/L following 8 years of TTh (P<0.0001). SBP decreased from 164±14 at baseline to 133±9 mmHg, signifying a reduction of 33±1 mmHg (P<0.0001). Conclusion In hypogonadal men with a history of CVD, TTh improves and preserves erectile function over prolonged periods with concurrent sustained improvements in cardiometabolic risk factors. Measuring ED and testosterone status may serve as an important male health indicator predicting subsequent CVD-related events and mortality and TTh may be an effective add-on treatment in secondary prevention of cardiovascular events in hypogonadal men with a history of CVD.
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Affiliation(s)
- Mustafa Alwani
- Jordan University of Science and Technology, School of Medicine, Irbid, Jordan.,Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology and Section of Surgical Research, Doha, Qatar
| | - Aksam Yassin
- Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology and Section of Surgical Research, Doha, Qatar.,Weill Cornell Medical College, New York, NY, USA.,Weill Cornell Medical College, Doha, Qatar
| | - Raidh Talib
- Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology and Section of Surgical Research, Doha, Qatar
| | - Ahmad Al-Qudimat
- Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology and Section of Surgical Research, Doha, Qatar
| | - Omar Aboumarzouk
- Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology and Section of Surgical Research, Doha, Qatar
| | - Raed M Al-Zoubi
- Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology and Section of Surgical Research, Doha, Qatar.,Jordan University of Science and Technology, Department of Chemistry, Irbid, Jordan
| | - Farid Saad
- Dresden International University, Center of Medicine and Health Sciences, Dresden, Germany
| | - Karim S Haider
- Klinikum Bremen-Mitte, Department of Urology, Bremen, Germany
| | - Abdulla Al Ansari
- Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology and Section of Surgical Research, Doha, Qatar
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22
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Totaro M, Dimarakis S, Castellini C, D'Andrea S, Parisi A, D'Amato F, Tienforti D, Palazzi S, Baroni MG, Francavilla S, Barbonetti A. Erectile dysfunction in hyperuricemia: A prevalence meta-analysis and meta-regression study. Andrology 2021; 10:72-81. [PMID: 34347943 DOI: 10.1111/andr.13088] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Whether and to what extent an association exists between hyperuricemia and erectile dysfunction (ED) has not yet been fully determined. OBJECTIVE To define pooled prevalence estimates and correlates of erectile dysfunction in men with hyperuricemic disorders. MATERIALS AND METHODS A thorough search of Medline, Scopus, and Cochrane Library databases was performed. Data were combined using random-effects models and the between-study heterogeneity was assessed by Cochrane's Q and I2 tests. A funnel plot was used to assess publication bias. RESULTS Overall, 8 studies included gave information about 85,406 hyperuricemic men, of whom 5023 complained of erectile dysfunction, resulting in a pooled erectile dysfunction prevalence estimate of 33% (95% Confidence Interval: 13-52%; I² = 99.9%). The funnel plot suggested the presence of a publication bias. At the meta-regression analyses, among the available covariates that could affect estimates, only type 2 diabetes mellitus was significantly associated with a higher prevalence of erectile dysfunction (β = 0.08; 95% Confidence Interval: 0.01, 0.15, p = 0.025). At the sub-group analysis, the pooled erectile dysfunction prevalence decreased to 4% (95% Confidence Interval: 0%-8%) when only the largest studies with the lowest prevalence of type 2 diabetes mellitus were included and increased up to 50% (95% Confidence Interval: 17%-84%) when the analysis was restricted to studies enrolling smaller series with higher prevalence of type 2 diabetes mellitus. CONCLUSIONS A not negligible proportion of men with hyperuricemia can complain of erectile dysfunction. While a pathogenetic contribution of circulating uric acid in endothelial dysfunction cannot be ruled out, the evidence of a stronger association between hyperuricemia and erectile dysfunction in type 2 diabetes mellitus points to hyperuricemia as a marker of systemic dysmetabolic disorders adversely affecting erectile function.
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Affiliation(s)
- Maria Totaro
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Sotirios Dimarakis
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Chiara Castellini
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Settimio D'Andrea
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Parisi
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federica D'Amato
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Daniele Tienforti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Sara Palazzi
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Giorgio Baroni
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Sandro Francavilla
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Arcangelo Barbonetti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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23
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Marinelli L, Lanfranco F, Motta G, Zavattaro M. Erectile Dysfunction in Men with Chronic Obstructive Pulmonary Disease. J Clin Med 2021; 10:2730. [PMID: 34205713 PMCID: PMC8234796 DOI: 10.3390/jcm10122730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/27/2021] [Accepted: 06/10/2021] [Indexed: 12/17/2022] Open
Abstract
Erectile dysfunction (ED) seems to be a widespread sexual issue in men affected by chronic obstructive pulmonary disease (COPD). Multiple causes appear to be involved such as hormonal imbalance, smoking habit, chronic inflammation, endothelial dysfunction, chronic hypoxia, psychiatric disorders (depression and anxiety), and medications. ED can have a significant impact on COPD men and consequently on their quality of life, which is usually already compromised. Given this situation, however, pneumologists usually do not properly care for the sexuality of COPD patients especially because men can be reluctant to talk about their intimate issues. The aim of this narrative review is to briefly summarize the evidence emerging from literature and to provide a wide point of view about sexual dysfunction in COPD men.
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Affiliation(s)
- Lorenzo Marinelli
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (L.M.); (G.M.); (M.Z.)
| | - Fabio Lanfranco
- Division of Endocrinology, Andrology and Metabolism, Humanitas Gradenigo, Department of Medical Sciences, University of Turin, 10153 Turin, Italy
| | - Giovanna Motta
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (L.M.); (G.M.); (M.Z.)
| | - Marco Zavattaro
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (L.M.); (G.M.); (M.Z.)
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Abstract
: Sexual health is an integral part of overall health, and an active and healthy sexual life is an essential aspect of a good life quality. Cardiovascular disease and sexual health share common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking) and common mediating mechanisms (endothelial dysfunction, subclinical inflammation, and atherosclerosis). This generated a shift of thinking about the pathophysiology and subsequently the management of sexual dysfunction. The introduction of phosphodiesterase type 5 inhibitors revolutionized the management of sexual dysfunction in men. This article will focus on erectile dysfunction and its association with arterial hypertension. This update of the position paper was created by the Working Group on Sexual Dysfunction and Arterial Hypertension of the European Society of Hypertension. This working group has been very active during the last years in promoting the familiarization of hypertension specialists and related physicians with erectile dysfunction, through numerous lectures in national and international meetings, a position paper, newsletters, guidelines, and a book specifically addressing erectile dysfunction in hypertensive patients. It was noted that erectile dysfunction precedes the development of coronary artery disease. The artery size hypothesis has been proposed as a potential explanation for this observation. This hypothesis seeks to explain the differing manifestation of the same vascular condition, based on the size of the vessels. Clinical presentations of the atherosclerotic and/or endothelium disease in the penile arteries might precede the corresponding manifestations from larger arteries. Treated hypertensive patients are more likely to have sexual dysfunction compared with untreated ones, suggesting a detrimental role of antihypertensive treatment on erectile function. The occurrence of erectile dysfunction seems to be related to undesirable effects of antihypertensive drugs on the penile tissue. Available information points toward divergent effects of antihypertensive drugs on erectile function, with diuretics and beta-blockers possessing the worst profile and angiotensin receptor blockers and nebivolol the best profile.
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De Rocco Ponce M, Vecchiato M, Neunhaeuserer D, Battista F, Caretta N, Savalla F, Favero C, Garolla A, Foresta C, Ermolao A. Association Between Penile Color Doppler Ultrasonography and Cardiorespiratory Fitness in Patients With Vascular Erectile Dysfunction. Sex Med 2021; 9:100347. [PMID: 33975195 PMCID: PMC8240347 DOI: 10.1016/j.esxm.2021.100347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Vascular erectile dysfunction (ED) is a burdensome condition, associated with increased cardiovascular risk. Peak systolic velocity (PSV) represents the maximum pulse velocity in the cavernous artery measured by a penile color doppler ultrasonography (PCDU) during a pharmacologically induced erection and is considered a reliable parameter for the diagnosis of vascular ED. However, the cut-off value of standard PSV (30 cm/s) provides high sensitivity only in the diagnosis of advanced arteriogenic disease. Thus, an age-adjusted PSV (6.73 + 0.7 x age cm/s) has been proposed to offer a more accurate diagnosis of vascular ED. AIM In this study it was aimed to answer the following question: "Is there any positive association between indexes of vascular erectile dysfunction and cardiorespiratory fitness?" MAIN OUTCOME MEASURE AND METHODS 25 patients with a medical history of ED (median age 55.3 years) underwent PCDU after pharmacological stimulation. Subsequently, a functional evaluation with ECG-monitored, incremental, maximal cardiopulmonary exercise testing was performed. RESULTS Peak oxygen uptake (VO2 peak), peak oxygen uptake per body weight (VO2 peak/kg) and Watt/kg correlated with standard PSV, even when corrected for age and BMI (p < 0.05). No differences emerged in cardiopulmonary fitness between pathological and healthy patients (4 vs 21) identified using the standard PSV cut-off. Conversely, the age-adjusted PSV cut-off identified a greater number of patients as pathological (18 vs 7), presenting a significantly lower cardiopulmonary fitness, exercise capacity and efficiency when compared to patients with normal age-adjusted PSV (all p < 0.05). CONCLUSION Data showed an age and BMI independent association between vascular disfunction of cavernous artery and cardiopulmonary fitness, a known solid predictor of all-cause and disease-specific mortality. Moreover, the age-adjusted PSV better identified a subgroup of patients with vascular ED presenting impaired cardiorespiratory fitness and thus increased cardiovascular risk. De Rocco Ponce M, Vecchiato M, Neunhaeuserer D, et al. Association Between Penile Color Doppler Ultrasonography and Cardiorespiratory Fitness in Patients With Vascular Erectile Dysfunction. Sex Med 2021;9:100347.
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Affiliation(s)
- Maurizio De Rocco Ponce
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy.
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Nicola Caretta
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Francesco Savalla
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Claudia Favero
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Garolla
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Carlo Foresta
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
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Detection of Coronary Artery Disease by an Erectile Dysfunction Questionnaire. Cardiol Res Pract 2021; 2021:6647995. [PMID: 33815837 PMCID: PMC7987458 DOI: 10.1155/2021/6647995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background Erectile dysfunction (ED) has been become an important health challenge in recent years affecting the quality of life significantly. In addition to imposed social problems, it may warn the existence of cardiovascular diseases especially that of ischemic heart disease (IHD). We aimed to investigate the association between ED and coronary artery disease (CAD) in a population of patients with stable angina based on angiographic findings. Methods In this cross-sectional study, among patients who are diagnosed with stable angina referring for coronary angiography (excluding those with acute coronary syndrome), 200 patients were selected. They were divided equally into two groups of case and control. The former were positively CAD patients and the latter were normal peers, with respect to angiographic results. International index of erectile function (IIEF) questionnaire was used in order to evaluate erectile function during recent four weeks. Statistical analyses of the t-test and logistic regression were performed. The significance level was considered as a P value less than 5%. Results The age range of the patients was 40–65 years old. The case group was significantly older (P=0.001). There was a remarkable relation between the low score from IIEF (ED) and existence of CAD. Also, the severity of ED was in a close relationship with severity of CAD. In addition, dyslipidemia in terms of high LDL and low HDL was associated with both ED and severity of CAD. Conclusion Other than CAD, ED could be considered as one of the manifestations of atherosclerosis. Accordingly, the IIEF questionnaire is a useful tool to early diagnosis of CAD. Also, IIEF-derived scores estimate CAD severity. We suggest subjects with low score of IIEF examine their cardiovascular health with special attention to possible existence of IHD.
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Cannarella R, Calogero AE, Aversa A, Condorelli RA, La Vignera S. Differences in Penile Hemodynamic Profiles in Patients with Erectile Dysfunction and Anxiety. J Clin Med 2021; 10:jcm10030402. [PMID: 33494316 PMCID: PMC7864480 DOI: 10.3390/jcm10030402] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Penile echo-color Doppler ultrasound (PCDU) is the gold standard for the diagnosis of arterial erectile dysfunction (ED). Its reliability in patients with anxiety was questioned, due to false-positive results. Aim: To assess the penile hemodynamic response to intracavernous injection (ICI) of alprostadil in patients with anxiety-related ED. Methods: Patients with non-organic ED and a 5-item International Index of Erectile Function (IIEF-5) score ranging between 5 and 7 were enrolled. They were asked to compile the 7-item Generalized Anxiety Disorder (GAD-7) questionnaire to assess the degree of anxiety and were divided according to the GAD-7 score in Group 1 with minimal level of anxiety (n = 20), Group 2 with mild anxiety (n = 20), Group 3 with moderate anxiety (n = 20), and Group 4 with severe anxiety (n = 20). Peak systolic velocity (PSV) and the end-diastolic velocity (EDV) were sampled in all patients, through PCDU in the flaccid state, and 5, 10, 15, and 20 min after ICI of alprostadil at the standard dose of 10 μg. Results: In penile flaccidity, the patients showed a mean PSV of 8.0 ± 4.0 cm/s. The degree of anxiety was found to significantly influence both PSV and EDV at all assessed time-points. Particularly, it was negatively associated with the PSV at time 5 (r = −0.9, p < 0.01), 10 (r = −0.9, p < 0.01), 15 (r = −0.9, p < 0.01), and 20 (r = −0.7, p < 0.01) minutes, and positively with the EDV at time 5 (r = 0.7, p < 0.01), 10 (r = 0.6, p < 0.01), 15 (r = 0.5, p < 0.01), and 20 (r = 0.3, p < 0.01) minutes. Although all patients showed a mean dynamic PSV > 25 cm/s (which excluded an arterial ED according to the current guidelines), a peculiar hemodynamic pattern was found in patients with severe anxiety. In these patients, normal PSV values were reached only after 20 min from ICI, suggesting a “late-responder” profile. Conclusion: If further studies confirm the existence of a distinct hemodynamic profile in patients with severe anxiety, sampling the PSV and the EDV values could be proposed, for detecting patients with severe anxiety-related ED. Dynamic PCDU could be considered an accurate diagnostic test in patients with non-organic ED, since zero false-positive results were found in the present study. PSV in the flaccid state is not able to discriminate between arterial- or non-organic ED.
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Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (R.C.); (A.E.C.); (R.A.C.); (S.L.V.)
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (R.C.); (A.E.C.); (R.A.C.); (S.L.V.)
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
- Correspondence:
| | - Rosita A. Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (R.C.); (A.E.C.); (R.A.C.); (S.L.V.)
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (R.C.); (A.E.C.); (R.A.C.); (S.L.V.)
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Schönhofen J, Räber L, Knöchel J, Keo HH, Regli C, Kostal F, Schumacher MC, Sammarchi L, Bechir M, Diehm N. Endovascular Therapy for Arteriogenic Erectile Dysfunction With a Novel Sirolimus-Eluting Stent. J Sex Med 2021; 18:315-326. [PMID: 33454205 DOI: 10.1016/j.jsxm.2020.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/10/2020] [Accepted: 10/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Arteriogenic erectile dysfunction is a common disease oftentimes not satisfactory treatable with medical therapy. AIM To assess the safety and clinical success rate of endovascular revascularization of erection-related arteries with the angiolite BTK stent in patients with arteriogenic erectile dysfunction. METHODS A total of 100 consecutive men (61.8 ± 10 years) with atherosclerotic lesions in erection-related arteries agreed to participate and were included into a single-center all-comers registry. Endovascular therapy with angiolite BTK drug-eluting stents was performed on a total of 211 lesions. Patients received a baseline International Index of Erectile Function (IIEF)-15 questionnaire at first presentation and 3 and 12 months after stenting. An improvement by 4 points in the erectile function domain consisting of 6 questions (IIEF-6) was defined as minimal clinically important difference. A total of 24 patients with 52 stented arterial lesions underwent angiographic follow-up of the initially treated arterial side during secondary revascularization of the contralateral side (angiographic sub-study). OUTCOME Clinical improvement of erections in 100 patients undergoing endovascular revascularization of erection-related arteries. RESULTS No major adverse events occurred during endovascular revascularization or within 30 days thereafter. Technical success was achieved in all lesions and procedural success in all patients. At 1 year, 55 of 97 patients (56.7%) improved by at least 4 points in IIEF-6 score and thus achieved a clinically relevant improvement of erectile function.In the angiographic sub-study, arterial patency and binary restenosis were observed in 46 of 52 (88.5%) and in 8 of 52 (15.4%), respectively, after a mean follow-up of 9.6 ± 5.8 months. CLINICAL IMPLICATIONS In patients with arteriogenic erectile dysfunction, endovascular therapy with a novel thin-strut sirolimus eluting stent is a safe and feasible treatment option. STRENGTHS & LIMITATIONS This real-world arterial revascularization registry included patients with a multitude of risk factors for ED, thereby representing the heterogeneity in patients in the clinical practice, which is one of its strengths but also one of its weaknesses. Another strength was the focus being laid on analyzing outcomes of patients with arteriogenic ED using only a single endovascular device. Further studies are warranted to better define subgroups of patients with impaired clinical outcomes. CONCLUSION Within the present all-comers registry, endovascular therapy of erectile dysfunction with the angiolite BTK stent was shown to be a safe and feasible treatment option resulting in clinical improvement rates comparable to earlier clinical trials although also showing that further research is warranted to define patient subgroups with particular benefits of endovascular therapy. Schönhofen J, Räber L, Knöchel J, et al. Endovascular Therapy for Arteriogenic Erectile Dysfunction With a Novel Sirolimus-Eluting Stent. J Sex Med 2021;18:315-326.
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Affiliation(s)
- Jan Schönhofen
- Department of Angiolog, Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas Knöchel
- Department of Angiolog, Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Hak Hong Keo
- Department of Angiolog, Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Christian Regli
- Department of Angiolog, Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Filip Kostal
- Department of Angiolog, Vascular Institute Central Switzerland, Aarau, Switzerland
| | | | - Lisa Sammarchi
- Department of Angiolog, Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Markus Bechir
- Department of Internal Medicine, Hirslanden Clinic, Aarau, Switzerland
| | - Nicolas Diehm
- Department of Angiolog, Vascular Institute Central Switzerland, Aarau, Switzerland.
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Zavattaro M, Felicetti F, Faraci D, Scaldaferri M, Dellacasa C, Busca A, Dionisi-Vici M, Cattel F, Motta G, Giaccone L, Ghigo E, Arvat E, Lanfranco F, Bruno B, Brignardello E. Impact of Allogeneic Stem Cell Transplantation on Testicular and Sexual Function. Transplant Cell Ther 2020; 27:182.e1-182.e8. [PMID: 33830036 DOI: 10.1016/j.jtct.2020.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 10/22/2022]
Abstract
High-dose chemotherapy and radiotherapy, administered as a conditioning regimen before stem cell transplantation, are known to negatively impact testicular function and sexuality. However, to date, only a few studies have simultaneously analyzed the real prevalence of these complications in this clinical setting. Therefore, this study aimed to assess the prevalence of testicular dysfunction and sexual impairment in a cohort of males who underwent allogeneic stem cell transplantation in adulthood. This observational, cross-sectional, single-center study consecutively enrolled 105 subjects on outpatient follow-up. Testicular function and sexuality were evaluated through a hormonal profile (testosterone, follicle-stimulating hormone, luteinizing hormone, and inhibin B) and the IIEF-15 questionnaire, respectively. We found a higher prevalence of hypogonadism (21%), impaired spermatogenesis (87%), and erectile dysfunction (72%) compared with the general population. Chronic graft-versus-host disease, especially of moderate/severe grade, was associated with an increased risk of developing erectile dysfunction (odds ratio, 6.338). Moreover, a high proportion of patients presented with alterations in all domains of sexual function, even after complete clinical remission of hematologic disease. Our data confirm both testicular function and sexuality alterations as frequent complications after allogeneic stem cell transplantation. A multidisciplinary approach is advisable for early diagnosis and adequate treatment.
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Affiliation(s)
- Marco Zavattaro
- Andrology Unit, Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Felicetti
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Danilo Faraci
- Department of Oncology, Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | | | - Chiara Dellacasa
- Department of Oncology, Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Alessandro Busca
- Department of Oncology, Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Margherita Dionisi-Vici
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Francesco Cattel
- Pharmacy, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Giovanna Motta
- Andrology Unit, Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luisa Giaccone
- Department of Oncology, Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Ezio Ghigo
- Andrology Unit, Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Emanuela Arvat
- Department of Medical Sciences, University of Turin, Turin, Italy; Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Fabio Lanfranco
- Andrology Unit, Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Benedetto Bruno
- Department of Oncology, Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Enrico Brignardello
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Turin, Italy.
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Mostafaei H, Mori K, Hajebrahimi S, Abufaraj M, Karakiewicz PI, Shariat SF. Association of erectile dysfunction and cardiovascular disease: an umbrella review of systematic reviews and meta-analyses. BJU Int 2020; 128:3-11. [PMID: 33260254 PMCID: PMC8359379 DOI: 10.1111/bju.15313] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectives To present an overall picture of the evidence regarding the association of erectile dysfunction (ED) with cardiovascular disease (CVD). Methods Systematic reviews and meta‐analyses that studied the association of ED with any CVD were included in this umbrella review. We did not restrict the population to a particular group or age. PubMed, Embase, the Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, and the PROSPERO register were searched to find relevant systematic reviews, with or without meta‐analyses, from inception to April 2020. The JBI Checklist for Systematic Reviews and Research Syntheses was used for the critical appraisal. Only studies with acceptable quality were included. Two independent reviewers extracted the data using the JBI data extraction tool for qualitative and quantitative data extraction. Results The summary estimate showed a higher risk of CVD (relative risk [RR] 1.45, 95% confidence interval [CI] 1.36–1.54; P < 0.001), coronary heart disease (RR 1.50, 95% CI 1.37–1.64; P < 0.001), cardiovascular‐related mortality (RR 1.50, 95% CI 1.37–1.64; P < 0.001), all‐cause mortality (RR 1.25, 95% CI 1.18–1.32; P < 0.001), myocardial infarction (RR 1.55, 95% CI 1.33–1.80; P < 0.001) and stroke (RR 1.36, 95% CI 1.26–1.46; P < 0.001) in patients with ED than in other patients. Conclusions Our results confirm that ED is an independent predictor of CVD and their outcomes. ED and CVD are two presentations of the same physiological phenomenon. ED normally precedes symptomatic CVD, providing a window of opportunity for healthcare practitioners to screen and detect high‐risk patients early to prevent avoidable morbidity and mortality.
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Affiliation(s)
- Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Research Centre for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Sakineh Hajebrahimi
- Research Centre for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern, Dallas, TX, USA.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Urology, University of Jordan, Amman, Jordan.,European Association of Urology Research Foundation, Arnhem, The Netherlands
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Culha MG, Canat L, Degirmentepe RB, Albayrak AT, Atalay HA, Merder E, Ariman A, Altunrende F. The correlation between atherogenic indexes and erectile dysfunction. Aging Male 2020; 23:1232-1236. [PMID: 32266853 DOI: 10.1080/13685538.2020.1749996] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aside from the ordinary plasma lipid level measurements, the ratios based on individual plasma lipid levels such as atherogenic index of plasma (AIP), Castelli's risk index 1/2 (CRI-1/2), and atherogenic coefficient (AC) are the novel parameters to evaluate the patients with a high risk of CVD. In this study, we aim to evaluate the relationship between AIP, AC, and CRI-1/2 with increased risk of ED. Between April 2018 and February 2019, 253 patients, who were diagnosed as a vasculogenic ED in our clinic, were enrolled in the study. While the first group (n = 134) consisted of patients with moderate and mild ED (IIEF-EF: 17-30), the second group (n = 119) consisted of patients with severe ED. In addition to the mean values of lipid parameters; CRI-1 (total cholesterol/HDL), CRI-2 (LDL/HDL) AIP (log10(triglycerides/HDL), and AC (non-HDL/HDL) were calculated. The mean age was 44.02 ± 10.41 (24-70), and the mean BMI was 27.80 ± 4.12 (18.52 ± 41.97). However, CRI-1 and AIP values were found to be higher in the severe ED group compared to the mild ED group (CRI-1: 4.50 ± 1.47, 4.88 ± 1.30; p = .039; AIP: 0.489 ± 0.315, 0.617 ± 0.283; p = .007). Our results demonstrated that CR-1 and AIP have a positive correlation with the severity of ED. Moreover, we can suggest that patients with higher CR-1 and AIP values are likely to have more severe ED in the future.
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Affiliation(s)
- Mehmet Gokhan Culha
- Department of Urology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Lutfi Canat
- Department of Urology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Recep Burak Degirmentepe
- Department of Urology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Tevfik Albayrak
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Hasan Anil Atalay
- Department of Urology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Erkan Merder
- Department of Urology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Ariman
- Department of Urology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Fatih Altunrende
- Department of Urology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
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Yang Y, Yong S, Li F, Dong L, Chang D. The effect of nebivolol on erectile function in the cases with coronary artery bypass surgery: A protocol for a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e21588. [PMID: 32769911 PMCID: PMC7593072 DOI: 10.1097/md.0000000000021588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Erectile dysfunction is a common disease. It affects the quality of life of both husband and wife and its prevalence is higher in patients with overt cardiovascular disease or cardiovascular risk factors. In recent years, multiple studies confirm that nebivolol exerts protective effects on erectile function against the disruptive effects of cardiopulmonary bypass in patients undergoing coronary artery bypass grafting, but its quality and efficacy have not been systematically evaluated. Therefore, it is necessary to carry out a systematic review and meta-analysis to fully evaluate the efficacy and safety of nebivolol on erectile function in the cases with coronary artery bypass grafting. METHODS AND ANALYSIS Chinese and English literature of nebivolol on erectile function in the cases with coronary artery bypass surgery published before August 31, 2020 will be comprehensive searched in PubMed, Cochrane Library, EMBASE, WANFANG, China National Knowledge Infrastructure, VIP Chinese Science and Technology Journal Database, Chinese biomedical document service system, and Clinicaltrials.gov. Only randomized controlled trials that meet the eligibility criteria will be included. Two researchers will independently complete literature screening, data extraction and assess the risk of bias, and the third investigator will handle disagreements. Our main evaluation includes 2 outcome indicators including the international index of erectile function 5 score and adverse events. RevMan 5.3 and Stata 14.0 will be used to conduct this systematic review. The preferred reporting items for systematic reviews and meta-analysis protocols (PRISMA-P) statement is followed in this protocol and the PRISMA statement will be followed in the completed systematic review. CONCLUSION AND DISSEMINATION The efficacy and safety of nebivolol on erectile function in the cases with coronary artery bypass grafting will be evaluated. We will publish the results of this systematic review in peer-reviewed journals to provide new evidence to clinicians. ETHICS AND DISSEMINATION Ethical approval is not required as the review is a secondary study based on published literature. The results will be published in a public issue journal to provide evidence-based medical evidence for urologists and andrologists to make better clinical decisions. REGISTRATION INFORMATION INPLASY202060110.
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Affiliation(s)
- Yali Yang
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Shanshan Yong
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Fuhao Li
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Liang Dong
- Department of Andrology, The Reproductive and Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Degui Chang
- Hospital of Chengdu University of Traditional Chinese Medicine
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Yildiz I, Gokalp F, Burak C, Karazindiyanoglu S, Yildiz PO, Rencuzogullari I, Karabag Y, Cagdas M. Relationship between the Severity of Coronary Artery Disease and Catheter-Associated Urethral Stricture in Patients with Acute Coronary Syndrome. J Tehran Heart Cent 2020; 15:113-118. [PMID: 33552206 PMCID: PMC7827122 DOI: 10.18502/jthc.v15i3.4221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 04/25/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Different arterial segments throughout the vascular system develop similar grades of atherosclerosis concomitantly. Urethral ischemia has been proposed as a cause of urethral stricture. Therefore, we aimed to investigate the relationship between coronary artery disease severity using a SYNTAX score and urethral stricture occurrence after urethral catheterization in patients with non-ST-segment-elevation acute coronary syndrome (ACS). Methods: This retrospective study consisted of 306 men with urethral catheters that were diagnosed with ACS and underwent coronary angiography between January 2016 and January 2018 in Kars Kafkas University and Osmaniye Government Hospital, Turkey. Hospital records were reviewed to collect the follow-up data of the patients regarding the occurrence of urethral stricture after urethral catheterization. The study population was divided into 2 groups according to urethral stricture development, and both groups were compared statistically. Results: SYNTAX scores were significantly higher in patients with urethral stricture than in those without urethral stricture (14.86±7.11 vs. 29.25±9.79; P<0.001). The SYNTAX score (OR=1.27; 95% CI: 1.16-1.39; P<0.001), diabetes, and serum albumin were found to be the independent predictors of urethral stricture. The receiver operating characteristic curve analysis showed that the cutoff value of the SYNTAX score for urethral stricture prediction was greater than 22.5, with 76.7% sensitivity and 85.1% specificity (AUC=0.88, 95% CI: 0.84-0.91; P<0.001). Conclusion: Coronary artery disease severity graded according to the SYNTAX score is an independent predictor of urethral stricture occurrence in ACS patients with a urethral catheter inserted.
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Affiliation(s)
- Ibrahim Yildiz
- Cardiology Clinic, Osmaniye Government Hospital, Osmaniye, Turkey.
| | - Fatih Gokalp
- Urology Clinic, Osmaniye Government Hospital, Osmaniye, Turkey.
| | - Cengiz Burak
- Department of Cardiology, Medical Faculty,Kafkas University, Kars, Turkey.
| | | | | | | | - Yavuz Karabag
- Department of Cardiology, Medical Faculty,Kafkas University, Kars, Turkey.
| | - Metin Cagdas
- Department of Cardiology, Medical Faculty,Kafkas University, Kars, Turkey.
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Hernández-Cerda J, Bertomeu-González V, Zuazola P, Cordero A. Understanding Erectile Dysfunction in Hypertensive Patients: The Need for Good Patient Management. Vasc Health Risk Manag 2020; 16:231-239. [PMID: 32606719 PMCID: PMC7297457 DOI: 10.2147/vhrm.s223331] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/26/2020] [Indexed: 12/20/2022] Open
Abstract
Erectile dysfunction (ED) is defined as a man’s consistent or recurrent inability to attain and/or maintain penile erection enough for successful vaginal intercourse. ED affects a large part of the population, increasing its incidence with age and comorbidities. It is estimated by the year 2025, 322 million men will suffer from ED. Incidence of ED has been related not only to chronic diseases such as diabetes mellitus, metabolic syndrome, hyperlipidemia, psychiatric diseases or urinary tract diseases, but also to hypertension and especially to antihypertensive treatments. This review summarizes current knowledge about the management of ED in hypertensive men and its role as cardiovascular disease predictor.
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Affiliation(s)
- Jorge Hernández-Cerda
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain.,Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Spain
| | - Vicente Bertomeu-González
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain.,Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Pilar Zuazola
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain
| | - Alberto Cordero
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain.,Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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The relationship between erectile dysfunction and the Atherogenic Index of Plasma. Int J Impot Res 2019; 32:462-468. [PMID: 31243351 DOI: 10.1038/s41443-019-0167-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 04/02/2019] [Accepted: 05/31/2019] [Indexed: 11/09/2022]
Abstract
The objective of this study was to compare the Atherogenic Index of Plasma (AIP) values as indicators of subclinical atherosclerosis among 124 patients with erectile dysfunction, which was thought to be vasculogenic and 126 control subjects who had no erectile dysfunction, and to compare cardiac performance values between both the groups using exercise stress tests (EST). Erectile function was assessed using the International Index of Erectile Function (IIEF-5) questionnaire form. AIP values were studied and compared between patients with ED (IIEF < 22) and those without ED (IIEF > 22) using the log10 TG/HDL-C formula. In addition, the correlation between the severity of ED and AIP was investigated according to IIEF-5 scoring. Metabolic equivalent (MET) values, maximal heart rates (max HR), and heart rate recovery (HRR) were evaluated with effort tests. AIP values were significantly higher in the ED group than in the control group (0.45 ± 0.27, and 0.37 ± 0.27; p = 0.015). According to IIEF-5 scoring, AIP values increased as ED scores decreased. In the EST, MET score and max HR values were significantly lower in the ED group (METs: 11.1 ± 2.2, and 11.6 ± 2.2; p = 0.045; Max HR: 162.8 ± 6.1, and 165 ± 8.7; p = 0.019). Although not statistically significant, HRR values were lower in the ED group. Higher AIP values were found in the ED group, and a positive correlation was established between AIP and the severity of ED. In addition, lower performance during the EST and lower HRR values, again in the ED group, confirms cardiac interaction with ED. These results indicate the importance of referral of patients with ED from urology clinics to cardiology units for risk determination and cardiac assessment, even if they areasymptomatic.
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Elshahid ARM, Shahein IM, Mohammed YF, Ismail NF, Zakarria HBAER, GamalEl Din SF. Folic acid supplementation improves erectile function in patients with idiopathic vasculogenic erectile dysfunction by lowering peripheral and penile homocysteine plasma levels: a case-control study. Andrology 2019; 8:148-153. [PMID: 31237081 DOI: 10.1111/andr.12672] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/19/2019] [Accepted: 05/29/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) has common risk factors with many cardiovascular (CV) impairments. In view of these facts, hyperhomocysteinemia (HHcys) has been postulated for involvement in endothelial dysfunction. OBJECTIVES We evaluated peripheral and penile homocysteine (Hcys) plasma levels before and after folic acid supplementation in idiopathic vasculogenic erectile dysfunction (ED) patients. MATERIALS AND METHODS This study included 50 consecutive patients and 50 consecutive healthy controls that were recruited from December 2017 to December 2018. The patients received folic acid (FA) daily for 3 months and were evaluated by the abridged 5-item International Index of Erectile Function (IIEF-5) and penile duplex before and after therapy, in addition to plasma Hcys levels. RESULTS Our study showed improvement in the severity of ED in our patients as all of them became mild to moderate ED after folic acid administration. Additionally, the median scores of IIEF-5 significantly increased from 6 to 14, respectively (p < 0.001). Furthermore, the median peripheral and penile Hcys plasma levels (μmol/l) significantly decreased after folic acid administration as 39 patients with moderate ED and 11 patients with severe ED were 0.62, 0.34, 5.37, 0.37, respectively, became mild to moderate ED with their median peripheral and penile Hcys plasma levels became 0.19, 0.15, p < 0.001, <0.001, respectively. Peripheral Hcys level correlates significantly with penile Hcys before and after folic acid administration (r: -0.06 p: 0.8, r: 0.9, p < 0.001, respectively). DISCUSSION AND CONCLUSION Recently, an emerging body of evidence suggests a role for Hcys and folate in erectile function. Interestingly, our interventional study is one of the first that evaluated the effect of folic acid supplementation on HHcys where it demonstrated a significant decrease in peripheral and penile Hcys plasma levels after folic acid administration. Thus, FA should be prescribed concomitantly with phosphodiesterase type 5 inhibitors in ED patients.
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Affiliation(s)
- A R M Elshahid
- Department of Dermatology and Venereolgy and Andrology, Al-Azhar University, Cairo, Egypt
| | - I M Shahein
- Department of Dermatology and Venereolgy and Andrology, Al-Azhar University, Cairo, Egypt
| | - Y F Mohammed
- Department of Dermatology and Venereolgy and Andrology, Al-Azhar University, Cairo, Egypt
| | - N F Ismail
- Clinical Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - S F GamalEl Din
- Andrology & STDs Department, Kasr Al-Ainy Faculty of Medicine, Giza, Egypt
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Boeri L, Capogrosso P, Ventimiglia E, Schifano N, Montanari E, Montorsi F, Salonia A. Sexual Dysfunction in Men with Prediabetes. Sex Med Rev 2019; 8:622-634. [PMID: 30852183 DOI: 10.1016/j.sxmr.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/19/2018] [Accepted: 11/25/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Previous studies have shown a strong association between diabetes mellitus (DM) and the frequency and severity of some aspects of male sexual dysfunction (SD). The same relationship with prediabetes (preDM) has been less well investigated. AIM To systematically review the current literature on the association between preDM and SD, focusing on erectile dysfunction (ED), sex steroid hormone alterations, and premature ejaculation (PE). METHODS The present review was conducted in accordance with the PRISMA declaration standards for systematic reviews. A systematic search for the terms "male sexual dysfunction," "prediabetes," "IFG or IGT," "glycemia," "ED," "ejaculation," and "hypoactive sexual desire disorder" was carried out in the PubMed and Embase databases. MAIN OUTCOME MEASURE Prevalence of SD in men with preDM and severity of ED, PE, and hormone alterations in men with preDM compared with controls. RESULTS 12 studies reporting data on the association between SD and preDM were found in the literature. According to these studies, ED is more prevalent in men with preDM compared with controls, the severity of ED increases progressively as a function of impaired glucose metabolism, testosterone values and preDM are strongly correlated, men with preDM are at increased risk of testosterone deficiency and hypogonadism, men with hypogonadism have a higher prevalence of preDM, and the association between PE and preDM is controversial. CONCLUSION PreDM is a common and underdiagnosed clinical condition that is strongly associated with male SD. A detailed glucose metabolism investigation should be performed in every patient with SD to screen for glucose abnormalities and eventually to implement prevention program to decrease their chances of developing life-changing chronic illnesses. Boeri L, Capogrosso P, Ventimiglia E, et al. Sexual Dysfunction in Men with Prediabetes. Sex Med Rev 2019;8:622-634.
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Affiliation(s)
- Luca Boeri
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Nicolò Schifano
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
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Yang G, Muzepper M. Platelet indices and erectile dysfunction: A systematic review and meta-analysis. Andrologia 2019; 51:e13248. [PMID: 30740770 DOI: 10.1111/and.13248] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/07/2019] [Accepted: 01/14/2019] [Indexed: 01/05/2023] Open
Abstract
Elevated platelet levels have been postulated to be associated with cardiovascular diseases, conditions closely linked to erectile dysfunction (ED). The current systematic review and meta-analysis was performed to assess the platelet indices, which including platelet count (PLT), mean platelet volume (MPV) and platelet distribution width (PDW) in subjects with ED compared to controls in an attempt to clarify the possible role of platelet indices in the pathogenesis of ED. We initially screened the candidate studies observing the possible association between platelet indices and ED following literature search of database Cochrane Library, PubMed, EMBASE and MEDLINE and therefore included the studies based on the pre-defined inclusion and exclusion criteria. Two independent investigators extracted the related information on article data and outcome measures from the qualified studies, and a meta-analysis was therefore performed using Stata 12.0 software. Subgroup analyses were conducted by the different ED aetiology obtained from the eligible studies. The standard mean difference (SMD) and the corresponding 95% confidence intervals (95% CIs) were applied to estimate the outcome measures. A total of 14 articles were qualified in our meta-analysis with a total of 1595 cases and 987 controls included. Pooled estimate was in favour of increased MPV levels in subjects with ED with a SMD of 0.651 fl, 95% CI 0.567-0.735, p = 0.000. Subgroup analysis showed that vasculogenic ED had a higher MPV levels than controls as well (SMD [95% CI] = 1.026 [0.823-1.228], p = 0.000). However, pooled analysis based on PLT and PDW levels has produced inconsistent results and not strong evidence on platelet level and ED correlation. In conclusion, vasculogenic ED patients had a higher MPV level in our study. However, the results need further interpretation with caution and more high-quality studies are warranted.
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Affiliation(s)
- Guangmin Yang
- Department of Vascular Surgery, Drum Tower Hospital Affiliated to School of Medicine, Nanjing University, Nanjing, China
| | - Mehmutjan Muzepper
- Department of Vascular Surgery, Drum Tower Hospital Affiliated to School of Medicine, Nanjing University, Nanjing, China
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Wei Y, Chen P, Chen Q, Zhu H. Serum vitamin D levels and erectile dysfunction: A systematic review and meta-analysis. Andrologia 2018; 51:e13211. [PMID: 30523636 DOI: 10.1111/and.13211] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/13/2018] [Accepted: 10/22/2018] [Indexed: 01/11/2023] Open
Abstract
Suboptimal levels of serum vitamin D levels have been implied to be associated with cardiovascular diseases and endothelial dysfunction, conditions closely associated with erectile dysfunction (ED). The present systematic review and meta-analysis was performed to evaluate the vitamin D levels in subjects with ED compared to controls and the 5-item version of the international index of erectile function (IIEF-5) score in subjects with vitamin D deficiency compared to those without vitamin D deficiency in order to elucidate the role of vitamin D in the pathogenesis of ED. Studies evaluating the possible association between vitamin D levels and ED were initially screened and thus included following electronic literature search of database Cochrane Library, PUBMED, EMBASE and MEDLINE. Essential article information including outcome measures was extracted from the qualified studies by two independent authors, and STATA 12.0 software was used conducted the meta-analysis. Subgroup analyses were conducted by vitamin D detection methods and sample size. The standard mean difference (SMD) as well as the 95% confidence intervals (95% CIs) was applied to estimate the outcome measures. A total of seven articles were included in our meta-analysis with a total of 4,132 subjects. Pooled estimate was in favour of increased vitamin D levels in subjects without ED with a SMD of 3.027 ng/ml, 95%CI 2.290-3.314, p = 0.000. However, subgroup analysis showed an opposite trend, after one study with a sample size over 1,000 that could possibly influence the weight balance was excluded, with a SMD of 0.267, 95%CI -0.052 to 0.585, p = 0.101. We also identified about 0.320 higher in IIEF-5 score (95%CI = 0.146-0.494, p = 0.000) in subjects without vitamin D deficiency versus with vitamin D deficiency. Nevertheless, subgroup analysis based on vitamin D detection methods obtained differential results (radioimmunoassay subgroup, SMD(95%CI) = 0.573 (0.275-0.870), p = 0.000; immunoassay subgroup, SMD(95%CI) = 0.189 (-0.025 to 0.404), p = 0.084). In conclusion, results from the present meta-analysis did not provide a strong relationship between vitamin D and the risk of ED. However, the results should be interpreted with caution and more high quality studies are warranted.
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Affiliation(s)
- Yong Wei
- Department of Urology, Nanjing Gaochun People's Hospital, Nanjing, China
| | - Peng Chen
- Department of Urology, Nanjing Gaochun People's Hospital, Nanjing, China
| | - Quanbing Chen
- Department of Urology, Nanjing Gaochun People's Hospital, Nanjing, China
| | - Hongru Zhu
- Department of Urology, Nanjing Gaochun People's Hospital, Nanjing, China
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, Bart van der Worp H, van Dis I, Verschuren WMM. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2018; 252:207-274. [PMID: 27664503 DOI: 10.1016/j.atherosclerosis.2016.05.037] [Citation(s) in RCA: 348] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Ugo Corrà
- Societie: European Society of Cardiology (ESC)
| | | | | | - Ian Graham
- Societie: European Society of Cardiology (ESC)
| | | | | | | | | | | | - Joep Perk
- Societie: European Society of Cardiology (ESC)
| | | | - Josep Redon
- Societie: European Society of Hypertension (ESH)
| | | | - Naveed Sattar
- Societie: European Association for the Study of Diabetes (EASD)
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Boeri L, Capogrosso P, Pederzoli F, Ventimiglia E, Frego N, Chierigo F, Montanari E, Montorsi F, Salonia A. Unrecognized Prediabetes Is Highly Prevalent in Men With Erectile Dysfunction–Results From a Cross-Sectional Study. J Sex Med 2018; 15:1117-1124. [DOI: 10.1016/j.jsxm.2018.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/14/2018] [Accepted: 06/17/2018] [Indexed: 11/28/2022]
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Werba JP, Misaka S, Giroli MG, Shimomura K, Amato M, Simonelli N, Vigo L, Tremoli E. Update of green tea interactions with cardiovascular drugs and putative mechanisms. J Food Drug Anal 2018; 26:S72-S77. [PMID: 29703388 PMCID: PMC9326886 DOI: 10.1016/j.jfda.2018.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 12/26/2022] Open
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Sexual Dysfunction After Abdominal Aortic Aneurysm Surgical Repair: Current Knowledge and Future Directions. Eur J Vasc Endovasc Surg 2018; 55:267-280. [DOI: 10.1016/j.ejvs.2017.11.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/27/2017] [Indexed: 12/26/2022]
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Kucukdurmaz F, Acar G, Resim S. Deterioration of Chronotropic Responses and Heart Rate Recovery Indices in Men With Erectile Dysfunction. Sex Med 2017; 6:8-14. [PMID: 29275061 PMCID: PMC5815967 DOI: 10.1016/j.esxm.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/26/2017] [Accepted: 10/14/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Erectile dysfunction (ED) and cardiovascular (CV) diseases share common risk factors and ED has been accepted as an early manifestation of CV disease. Exercise stress testing (EST) is used to evaluate CV functions in men with ED. Low exercise workload, a slower heart rate recovery (HRR) after exercise, and inability to increase heart rate during EST (chronotropic incompetence) are independent negative predictors of adverse CV outcomes. Aim To assess the association among EST parameters, ED, and testosterone levels. Methods The study population consisted of 41 patients with ED and 40 controls. All participants underwent treadmill EST to assess cardiac autonomic functions. HRR indices were calculated by subtracting 1st (HRR1), 2nd (HRR2), and 3rd (HRR3) minute heart rates during the recovery period from maximal heart rate. Total exercise duration, exercise capacity and chronotropic response, and plasma testosterone levels were evaluated. Erectile functions were evaluated with the Sexual Health Inventory for Men. Patients were divided into subgroups according to severity and duration of ED. Main Outcome Measures Mean HRR1 (30.6 ± 11.9 vs 36.9 ± 9.9; P = .01), HRR2 (44.9 ± 12.4 vs 54.9 ± 7.8; P < .001), and HRR3 (50.1 ± 11.7 vs 63.0 ± 7.9; P < .001) were significantly lower in the ED than in the control group. Total exercise duration (9.4 ± 1.9 vs 10.9 ± 1.7 minutes; P < .001), exercise capacity (12.5 ± 1.9 vs 13.6 ± 1.4 metabolic equivalents; P = .004), and chronotropic response (0.88 ± 0.1 vs 1.0 ± 0.1; P < .001) were worse in the ED group. However, we found no association between severity and duration of ED and EST parameters. In addition, serum testosterone levels were significantly correlated with HRR1 (r = 0.36, P = .02) in men with ED. Conclusion Our data suggested that cardiac autonomic functions are impaired in patients with ED. A weak correlation between cardiac autonomic dysfunction and low testosterone levels in patients with ED was noted. However, further studies are needed to elucidate the prognostic significance and clinical implications of impaired autonomic functions and testosterone replacement therapy in patients with ED. Kucukdurmaz F, Agar G, Resim S. Deterioration of Chronotropic Responses and Heart Rate Recovery Indices in Men With Erectile Dysfunction. Sex Med 2018;6:8–14.
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Affiliation(s)
- Faruk Kucukdurmaz
- Department of Urology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
| | - Gurkan Acar
- Department of Cardiology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Sefa Resim
- Department of Urology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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Sambel M, Kilic M, Demirbas M, Onen E, Oner S, Erdogan A, Aydos MM. Relationship between erectile dysfunction and the neutrophil to lymphocyte and platelet to lymphocyte ratios. Int J Impot Res 2017; 30:27-35. [DOI: 10.1038/s41443-017-0007-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 06/30/2017] [Accepted: 08/25/2017] [Indexed: 12/22/2022]
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Kilinc MF, Yasar E, Aydin HI, Yildiz Y, Doluoglu OG. Association between coronary artery disease severity and overactive bladder in geriatric patients. World J Urol 2017; 36:35-40. [DOI: 10.1007/s00345-017-2098-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022] Open
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47
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Mobley DF, Khera M, Baum N. Recent advances in the treatment of erectile dysfunction. Postgrad Med J 2017; 93:679-685. [PMID: 28751439 DOI: 10.1136/postgradmedj-2016-134073] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 02/21/2017] [Accepted: 04/23/2017] [Indexed: 01/01/2023]
Abstract
Erectile dysfunction (ED) is one of the most common conditions affecting middle-aged and older men. Nearly every primary care physician, internist and geriatrician will be called upon to manage this condition or to make referrals to urologists, endocrinologists and cardiologists who will assist in the treatment of ED. This article will briefly discuss the diagnosis and management of ED. In addition, emerging concepts in ED management will be discussed, such as the use of testosterone to treat ED, the role of the endothelium in men with ED and treating the partner of the man with ED. Finally, future potential therapies for ED will be discussed.
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Affiliation(s)
- David F Mobley
- Department of Urology, Weill-Cornell Medicine, Houston, Texas, USA
| | - Mohit Khera
- Department of Urology, Baylor College of Medicine, Houston, Texas, USA
| | - Neil Baum
- Department of Urology, Tulane Medical School, New Orleans, Louisiana, USA
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48
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Gür Ö, Gurkan S, Yumun G, Turker P. The Comparison of the Effects of Nebivolol and Metoprolol on Erectile Dysfunction in the Cases with Coronary Artery Bypass Surgery. Ann Thorac Cardiovasc Surg 2017; 23:91-95. [PMID: 28302931 PMCID: PMC5422634 DOI: 10.5761/atcs.oa.16-00242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/29/2016] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Beta-blocker use is common in the cases with coronary artery bypass surgery. According to the literature, beta-blockers have positive effects but may cause erectile dysfunction (ED). The most commonly used beta-blockers in ischemic cardiac disease are nebivolol and metoprolol. In our clinic, we aimed to compare the effects of nebivolol and metoprolol succinate on ED in the sexually active cases with coronary artery bypass surgery. METHODS In our clinic, a total of 119 patients with coronary artery bypass surgery were included in the study. International Index of Erectile Function (IIEF-5) Test was used to evaluate whether the patients had ED and to grade the cases. RESULTS No significant difference was found in terms of anti-ischemic efficacy between metoprolol succinate and nebivolol in the postoperative period; however, the incidence of any grade ED was %85.96 in Group 1, %83.87 in Group 2. This difference was considered as statistically significant (p = 0.036). CONCLUSION Beta-blocker use increases the risk of ED in cases with ischemic cardiac disease. We suggest that the complaints of ED could be less frequent with nebivolol use in sexually active cases with ischemic cardiac disease.
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Affiliation(s)
- Özcan Gür
- Department of Cardiovascular Surgery, Namik Kemal University, Tekirdag, Turkey
| | - Selami Gurkan
- Department of Cardiovascular Surgery, Namik Kemal University, Tekirdag, Turkey
| | - Gunduz Yumun
- Department of Cardiovascular Surgery, Namik Kemal University, Tekirdag, Turkey
| | - Polat Turker
- Department of Urology, Namik Kemal University, Tekirdag, Turkey
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49
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2016 European Guidelines on cardiovascular disease prevention in clinical practice. Int J Behav Med 2017; 24:321-419. [DOI: 10.1007/s12529-016-9583-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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50
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Zhang Z, Xu Z, Dai Y, Chen Y. Elevated serum homocysteine level as an independent risk factor for erectile dysfunction: a prospective pilot case-control study. Andrologia 2016; 49. [PMID: 27709655 DOI: 10.1111/and.12684] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 12/20/2022] Open
Abstract
Homocysteine is an amino acid that is produced from the metabolic demethylation of dietary methionine. It has gained arising attention for its association with increased risk of myocardial infarction, stroke and venous thromboembolism. Erectile dysfunction (ED), especially for vasculogenic ED, is a vascular disorder of cavernosal vascular bed. In this prospective pilot case-control study, we investigated plasma homocysteine levels in 32 ED patients and 20 healthy control men. Related patients characteristics including age, weight, height, marital status, smoking and drinking status, level of education were collected and analysed as well as penile colour Doppler ultrasound parameters. ED patients were further categorised into mild, moderate and severe ED based on 5-item of the International Index of Erectile Function. Higher homocysteine levels were observed in ED patients as compared with controls (p < .05). A multivariate logistic regression with likelihood ratio test revealed that homocysteine and penile peak systolic blood flow velocity (PSV) levels posed significant indicators for ED (chi-square of likelihood ratio = 20.42, df = 2, p < .005) as well as moderate and severe ED occurrence (chi-square of likelihood ratio = 28.50, df = 2, p < .005). The threshold value of homocysteine concentration to discriminate ED and control subjects was 12.65 μmol/L by performing receiver operating characteristic curve analyses. These data suggested that elevation of homocysteine levels was associated with an increased risk of ED.
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Affiliation(s)
- Z Zhang
- Department of Andrology, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Z Xu
- Department of Andrology, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Y Dai
- Department of Andrology, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Y Chen
- Department of Andrology, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, China
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