The International Index of Erectile Function (IIEF)—A Systematic Review of Measurement Properties

Sexual health and emotional wellbeing of patients with haematological malignancies: general review

Sexual health is an important aspect of a person's life. Many patients and haematologists believe that intimacy and sexuality issues are substantial during cancer treatment. The haematological cancer disease, diagnosis, shock of the announcement, treatment, and follow-up appointments, can all have negative effects on the quality of life of patients, their partners, other family members, and friends. Addressing the intimate aspects of patients' lives not only enhances their wellbeing but also contributes to the quality of their survivorship. Progress has been made in the management of sexual life-related complications; however, novel strategies in coordination with a multidisciplinary team need to be implemented. New and comprehensive approaches must be developed on a multidisciplinary scale. In this Series paper, we discuss the factors affecting the sexual life of patients with haematological malignancies, different methods to assess sexual function, as well as management approaches of sexual wellbeing among patients with haematological cancers.

Effect of indwelling ureteral stents on sexual function: a real-world observational study

BACKGROUND

Ureteral DJ stents are commonly used devices in urology. However, stent placement may cause LUTS and affect the quality of life. We evaluated the direct relationship between ureteral stents and sexual function.

METHODS

From October 2022 to December 2023, 82 male and 90 female sexually active patients who underwent ureteroscopy at Beijing Tiantan Hospital, Capital Medical University, were enrolled. The basic information, surgical data, and two questionnaire data including the International Index of Erectile Function-5 and the Female Sexual Function Index of patients before the operation (baseline, T0), on the day of the ureteral DJ tube extraction (T1), and 4 weeks after ureteral DJ tube extraction (T2) were collected to analyze the changes in the patients' sexual function.

RESULTS

The average age of male patients was 36 years and of female patients 39 years. Before the ureteral DJ stent placement, the mean ± SD IIEF-5 score was 22.86 ± 0.91, and the average FSFI score was 31.66 ± 1.44. On the day of the ureteral DJ stent removal, the IIEF-5 score was 16.37 ± 2.62 (p < 0.01) and the FSFI score was 15.83 ± 4.05 (p < 0.01). Four weeks after ureteral DJ stent removal, the average IIEF-5 score was 22.77 ± 1.06 (p = 0.61) and the average FSFI score was 30.99 ± 1.79 (p = 0.78).

CONCLUSIONS

Indwelling ureteral stents after ureteroscopy can temporarily affect the sexual function of both male and female patients, typically recovering within 4 weeks after stent removal.

A contemporary review of the treatments and challenges associated with penile rehabilitation after radical prostatectomy including a proposed optimal approach

Prostate cancer is one of the most prevalent malignancies affecting men worldwide. Despite advancements in understanding prostate anatomy and minimally invasive approaches to surgical treatment, surgery can have significant adverse effects on sexual function. Penile rehabilitation strategies have emerged as a promising approach to mitigate the impact of prostate cancer treatments on erectile function and improve quality of life. Several methods have been employed for penile rehabilitation, including pharmacotherapy, vacuum erection devices, intracavernous injections, and emerging novel techniques. Yet, there is no consensus on the exact programs or timing of initiation that should be utilized for optimal recovery after surgery. This review discusses various rehabilitation protocols and long-term outcomes and explores the cost-effectiveness of different interventions. Additionally, this review discusses the importance of a multidisciplinary approach to penile rehabilitation which includes patient education, counseling, and the selection of an appropriate rehabilitation strategy tailored to each individual's needs and preferences. Continued research and collaboration among healthcare professionals are essential to refine rehabilitation approaches and ensure optimal outcomes for patients with prostate cancer.

Effectiveness of continuous positive airway pressure therapy on romantic relationships and intimacy among individuals with obstructive sleep apnea: A systematic review and a meta-analysis

Obstructive sleep apnea is a common yet often overlooked chronic sleep disorder with significant health implications globally. Bedpartners play a vital role in motivating individuals with obstructive sleep apnea to seek medical help, though their sleep quality may suffer, straining the couple's relationship. From September 2023 to January 2024, utilizing PubMed, Scopus, BioMed Central, Cochrane Library, ScienceDirect and www.clinicaltrials.gov databases, this systematic review meticulously examined data from 27 studies to investigate how continuous positive airway pressure therapy, recognized as the gold-standard for treating obstructive sleep apnea, may positively influence psychological dynamics within couples. Additionally, a meta-analysis was conducted on nine studies, to assess the effect of continuous positive airway pressure on erectile function, which is often compromised in patients with obstructive sleep apnea. The PRISMA checklist and specific quality assessments were followed to ensure methodological rigour and transparency. Findings reveal positive changes in conflict resolution for patients with obstructive sleep apnea post- continuous positive airway pressure adaptation (p < 0.05). Emotional functioning (p = 0.002) and social relationships (p < 0.001) also show improvements in bedpartners. While six subjective assessments indicate enhancements in sexual quality of life for patients with obstructive sleep apnea, challenges related to continuous positive airway pressure use as a barrier to intimacy are acknowledged. Focusing on male patients with obstructive sleep apnea, findings demonstrated a substantial improvement in erectile function post-continuous positive airway pressure utilization, with a Z-score of 4.84 (p < 0.00001). Female patients with obstructive sleep apnea using continuous positive airway pressure show no significant improvements in sexual functioning, while female bedpartners report positive changes. These insights emphasize the importance of holistic approaches in addressing the impact of obstructive sleep apnea on both individuals and their relationships.

Impact of cardiac rehabilitation on erectile dysfunction in cardiovascular patients: a systematic review and meta-analysis

Background

Cardiovascular diseases (CVDs) and erectile dysfunction (ED) frequently co-occur, significantly affecting the quality of life of individuals.

Aim

To assess the impact of cardiac rehabilitation (CR) on ED in patients with CVD through a systematic review and meta-analysis.

Methods

This study analyzed randomized controlled trials and other studies comparing CR with usual care for adult males (≥18 years) with any cardiac disease. Literature searches were extensive, and the risk of bias was evaluated by the Cochrane Collaboration tool. Data from 6 studies involving 668 participants were included in the meta-analysis.

Outcomes

The primary outcome was the improvement in ED, as measured with the International Index of Erectile Function.

Results

A statistically significant improvement in erectile function was observed across 6 studies, with a Morris dppc2 effect size of 0.38 (95% CI, 0.17-0.59). Despite initial high heterogeneity (I 2 = 95.7%), identification and correction for selective outcome reporting bias mitigated this issue.

Clinical Translation

CR has a modest but statistically significant impact on improving ED in patients with CVD, indicating its potential positive contribution to the quality of life of this group.

Strengths and Limitations

The study's strengths include a comprehensive literature search and a rigorous methodological approach. Limitations involve high heterogeneity among studies and a low level of evidence due to small sample sizes and study quality; however, the source of heterogeneity was identified and mitigated following risk-of-bias assessment.

Conclusion

The results suggest that CR has a statistically significant but modest impact on improving ED in patients with CVD. Clinicians should consider the integration of CR into the clinical management of these individuals. This study underscores the potential for CR to contribute positively to the quality of life for patients with CVD by addressing associated ED (PROSPERO: CRD42022374625).

Prospective Evaluation of Sexual Dysfunction in Men With Chronic Pancreatitis: A Pilot Study

OBJECTIVE

Our study aimed to determine the prevalence of sexual dysfunction (SD) and its association with quality of life (QOL) in men with chronic pancreatitis (CP).

MATERIALS AND METHODS

Male patients with CP were prospectively enrolled in our pancreas center and completed the following 4 validated questionnaires: International Index of Erectile Function 5, Erectile Hardness Score, Pancreatitis Quality of Life Instrument, and Short Form Survey. Patients were classified as having mild, moderate, or severe SD based on review of questionnaires.

RESULTS

Thirty patients were enrolled in the study, of which 18 patients had SD (mild in 9, moderate in 1, and severe in 8 patients). No significant differences were seen demographic or clinical characteristics in patients with and without SD. Patients with SD had more abdominal pain compared with those without SD (94.4% vs 83.3%, P = 0.001). No significant differences were noted in QOL metrics between the 2 groups.

CONCLUSIONS

This pilot study shows that SD is present in 60% males with CP. No difference was noted in the QOL of patients with and without SD, albeit limited by our small sample size. Physicians caring for CP patients should routinely inquire for symptoms of SD and offer a urology referral if indicated.

Do oral antiviral drugs used in the treatment of chronic hepatitis B cause erectile dysfunction?

OBJECTIVE

The effect of antiviral drugs on the erectile dysfunction (ED) problem expressed by some patients using antiviral drugs due to chronic hepatitis B infection (HBV) was investigated.

METHODS

A total of 102 male patients receiving antiviral therapy for HBVinfection without any known non-cirrhotic and comorbid disease that may cause ED and whodon't use any drugs with an ED formation potential were analyzed through the InternationalIndex of Erectile Function test.

RESULTS

Among the patients admitted to the study, anxiety disorder was detected as 24.5% (n = 25) and depression as 46.1% (n = 47). 70.6% (n = 72) of the patients suffered ED. Severe ED was only detected in 3 (n = 2.9%) patients. ED was detected in 70.6% of the entecavir, 64.2% of tenofovir, and 80% of Tenofovir alafenamide users ( P  = 0.287). On the other hand, the logistics regression analysis revealed that the most important factors that increase the risk of ED are age (>55 age; RR: 2.66; P  < 0.001), and anxiety disorder (RR: 2.30; P  < 0.0001). The cumulative effect of antiviral drugs on ED was 5.7% (RR: 0.8; P  = 0.156).

CONCLUSION

We could not find any mounting evidence relating to the effect ofcommonly used antiviral drugs for hepatitis B causing ED. The incidence rate of ED on ourpatients was at a similar rate with population studies in the literature based on society. It is notappropriate to terminate antiviral therapy in hepatitis B for this reason.

Patient-reported outcome measures compared to clinician reported outcomes regarding incontinence and erectile dysfunction in localized prostate carcinoma after robot assisted radical prostatectomy: Impact on management

PURPOSE/ BACKGROUND

Patient-reported outcome measures (PROMs) are widely used after robot assisted radical prostatectomy (RARP) in order to evaluate the impact/burden of the treatment. The most bothersome side effects of RARP are urine incontinence (UI) and erectile dysfunction (ED). During the follow up consultations, clinicians report these side effects in interviewing patients. Our study examined the discrepancy between the PROMs and clinician report outcomes (CROs) and hypothesized that the disagreement could have an impact on the management of UI and ED.

METHODS

Up to 1 year after RARP, UI and ED recovery of 312 men with localized and locally advanced prostate cancer were assessed using the International Consultation Incontinence Questionnaire Short-Form (ICIQ-SF) and the International Index of Erectile Function (IIEF-EF) and CROs by interview. Discrepancies between PROs and CROs were studied in light of treatment offered and management.

RESULTS

The ICIQ-SF Score matched with CROs in all sum score categories except in ICIQ sum score 6 to 12; here the UI was underreported by clinicians in 58% and 59% of patients at 8 and 12 months (P < 0.001). Furthermore, at 8 and 12 months postoperatively, clinicians underreported UI in 29% and 23% of patients with ICIQ score 13-18 (P < 0.001). The clinician significantly over-reported the recovery of erectile function ("normal erection") (P < 0.001), especially in men with IIEF-EF sum score 6 to 16. Independently of ICIQ-SF/IIEF-EF scores, discrepancy between PROs and CROs did not affect rate of health care offered to patients.

CONCLUSIONS

This is to our knowledge the first study that compared the PROs with clinician reported functional outcomes and the impact of discrepancies on the management of side effects of RARP in prostate cancer. Observed discrepancies between the PROs and CROs did not affect offered management and counseling of UI and ED.

Efficacy of online cognitive behavioral therapy for nonorganic erectile dysfunction in reproductive-age males during the COVID-19 pandemic: a randomized wait list-controlled trial

BACKGROUND

Previous research has documented the impact of the COVID-19 pandemic on male sexual and mental health. However, no prior study has evaluated the efficacy of online cognitive behavioral therapy (CBT) during the COVID-19 pandemic for treating nonorganic erectile dysfunction (ED) by improving negative emotions and self-esteem.

AIM

To test the efficacy of online CBT for nonorganic ED during the COVID-19 pandemic in Shanghai, China.

METHODS

A randomized controlled trial was conducted during the COVID-19 pandemic. Paired t-tests and 1-way analysis of variance were used to analyze and compare erectile functioning, self-esteem, and emotional state between and within groups.

OUTCOMES

The main outcome measures included scores on the 5-item International Index of Erectile Function, Rosenberg Self-esteem Scale, 9-item Patient Health Questionnaire, and 7-item Generalized Anxiety Disorder scale to evaluate erectile functioning, self-esteem, depression, and anxiety, respectively.

RESULTS

In the CBT group, erectile functioning, intercourse satisfaction, orgasmic functioning, sexual desire, and overall satisfaction were significantly improved at posttreatment as compared with pretreatment (P < .05). After treatment, group differences in emotional state and self-esteem were observed between the CBT group and the control group. Results revealed that the CBT group had significantly better scores than the control group at posttreatment on the Rosenberg Self-esteem Scale (mean ± SD, 30.43 ± 6.51 vs 22.67 ± 10.74), Patient Health Questionnaire (7.07 ± 2.74 vs 11.07 ± 4.41), and Generalized Anxiety Disorder scale (8.36 ± 1.97 vs 11.13 ± 3.94; P < .05).

CLINICAL IMPLICATIONS

This study represents an important advance in understanding of the efficacy of online CBT for treating nonorganic ED in reproductive-age males during the COVID-19 pandemic.

STRENGTHS AND LIMITATIONS

The study participants, treatment modality, and COVID-19 pandemic background of this study are innovative and therefore strengths. However, our study has several limitations-namely, its sample size and use of self-report data to measure erectile functioning due to the pandemic. Further studies should incorporate sexual functioning-monitoring instruments as well as self-report data to measure erectile function.

CONCLUSION

Online CBT clearly improved the emotional state and self-esteem of patients with ED during the COVID-19 pandemic.

Patient-reported outcomes for people with diabetes: what and how to measure? A narrative review

Patient-reported outcomes (PROs) are valuable for shared decision making and research. Patient-reported outcome measures (PROMs) are questionnaires used to measure PROs, such as health-related quality of life (HRQL). Although core outcome sets for trials and clinical practice have been developed separately, they, as well as other initiatives, recommend different PROs and PROMs. In research and clinical practice, different PROMs are used (some generic, some disease-specific), which measure many different things. This is a threat to the validity of research and clinical findings in the field of diabetes. In this narrative review, we aim to provide recommendations for the selection of relevant PROs and psychometrically sound PROMs for people with diabetes for use in clinical practice and research. Based on a general conceptual framework of PROs, we suggest that relevant PROs to measure in people with diabetes are: disease-specific symptoms (e.g. worries about hypoglycaemia and diabetes distress), general symptoms (e.g. fatigue and depression), functional status, general health perceptions and overall quality of life. Generic PROMs such as the 36-Item Short Form Health Survey (SF-36), WHO Disability Assessment Schedule (WHODAS 2.0), or Patient-Reported Outcomes Measurement Information System (PROMIS) measures could be considered to measure commonly relevant PROs, supplemented with disease-specific PROMs where needed. However, none of the existing diabetes-specific PROM scales has been sufficiently validated, although the Diabetes Symptom Self-Care Inventory (DSSCI) for measuring diabetes-specific symptoms and the Diabetes Distress Scale (DDS) and Problem Areas in Diabetes (PAID) for measuring distress showed sufficient content validity. Standardisation and use of relevant PROs and psychometrically sound PROMs can help inform people with diabetes about the expected course of disease and treatment, for shared decision making, to monitor outcomes and to improve healthcare. We recommend further validation studies of diabetes-specific PROMs that have sufficient content validity for measuring disease-specific symptoms and consider generic item banks developed based on item response theory for measuring commonly relevant PROs.

Sex-related quality of life after total laryngectomy for cancer

OBJECTIVES

Analysis of the quality of sexual life after total laryngectomy (TL) for cancer.

MATERIAL AND METHODS

The Cochrane, PubMed, Embase, ClinicalKey and Science Direct databases were searched using the keywords: "total laryngectomy, sexual function, sexual behavior, sexual complications, sexual dysfunction, sexuality, intimacy". The abstracts of 69 articles were read by two of the authors and 24 articles were selected. The main endpoint was the impact of impairment of quality of sexual life after TL for cancer and the methods used to assess this. The secondary endpoints were the type of sexual impairment, associated variables and their treatment.

RESULTS

The study population consisted of 1511 TL patients aged 21 to 90 years, with a male/female sex ratio of 7.49. One of the 7 validated Likert scales was used in 79% of the articles to evaluate impairment of sexual quality of life. Impaired quality of sexual life was reported by 47% of patients on average (range, 5-90%). Erectile and ejaculatory function and ejaculatory behavior of male patients decreased after TL. Other impairments comprised decreases in libido, frequency of sexual intercourse and satisfaction. Tracheostomy, advanced disease stage, young age and associated depression were factors for impairment. In all, 23% of patients reported lack of postoperative support in this area.

CONCLUSION

The quality of sexual life is severely impacted by TL for cancer. The present data are a source of information and should be taken into account before carrying out TL. A common information tool needs to be developed. There is patient demand for improved management of sexuality.

Prevalence and risk factors of erectile dysfunction in COVID-19 patients: a systematic review and meta-analysis

PURPOSE

Studies have found that erectile dysfunction (ED) may be a short-term or long-term complication in coronavirus disease 2019 (COVID-19) patients, but no relevant studies have completed a pooled analysis of this claim. The purpose of the review was to comprehensively search the relevant literature, summarize the prevalence of ED in COVID-19 patients, assess risk factors for its development, and explore the effect of the COVID-19 infection on erectile function.

METHODS

Medline, Embase, and the Cochrane Library was performed from database inception until April 14, 2022. Heterogeneity was analyzed by χ² tests and I² was used as a quantitative test of heterogeneity. Subgroup analyses, meta-regression, and sensitivity analyses were used to analyze sources of heterogeneity.

RESULTS

Our review included 8 studies, 4 of which functioned as a control group. There were 250,606 COVID-19 patients (mean age: 31-47.1 years, sample size: 23-246,990). The control group consisted of 10,844,200 individuals (mean age: 32.76-42.4 years, sample size 75-10,836,663). The prevalence of ED was 33% (95% CI 18-47%, I² = 99.48%) in COVID-19 patients. The prevalence of ED based on the international coding of diseases (ICD-10) was 9% (95% CI 2-19%), which was significantly lower than the prevalence of ED diagnosed based on the International Index of Erectile Function (IIEF-5) (46%, 95% CI 22-71%, I² = 96.72%). The pooling prevalence of ED was 50% (95% CI 34-67%, I² = 81.54%) for articles published in 2021, significantly higher than that for articles published in 2022 (17%, 95% CI 7-30%, I² = 99.55%). The relative risk of developing ED was 2.64 times in COVID-19 patients higher than in non-COVID-19 patients (RR: 2.64, 95% CI 1.01-6.88). The GRADE-pro score showed that the mean incidence of ED events in COVID-19 patients was 1,333/50,606 (2.6%) compared with 52,937/844,200 (0.4%) in controls; the absolute impact of COVID-19 on ED was 656/100,000 (ranging from 4/100,000 to 2352/100,000). Anxiety (OR: 1.13, 95% CI 1.03-1.26, I² = 0.0%) in COVID-19 patients was a risk factor for ED.

CONCLUSION

COVID-19 patients have a high risk and prevalence of ED, mainly driven by anxiety. Attention should be paid to patient's erectile functioning when treating COVID-19.

Do colorectal cancer patients with a postoperative stoma have sexual problems? A pooling up analysis of 2566 patients

PURPOSE

This study aimed to evaluate the effect of the stoma on sexual function in colorectal cancer patients.

METHODS

Search strategy was conducted in four databases including PubMed, Embase, the Cochrane Library, and Medline on Nov 20, 2022. After that, the quality of eligible studies was assessed by the Newcastle Ottawa Scale (NOS) and the Agency for Healthcare Research Quality (AHRQ). In order to evaluate the sexual function between the stoma group and the non-stoma group, mean values and standard deviation were pooled for scores in questionnaires, and odds ratio and 95% confidence intervals were pooled for self-designed problems. Results were shown in forest plots; Egger's test and the trim and fill analysis were used for assessing the publication bias. All the data analyses above were performed by STATA 16.0 software.

RESULTS

Six cohort studies and three cross-sectional studies were included for this pooling up analysis. As for the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-C38), male patients with stomas had more sexual problems (mean differences = 0.32, 95% confidence intervals = 0.01 to 0.63, I² = 67.80%, P = 0.05); however, other indicators including sexual functioning, sexual enjoyment, and female sexual problems had little difference between the two groups. As for other questionnaires and problems, stoma did not have an impact on sexual function.

CONCLUSION

The stoma after surgery was not significantly associated with the sexual function of female patients with colorectal cancer and was associated with worse scores on only sexual problems for males.

Evaluation of sexual functional status and consistency of scales in patients with hypogonadotropic hypogonadism before and after testosterone replacement therapy: a single-center experience

Objective

This study aimed to investigate the frequency of sexual dysfunction and the effect of short-term testosterone replacement therapy on sexual functions in congenital hypogonadism patients. Furthermore, we sought to reveal the consistency of the self-report scales used for the diagnosis of sexual dysfunction and the relationship between biochemical parameters.

Materials and methods

The study was conducted on 47 young male patients aged above 18 years who were diagnosed with hypogonadotropic hypogonadism. Short (IIEF-5) and long (IIEF-15) forms of the International Index of Erectile Function and Arizona Sexual Experiences Scale (ASEX) were applied before treatment under the supervision of a physician. The patients' blood pressure, height, and weight were measured, and their luteinizing hormone (LH), FSH, and total testosterone levels were recorded. Patients who started their treatments were called for a follow-up checkup after 6 months. Their blood pressure, height, and weight were measured by reapplying the ASEX, IIEF-5, and IIEF-15. In addition, their LH, FSH, and total testosterone levels in the biochemical tests were rerecorded.

Results

In this study, the sexual dysfunction status of patients diagnosed with hypogonadotropic hypogonadism before and after treatment was evaluated using the ASEX, IIEF-15, and IIEF-5 scales. A decrease in sexual dysfunction was observed in all three scales after treatment compared with that before treatment. The IIEF-5 and IIEF-15 scales were found to be uncorrelated in terms of the pretreatment values but were correlated in terms of the post-treatment values. Although a correlation was observed between ASEX and IIEF- 5 before treatment, no correlation was detected between ASEX and IIEF-15. After the treatment, ASEX was found to be correlated with both IIEF-5 and IIEF-15. The results of the scales indicated the correlation in all categories, except the pretreatment results of the IIEF-15 scale.

Conclusion

The results of the current study demonstrated a significant improvement in the sexual function of hypogonadism patients undergoing short-term testosterone therapy. The ASEX, IIEF-5, and IIEF-15 scales used in the diagnosis and follow-up of sexual dysfunction were useful for evaluating sexual functions in hypogonadotropic hypogonadism patients.

The Spanish Version of the International Index of Erectile Function: Adaptation and Validation

BACKGROUND

The International Index of Erectile Function (IIEF) is a widely employed questionnaire in urology to assess erectile dysfunction (ED) in both clinical research and practice.

OBJECTIVE

To translate and culturally adapt the Spanish version of the International Index of Erectile Function (IIEF) and to analyze its psychometric properties in Spanish men with erectile dysfunction (ED).

METHODS

Firstly, direct and reverse translations were performed. Secondly, a pilot study was carried out on 23 patients with the lowest possible education level without being illiterate. Finally, 170 participants completed the IIEF. Test-retest reliability, internal consistency and construct validity (exploratory factor analysis) were assessed. Concurrent and divergent validity were evaluated with the Hospital Anxiety and Depression Scale (HADS) and the 12-item Short-Form Health Survey (SF-12), respectively. Discriminant validity (with and without anxiety or depression) was calculated using a receiver-operating characteristic curve analysis.

RESULTS

High internal consistency (Cronbach's alpha = 0.968, total score) and moderate-to-excellent test-retest reliability were found. The factor analysis showed a two-factor structure (explained variance of 77.34%). Significant correlations of the IIEF total score (p < 0.01) and domains (p < 0.05) with HADS anxiety and depression scores were observed (concurrent validity), while non-significant correlations with SF-12 physical and mental summary scores were found (divergent validity). The IIEF total score could discriminate between participants with and without anxiety (p < 0.05) and depression (p < 0.01), with an optimal cut-off point of <39.50 for both anxiety (48.30% sensitivity and 78.75% specificity) and depression (50.00% sensitivity and 81.01% specificity).

CLINICAL IMPLICATIONS

The psychometric properties of the IIEF have not been analyzed in Spanish people to date. Strengths and Limitations: The Spanish version of the IIEF was shown to be capable of discriminating between men with erectile dysfunction with and without depression or anxiety. There are some limitations to this study that should be noted. It was conducted on Spanish participants, and, thus, it should be employed with caution in other Spanish-speaking countries. This study was carried out on a selected population, and, therefore, the generalizability of its results to other populations might be limited. Moreover, a large majority of the participants (89.41%) had secondary or higher education. Future studies should be performed on a more general population with a varied geographical and educational background.

CONCLUSIONS

The Spanish IIEF is a valid and reliable instrument for assessing erectile function among Spanish men with ED.

Sexual Function of Male Survivors of Hematological Malignancy Treated by Autologous Hematopoietic Stem Cell Transplantation: A Multicenter Controlled Observational Study

A multicenter, observational, cross-sectional study was conducted to assess the sexual function of male survivors of hematological malignancy treated by autologous hematopoietic stem cell transplantation (AHSCT) and to compare it with that of healthy male controls. By convenience sampling, 71 sexually active male survivors of hematological malignancy who underwent AHSCT were recruited, as well as 74 healthy men. A questionnaire with demographic and clinical data and the International Index of Erectile Function (IIEF) were completed. Survivors had a median age of 47 years, a median time since transplant of 3 years, and 46.5% had Hodgkin lymphoma. Based on the IIEF, they had a high level of sexual function, with best functioning domain "erection" and worst "overall satisfaction". Healthy men had statistically significantly higher scores in all domains of the IIEF, except for "orgasm" (p = 0.205). There was a statistically significant association between sexual function and age (p < 0.0005), years since transplantation (p = 0.006), functional status (p < 0.0005), having children (p < 0.0005), relationship status (p = 0.001), education (p < 0.0005), diagnosis (p < 0.0005) and disease relapse (p = 0.017). Multivariate analysis showed that only age was a strong prognostic factor of sexual function (p < 0.0005). After age was excluded from the model, because of the strong effect it had on the dependent variable, functional status (p = 0.015), education (p = 0.002) and diagnosis (p = 0.001) had a statistically significant association with sexual function. These findings indicate the importance of sexual function for survivors' well-being and the need for implementation of integrated care plans for survivors of hematological malignancy.

Effects of non-invasive spinal cord stimulation on lower urinary tract, bowel, and sexual functions in individuals with chronic motor-complete spinal cord injury: Protocol for a pilot clinical trial

INTRODUCTION

Electrical spinal cord neuromodulation has emerged as a leading intervention for restoring autonomic functions, such as blood pressure, lower urinary tract (LUT), bowel, and sexual functions, following spinal cord injury (SCI). While a few preliminary studies have shown the potential effect of non-invasive transcutaneous spinal cord stimulation (tSCS) on autonomic recovery following SCI, the optimal stimulation parameters, as well as real-time and long-term functional benefits of tSCS are understudied. This trial entitled "Non-invasive Neuromodulation to Treat Bladder, Bowel, and Sexual Dysfunction following Spinal Cord Injury" is a pilot trial to examine the feasibility, dosage effect and safety of tSCS on pelvic organ function for future large-scale randomized controlled trials.

METHODS AND ANALYSIS

Forty eligible participants with chronic cervical or upper thoracic motor-complete SCI will undergo stimulation mapping and assessment batteries to determine the real-time effect of tSCS on autonomic functions. Thereafter, participants will be randomly assigned to either moderate or intensive tSCS groups to test the dosage effect of long-term stimulation on autonomic parameters. Participants in each group will receive 60 minutes of tSCS per session either twice (moderate) or five (intensive) times per week, over a period of six weeks. Outcome measures include: (a) changes in bladder capacity through urodynamic studies during real-time and after long-term tSCS, and (b) resting anorectal pressure determined via anorectal manometry during real-time tSCS. We also measure assessments of sexual function, neurological impairments, and health-related quality of life using validated questionnaires and semi-structured interviews.

ETHICS AND DISSEMINATION

Ethical approval has been obtained (CREB H20-01163). All primary and secondary outcome data will be submitted to peer-reviewed journals and disseminated among the broader scientific community and stakeholders.

Potential biomarkers for distinguishing primary from acquired premature ejaculation: A diffusion tensor imaging based network study

Introduction

Premature ejaculation (PE) is classified as primary and acquired and may be facilitated by different pathophysiology. Brain plays an important role in PE, however, differences in the central neuropathological mechanisms among subtypes of PE are unknown.

Materials and methods

We acquired diffusion tensor imaging (DTI) data from 44 healthy controls (HC) and 47 PE patients (24 primary PE and 23 acquired PE). Then, the whole-brain white matter (WM) structural networks were constructed and between-group differences of nodal segregative parameters were identified by the method of graph theoretical analysis. Moreover, receiver operating characteristic (ROC) curves were performed to determine the suitability of the altered parameters as potential neuroimaging biomarkers for distinguishing primary PE from acquired PE.

Results

PE patients showed significantly increased clustering coefficient C(i) in the left inferior frontal gyrus (triangular part) (IFGtriang.L) and increased local efficiency E_loc(i) in the left precental gyrus (PreCG.L) and IFGtriang.L when compared with HC. Compared to HC, primary PE patients had increased C(i) and E_loc(i) in IFGtriang.L and the left amygdala (AMYG.L) while acquired PE patients had increased C(i) and E_loc(i) in IFGtriang.L, and decreased C(i) and E_loc(i) in AMYG.L. Compared to acquired PE, primary PE patients had increased C(i) and E_loc(i) in AMYG.L. Moreover, ROC analysis revealed that PreCG.L, IFGtriang.L and AMYG.L might be helpful for distinguishing different subtypes of PE from HC (PE from HC: sensitivity, 61.70–78.72%; specificity, 56.82–77.27%; primary PE from HC: sensitivity, 66.67–87.50%; specificity, 52.27–77.27%; acquired PE from HC: sensitivity, 34.78–86.96%; specificity, 54.55–100%) while AMYG.L might be helpful for distinguishing primary PE from acquired PE (sensitivity, 83.33–91.70%; specificity, 69.57–73.90%).

Conclusion

These findings improved our understanding of the pathophysiological processes that occurred in patients with ejaculatory dysfunction and suggested that the abnormal segregation of left amygdala might serve as a useful marker to help clinicians distinguish patients with primary PE from those with acquired PE.

Focal Therapy for Prostate Cancer: The Impact on Sexual Function

Focal therapy (FT) has emerged as a potential treatment for localized prostate cancer (PCa) with encouraging functional outcomes. According to the compelling evidence based on meta-analyses and recent trials, erectile function (EF) is mostly retained at 6 and 12 months after FT when compared to baseline. These findings are consistent across different energy sources reported to date. However, overall, quality of life, including impotence, was not the endpoint for most studies. Additionally, impotency has not been consistently reported in most of the recent literature. Furthermore, confounding factors such as baseline potency and usage of phosphodiesterase 5 inhibitors (PDE5-I) were also frequently undisclosed. Long-term functional outcomes are awaited. To fully comprehend how FT affects EF, more extensive long-term randomized clinical trials using EF as a primary outcome are needed.

Influence of holmium laser enucleation of the prostate on erectile function: results of a multicentric analysis of 235 patients

PURPOSE

Preserved sexual function is one of the endpoints of the surgical management of lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Our aim was to investigate the evolution of erectile function (EF) at 3 and 12 months after holmium laser enucleation of the prostate (HoLEP).

METHODS

A multicentric retrospective study was performed including 235 sexually active patients who underwent HoLEP between January 2016 and June 2017. Evaluation of EF was carried out with the five-item version of the International Index of Erectile Function (IIEF-5) completed before surgery and at 3 and 12 months after surgery. A change of more than five points in either direction in the IIEF-5 score compared to baseline was considered as an improvement or impairment of EF.

RESULTS

No significant differences were found between median pre-operative IIEF-5 and median scores at 3 and 12 months (p  =  0.15 and p  =  0.45). At 3 and 12 post-operative months, respectively, 10% and 13% of patients reported an improvement, whereas 15% and 16% reported an impairment. The reduction in IIEF-5 score was only statistically significant within the sub-group of patients with normal pre-operative EF (p < 0.001). In this sub-group, 15% of patients reported a decrease of more than five points in total IIEF-5 score.

CONCLUSION

This multicentric evaluation confirmed that median IIEF-5 score was not significantly impaired after HoLEP. However, for patients with normal pre-operative EF, a significant decrease in EF after HoLEP was observed. These results may be taken into account when counselling patients before HoLEP.

Cutting the First Turf to Heal Post-SSRI Sexual Dysfunction: A Male Retrospective Cohort Study

Post-SSRI sexual dysfunction (PSSD) is a set of heterogeneous sexual problems, which may arise during the administration of selective serotonin reuptake inhibitors (SSRIs) and persist after their discontinuation. PSSD is a rare clinical entity, and it is commonly associated with non-sexual concerns, including emotional and cognitive problems and poor quality of life. To date, however, no effective treatment is available. The aim of this study was to retrospectively evaluate the potential efficacy of the different treatments used in clinical practice in improving male PSSD. Of the 30 patients referred to our neurobehavioral outpatient clinic from January 2020 to December 2021, 13 Caucasian male patients (mean age 29.53 ± 4.57 years), previously treated with SSRIs, were included in the study. Patients with major depressive disorder and/or psychotic symptoms were excluded a priori to avoid overlapping symptomatology, and potentially reduce the misdiagnosis rate. To treat PSSD, we decided to use drugs positively affecting the brain dopamine/serotonin ratio, such as bupropion and vortioxetine, as well as other compounds. This latter drug is known not to cause or reverse iatrogenic SD. Most patients, after treatment with vortioxetine and/or nutraceuticals, reported a significant improvement in all International Index of Erectile Function-(IIEF-5) domains (p < 0.05) from baseline (T0) to 12-month follow-up (T1). Moreover, the only patient treated with pelvic muscle vibration reached very positive results. Although our data come from a retrospective open-label study with a small sample size, drugs positively modulating the central nervous system serotonin/dopamine ratio, such as vortioxetine, could be used to potentially improve PSSD. Large-sample prospective cohort studies and randomized clinical trials are needed to investigate the real prevalence of this clinical entity and confirm such a promising approach to a potentially debilitating illness.

NeuroSAFE PROOF: study protocol for a single-blinded, IDEAL stage 3, multi-centre, randomised controlled trial of NeuroSAFE robotic-assisted radical prostatectomy versus standard robotic-assisted radical prostatectomy in men with localized prostate cancer

BACKGROUND

Robotic radical prostatectomy (RARP) is a first-line curative treatment option for localized prostate cancer. Postoperative erectile dysfunction and urinary incontinence are common associated adverse side effects that can negatively impact patients' quality of life. Preserving the lateral neurovascular bundles (NS) during RARP improves functional outcomes. However, selecting men for NS may be difficult when there is concern about incurring in positive surgical margin (PSM) which in turn risks adverse oncological outcomes. The NeuroSAFE technique (intra-operative frozen section examination of the neurovascular structure adjacent prostate margin) can provide real-time pathological consult to promote optimal NS whilst avoiding PSM.

METHODS

NeuroSAFE PROOF is a single-blinded, multi-centre, randomised controlled trial (RCT) in which men are randomly allocated 1:1 to either NeuroSAFE RARP or standard RARP. Men electing for RARP as primary treatment, who are continent and have good baseline erectile function (EF), defined by International Index of Erectile Function (IIEF-5) score > 21, are eligible. NS in the intervention arm is guided by the NeuroSAFE technique. NS in the standard arm is based on standard of care, i.e. a pre-operative image-based planning meeting, patient-specific clinical information, and digital rectal examination. The primary outcome is assessment of EF at 12 months. The primary endpoint is the proportion of men who achieve IIEF-5 score ≥ 21. A sample size of 404 was calculated to give a power of 90% to detect a difference of 14% between groups based on a feasibility study. Oncological outcomes are continuously monitored by an independent Data Monitoring Committee. Key secondary outcomes include urinary continence at 3 months assessed by the international consultation on incontinence questionnaire, rate of biochemical recurrence, EF recovery at 24 months, and difference in quality of life.

DISCUSSION

NeuroSAFE PROOF is the first RCT of intra-operative frozen section during radical prostatectomy in the world. It is properly powered to evaluate a difference in the recovery of EF for men undergoing RARP assessed by patient-reported outcome measures. It will provide evidence to guide the use of the NeuroSAFE technique around the world.

TRIAL REGISTRATION

NCT03317990 (23 October 2017). Regional Ethics Committee; reference 17/LO/1978.

Association between erectile dysfunction, cardiovascular risk factors, and coronary artery disease: Role of exercise stress testing and International Index of Erectile Function (IIEF-5) questionnaire

Background

The exercise stress test (EST) is a non-invasive investigation to diagnose coronary artery disease. This research aimed to determine the relationship between erectile dysfunction (ED), cardiovascular risk factors, and coronary artery disease (CAD) in men referred for EST.

Methods

A prospective cohort study enrolling 303 patients from August 2020 through September 2021. All patients filled out the international Index of Erectile Function (IIEF-5) questionnaire. . They underwent an exercise stress test (EST). A two-tailed independent sample t-test, chi-square tests, and binary logistic regression were used for statistical analysis.

Results

EST was positive in 110 (36.3%) patients, negative in 154 (50.8%), and inconclusive in 39 (12.8%) patients. ED was present in 225 (74.3%) patients and absent in 78 (25.8%) patients. 278 (91.7%) had one or more cardiovascular risk factors. This study reported a significant relationship between diabetes mellitus (DM), hypertension (HTN), and the results of EST and ED. Compared to patients without ED, patients with ED had a positive EST result. Definite CAD was diagnosed in 21% of patients with ED compared to 1.3% in patients without ED. For a one-unit increase in age, the odds of ED increased by about 5%. Similarly, a negative EST is compared to a positive EST. Negative EST reduced the likelihood of ED by 82%.

Conclusions

This research found a statistically significant connection between CAD, certain cardiovascular risk factors, and ED using the EST and IIEF-5 questionnaires. This research is significant because it may alter the way cardiovascular risk stratification is done.

Spanish Cross-Cultural Validation of the Electronic Version of the International Index of Erectile Function-5 (IIEF-5)

The IIEF-5 questionnaire is a validated scale used as a diagnostic tool in erectile dysfunction (ED). This simplified version includes five items that focus on erectile function and satisfaction during sexual intercourse; it has favourable properties for detecting the presence and severity of erectile dysfunction The main objective of this study was to make a cross-cultural adaptation to Spanish of the IIEF-5 scale and to evaluate its psychometric properties of validity, reliability, and feasibility in the Spanish population. Validation of the IIEF-5 included: (i) professional translation of the scale; (ii) scientific evaluation of the translation; (iii) professional retranslation; (iv) assessment of 10 individuals to test correct comprehension and idiomatic adequacy; (v) validation of the IIEF-5 by an online survey. The study sample consisted of 100 participants, who received the online form either directly or through other participants who distributed it. Participants obtained a mean score of 22.3 (SD 2.7), implying normal erectile function. However, 23 results of mild dysfunction (n = 23) and 2 of mild to moderate dysfunction (5.1%) were identified. A Cronbach’s alpha coefficient of 0.75 was obtained for the total of the final questionnaire, indicating high reliability. Validity analysis had a value of 0.784 (>0.5) and was therefore considered appropriate. The IIEF-5 scale is a reliable tool to test ED, and its Spanish version is satisfactorily understood by patients.

Mirabegron for treatment of erectile dysfunction concomitant with lower urinary tract symptoms in patients with benign prostatic obstruction: A randomized controlled trial

OBJECTIVE

To assess the efficacy of mirabegron in the treatment of erectile dysfunction concomitant with lower urinary tract symptoms in benign prostatic obstruction patients.

METHODS

In this randomized controlled trial, 55 sexually active lower urinary tract symptoms/benign prostatic obstruction patients with concomitant erectile dysfunction were randomly allocated in two groups: the first received mirabegron 50 mg plus doxazosin 2 mg once daily (mirabegron group) and the second received tolterodine 4 mg plus doxazosin 2 mg (tolterodine group) for 12 weeks. The evaluation was based on the International Index of Erectile Function questionnaire, Erection Hardness Score questionnaire, International Prostate Symptom Score, quality of life, uroflowmetry and post-voiding residual. The therapeutic outcomes were assessed at 4 and 12 weeks compared with the baseline.

RESULTS

Only the mirabegron group achieved significant improvement in sexual functions after 4 and 12 weeks. By using ≥5 points difference from the baseline as a cut-off point of change, there was a significant difference in change of direction of the International Index of Erectile Function-15 total score in favor of the mirabegron group; after 12 weeks, the International Index of Erectile Function-15 total score decreased in 0%, was unchanged in 8.3% and improved in 91.7% in the mirabegron group compared with 8.7%, 65.2% and 26.1%, respectively, in the tolterodine group (P < 0.001). Regarding the urinary characteristics, both groups showed significant improvement in the International Prostate Symptom Score, quality of life, and post-voiding residual after 4 and 12 weeks, with no significant difference among them.

CONCLUSION

Mirabegron improves urinary characteristics and the associated sexual dysfunction in patients with lower urinary tract symptoms/benign prostatic obstruction.

Effect of tadalafil combined with atorvastatin on hemodynamics and sexual function in middle-aged and elderly patients with hyperlipidemia complicated with erectile dysfunction

Objective:

To evaluate the effect and clinical significance of tadalafil combined with atorvastatin on hemodynamics and sexual function in middle-aged and elderly patients with hyperlipidemia complicated with Erectile dysfunction (ED).

Methods:

Eighty patients with hyperlipidemia complicated with ED who were treated at The Second Hospital of Hebei Medical University from January 2019 to June 2020 were selected. Using a completely randomized design experimental method, these 80 patients were randomly divided into two groups: the experimental group and the control group, with 40 cases in each group. The control group was treated with a single drug, atorvastatin calcium, while the experimental group was given tadalafil orally on the basis of the control group for 3 months. Changes in the levels of inflammatory factors such as IL-6, TNF and CRP, adverse drug reactions, changes in hemodynamic indicators such as HSV, LSV, PSV, HCT and ESR before and after treatment, as well as changes in sexual function after treatment were compared and analyzed between the two groups.

Results:

TNF-a, CRP and IL-6 in the experimental group were significantly lower than those in the control group after treatment, with statistically significant differences (p<0.05). There was no significant difference in the incidence of adverse drug reactions between the two groups (p=0.18). After treatment, hemodynamic indexes and sexual function indexes of the experimental group were significantly improved compared with those in the control group, with statistically significant differences (p<0.05).

Conclusion:

A significant improvement effect can be achieved by tadalafil combined with atorvastatin on hemodynamics and sexual function in middle-aged and elderly patients with hyperlipidemia complicated with ED. At the same time, the combination of the two has synergism on inflammatory factors and blood rheology, and the incidence of adverse reactions is not significantly increased.

Colombian Clinical Validation of the International Index of Erectile Function (IIEF-5)

Background

Erectile dysfunction represents an important health problem and the instrument most frequently used for the evaluation of its evaluation is the International Index of Erectile Function (IIEF-5).

Aim

Due to lack of adaptation and validation for Spanish-speaking populations, this study aimed to adapt and validate the Colombian version of International Index of Erectile Function (IIEF-5).

Methods

Two independent samples were evaluated. One used to validate the scale and the other to calculate cut-off point of this version, with 2,021 men from the general population and outpatients from a clinic. The age range was 18 to 75 years old (M = 37.80; SD = 14.06). The second sample included 74 men, 64.9% did not meet DSM-5 criteria for erectile dysfunction, and 35.1% meet DSM-5 criteria to ED. Age range was 19 to 73 years old (M = 40.38; SD = 13.22).

Outcomes

All participants answered the Spanish versions of the International Index of Erectile Function-5 (IIEF-5) and the Massachusetts General Health-Sexual Functioning Questionnaire.

Results

The Colombian version of IIEF-5 showed adequate psychometric properties, confirmed the one-dimension factorization of the scale, and showed adequate evidence of reliability and validity. Significant differences were observed in the IIEF-5 total score between the non-clinical and clinical groups who meet DSM-5 criteria for erectile dysfunction, with a large effect size. Also, the cut-off the Colombian version was set to 16, with an area under the curve of 94.9%.

Clinical Implications

The Colombian version of the IIEF-5 is a useful evaluation instrument that provides to determine the presence of erectile dysfunction compatible with DSM-5 criteria.

Strengths & Limitations

The inventory reports adequate psychometric properties, a confirmed one-dimensional structure, evidence of reliability and validity, and the first cut-off point for Hispanic populations. A more in-depth evaluation of the diagnosis of ED and thus replication in other Spanish-speaking countries and sexual minorities is recommended.

Conclusion

The Spanish version of the IIEF-5 is a useful evaluation tool for identifying erectile dysfunction, following DSM-5 criteria.

Vallejo-Medina P, Saffon JP, Álvarez-Muelas A Colombian Clinical Validation of the International Index of Erectile Function (IIEF-5). Sex Med 2022;10:100461.

Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction

Background: Erectile dysfunction (ED) remains an emotional wrench to patients and a therapeutic challenge to urologists in andrology clinics worldwide. This is, in part, related to refraction to, or transient effect of phosphodiesterase 5 inhibitors (PDE5i), coupled with patients’ dissatisfaction with this treatment modality. Low-intensity extracorporeal shockwave therapy (Li-ESWT) is an evolving treatment option, with promising curative potential. Current international guidelines are inconclusive, bear weak recommendation strength, and lack ethnogeographic consensus. Objectives: This study evaluated the safety, efficacy, and effect duration of Li-ESWT, as well as exploring disease-associated determinants of treatment success in Taiwanese males with ED. Methods: A cohort of 69 eligible cases treated with 12 sessions of Li-ESWT and followed up for at least 12 months after treatment, between January 2018 and December 2019 at our medical facility, was used. The present single-center, retrospective, non-randomized, single-arm study employed standardized erectile function evaluation indices, namely, the five-item International Index of Erectile Function (IIEF-5) and Erection Hardness Score (EHS). Clinicopathological analyses of selected variables and comparative analyses of time-phased changes in the EF indices relative to baseline values were performed. Evaluation of treatment success was based on minimal clinically important difference (MCID), using a binomial logistic regression model. Results: The median age and duration of ED for our Taiwanese cohort were 55 years and 12 months, respectively, and an average of 31.3% presented with co-morbidities. The mean improvement in IIEF-5, EHS, and quality of life (QoL) domain scores relative to the baseline values was statistically very significant (p < 0.001) at all indicated follow-up time-points. When stratified, Taiwanese patients with severe and moderate ED benefited more from Li-ESWT, compared with those in the mild or mild-to-moderate group. Patients’ pre-Li-ESWT PDE5i response status was not found to significantly influence Li-ESWT response. Univariate analysis showed that age > 45 years (p = 0.04), uncontrolled diabetes mellitus (p = 0.04), and uncontrolled hyperlipidemia (p = 0.01) were strongly associated with Li-ESWT efficacy; however, only age > 45 years (p = 0.04) and uncontrolled hyperlipidemia (p = 0.03) were found to be independent negative predictors of Li-ESWT success by the multivariate logistic model. Follow-up was uneventful, with no treatment-related adverse events or side effects reported. Of the treated patients, 86.1% indicated satisfaction with the treatment regimen, and over 90% indicated they would recommend the same therapy to others. Conclusions: Li-ESWT is a safe and efficacious therapeutic modality for Taiwanese patients with ED. Uncontrolled hyperlipidemia and age > 45 years are independent negative predictors of treatment success for this cohort.

Associations Between Online Pornography Consumption and Sexual Dysfunction in Young Men: Multivariate Analysis Based on an International Web-Based Survey

BACKGROUND

Expanding access to the internet has resulted in more and earlier consumption of online pornography. At the same time, a higher prevalence of erectile dysfunction (ED) among young men is seen. Increased pornography consumption has been suggested as a possible explanation for this rise.

OBJECTIVE

The aim of this study was to better understand associations between problematic pornography consumption (PPC) and ED.

METHODS

A 118-item survey was published online, and data collection took place between April 2019 and May 2020. Of the 5770 men who responded, the responses from 3419 men between 18 years old and 35 years old were analyzed. The survey used validated questionnaires such as the Cyber Pornography Addiction Test (CYPAT), International Index of Erectile Function (IIEF-5), and Alcohol Use Disorders Identification Test-Concise (AUDIT-C). The estimated amount of porn watching was calculated. Univariable and multivariable analyses were performed. For the multivariable analysis, a logistic regression model using a directed acyclic graph was used.

RESULTS

According to their IIEF-5 scores, 21.48% (444/2067) of our sexually active participants (ie, those who attempted penetrative sex in the previous 4 weeks) had some degree of ED. Higher CYPAT scores indicating problematic online pornography consumption resulted in a higher probability of ED, while controlling for covariates. Masturbation frequency seemed not to be a significant factor when assessing ED.

CONCLUSIONS

This prevalence of ED in young men is alarmingly high, and the results of this study suggest a significant association with PPC.

TRIAL REGISTRATION

Research Registry researchregistry5111; https://tinyurl.com/m45mcaa2.

Detailing Sexual Outcomes After Focal Therapy for Localised Prostate Cancer: A Systematic Review and Meta-analysis

CONTEXT

Focal therapy has emerged as a promising option to treat well-selected men with localised prostate cancer while preserving healthy prostate tissue and key structures, such as the urethral sphincter and neurovascular bundles. However, how this tissue preservation may translate into improved outcomes, particularly into improved sexual outcomes, is still an active research field.

OBJECTIVE

We conducted a systematic review and meta-analysis of the literature to summarise the existing evidence, in order to provide patients with updated data on what to expect after treatment and help identify gaps in current knowledge that may warrant future research.

EVIDENCE ACQUISITION

A systematic literature search was conducted on Medline, EMBASE, Scopus, and Web of Science. The search strategy was defined using the "litsearchr" function in R based on a preliminary "naïve" search using the following terms on Medline: (("focal therapy" OR "focal treatment") AND ("prostate cancer") AND ("sexual function" OR "erectile function")). A total of 42 studies, comprising 3117 patients treated and 2352 with available sexual outcomes, were included in the qualitative data synthesis and 26 in a random-effect meta-analysis.

EVIDENCE SYNTHESIS

The five-item International Index of Erectile Function (IIEF-5) was the most frequently used questionnaire (30/42 studies), with completion rates ranging from 24% to 100% at 18-24 mo. A decrease was noted at 3 mo (IIEF-5 decrease estimate -3.70 [95% confidence interval -4.43, -2.96]), with improvements at 6 mo (-2.18 [-2.91, -1.46]) and 12 mo (-2.14 [-2.96, -1.32]). Studies in which patients had an altered baseline sexual function were more likely to report a significant and durable postoperative decrease in erectile function scores. The patient-reported outcome questionnaires used were not designed for a diverse population. Functional outcomes were not the primary endpoint and have not been reported consistently in most studies considered.

CONCLUSIONS

Focal therapy led to changes in erectile function in most cases under the significance threshold of the patient-reported outcome questionnaires used. However, patients should be counselled according to their baseline erectile function. More research is warranted to detail aspects other than erectile function, such as ejaculation or orgasm. The early postoperative period appears key to study sexual changes after focal therapy, while only a moderate decrease is expected at 12 mo.

PATIENT SUMMARY

We reviewed the published literature detailing the sexual consequences of focal therapy for localised prostate cancer using patient-reported outcome questionnaires. Patients were likely to describe a significant decrease in their erectile function at 3 mo, with improvements noted at 6 and 12 mo. The results obtained may not be reproducible in a more diverse population, and further research is warranted to better study aspects other than erectile function, such as ejaculation or orgasm.

Efficacy and safety of aildenafil citrate in Chinese men with erectile dysfunction: a multicenter, randomized, double-blind, placebo-controlled crossover trial

Background

To evaluate the efficacy and safety of aildenafil citrate in the treatment of erectile dysfunction (ED) in Chinese population.

Methods

A multicenter, randomized, double-blind, placebo-controlled, double-cycle crossover trial was conducted in three medical centers. Male patients with mild to moderate ED were randomized into two groups and received either aildenafil citrate or placebos, followed by a crossover administration after a 7-day washout. The primary outcome was the duration of penile rigidity over 60% measured by RigiScan^® Plus. Main secondary outcomes were the duration of penile rigidity over 80% and erectile hardness score (EHS).

Results

A total of 60 patients with mild to moderate ED were enrolled in the study and 57 of them completed the trial (30 in the aildenafil group and 27 in the placebo group). The median duration of penile tip rigidity over 60% was 4.25 (0.00, 19.00) min in the aildenafil group, as compared with 0.50 (0.00, 2.75) min in the placebo group (P<0.001). The median duration of penile base rigidity over 60% was 3.25 (0.00, 12.50) min in the aildenafil group, as compared with 0.00 (0.00, 2.50) min in the placebo group (P<0.001). The duration of penile base rigidity over 80% was significantly increased in the aildenafil group versus the placebo group (P=0.002). The EHS was significantly improved in the aildenafil group (P<0.001). No severe adverse events associated with aildenafil citrate occurred in both groups.

Conclusions

These results suggested that aildenafil citrate was efficient and well-tolerated in the treatment of Chinese men with mild to moderate ED.

Trial Registration

Chinese Clinical Trial Registry ChiCTR1900026025.

Increased attentional network activity in premature ejaculation patients with anxiety revealed by resting-state functional magnetic resonance imaging

Psychological account hypothesizes that premature ejaculation (PE) is a learned pattern of rapid ejaculation maintained by anxiety about sexual failure, whereas neuropsychological accounts hypothesizes that PE is the result of dysfunction of central nervous system regulating ejaculatory. However, the central neural mechanism underlying PE patients with anxiety remains unclear. Resting-state functional magnetic resonance imaging (fMRI) data were collected in 20 PE (diagnoses based on PE Guidelines drafted by the International Society for Sexual Medicine [ISSM]) patients with anxiety and 25 matched healthy controls (HCs) from January 2019 to December 2020. The values of fractional amplitude of low-frequency fluctuation (fALFF) were compared between groups. Moreover, the correlations between fALFF and the severity of PE and anxiety of patients were examined. PE patients with anxiety had increased fALFF values in the right inferior frontal gyrus (opercular part) and middle frontal gyrus. In addition, significant positive correlations were found between the scores of PE diagnostic tool (PEDT) and fALFF values of the right inferior frontal gyrus (opercular part), as well as the right middle frontal gyrus. Moreover, fALFF values of the right inferior frontal gyrus (opercular part) and middle frontal gyrus were positively correlated with the scores of self-rating anxiety scale (SAS). Our results suggested that increased attentional network activity might play a critical role in the neural basis of PE patients with anxiety.

Cavernous artery intima-media thickness predicts the response to sildenafil in erectile dysfunction patients as a morphological parameter

While the intima-media thickness (IMT) of the cavernous artery was used for diagnosis for vascular erectile dysfunction (ED) with more accuracy than the peak systolic velocity, the role of the IMT in predicting treatment responses remained unexamined. A total of 136 patients with ED were enrolled. The baseline clinical and laboratory characteristics were collected. Penile Doppler ultrasonography (PDU) was performed on all patients by a blinded sonographer. Sildenafil was administrated to all patients with an adjusted dose of 50 or 100 mg on demand over a period of 3 months. A follow-up was conducted on all patients using the Erectile Hardness Score (EHS) questionnaire along with the visual and tactile version of the standardised EHS tool. The peak systolic velocity (PSV) and IMT were compared between sildenafil responders and sildenafil nonresponders, while receiver operator characteristic (ROC) curves were used to calculate the cut-off values and compare the test power respectively. There was no statistical difference from the baseline characteristics. The IMT of cavernous artery was more accurate than PSV to predict the sildenafil response (AUC = 0.809, 0.626 respectively). IMT could predict sildenafil responders more accurately than PSV, and the cut-off value of the IMT of the cavernous artery was less than 0.22 mm.

Quantification of penile fat infiltration using the mDIXON Quant sequence: a pilot study on the correlation with penis hardness and erectile dysfunction

OBJECTIVE

The purpose of this study was to determine fat/water signal ratios using the mDIXON Quant sequence, quantitatively assess fat infiltration in the penis, and explore its possible relationship with penile hardness and erectile dysfunction.

METHODS

Routine pelvic MRI with the mDIXON Quant sequence was performed in 62 subjects, including 22 people in the normal group, 20 people in the normal erectile hardness group, and 20 people in the erectile dysfunction (ED) group. The fat/water signal ratio in the penis was measured using the mDIXON Quant sequence. Shear wave elastography was used to evaluate the hardness of the corpus cavernosa of the penis.

RESULTS

The fat/water signal ratio of the corpus spongiosum was significantly lower than that of the corpus cavernosa in the normal group (p = 0.03) and ED group (p < 0.01). There was no significant difference in the fat/water signal ratios between the normal group and the normal erectile hardness group. Fat infiltration was significantly lower, and erectile hardness was significantly higher in the normal erectile hardness group than in the ED group, and the fat infiltration in the left and right corpus cavernosa was inversely proportional to the erectile hardness of the penis.

CONCLUSION

This study suggests that mDIXON Quant can be used as a non-invasive, quantitative, and objective method for evaluating penile fat infiltration. This method could help diagnose penile fat infiltration in patients with erectile dysfunction and varying body mass indexes. Our results could also allow for a more accurate diagnosis and monitoring of erectile hardness function by quantitatively measuring penile fat infiltration.

ADVANCES IN KNOWLEDGE

(1) The proton density fat fraction technology is a new tool for the objective, quantitative and non-invasive evaluation of penile fat infiltration. (2) The quantitative measurement of fat infiltration in the corpora cavernosa might help diagnose and monitor penile erection hardness and its function more accurately.

Chronic primary or secondary non-inflammatory musculoskeletal pain is associated with disrupted sexual function and relationships: a systematic review

OBJECTIVE

Evidence points to the impact of chronic musculoskeletal pain conditions on sexual function, yet there is little systematic appraisal and synthesis of evidence examining these associations across non-inflammatory conditions. We aimed to systematically review evidence surrounding the association between chronic primary and secondary musculoskeletal pain with intimate relationships and sexual function.

METHODS

Four electronic databases were searched from 1^st January 1990 to 5^th September 2019 for cross-sectional or prospective epidemiologic and qualitative studies among cohorts with chronic primary or secondary non-inflammatory musculoskeletal pain, defined by ICD-11 classification criteria.

RESULTS

Fifty-one eligible studies were included (46 quantitative, 3 qualitative, 2 mixed-methods designs). Sample sizes ranged from 13 to 12,377 and mean age from 32.6 to 69.2 years. Cross-sectional controlled cohort studies consistently reported poorer sexual function outcomes among cohorts with pain relative to comparison groups. Of 15 studies reporting outcomes for the Female Sexual Function Index, 14 demonstrated mean scores ≤26.55 for the pain group, indicating sexual dysfunction. In four studies reporting the International Index of Erectile Function, the pain cohorts demonstrated consistently lower mean subscale scores and the erectile function subscale scores were ≤25.0, indicating erectile dysfunction. Three key themes emerged from a meta-synthesis of qualitative studies: impaired sexual function; compromised intimate relationships; and impacts of pain on sexual identity, body image and self-worth.

CONCLUSION

Sexual dysfunction and negative impacts on intimate relationships are highly prevalent among people with chronic non-inflammatory musculoskeletal pain. Consideration of these associations is relevant to the delivery of holistic, person-centred musculoskeletal pain care.

Discordant erectile function assessment between validated questionnaire scores and penile Doppler ultrasound in Peyronie's disease

Peyronie's disease results in curvature of the penis which may cause difficulty with penetrative intercourse. The diagnosis of Peyronie's disease is easily obtained through history and physical examination alone, but the severity of erectile dysfunction relies on patient history and use of validated questionnaires. However, erectile dysfunction questionnaires were not validated in the Peyronie's disease population and may not be a reliable assessment. Penile Doppler ultrasound is a noninvasive tool that assesses vascular function. We hypothesized that penile Doppler ultrasound will be discordant with International Index of Erectile Function (IIEF) results in men with Peyronie's disease and erectile dysfunction. In this cross-sectional study, we reviewed a prospectively collected database of men with Peyronie's disease. In total, 108 men had questionnaire and ultrasound data. Of them, 87 had erectile dysfunction based on IIEF-EF or IIEF-5 (SHIM). However, 48 (55%) of those men had normal vascular parameters. Interestingly, among a subgroup of 33 men with severe erectile dysfunction on IIEF-EF or IIEF-5, 20 (61%) had normal vascular parameters. Our study demonstrates significant discordance between questionnaires and penile Doppler ultrasound. Therefore, ultrasound may be a useful tool in the workup of men with Peyronie's disease and erectile dysfunction.

Assessment methods in sexual rehabilitation after stroke: a scoping review for rehabilitation professionals

PURPOSE

The aim was to identify and describe the assessment methods used by rehabilitation professionals to evaluate sexuality for individuals post-stroke, as well as the domains of sexuality addressed.

METHODS

Seven databases were selected for this scoping review. Articles needed to meet these inclusion criteria: published studies with a sample of ≥ 50% stroke clients and describing a quantitative or qualitative assessment method that could be used by rehabilitation professionals. This study was conducted following the PRISMA guidelines and domains of sexuality were categorized using the ICF core set for stroke.

RESULTS

Of the 2447 articles reviewed, the 96 that met the selection criteria identified a total of 116 assessment methods classified as standardized assessment tools (n = 62), original questionnaires (n = 28), semi-structured interviews (n = 16) or structured interviews (n = 10). Sexual functions were predominantly assessed using standardized tools, while intimate relationships and partner's perspective were generally addressed more by original questionnaires and qualitative methods. A stepwise approach combining relevant assessment methods is presented.

CONCLUSIONS

Individually, these diverse assessment methods addressed a limited scope of relevant domains. Future research should combine quantitative and qualitative methods to encompass most domains of sexuality of concern to post-stroke individuals.IMPLICATIONS FOR REHABILITATIONMost of the studies reviewed here used quantitative methods to assess sexuality, rather than qualitative methods, and mostly used standardized assessment tools.Few assessment methods covered all domains related to sexuality.Qualitative methods and standardized assessment tools were shown to be complementary, therefore emphasizing the added value of mixed methods in assessing sexuality after a stroke.Among the methods that were reviewed, certain would be more suitable for the identification of the need to address sexuality (e.g., Life Satisfaction Checklist-11) and others to assess more thoroughly sexuality (e.g., Change in Sexual Functioning Questionnaire (CSFQ-14)).

Erectile dysfunction and coronary artery calcification in incident dialysis patients

PURPOSE

Erectile dysfunction, which has been associated with mortality in the general population, is common in individuals on hemodialysis. Our aim was to determine the relationship between erectile dysfunction, coronary artery calcification and mortality in incident hemodialysis patients.

MATERIALS AND METHODS

A prospective cohort of incident adult dialysis patients with no history of coronary artery disease underwent coronary artery calcification measurement by ECG-triggered multi-slice computed tomography (MSCT) scan at baseline and at least 12 months later. Erectile dysfunction was determined using the 15-item validated International Index of Erectile Function (IIEF-15) questionnaire.

RESULTS

Erectile dysfunction was prevalent in 83% of patients, with 43% classified as severe erectile dysfunction, 22.4% as moderate erectile dysfunction, and 17.2% as mild erectile dysfunction. The median (IQR) coronary artery calcification score was 43.4 (0.25-353.8) for those with erectile dysfunction and 0 (0-0) for those without erectile dysfunction (p = 0.007). More than half (55.6%) of the patients with erectile dysfunction experienced progression of coronary artery calcification compared to 14.3% of patients without erectile dysfunction (p = 0.05). Mortality was 21% during an average follow-up of 5.2 (1.3) years. Twenty-three percent of patients with erectile dysfunction died compared to 10% of people without erectile dysfunction (p = 0.4). Erectile dysfunction was not significantly associated with mortality [HR 1.2 (1.3), p = 0.87].

CONCLUSIONS

Erectile dysfunction is common in individuals who start dialysis. It is significantly associated with an increased coronary artery calcification score, however, it is not associated with increased mortality in incident dialysis patients with no history of coronary artery disease.

Validity and reliability of the Indonesian version of the International Index of Erectile Function

Objective:

This study aimed to evaluate the validity and reliability of the Indonesian-translated version of the International Index of Erectile Function (IIEF-15).

Subjects and methods:

A total of 100 male participants were involved in this study. Written consent was given by each participant before filling in the questionnaire. The original main structure and domains were kept in the translated version. Pearson product–moment correlation was used to test the validity of the results. The reliability was determined based on the Cronbach’s alpha internal consistency measurement and intraclass correlation coefficient.

Results:

The Pearson correlation findings indicate an excellent level of validity compared to the critical value table ( r>0.254, p<0.01). Almost every domain shows excellent internal consistency (α>0.9) and good reliability (0.75<α<0.90) except for sexual desire (α=0.631, r=0.461) and overall satisfaction (α=0.705, r=0.545), which show lower but acceptable consistency as well as moderate reliability, respectively. Overall, the questionnaire exhibits promising consistency (α=0.974) and reliability ( r=0.712).

Conclusion:

The Indonesian version of the IIEF-15 is valid and reliable to be used as both a clinical diagnostic tool and an instrument for further studies focusing on male sexual dysfunction in Indonesia.

Level of evidence:

Not applicable

Effect of lateral lymph node dissection on the quality of life and genitourinary function after neoadjuvant chemoradiotherapy for rectal cancer

Purpose

This study was performed to evaluate the quality of life and genitourinary function after total mesorectal excision with lateral lymph node dissection compared to those after total mesorectal excision alone following neoadjuvant chemoradiotherapy for rectal cancer.

Methods

Among patients who underwent rectal cancer surgery after completing neoadjuvant chemoradiotherapy between September 2011 and October 2018 at the National Cancer Center, Korea, patients who completed the validated questionnaires before initiation of neoadjuvant chemoradiotherapy and at 3 months and 1 year postoperatively were included in this study. The European Organization for Research and Treatment of Cancer (EORTC) core quality of life questionnaire (QLQ-C30), colorectal cancer-specific quality of life questionnaire (QLQ-CR38), and International Prostate Symptom Score (IPSS) questionnaire were used for collecting data.

Results

The total mesorectal excision alone group and the total mesorectal excision with lateral lymph node dissection group included 52 and 38 patients, respectively. The second group included significantly younger patients (P = 0.024), had a higher incidence of clinical T4 stage disease (P = 0.033), estimated blood loss (P = 0.003), and longer operation time (P < 0.001). Significant differences were not observed between the groups with respect to the EORTC QLQ-C30, QLQ-CR38, and IPSS. Multivariable analysis showed that lateral lymph node dissection had no statistically significant association with postoperative urinary dysfunction (P = 0.953).

Conclusion

The overall quality of life and urinary function after total mesorectal excision does not differ significantly when lateral lymph node dissection is performed as well.

International Index of Erectile Functioning-5: A Critical Appraisal

Background:

Some studies have reported methodological flaws and shortcomings in the International Index of Erectile Functioning-5 (IIEF-5) which is a self-report measure for the assessment of erectile dysfunction (ED).

Aim:

The aim of this research is to point out methodological flaws and shortcomings in IIEF-5 when used with Pakistani men.

Settings and Design:

Two independent clinical trials were run to assess the efficacy of different forms of treatment for ED in young Pakistani men.

Materials and Methods:

The IIEF-5 in Urdu version was employed to diagnose and assess the severity of ED in young men at 3 time points.

Results and Conclusions:

Several flaws and shortcomings were noted including the unidimensionality of the scale, categorization of the scale into severity categories based on cutoff points, the inability of the scale to differentiate between organic and nonorganic ED, double barrel item statement, and lack of standardized translation in local or regional languages of Pakistan. The validity of IIEF-5 can be increased if the above-mentioned flaws and shortcomings are addressed.

The relation between sexuality and obesity: the role of psychological factors in a sample of obese men undergoing bariatric surgery

Obesity produces a significant deterioration in general and sexual health. The aim of this cross-sectional study was to investigate the impact of obesity on sexuality, illustrating the psychological constructs that may play a significant role in determining sexual functioning and satisfaction. During the psychological assessment for bariatric surgery eligibility, 171 obese men filled out a socio-demographic questionnaire, the International Index of Erectile Function (IIEF), the 20 Item-Toronto Alexithymia Scale, the Symptom Checklist-90-Revised, the Body Uneasiness Test, and the Obesity-related Disability test. A series of hierarchical multiple regression analyses highlighted how obese men sexual desire (F_(11,159) = 10.128, p < 0.001), erectile function (F_(10,160) = 63.578, p < 0.001), orgasmic function (F_(10,160) = 33.967, p < 0.001), intercourse satisfaction (F_(7,163) = 159.752, p < 0.001), and general satisfaction (F_(10,160) = 18.707, p < 0.001) were significantly associated with other IIEF sexual domains, difficulties in identifying feelings, psychopathological symptoms (such as depression and paranoid ideation), body image, and quality of life. Findings are useful for deepening understanding of obese male sexual response, and more generally, for analyzing the complex and multivariate relation between obesity and sexuality, supporting the need of a multidisciplinary approach to obesity care that includes professionals with specific training in sexology.

Impact of cancer therapy on post-treatment ejaculation disorder and sexual life in testicular cancer survivors

OBJECTIVE

To evaluate the impact of cancer therapy on post-treatment ejaculation in patients with testicular cancer.

METHODS

A total of 74 testicular cancer survivors provided completed International Index of Erectile Function-15 questionnaires before and after treatment between 2010 and 2017. Sexual function, particularly ejaculatory function, was evaluated before and after treatment. In this study, patients who answered "1 = almost never/never" or "2 = a few times" for questionnaire number 9 (ejaculation frequency) were defined as having "ejaculation disorder."

RESULTS

Of 74 testicular cancer survivors, 50 (68%) had no ejaculation disorders before treatment. Four (44%) of nine survivors, who received chemotherapy and retroperitoneal lymph node dissection, developed ejaculation disorders after treatment. On multivariate analysis, retroperitoneal lymph node dissection was a significant predictor of post-treatment ejaculation disorder (P = 0.042). Of 60 survivors with evaluable ejaculation function after treatment, 24 (40%) did not attempt sexual intercourse, and multivariate analysis showed ejaculation disorder had a significant negative impact on having sexual intercourse (P = 0.035). Furthermore, the mean International Index of Erectile Function-15 scores in the groups with and without ejaculation disorders after treatment were 24.0 and 51.9, respectively (P < 0.001).

CONCLUSION

Ejaculation disorders occur at high rate after retroperitoneal lymph node dissection. Many testicular cancer survivors reporting no sexual intercourse have ejaculation disorders, suggesting an adverse impact on sexual life. Urologists should provide proper counselling regarding the risk of ejaculation disorder and its possible impact on sexual life.

Relationship between radiation doses and erectile function deterioration in patients with localized prostate cancer treated with permanent prostate brachytherapy

OBJECTIVES

To investigate the relationship between radiation doses in prostate brachytherapy and deterioration of erectile function in patients with localized prostate cancer.

METHODS

A longitudinal survey study was carried out among 261 prostate cancer patients who received prostate brachytherapy. A total of 48 patients were potent at baseline and they did not receive any supplemental therapy preoperatively. Dosimetry parameters of the whole prostate gland, prostate apex, urethra and rectum were collected using the VariSeed 8.0 treatment planning system (Varian Medical Systems, Palo Alto, CA, USA). We carried out a logistic regression analysis to clarify the relationship between radiation doses and erectile function deterioration, which was assessed using the International Index of Erectile Function-15 questionnaire.

RESULTS

The median patient age was 66 years (range 53-70 years) with a median follow-up time of 44 months (36-71 months). The mean total International Index of Erectile Function-15 score decreased from 49.9 at baseline to 34.7 after 12 months (P < 0.001), but gradually plateaued within 36 months. Erectile function deterioration was noted in 32 (66.7%) patients 36 months after prostate brachytherapy. In an analysis of risk factors for erectile function deterioration after prostate brachytherapy, age ≥70 years (P = 0.029), prostate V100 ≥95% (P = 0.024), apex V100 ≥95% (P = 0.024), apex V150 ≥70% (P = 0.009) and apex D90 ≥150 Gy (P = 0.011) correlated with erectile function deterioration. A multivariate analysis identified an age of ≥70 years (odds ratio 7.91, P = 0.024) and apex V150 ≥70% (odds ratio 7.75, P = 0.007) as independent risk factors for erectile function deterioration after prostate brachytherapy.

CONCLUSIONS

An excessive radiation dose, particularly to the prostate apex area, and an advanced age might have a negative impact on the preservation of potency after prostate brachytherapy.

Clinical effect of computed guided pudendal nerve block for patients with premature ejaculation: a pilot study

Background: Premature ejaculation has a complex etiology, and its pathophysiology is still unclear, with penile hypersensitivity being the most accepted hypothesis. The aim was to investigate the efficacy and safety of a computed tomography-guided pudendal nerve block at the level of the sacrospinous ligament and the Alcock's canal in patients with premature ejaculation refractory to conventional pharmacological treatment.Methods: This is a prospective pilot study involving five patients suffering from premature ejaculation refractory to standard treatment and clinical features of pudendal nerve entrapment. A CT-guided infiltration of ropivacaine and methylprednisone was done at the levels of sacrospinous ligament and Alcock's canal. Intra-vaginal ejaculatory latency time (IELT) was recorded several times for each patient before and after infiltration. International Index of Erectile Function (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT) and Sexual Quality of Life-Male version (SQoL-M) questionnaire were also evaluated before and after infiltration.Results: Overall IELT differed significantly before and after treatment (21.94 vs 215.42 s; p = 0.039). IIEF-5, PEDT and SQoL-M also differed significantly before and after treatment. No complications for the CT-guided infiltration were recorded.Conclusion: CT-guided pudendal nerve block at the sacrospinous ligament and the Alcock's canal was effective in improving premature ejaculation. Therefore, pudendal nerve entrapment may be a curable cause of sensory premature ejaculation.

Evaluation of care given to patients suffering from erectile dysfunction by French urologists in 2018

Erectile dysfunction varied by country, affecting between 20 to 40% of men aged 60 and 69 and more than 50% of men aged over 75. Our objective was to evaluate the habits of urologists in 2018 and also evaluate the need for additional, objective tools to aid physicians when providing care. A questionnaire was sent from the French Urology Association to 1158 physicians between November and December 2018. In all, 177 urologists (15.28%) took part in the study. Only 22% of urologists regularly used a questionnaire, such as the IIEF-5. When faced with erection problems, 56.5% of them did not carry out systematic cardiology evaluations. More than half of urologists requested fasting glucose, lipid and total testosterone levels. Twenty-seven percent did not carry out additional tests. First line treatment included a phosphodiesterase 5 inhibitor in 81% of cases. Two thirds of urologists (78%) rated themselves as being correctly trained in the area of erectile dysfunction. However, only 49% systematically inquired about erection problems when faced with benign prostatic hyperplasia and 65% thought that erectile dysfunction was not treated optimally. Despite existing recommendations, only half of urologists carry out a cardiac evaluation when a finding of erectile dysfunction is made. One third of urologists do not request additional testing. Greater training, along with the use of an objective diagnostic tool could help urologists to optimise the care they provide for patients suffering from erectile dysfunction, allowing them to keep working within current guidelines. LEVEL OF EVIDENCE: 3.

Can subfoveal choroidal thickness replace subjective tests in patients using tadalafil to treat erectile dysfunction?

We aimed to determine the effect on choroidal thickness of daily 5 mg tadalafil use in patients with erectile dysfunction (ED) and to evaluate agreement between short form of International Index of Erectile Function (IIEF 1-5, 15) scores and choroidal thickness during follow-up. Enhanced depth imaging spectral domain-optical coherence tomography (EDI-OCT) was used to measure full choroidal thickness in the subfoveal area, choroidal thickness (CT) and small-choroidal-vessel-layer (SCVL) thickness. Thirty of the 45 patients included complete their follow-ups and exhibited medication continuity. Patients were divided into two groups, five (16.7%) with ED at any level at third-month follow-up, and 25 (83.3%) with no ED, and subgroup analysis was then performed. Median changes in SCVL thickness at first- and sixth-month follow-ups were 20.5 µm versus 9.0 μm (p = .001) and 23.5 µm versus 12.5 µm (p = .005) in patients without and with ED respectively. The SCVL thickness increased by 20 μm compared with the baseline level, indicating an improvement in the patient's complaints of erectile dysfunction. The level of increase in SCVL thickness can be a useful and objective guide to clinicians if they cannot be present when the IIEF questionnaire is administered.

Long-term sexual outcomes in patients with exstrophy-epispadias complex

Exstrophy-epispadias complex (EEC) is a spectrum of genitourinary malformations that ranges in severity and affects external genitalia and the lower urinary tract. The aim of this study was to determine the long-term sexual outcomes of patients with EEC. Sexual outcomes were hypothesized to be related to those of urinary ones. A retrospective database including all patients with EEC who had surgery at a tertiary referral institution from 1990 to 2019 was created. Data based on patient's charts were collected: demographics, surgeries, sexual outcomes, urinary outcomes. Fifty-eight patients with EEC had surgery at tertiary referral institution and entered our database. For this analysis of sexual outcomes, a sub-set of the whole population was selected: patients being 14 years old and older, having at least one surgery at our institution and having at least 12 months of follow-up. Applying this selection criteria to our database resulted in a series of 29 patients. High rates of sexual activity were observed in pubertal and post-pubertal men (96%) and women (75%). Seventy-nine percent of men and 67% of women reported sexual satisfaction; 63% of men reported normal ejaculation. To achieve these rates, 96% of men required surgery (84% penoplasty, 52% phalloplasty), and 25% of women required introitoplasty. Fertility was achieved in 67% of men and 100% of women. Assisted reproductive technology was needed in one man. Continence rates were high (diurnal continence in 83% and nocturnal continence in 93%). However, 76% required multiple continence procedures. Men and women with EEC can have good long-term sexual and urinary outcomes, but this may require multiple surgeries. Good sexual outcomes seem to be related to good urinary and continence outcome.