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García-Gómez B, García-Cruz E, Bozzini G, Justo-Quintas J, García-Rojo E, Alonso-Isa M, Romero-Otero J. Sexual Satisfaction: An Opportunity to Explore Overall Health in Men. Urology 2017; 107:149-154. [DOI: 10.1016/j.urology.2017.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/17/2017] [Accepted: 06/20/2017] [Indexed: 01/21/2023]
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Cho MC, Paick JS. A review of the efficacy and safety of mirodenafil in the management of erectile dysfunction. Ther Adv Urol 2016; 8:100-17. [PMID: 27034723 DOI: 10.1177/1756287215625408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Erectile dysfunction (ED) is a common disorder that can jeopardize quality of life and the partnership of patients and their sexual partners. The advent of oral phosphodiesterase type 5 inhibitors (PDE5Is) has revolutionized a treatment for ED, and they are recognized as the first-line therapy for ED, regardless of its etiology. Mirodenafil, a second-generation PDE5I, has biochemical profiles such as high affinity for PDE5 and high selectivity for PDE5 over other PDE isoforms, compared to other existing PDE5Is such as sildenafil, vardenafil and tadalafil. Available evidence has suggested that doses of 50 and 100 mg mirodenafil effectively improve ED [with improvements in the erectile function domain of the International Index of Erectile Function (IIEF-EF) scores, positive responses to questions 2 of the Sexual Encounter Profiles (SEP2) and questions 3 of the Sexual Encounter Profiles (SEP3): 7.6-11.6 points, 27.72-38.98% and 44.20-67.33%, respectively] in a broad range of patient populations with ED of a variety of underlying etiologies, severities and ages, without any serious treatment-related adverse effects. In the treatment of diabetic ED, a traditionally difficult-to-treat population, 100 mg mirodenafil has been reported to offer favorable efficacy (with improvements in the IIEF-EF scores, and positive responses to the SEP2 and the SEP3: 9.3 points, 36.1% and 61.8%, respectively) and tolerability (mild adverse effects of less than 19.6%), which are comparable with results from clinical studies on other PDE5Is. Mirodenafil appears to be effective, safe and well tolerated in men with both ED and hypertension or lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) who are taking concomitant antihypertensive medications or α1-blockers. Furthermore, recent evidence has indicated that mirodenafil may be a potential option for chronic dosing in the treatment of ED despite its short half-life (T 1/2). Most of the available clinical studies have reported that adverse effects (up to 53.7%) caused by 50 and 100 mg mirodenafil are mild or moderate in severity, with headache (1.8-14.8%) and flushing (6.7-24.1%) being the most common. Due to the pharmacodynamic profiles of mirodenafil, its tolerability is expected to be somewhat better than those of the other PDE5Is. However, further well designed studies with larger cohorts of different ethnicities, flexible dosing schedules and long-term follow up are necessary to confirm the favorable efficacy and tolerability profiles of mirodenafil for the treatment of ED.
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Affiliation(s)
- Min Chul Cho
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University College of Medicine, 28, Yongon-Dong, Chongno-Ku, Seoul 110-744, Korea
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Hend MT, Heba MAA, Yasmen SM, Nahla SELS. Efficacy of Tribulus terrestris extract and metformin on fertility indices and oxidative stress of testicular tissue in streptozotocin-induced diabetic male rats. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/ajpp2015.4450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Effects of Dracaena arborea (Dracaenaceae) on sexual dysfunction in 4 weeks hyperglycemic male rats. ASIAN PAC J TROP MED 2014; 7:609-619. [DOI: 10.1016/s1995-7645(14)60103-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/15/2014] [Accepted: 07/15/2014] [Indexed: 11/17/2022] Open
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Redrow GP, Thompson CM, Wang R. Treatment strategies for diabetic patients suffering from erectile dysfunction: an update. Expert Opin Pharmacother 2014; 15:1827-36. [PMID: 24976035 DOI: 10.1517/14656566.2014.934809] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is one of the most common complications of diabetes. The complex pathophysiology of this disease makes it difficult to create clinical treatments tailored specifically for diabetic patients. AREAS COVERED This article will provide an update of both medical and surgical treatment approaches for diabetic ED, as well as discuss established treatments that are the cornerstone of this field. EXPERT OPINION Currently, PDE type 5 inhibitors represent the first-line treatment for all patients with ED. In the interim since this article's first publication several new PDE5 inhibitors have come to market. Several others that were previously on the market are now available for daily dosing. Analysis of both testosterone level and hemoglobin A1c is an essential part of treatment. Intracavernosal injections and vacuum constriction devices remain safe, and are highly effective treatment options. The implantable penile prosthesis remains a safe, and definitive treatment modality for those patients with refractory ED. Over the coming years as the understanding of the underlying causes of diabetic ED continues, the development of new, noninvasive, but effective medical treatments will lead to even more options for the treatment of this difficult disease.
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Affiliation(s)
- Grant P Redrow
- University of Texas Medical School , 6431 Fannin Street, Suite 6.018, Houston, TX 77030 , USA
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Hatzimouratidis K, Hatzichristou D. How to treat erectile dysfunction in men with diabetes: from pathophysiology to treatment. Curr Diab Rep 2014; 14:545. [PMID: 25193347 DOI: 10.1007/s11892-014-0545-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Erectile dysfunction (ED) is highly prevalent affecting at least 50 % of men with diabetes mellitus (DM). DM may cause ED through a number of pathophysiological pathways. These include neuropathy, endothelial dysfunction, cavernosal smooth muscle structural/functional changes, and hormonal changes. Lifestyle changes, diabetes control, and treatment of hypogonadism are important as the first step in ED management since there is no curative treatment for ED. Phosphodiesterase type 5 inhibitors (PDE5i) are the first-line treatment option. Intracavernous administration of vasoactive drugs is commonly used as a second-line medical treatment when PDE5i have failed. Alprostadil is the most widely used drug in this second-line setting. The combination of papaverine, phentolamine, and alprostadil represents the most efficacious intracavernous pharmacologic treatment option that may save non-responders to alprostadil. Penile prosthesis implantation can be considered in treatment refractory cases, with excellent functional and safety results in the properly informed patients.
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Ibrahim F, Sian TC, Shanggar K, Razack AH. Muslim prayer movements as an alternative therapy in the treatment of erectile dysfunction: a preliminary study. J Phys Ther Sci 2013; 25:1087-91. [PMID: 24259921 PMCID: PMC3818777 DOI: 10.1589/jpts.25.1087] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/19/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Our objective was to assess the effect of salat and mimicking salat movements and postures on subjects with erectile dysfunction. [Methods] Ten volunteers were recruited in this study. Subjects who were Muslims (Group I) were asked to perform their daily salat and a new intervention of an additional 12 movement cycles of salat for three sessions a week. Non-Muslim subjects (Group II) were taught to mimic salat movements, and were asked to perform a total of 12 movement cycles without reading the recitation for three sessions a week. An International Index for Erectile Function 5 (IIEF-5) questionnaire was given to the subjects before and after the intervention of performing salat or mimicking salat movements and postures. A nocturnal electrobioimpedance volume assessment (NEVA) device was used to measure the nocturnal penile tumescence (NPT) parameters over two consecutive nights. A nonparametric test was conducted to find the significant NPT parameters. [Results] The results showed that all measured parameters improved significantly, with the largest change observed in the maximum percent volumetric change over the baseline (from 138 to 222%). [Conclusion] This preliminary study suggests that the alternative approach of salat and mimicking salat movements and postures, may have beneficial effects for ED patients.
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Affiliation(s)
- Fatimah Ibrahim
- Medical Informatics and Biological Micro-Electro-Mechanical
Systems (MIMEMS) Specialized Lab, Department of Biomedical Engineering, Faculty of
Engineering, University of Malaya
| | - Tee Chee Sian
- Department of Surgery, Faculty of Medicine, University of
Malaya
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Liu J, Zhou F, Li GY, Wang L, Li HX, Bai GY, Guan RL, Xu YD, Gao ZZ, Tian WJ, Xin ZC. Evaluation of the effect of different doses of low energy shock wave therapy on the erectile function of streptozotocin (STZ)-induced diabetic rats. Int J Mol Sci 2013; 14:10661-73. [PMID: 23698784 PMCID: PMC3676859 DOI: 10.3390/ijms140510661] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 05/04/2013] [Accepted: 05/08/2013] [Indexed: 12/21/2022] Open
Abstract
To investigate the therapeutic effect of different doses of low energy shock wave therapy (LESWT) on the erectile dysfunction (ED) in streptozotocin (STZ) induced diabetic rats. SD rats (n = 75) were randomly divided into 5 groups (normal control, diabetic control, 3 different dose LESWT treated diabetic groups). Diabetic rats were induced by intra-peritoneal injection of STZ (60 mg/kg) and rats with fasting blood glucose ≥ 300 mg/dL were selected as diabetic models. Twelve weeks later, different doses of LESWT (100, 200 and 300 shocks each time) treatment on penises were used to treat ED (7.33 MPa, 2 shocks/s) three times a week for two weeks. The erectile function was evaluated by intracavernous pressure (ICP) after 1 week washout period. Then the penises were harvested for histological study. The results showed LESWT could significantly improve the erectile function of diabetic rats, increase smooth muscle and endothelial contents, up-regulate the expression of α-SMA, vWF, nNOS and VEGF, and down- regulate the expression of RAGE in corpus cavernosum. The therapeutic effect might relate to treatment dose positively, and the maximal therapeutic effect was noted in the LESWT300 group. Consequently, 300 shocks each time might be the ideal LESWT dose for diabetic ED treatment.
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Affiliation(s)
- Jing Liu
- Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China; E-Mails: (J.L.); (L.W.); (H.-X.L.); (G.-Y.B.); (R.-L.G.); (Y.-D.X.); (Z.-Z.G.)
| | - Feng Zhou
- Department of Urology, First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, China; E-Mail:
| | - Guang-Yong Li
- Department of Urology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China; E-Mail:
| | - Lin Wang
- Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China; E-Mails: (J.L.); (L.W.); (H.-X.L.); (G.-Y.B.); (R.-L.G.); (Y.-D.X.); (Z.-Z.G.)
| | - Hui-Xi Li
- Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China; E-Mails: (J.L.); (L.W.); (H.-X.L.); (G.-Y.B.); (R.-L.G.); (Y.-D.X.); (Z.-Z.G.)
| | - Guang-Yi Bai
- Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China; E-Mails: (J.L.); (L.W.); (H.-X.L.); (G.-Y.B.); (R.-L.G.); (Y.-D.X.); (Z.-Z.G.)
| | - Rui-Li Guan
- Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China; E-Mails: (J.L.); (L.W.); (H.-X.L.); (G.-Y.B.); (R.-L.G.); (Y.-D.X.); (Z.-Z.G.)
| | - Yong-De Xu
- Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China; E-Mails: (J.L.); (L.W.); (H.-X.L.); (G.-Y.B.); (R.-L.G.); (Y.-D.X.); (Z.-Z.G.)
| | - Ze-Zhu Gao
- Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China; E-Mails: (J.L.); (L.W.); (H.-X.L.); (G.-Y.B.); (R.-L.G.); (Y.-D.X.); (Z.-Z.G.)
| | - Wen-Jie Tian
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin, China; E-Mail:
| | - Zhong-Cheng Xin
- Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China; E-Mails: (J.L.); (L.W.); (H.-X.L.); (G.-Y.B.); (R.-L.G.); (Y.-D.X.); (Z.-Z.G.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel./Fax: +86-10-8322-2822
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Thorve VS, Kshirsagar AD, Vyawahare NS, Joshi VS, Ingale KG, Mohite RJ. Diabetes-induced erectile dysfunction: epidemiology, pathophysiology and management. J Diabetes Complications 2011; 25:129-36. [PMID: 20462773 DOI: 10.1016/j.jdiacomp.2010.03.003] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 03/16/2010] [Accepted: 03/29/2010] [Indexed: 01/23/2023]
Abstract
Erectile dysfunction (ED) is defined as the inability of the male to attain and maintain erection of penis sufficient to permit satisfactory sexual intercourse. Prevalence of impotence in diabetic men is ≥50%. The pathophysiology of diabetes-induced erectile dysfunction (DIED) is multifactorial and no single etiology is at the forefront. The proposed mechanisms of erectile dysfunction in diabetic patients includes elevated advanced glycation end-products, increased levels of oxygen free radicals, impaired nitric oxide synthesis, increased endothelin B receptor binding sites and up-regulated RhoA/Rho-kinase pathway, neuropathic damage and impaired cyclic guanosine monophosphate (cGMP)-dependent protein kinase-1. The treatment of DIED is multimodal. Treatment of the underlying hyperglycemia and comorbidities is of utmost importance to prevent or halt the progression of disease. Oral medications are considered as the first line therapy for management of DIED. If oral agents cannot be used or have insufficient efficacy despite appropriate dosing and education, second-line treatments should be addressed. When there is lack of efficacy or when there is dissatisfaction with other modalities, penile prostheses are often the best alternative for ED and are considered as the third line therapy for DIED. Future strategies in the evolution of the treatment of DIED are aimed at correcting or treating the underlying mechanisms of DIED.
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Affiliation(s)
- Vrushali S Thorve
- Department of Pharmacology, AISSMS College of Pharmacy, Near R.T.O., Pune-411 001, India
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