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Ragab A, Sayed AR, GamalEl Din SF, Zeidan A, Ewis FF, Hamed MA. Evaluation of serum irisin level and severity of erectile dysfunction in diabetic males: a cross sectional prospective study. Diabetol Metab Syndr 2024; 16:233. [PMID: 39294664 PMCID: PMC11412007 DOI: 10.1186/s13098-024-01452-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 08/20/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND Irisin is an exercise-induced myokine that alleviates endothelial dysfunction and reduces insulin resistance in type 2 diabetes mellitus (T2DM). The current study aimed to assess the serum level of irisin in T2DM men with erectile dysfunction (ED) compared to T2DM patients with normal erectile function and healthy controls, as well as investigate the association between serum irisin level and the severity of ED in T2DM patients. PATIENTS AND METHODS A cross-sectional study was conducted on 90 males, divided into three groups: 32 T2DM patients with ED, 24 T2DM patients without ED, and 34 healthy controls. Socio-demographic characteristics and scores of the validated Arabic version of the international Index of Erectile Function-5 (ArIIEF-5), Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were obtained. Furthermore, routine laboratory tests employed for diabetes monitoring and serum levels of total testosterone and irisin were assessed within these groups. RESULTS T2DM men with ED had significantly lower serum levels of irisin and testosterone, as well as a lower ArIIEF-5 score, but their GAD-7 and PHQ-9 scores were significantly higher than those without ED or controls (p < 0.001). Among T2DM men, serum irisin levels positively associated with ArIIEF-5 scores and serum testosterone (r = 0.413, p = 0.002; r = 0.936, p < 0.001, respectively) but negatively associated with glycosylated hemoglobin levels (r = -0.377, p = 0.004). Multivariate regression analysis to predict ED in T2DM patients found that GAD-7 score was the only most significant predictor for ED (ꞵ = - 1.176, standard error = 0.062, p < 0.001). CONCLUSION The current study had demonstrated that irisin positively correlated with the ArIIEF-5 and serum testosterone but negatively correlated with HbA1c in T2DM men. Nevertheless, further validation of these findings is necessary through cohort studies.
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Affiliation(s)
- Ahmed Ragab
- Department of Andrology, Sexology and STDs, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed Reda Sayed
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Sameh Fayek GamalEl Din
- Department of Andrology, Sexology and STDs, KasrAlainy Faculty of Medicine, Cairo University, Al-Saray Street, El Manial, Cairo, 11956, Egypt.
| | - Ashraf Zeidan
- Department of Andrology, Sexology and STDs, KasrAlainy Faculty of Medicine, Cairo University, Al-Saray Street, El Manial, Cairo, 11956, Egypt
| | | | - Mostafa Ahmed Hamed
- Department of Andrology, Sexology and STDs, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Liu YF, Wang HH, Geng YH, Han L, Tu SH, Chen JS, Wen CY. Uncovering the Potential Mechanisms and Effects of Hyperuricemia and its Associated Diseases on Male Reproduction. Reprod Sci 2024; 31:2184-2198. [PMID: 38379071 DOI: 10.1007/s43032-024-01453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/03/2024] [Indexed: 02/22/2024]
Abstract
Male fertility and metabolic disorders, including obesity and diabetes, are closely connected. Since hyperuricemia and metabolic syndrome are strongly related, male fertility and hyperuricemia may, to some degree, be associated. According to recent studies, hyperuricemia imposes various effects on sex hormones, semen quality, and male erectile dysfunction. Some researchers claim that uric acid worsens male semen and raises the risk of erectile dysfunction (ED), while others state that it safeguards both penile erection and male semen. Additionally, it has been shown that gout and metabolic syndrome also raise the risk of ED. To clarify this controversy, the influence and potential mechanisms of hyperuricemia on ED, semen quality, sex hormone levels, and the effects of hyperuricemia-related disorders on ED will be comprehensively summarized.
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Affiliation(s)
- Ya-Fei Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Huan-Huan Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yin-Hong Geng
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liang Han
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng-Hao Tu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian-She Chen
- The Reproduction Center, Henan Provincial Hospital of Traditional Chinese Medicine, Zhengzhou, China
| | - Cai-Yuzhu Wen
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Katsimardou A, Patoulias D, Zografou I, Siskos F, Stavropoulos K, Imprialos K, Tegou Z, Boulmpou A, Georgopoulou V, Hatzipapa N, Papadopoulos C, Doumas M. The Impact of Metabolic Syndrome Components on Erectile Function in Patients with Type 2 Diabetes. Metabolites 2023; 13:metabo13050617. [PMID: 37233658 DOI: 10.3390/metabo13050617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/31/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
Erectile dysfunction is commonly encountered in diabetic patients and in patients with metabolic syndrome; however, only a few studies have assessed patients with metabolic syndrome and type 2 diabetes mellitus (T2DM) regarding their sexual function. The purpose of this study is to examine the effect of metabolic syndrome and its components on the erectile function of T2DM patients. A cross-sectional study including T2DM patients was conducted from November 2018 until November 2020. Participants were evaluated for the presence of metabolic syndrome and their sexual function was assessed using the International Index of Erectile Function (IIEF) questionnaire. A total of 45 consecutive male patients participated in this study. Metabolic syndrome was diagnosed in 84.4% and erectile dysfunction (ED) in 86.7% of them. Metabolic syndrome was not associated with ED or ED severity. Among metabolic syndrome components, only high-density lipoprotein cholesterol (HDL) was associated with ED [x2 (1, n = 45) = 3.894, p = 0.048; OR = 5.5 (95% CI: 0.890-33.99)] and with the IIEF erectile function scores (median 23 vs. 18, U = 75, p = 0.012). Multiple regression analyses showed that HDL was non-significantly associated with the IIEF erectile function scores. In conclusion, among T2DM patients HDL is associated with ED.
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Affiliation(s)
- Alexandra Katsimardou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Dimitrios Patoulias
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Ioanna Zografou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Fotios Siskos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Konstantinos Imprialos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Zoi Tegou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Aristi Boulmpou
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Vivian Georgopoulou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Nikoleta Hatzipapa
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Christodoulos Papadopoulos
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
- Veterans Affairs Medical Center, George Washington University, Washington, DC 20422, USA
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Yıldırım Ç, Salman MY, Yavuz A, Bayar G. Comparison of three different tadalafil regimens for erectile dysfunction treatment in patients with diabetes mellitus microvascular complications. Andrologia 2022; 54:e14536. [DOI: 10.1111/and.14536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/22/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Mehmet Yılmaz Salman
- Urology Department Sancaktepe Martyr Prof Dr Ilhan Varank Training and Research Hospital Istanbul Turkey
| | | | - Göksel Bayar
- Urology Department Gelisim Private Hospital İskenderun Turkey
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Lee YC, Huang SP, Tsai CC, Cheng KH, Juan YS, Wu WJ, Bao BY, Huang CN, Wang CJ, Liu CC. Associations of VEGF Gene Polymorphisms With Erectile Dysfunction and Related Risk Factors. J Sex Med 2017; 14:510-517. [DOI: 10.1016/j.jsxm.2017.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/27/2017] [Accepted: 02/08/2017] [Indexed: 01/08/2023]
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Defeudis G, Gianfrilli D, Di Emidio C, Pofi R, Tuccinardi D, Palermo A, Lenzi A, Pozzilli P. Erectile dysfunction and its management in patients with diabetes mellitus. Rev Endocr Metab Disord 2015; 16:10.1007/s11154-015-9321-4. [PMID: 26497842 DOI: 10.1007/s11154-015-9321-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Diabetes can be described as a syndrome of multiple closely related conditions induced by a chronic state of hyperglycaemia resulting from defective insulin secretion, insulin action or both. Chronic complications associated with diabetes (including neuropathy, vascular disease, nephropathy and retinopathy) are common, and of these, erectile dysfunction (ED) deserves special attention. ED and its correlation with cardiovascular disease require careful evaluation and appropriate treatment. PDE5 inhibitors (PDE5is) are an important tool for the treatment of ED, with new drugs coming onto the market since the late 90s. This review offers an overview of PDE5is and their use in treating ED in diabetes. We underline the differences between different types of PDE5i, focusing on available doses, duration of action, T ½, side effects and selectivity profiles in relation to patients with diabetes. We also discuss the link between diabetes and ED in presence of various associated cofactors (obesity, hypertension and its pharmacological treatments, atherosclerosis, hyperhomocysteinaemia, neuropathy, nephropathy, hypogonadism and depression). Finally a number of past and ongoing clinical trials on the use of PDE5is in patients with diabetes are presented to offer an overview of the appropriate treatment of ED in this condition.
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Affiliation(s)
- Giuseppe Defeudis
- Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 21, Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, Rome, Italy
| | - Chiara Di Emidio
- Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 21, Rome, Italy
| | - Riccardo Pofi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, Rome, Italy
| | - Dario Tuccinardi
- Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 21, Rome, Italy
| | - Andrea Palermo
- Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 21, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, Rome, Italy
| | - Paolo Pozzilli
- Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 21, Rome, Italy.
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Kirilmaz U, Guzel O, Aslan Y, Balci M, Tuncel A, Atan A. The effect of lifestyle modification and glycemic control on the efficiency of sildenafil citrate in patients with erectile dysfunction due to type-2 diabetes mellitus. Aging Male 2015; 18:244-8. [PMID: 26248034 DOI: 10.3109/13685538.2015.1072154] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES We evaluated the effect of lifestyle modifications and glycemic control on the efficiency of sildenafil citrate in patients with type-2 diabetes (T2DM) and erectile dysfunction (ED). METHODS Eighty-three men with ED due to T2DM were included in the study. The Group 1 (n = 41) patients received lifestyle modifications (diet and exercise), and medical treatment for intensive glycemic control. In Group 2 (n = 42), in addition to the intensive glycemic control, the patients were given sildenafil citrate® 100 mg for 2-3 per weeks. The changes in ED were compared between the two groups after three months of treatment. RESULTS The mean age was 54.9 ± 9.1 (26-75) years. An increase in the IIEF-5 scores was observed in 23 of 41 patients in Group 1 (44.2%) and 29 of 42 in Group 2 (55.8%). When the changes of the IIEF-5 scores were evaluated, the mean increase was 2.5 in Group 1, and 5.0 in Group 2 (p = 0.012). The mean IIEF changes according to the duration of diabetes were 4.8 in <5 years, 3.6 in 5-10 years and 1.6 in >10 years (p = 0.021). CONCLUSIONS Glycemic control and lifestyle changes are not solely adequate for a better sexual function in ED due to diabetes, and sildenafil citrate should be used additionally.
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Affiliation(s)
- Utku Kirilmaz
- a Department of Urology , Ankara Numune Research and Training Hospital , Ankara , Turkey
| | - Ozer Guzel
- a Department of Urology , Ankara Numune Research and Training Hospital , Ankara , Turkey
| | - Yilmaz Aslan
- a Department of Urology , Ankara Numune Research and Training Hospital , Ankara , Turkey
| | - Melih Balci
- a Department of Urology , Ankara Numune Research and Training Hospital , Ankara , Turkey
| | - Altug Tuncel
- a Department of Urology , Ankara Numune Research and Training Hospital , Ankara , Turkey
| | - Ali Atan
- a Department of Urology , Ankara Numune Research and Training Hospital , Ankara , Turkey
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Cander S, Coban S, Altuner S, Oz Gul O, Yetgin ZA, Akkurt A, Ucar H, Tuncel E. Prevalence and Correlates of Erectile Dysfunction in Type 2 Diabetes Mellitus: A Cross-Sectional Single-Center Study Among Turkish Patients. Metab Syndr Relat Disord 2014; 12:324-9. [DOI: 10.1089/met.2013.0150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Soner Cander
- Clinic of Endocrinology and Metabolism, Sevket Yilmaz Training and Research Hospital, Bursa, Turkey
| | - Soner Coban
- Clinic of Urology, Sevket Yilmaz Training and Research Hospital, Bursa, Turkey
| | - Sakir Altuner
- Clinic of Internal Medicine, Sevket Yilmaz Training and Research Hospital, Bursa, Turkey
| | - Ozen Oz Gul
- Clinic of Endocrinology and Metabolism, Sevket Yilmaz Training and Research Hospital, Bursa, Turkey
| | - Zeynel Abidin Yetgin
- Clinic of Cardiology, Sevket Yilmaz Training and Research Hospital, Bursa, Turkey
| | - Aysen Akkurt
- Department of Endocrinology and Metabolism, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Hakan Ucar
- Clinic of Cardiology, Sevket Yilmaz Training and Research Hospital, Bursa, Turkey
| | - Ercan Tuncel
- Department of Endocrinology and Metabolism, Uludag University Faculty of Medicine, Bursa, Turkey
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Aslan Y, Guzel O, Balci M, Tuncel A, Yildiz M, Atan A. The impact of metabolic syndrome on serum total testosterone level in patients with erectile dysfunction. Aging Male 2014; 17:76-80. [PMID: 24576299 DOI: 10.3109/13685538.2014.895318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine the association between metabolic syndrome (MetS) and serum testosterone levels (TT) in patients with erectile dysfunction (ED). METHODS This study included 280 ED patients above 40-years-of-age. Participants were divided into two groups according to 2005 criteria of International Diabetes Federation. The severity of ED was determined according to the International Index of Erectile Function-EF (IIEF-EF score; 0-10 severe ED, 11-25 mild to moderate ED). The severity of ED, serum TT levels and other MetS components were compared between the groups. RESULTS The mean age of the patients was 55.7 ± 8.2 years. One hundred eighteen patients (%42.1) had MetS. Sixty-eight patients with MetS (57.6%) and 71 patients without MetS (43.8%) had severe ED (p = 0.031). A total of 46 (16.4%) patients had hypogonadism. Hypogonadism was seen more prevalent in patients with MetS (22.9% vs. 11.7%, p = 0.013). Logistic regression analyses for ED risk factors demonstrated that abnormal FBG increased the relative risk of severe ED up to 10.7-fold (p < 0.001) but not presence of hypogonadism (p = 0.706). CONCLUSION Metabolic syndrome was seen in almost half of the patients with ED. ED was more severe among MetS patients. Hypogonadism alone is a not risk factor for severe ED.
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Affiliation(s)
- Yilmaz Aslan
- Department of Urology, Ankara Numune Research and Training Hospital, Ministry of Health , Ankara , Turkey and
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Balcı M, Aslan Y, Bozarslan B, Tuncel A, Kayalı M, Atan A. The impact of metabolic syndrome on retinal findings in patients with erectile dysfunction. Turk J Urol 2013; 39:22-8. [PMID: 26328073 PMCID: PMC4548575 DOI: 10.5152/tud.2013.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 08/29/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In the present study, we investigated the association between metabolic syndrome (MS) and retinal findings in patients presenting with erectile dysfunction (ED) complaints. MATERIAL AND METHODS A total of 102 patients with ED were included in this study. The patients were divided into two groups according to the National Cholesterol Education Program Adult Treatment Panel - III consensus definition: patients with MS (Group 1, n=62) and patients without MS (Group 2, n=40). The severity of ED was determined according to the first five versions of the International Index of Erectile Function. A detailed fundus examination was performed to evaluate the patients for retinopathy. The patients' retinopathy grades were classified according to the Early Treatment Diabetic Retinopathy Study. RESULTS The mean age of the patients was 51.4 years. Twenty-two patients (35.5%) in Group 1 and nine (22.5%) in Group 2 had severe ED (p=0.241). Ten (16.1%) patients in Group 1 and one (2.5%) patient in Group 2 had any degree of retinopathy (p=0.047). The logistic regression analysis of the correlation between severe ED and MS risk factors revealed that a fasting glucose level (FBG) of >110 mg/dL increased the risk of severe ED by 2.5 times (95% CI 1-6.2, p=0.058). Additionally, the logistic regression analysis of metabolic risk factors showed that only the FBS level was strongly associated with retinopathy, with the relative risk increased to 10.6 (95% CI 1.2-93, p=0.033). CONCLUSION Our results showed that elevated FBG levels were the most critical MS component in the development of severe ED and retinopathy.
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Affiliation(s)
- Melih Balcı
- Third Clinic of Urology, Ankara Numune Research and Training Hospital, Ministry of Health, Ankara, Turkey
| | - Yılmaz Aslan
- Third Clinic of Urology, Ankara Numune Research and Training Hospital, Ministry of Health, Ankara, Turkey
| | - Berçem Bozarslan
- First Clinic of Ophtalmology, Ankara Numune Research and Training Hospital, Ministry of Health, Ankara, Turkey
| | - Altuğ Tuncel
- Third Clinic of Urology, Ankara Numune Research and Training Hospital, Ministry of Health, Ankara, Turkey
| | - Mustafa Kayalı
- Third Clinic of Urology, Ankara Numune Research and Training Hospital, Ministry of Health, Ankara, Turkey
| | - Ali Atan
- Third Clinic of Urology, Ankara Numune Research and Training Hospital, Ministry of Health, Ankara, Turkey
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Ellati RT, Dokun AO, Kavoussi PK, Steers WD, Annex BH, Lysiak JJ. Increased phosphodiesterase type 5 levels in a mouse model of type 2 diabetes mellitus. J Sex Med 2012; 10:362-9. [PMID: 22812665 DOI: 10.1111/j.1743-6109.2012.02854.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Diabetes mellitus (DM) is a major risk factor for developing erectile dysfunction (ED) and men with DM are often less responsive to phosphodiesterase type 5 (PDE5) inhibitors than ED due to other causes. AIMS The aim of this study was to explore potential mechanisms whereby PDE5 inhibitors may have reduced efficacy in type 2 DM. METHODS At 4 weeks of age, mice were either fed a high-fat diet (HFD) for 22-36 weeks or fed regular chow (control). An additional group of mice in the same genetic background had a genetic form of type 1 DM. MAIN OUTCOME MEASURES Glucose tolerance testing, intracorporal pressures (ICPs), oxidative stress (OS), apoptotic cell death (active caspase-3 and apostain), PDE5, p53, and cyclic guanosine monophosphate (cGMP) levels, and histological examination of inflow arteries were performed in mice fed a HFD and control mice. A group of mice with type 1 DM were studied for PDE5 expression levels. RESULTS All mice fed a HFD had impaired glucose tolerance compared with the age-matched mice fed on standard chow diet (control). HFD fed mice had reduced maximum ICPs following in vivo cavernous nerve electrical stimulation and increased apoptotic cell death, OS, and p53 levels in the corporal tissue. Interestingly, PDE5 levels were increased and cGMP levels were decreased. In contrast, mice with type 1 DM did not have increases in PDE5. CONCLUSIONS Taken together, our results suggest that type 2 DM-induced ED is associated with findings that could lead to reduced cGMP and may account for reduced efficacy of PDE5 inhibitors.
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Affiliation(s)
- Riyad T Ellati
- Department of Urology, University of Virginia Health System, Charlottesville, VA 22908, USA
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Phé V, Rouprêt M. Erectile dysfunction and diabetes: a review of the current evidence-based medicine and a synthesis of the main available therapies. DIABETES & METABOLISM 2011; 38:1-13. [PMID: 22056307 DOI: 10.1016/j.diabet.2011.09.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 09/25/2011] [Indexed: 12/20/2022]
Abstract
AIM This review aimed to provide an update of the epidemiology, pathophysiology and management of erectile dysfunction (ED) in diabetes patients. METHODS Data on the management of ED in diabetes patients in the literature were analyzed using Medline, and by matching the following keywords: diabetes; erectile dysfunction; endothelial dysfunction; cardiovascular disease; phosphodiesterase inhibitors; intracavernous injection; and penile prosthesis. RESULTS ED has a higher incidence in diabetic patients. The pathophysiology is multifactorial, involving endothelial dysfunction, specific complications of diabetes and psychological factors. Recent studies have shown that ED is able to predict future cardiovascular events not only in non-diabetics, but also in patients with diabetes. ED could also be a potential marker to screen for silent coronary artery disease. The management of ED has been revolutionized by the discovery of phosphodiesterase type-5 (PDE5) inhibitors, the first-line therapeutic options for diabetic men with ED that are efficient and safe. As a second line, intracavernous injections remain a gold-standard treatment, although a vacuum device can be used as well. In cases of failure, penile prosthesis may be considered. Hypogonadism, commonly found in diabetics, may require identification and treatment. Optimalized glycaemic control, management of associated co-morbidities and lifestyle modifications are essential in all patients. As ED and diabetes negatively impact male self-esteem, and generate depression and anxiety, the psychological treatment of patients is also likely to be beneficial. CONCLUSION The aetiology of diabetic ED is multifactorial. Endothelial dysfunction is the link between diabetes-induced ED and coronary artery disease. A global approach is needed for the successful management of diabetic ED.
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Affiliation(s)
- V Phé
- Urology and Andrology Academic Department of Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre-et-Marie-Curie, University Paris-VI, Paris, France
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Abstract
The metabolic syndrome is common in countries with Western lifestyles. It comprises a number of disorders-including insulin resistance, hypertension and obesity-that all act as risk factors for cardiovascular diseases. Urological diseases have also been linked to the metabolic syndrome. Most established aspects of the metabolic syndrome are linked to benign prostatic hyperplasia (BPH) and prostate cancer. Fasting plasma insulin, in particular, has been linked to BPH and incident, aggressive and lethal prostate cancer. The metabolic syndrome has also been shown to be associated with nonprostatic urological conditions such as male hypogonadism, nephrolithiasis, overactive bladder and erectile dysfunction, although data on these conditions are still sparse. Overall, the results of studies on urological aspects of the metabolic syndrome seem to indicate that BPH and prostate cancer could be regarded as two new aspects of the metabolic syndrome, and that an increased insulin level is a common underlying aberration that promotes both BPH and clinical prostate cancer. Urologists need to be aware of the effect that the metabolic syndrome has on urological disorders and should transfer this knowledge to their patients.
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Lee YC, Liu CC, Huang CN, Li WM, Wu WJ, Yeh HC, Wang CJ, Huang CH, Huang SP. The Potential Impact of Metabolic Syndrome on Erectile Dysfunction in Aging Taiwanese Males. J Sex Med 2010; 7:3127-34. [DOI: 10.1111/j.1743-6109.2010.01852.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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