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Chen D, Chen F, Luo Q, Fan W, Chen C, Liu G. Association between the systemic immune-inflammation index and erectile dysfunction: A cross-sectional study. Immun Inflamm Dis 2024; 12:e1363. [PMID: 39092776 PMCID: PMC11295087 DOI: 10.1002/iid3.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 07/18/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Erectile dysfunction (ED) is associated with inflammation. The systematic immune-inflammation index (SII), as a new inflammation marker, was applied to predict the risk of diseases. However, no research explores the relationship between SII and ED. Hence, the purpose of this study was to investigate the association between SII and ED. METHODS Related data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2001-2004. Based on self-report, all participants were classified into ED and non-ED group. Weighted multivariate regression analysis the relationship between categorical SII and ED in unadjusted and adjusted models. Restricted cubic spline (RCS) was used to examine the association of continuous SII and ED risk. Furthermore, the association between categorical SII and the risk of ED was evaluated among subgroups of age, body mass index, hypertension, diabetes and cardiovascular disease. Finally, weighted multivariate regression analysis and RCS were performed to assessed the connection between SII and the risk of severe ED. RESULTS Initially, data on 21,161 participants were obtained. After implementing the inclusion and exclusion criteria, 3436 participants were included in analyses. Weighted multivariate regression analysis demonstrated that Q4 group SII was associated with an increased risk of ED (OR = 1.03, 95% confidence intervals: 1.00-1.05, p = .03). RCS showed SII was nonlinearly associated with the risk of ED, and the inflection point of SII was at 485.530. In addition, subgroup analyses demonstrated that participants in the SII > 485.530 group had a higher ED risk than SII ≤ 485.530 group among subgroups of age ≥50, hypertension, and non-diabetes. Weighted multivariate regression analysis and RCS found no relationship of SII and the risk of severe ED. CONCLUSION In US adults, SII > 485.530 was correlated with an increased risk of ED. While, no significant association between SII and severe ED risk. Additional studies are required to support our results.
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Affiliation(s)
- Di Chen
- The Department of UrologyReproductive Hospital of Guangxi Zhuang Autonomous RegionNanningChina
- Graduate SchoolGuangxi Medical UniversityNanningChina
| | - Fuchang Chen
- The Second Department of UrologyThe First People's Hospital of Qinzhou CityQinzhouChina
| | - Quanhai Luo
- The Department of UrologyReproductive Hospital of Guangxi Zhuang Autonomous RegionNanningChina
| | - Wenji Fan
- The Department of UrologyThe Second People's Hospital of Nanning CityNanningChina
| | - Changsheng Chen
- The Department of UrologyPeople's Hospital of Guangxi Zhuang Autonomous RegionNanningChina
| | - Gang Liu
- The Department of UrologyReproductive Hospital of Guangxi Zhuang Autonomous RegionNanningChina
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GamalEl Din SF, Nabil Ismail N, Moawad HH, Adel IM, Motawi A, Foaad H. Evaluation of tadalafil supplementation on the neutrophil/lymphocyte and the platelet/lymphocyte ratios in patients with erectile dysfunction: A prospective study. Urologia 2024; 91:598-603. [PMID: 38532550 DOI: 10.1177/03915603241240649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVES We aimed to evaluate the effect of daily 5 mg tadalafil on the neutrophil/lymphocyte ratio (NLR) and the platelet/lymphocyte ratio (PLR) in patients with erectile dysfunction (ED). PATIENTS AND METHODS 30 subjects with ED were given tadalafil as well as 30 subjects with ED who were not receiving tadalafil were recruited. 30 healthy individuals served as controls. RESULTS Receiver operating characteristic curve (ROC) showed that the best cut off point of pre-treatment and post treatment NLR in the ED treatment group was found <1.51, <1.51, sensitivity of 68.3%, 58.3%, specificity of 53.3%, 53.3%, lower bound of 0.558, 0.517, upper bound of 0.789, 0.757, total accuracy of 67.4%, 63.7% and p 0.003, 0.0025, respectively. Additionally, the best cut off point of pre-treatment and post treatment PLR in the ED treatment group was found <5.89, <5.99, sensitivity of 65%, 63.3%, specificity of 63.3%, 53.3%, lower bound of 0.515, 0.435, upper bound of 0.755, 0.687, total accuracy of 63.5%, 56.1% and p 0.027, 0.341, respectively. CONCLUSION Daily 5 mg Tadalafil supplementation significantly improves erectile function through decreasing these markers as well as depression and anxiety.
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Affiliation(s)
- Sameh Fayek GamalEl Din
- Department of Andrology, Sexology, and STDs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nashaat Nabil Ismail
- Department of Andrology, Sexology, and STDs, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Hanan Hosni Moawad
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | | | - Ahmad Motawi
- Department of Andrology, Sexology, and STDs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hisham Foaad
- Department of Andrology, Sexology, and STDs, Faculty of Medicine, Cairo University, Cairo, Egypt
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Chen D, Chen J, Zhou Q, Mi H, Liu G. Association of the hemoglobin, albumin, lymphocyte, and platelet score with the risk of Erectile dysfunction: a cross-sectional study. Sci Rep 2024; 14:15869. [PMID: 38982136 PMCID: PMC11233679 DOI: 10.1038/s41598-024-66667-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 07/03/2024] [Indexed: 07/11/2024] Open
Abstract
Erectile dysfunction (ED) is related to nutritional and inflammatory factors. The hemoglobin, albumin, lymphocyte, and platelet score (HALP), a new index reflecting the nutritional and inflammatory status, has been associated with a higher risk of diabetic retinopathy, particularly at lower values (≤ 42.9). However, studies focusing on the relationship between HALP and ED risk are scarce. Hence, this study aimed to investigate the association between HALP and ED. Data were extracted from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2004. Based on self-reported data, participants were classified into either the ED group or the non-ED group. Next, the HALP score was categorized into four quartiles (Q1-4). Weighted multivariate regression analysis was performed to assess the relationship between categorical HALP and ED risk. Additionally, restricted cubic spline (RCS) analysis was conducted to examine the association between continuous HALP scores and ED risk. Furthermore, subgroup analyses were conducted to examine the association between categorical HALP and the risk of ED based on age, as well as the status of hypertension, diabetes and cardiovascular disease. Finally, a mediation analysis was carried out to investigate the mediating effect of HALP and related parameters on the association between urinary cobalt levels and ED. Initially, the data of 21,161 participants were collected. After implementing the inclusion and exclusion criteria, 3406 participants were included in the final analyses. Weighted multivariate regression analysis demonstrated that the Q4 HALP group was associated with a lower risk of ED (OR 0.96, 95% confidence intervals 0.92-1.00, P = 0.037). Meanwhile, RCS analysis showed that HALP was nonlinearly associated with the risk of ED. In addition, subgroup analyses demonstrated that participants in the Q3/4 HALP group had a significantly lower ED risk than those in the Q1 group among patients aged ≥ 50 years, as well as those with hypertension and diabetes. Lastly, mediation analysis revealed that HALP and its associated parameters had a marginal average causal mediation effect on the relationship between urinary cobalt levels and ED risk (P > 0.05). In US adults, high HALP scores were correlated with a lower risk of ED. The relationship was more pronounced in participants aged ≥ 50 years with hypertension and diabetes. Furthermore, HALP and its parameters may not mediate the association between urinary cobalt levels and ED risk.
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Affiliation(s)
- Di Chen
- The Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinji Chen
- The Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qiufeng Zhou
- The 924th Hospital of Chinese PLA Joint Service Support Force, Guilin, China
| | - Hua Mi
- The Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
| | - Gang Liu
- The Department of Urology, Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
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4
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Panunzio A, Labate C, Zacheo F, Orlando R, Rizzo FL, Porcaro AB, Migliorini F, Pagliarulo V, Tafuri A. Platelet-rich plasma intracavernosal injections for the treatment of primary organic erectile dysfunction: a systematic review and meta-analysis of contemporary controlled studies. Int J Impot Res 2023:10.1038/s41443-023-00798-y. [PMID: 37993601 DOI: 10.1038/s41443-023-00798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/24/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
We aim to summarize the latest evidence on platelet-rich plasma (PRP) intracavernosal injections efficacy in men affected by primary organic erectile dysfunction (ED). We reviewed the literature for randomized controlled trials (RCTs) or prospective and retrospective comparative studies evaluating PRP alone or in combination for ED treatment. A comprehensive search in PubMed, Scopus, Web of Science, and ClinicalTrials.gov was performed for English language full-text articles or conference abstracts. A qualitative and quantitative data synthesis was provided. Overall, seven records were included: three RCTs evaluated PRP vs. placebo, one study separately tested PRP and low-intensity shock wave therapy (Li-SWT), three studies compared Li-SWT or low-intensity pulsed ultrasound alone with their combination with PRP. Of 641 included patients, 320 received PRP. Despite the heterogeneity among inclusion criteria, dose and protocol of PRP administration, and outcomes measured, most studies independently reported better sexual outcomes in patients who received PRP, without significant severe side effects. In meta-analysis, where only placebo-controlled studies were included, patients treated with PRP showed higher International Index of Erectile Function (erectile function domain) score compared to patients who received placebo: pooled mean difference (95% Confidence Interval) of 2.99 (1.86, 4.13) after 1 month (209 patients) vs. 2.85 (1.61, 4.09) after 3 months (204 patients) vs. 3.21 (1.82, 4.60) after 6 months (199 patients) of follow-up. In men affected by primary organic ED, PRP intracavernosal injections demonstrated an objective improvement or at least a tendency in erectile function recovery. Patient numbers, and the short-term follow-up may limit the generalizability of these observations. High quality, large-scale, and standardized controlled trials are needed before recommending its definitive use in clinical practice.
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Affiliation(s)
| | - Connie Labate
- Department of Urology, "Vito Fazzi" Hospital, Lecce, Italy
| | | | | | | | - Antonio Benito Porcaro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Liu C, Gao Y, Ji J, Sun C, Chen M. Association between inflammatory indexes and erectile dysfunction in U.S. adults: National Health and Nutrition Examination Survey 2001-2004. Sex Med 2023; 11:qfad045. [PMID: 37577069 PMCID: PMC10413424 DOI: 10.1093/sexmed/qfad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Background The association of inflammatory biomarkers with erectile dysfunction (ED) is still largely unknown. Aim The study sought to explore the association of inflammatory biomarkers with ED in U.S. adults. Methods Participant data for this study were extracted from the National Health and Nutrition Examination Survey, and individuals that lacked information on clinical variables were excluded. Dose-response curve analysis was applied to explore the association of inflammatory biomarkers with ED prevalence. The confounders were adjusted for with weighted logistic regression analysis. We employed 1:1 propensity score matching to eliminate the effects of clinical variables to confirm the reliability of the results. Outcomes ED prevalence was investigated with potential risk factors. Results A total of 2331 men ≥20 years of age who participated in the National Health and Nutrition Examination Survey 2001-2004 were included in this study. Compared with individuals without ED, ED cohort displayed higher levels of neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammatory index, and systemic inflammation response index. Dose-response curve analysis indicated ED prevalence increased with the increase of platelet-to-lymphocyte ratio, systemic immune-inflammatory index, and systemic inflammation response index. Weighed logistic regression analysis revealed neutrophil-to-lymphocyte ratio was positively associated with ED. The reliability of the results was confirmed by 1:1 propensity score matching reanalysis. Clinical Implications Individuals with chronic inflammatory conditions should be alert for the development of ED. Strengths and Limitations It is a large controlled study to investigate the relationship between inflammatory indexes and ED. However, it is a cross-sectional study and it lacks an accurate assessment of the degree of ED. Conclusion Inflammatory biomarkers were associated with ED prevalence.
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Affiliation(s)
- Chunhui Liu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, China
| | - Yue Gao
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, 210009, China
| | - Jie Ji
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, 210009, China
| | - Chao Sun
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, China
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, China
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Crafa A, Cannarella R, Barbagallo F, Leanza C, Palazzolo R, Flores HA, La Vignera S, Condorelli RA, Calogero AE. Mechanisms Suggesting a Relationship between Vitamin D and Erectile Dysfunction: An Overview. Biomolecules 2023; 13:930. [PMID: 37371510 DOI: 10.3390/biom13060930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Vitamin D deficiency (VDD) and erectile dysfunction (ED) heavily burden the male population. The higher prevalence of both conditions in the elderly suggests a possible relationship between the two conditions. In addition, in vitro, animal, and human studies have revealed several mechanisms that may relate VDD to ED. The main mechanism by which vitamin D might exert its action on sexual function appears to be through the regulation of endothelial function. Indeed, VDD correlates with several markers of endothelial function. The action of vitamin D on the endothelium would be exercised both indirectly through its intervention in inflammatory processes and through the production of oxygen free radicals, and directly through the regulation of vascular stiffness, the production of nitric oxide, and the regulation of vessel permeability. Furthermore, the ubiquitous distribution of the vitamin D receptor in the human body means that this hormone can also exert a beneficial effect on erectile function by interfering with those comorbidities significantly associated with ED, such as hypertension, diabetes mellitus, hypercholesterolemia, chronic kidney disease, and hypogonadism. In this review, we thoroughly and carefully presented the evidence and mechanisms that would appear to relate vitamin D levels to erectile function. Furthermore, we have summarized the meta-analytic evidence for and against this association to provide a true representation of this topic. Data published to date suggest that low levels of vitamin D could contribute to worsening erectile function through several mechanisms. Therefore, vitamin D levels should be measured in patients with ED and maintained at adequate levels by specific supplementation in case of deficiency. However, the low quality and heterogeneity of clinical trials evaluating the effects of vitamin D administration on erectile function and ED-associated comorbidities do not allow for a univocal conclusion, and indicate the need for further studies to analyze these aspects.
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Affiliation(s)
- Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, 95121 Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, 95121 Catania, Italy
- Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Federica Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, 95121 Catania, Italy
| | - Claudia Leanza
- Department of Clinical and Experimental Medicine, University of Catania, 95121 Catania, Italy
| | - Roberto Palazzolo
- Department of Clinical and Experimental Medicine, University of Catania, 95121 Catania, Italy
| | - Hunter Ausley Flores
- Scott Department of Urology, Baylor College of Medicine in Houston, Houston, TX 77030, USA
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95121 Catania, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, 95121 Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, 95121 Catania, Italy
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7
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Subclinical inflammation as a predictor for erectile dysfunction after brachytherapy for localized prostate cancer. Brachytherapy 2022; 21:864-869. [PMID: 35879137 DOI: 10.1016/j.brachy.2022.02.001] [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: 08/25/2021] [Revised: 01/12/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Neutrophil-to-lymphocyte ratio (NLR), a marker for subclinical inflammation, has been previously shown to be associated with erectile dysfunction (ED). We studied the potential predictive value of the NLR on ED after prostate brachytherapy (PB) for PCa. METHODS AND MATERIALS Between July 2005 and January 2021, 842 patients were included in this retrospective study of a prospectively maintained database. ED was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) physician-reported scale. ED was defined as a Grade 2 or 3 function. NLR count was determined 1-2 months before PB and separated into values PB <2 and ≥2. Patient characteristics and erectile function at last follow-up were compared for patients with a Univariate and multivariate analyses were performed to evaluate the predictive value of baseline NLR ≥2 on post-PB ED. RESULTS Baseline NLR ≥2 was found to be a statistically significant predictor of post-PB ED on both univariate (p = 0.002) and multivariate analyses (p = 0.008). Furthermore, the difference in ED prevalence between the NLR <2 and NLR ≥2 groups became more pronounced with longer follow-up after PB. The ED rate at 5 years post-PB was 43% for the NLR ≥2 groups, compared to 29% for the NLR <2 groups. CONCLUSIONS Subclinical systemic inflammation is a potentially important factor for predicting sexual toxicity after pelvic radiotherapy. NLR may be used as a proxy for predicting post-PB ED.
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Fujita N, Hatakeyama S, Momota M, Hamaya T, Tobisawa Y, Yoneyama T, Okamoto T, Yamamoto H, Yoneyama T, Hashimoto Y, Yoshikawa K, Ohyama C. Relationships of low-grade systemic inflammation and nutritional status with erectile dysfunction severity in men on dialysis. Andrology 2022; 10:1548-1555. [PMID: 35929981 DOI: 10.1111/andr.13259] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/04/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Low-grade systemic inflammation and malnutrition are frequently observed in patients on dialysis and contribute to the development of endothelial dysfunction, however, the role of these conditions in erectile dysfunction (ED) severity remains to be elucidated. OBJECTIVES To investigate the relationships of low-grade systemic inflammation and nutritional status with ED severity in men on dialysis. MATERIALS AND METHODS The present study included 71 men on dialysis. The Sexual Health Inventory for Men (SHIM) was used to assess ED. Men were classified as the mild/moderate (SHIM score ≥ 8) and severe ED (SHIM score ≤ 7) groups. C-reactive protein/albumin ratio (CAR) and Geriatric Nutritional Risk Index (GNRI) were used to evaluate low-grade systemic inflammation and nutritional status, respectively. We performed multivariate analysis to assess the relationships of CAR and GNRI with severe ED. RESULTS The median age of the included men was 64 years old. All men had any degree of ED with 65% having severe ED. In the univariate analyses, a significant association was observed between elevated CAR (≥ 0.09) and severe ED (odds ratio [OR]: 4.038, P = 0.025), whereas no significant association was observed between lower GNRI (< 92) and severe ED (OR: 2.357, P = 0.109). In the multivariate analysis, an association between elevated CAR and severe ED was still significant (OR: 5.985, P = 0.010). DISCUSSION AND CONCLUSION Low-grade systemic inflammation was significantly associated with ED severity, whereas lower GNRI was not. These results may be helpful for further research to identify the optimal treatment for men suffering from severe ED. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaki Momota
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoko Hamaya
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Zhang W, Zhang Y, Liu G, Wu X, Huang H, Jiang H, Zhang X. An objective correlation of specific haematological parameters with ED severity. Andrologia 2022; 54:e14448. [PMID: 35894065 DOI: 10.1111/and.14448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/05/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022] Open
Abstract
This study aims to investigate the role of nocturnal penile tumescence and rigidity (NPTR) and laboratory features in patients with mild, moderate and severe ED and then explored the correlation between ED severity with certain blood count parameters such as WBC and NLR. A total of 86 ED patients (age 29.8 ± 7.09 years) were enrolled. Classification of ED severity according to IIEF-5 scores was as follows: mild ED, 43.02% (37/86); moderate ED, 27.91% (24/86) and severe ED, 29.07% (25/86). Patients with moderate and severe ED had declined IIEF-5 scores and increased GAD-7 and PHQ-9 scores compared with mild ED. The mean NLR value of the mild, moderate and severe ED groups was 1.43 ± 0.39, 1.74 ± 0.45 and 2.0 ± 0.58, respectively. Stratification analysis according to NPTR results indicated that there was a significant difference in WBC and NLR between the two groups. Patients with abnormal NPTR had increased WBC and NLR levels compared with the normal groups. Multivariate logistic regression analysis suggested that severe ED (OR [95% CI]: 5.736 [1.248-26.354]), WBC (OR [95% CI]: 1.676 [1.094-2.567]) and NLR (OR [95% CI]: 5.595 [1.478-21.178]) were identified as independent risk factors for severe ED (abnormal NPTR results). In conclusion, this study indicates a significant difference in NLR, PLR, PDW, MPV and HDL between the mild, moderate and severe ED groups. The WBC and NLR are significantly increased in patients with severe ED (abnormal NPTR results) and it can be available as a quick, easy and cheap investigation compared with the RigiScan to evaluate the severity of ED with good sensitivity and specificity, which is important for the diagnosis and evaluation of ED.
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Affiliation(s)
- Wei Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuyang Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guodong Liu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xu Wu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Houbao Huang
- Department of Urology, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Hui Jiang
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Xiansheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Zhang W, Zhang Y, He W, Wu X, Liu G, Huang H, Jiang H, Zhang X. Variation in the sexual behavior and blood count parameters induced by sleep deprivation in male rats. Andrology 2022; 10:800-807. [PMID: 35226413 DOI: 10.1111/andr.13168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/05/2022] [Accepted: 02/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sleep is a fundamental biological requirement, and lack of sleep has increasingly been recognized to cause metabolic consequences and adversely affect immune function. Recent articles have pointed to how sleep and sexual functions may be interlinked, involving inflammation, vascular alterations, tissue damage, and endothelial dysfunction. OBJECTIVES We examined the effect of paradoxical sleep deprivation (PSD) on sexual behavior and hemogram parameters in male rats. In addition, we also explored whether 7 days of recovery sleep is sufficient to offset these detriments. MATERIALS AND METHODS Male rats were given sexual experience through training. At the 5th test, the sexually vigorous males were randomly separated into 3 experimental groups: PSD (rats submitted to 96 hours of PSD, n = 6), RS (recovery sleep 7 days after PSD, n = 6), and control (n = 10). We evaluated the sexual behaviors of three groups. Blood samples were collected to analysis hemogram parameters. RESULTS In this study, we recognized that repeated copulatory tests can lead to changes in sexual behavior over time. We found that 96 hours of acute sleep deprivation impaired the sexual behavior of male rats. Our results demonstrated that 96 hours of PSD also increased levels of white blood cell (WBC) subpopulations, in particular neutrophils. Recovery sleep after sleep deprivation has a certain reversal effect on WBC subgroups and impairment of sexual behavior, with some signs that not all levels were back to baseline even after 7 days of recovery. CONCLUSION In general, we found that 96 hours of PSD impaired the sexual behavior of male rats. Our results demonstrated that PSD can cause systemic inflammation by affecting WBC subpopulations, in particular neutrophils. 7 days of recovery sleep after sleep deprivation has a certain reversal effect to these impairments. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Wei Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yuyang Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wentao He
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xu Wu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Guodong Liu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Houbao Huang
- Department of Urology, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, Anhui, China
| | - Hui Jiang
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Xiansheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Candela L, Boeri L, Capogrosso P, Cazzaniga W, Pozzi E, Belladelli F, Baudo A, Ravizzoli A, Ventimiglia E, Viganò P, Alfano M, Abbate C, Cornelius J, Mattei A, Montorsi F, Salonia A. Correlation among isolated teratozoospermia, sperm DNA fragmentation and markers of systemic inflammation in primary infertile men. PLoS One 2021; 16:e0251608. [PMID: 34097690 PMCID: PMC8184012 DOI: 10.1371/journal.pone.0251608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/28/2021] [Indexed: 01/03/2023] Open
Abstract
Aim To assess the prevalence of isolated teratozoospermia (iTZS) in a cohort of infertile and fertile men; explore the relationship between iTZS, inflammatory parameters and sperm DNA fragmentation index (SDF) in the same cohort. Materials and methods 1824 infertile men and 103 fertile controls. Semen analysis, the neutrophil-to-lymphocyte ratio (NLR) and serum hormones were investigated. DFI was tested in infertile men only. According to 2010 WHO semen analysis, patients were categorized in 3 sub-groups of isolated sperm defects: isolated oligozoospermia (iOZS), isolated asthenozoospermia (iAZS) and iTZS. Descriptive statistics and linear regression models tested the association between clinical variables and inflammatory markers. Results Among infertile men, iAZS, iTZS, and iOZS were found in 13.9%, 11.9% and 4.1% participants, respectively. iTZS was found in 37 (35.9%) fertile men. Infertile men with iTZS had higher NLR values than those with iOZS, iAZS and men with normal semen parameters (all p<0.001). FSH and LH were higher and inhibin B lower in iOZS infertile men compared to all other groups (p≤0.001). Hormonal characteristics were similar between iTZS infertile and fertile men. Similarly, iTZS infertile men had higher SDF than all other groups (all p<0.001). Infertile men with iTZS had higher NLR values than fertile men with iTZS (p<0.01). Linear regression analysis showed that, in infertile men, iTZS was associated with SDF and NLR (all p≤0.01). Conclusions iTZS was found in 11.9% of infertile men but it was even more prevalent in fertile controls. Infertile men with iTZS had higher NLR than fertile controls and increased SDF values than infertile participant with iAZS, iOZS, or normal semen parameters. No differences in hormonal characteristics were found between infertile and fertile men with iTZS.
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Affiliation(s)
- Luigi Candela
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Luca Boeri
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation,Varese, Italy
| | - Walter Cazzaniga
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Baudo
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Ravizzoli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paola Viganò
- Obstetrics and Gynaecology Department, IRCCS Ospedale San Raffaele, Milan, Italy
- Division of Genetics and Cell Biology, Reproductive Sciences Laboratory, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Alfano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Costantino Abbate
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Julian Cornelius
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
- * E-mail:
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12
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Alcaidinho A, Nguyen DD, Delouya G, Zorn KC, Saad F, Taussky D, Liberman D. The interaction between inflammation, urinary symptoms and erectile dysfunction in early-stage prostate cancer treated with brachytherapy. Andrologia 2021; 53:e14070. [PMID: 33852165 DOI: 10.1111/and.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/12/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022] Open
Abstract
Erectile function has been shown to decline as a function of increasing peripheral blood inflammatory markers, namely the neutrophil-to-lymphocyte ratio (NLR). We evaluated if the association between NLR and erectile dysfunction (ED) applies to patients with localised prostate cancer. We included 1,282 patients who underwent brachytherapy. ED was classified before treatment according to the Terminology Criteria for Adverse Event Scale version 3.0. ED was defined as the need for the use of oral pharmacologic or mechanical assistance to have satisfactory sexual function. We found that patients with ED were older (p < .001), more likely to have hypertension (p = .002), statin use (p = .002), diabetes (p < .001) or an IPSS ≥ 8 (p < .001). On univariable logistic regression analysis, an NLR of ≥3 was statistically significantly associated with ED (OR 1.32, p = .029). But on multivariable analysis, the association between elevated NLR and ED was not statistically significant (p = .17). Significant were age (OR 1.12, p < .001), IPSS ≥ 8 (OR 1.50, p = .008), the presence of hypertension, hyperlipidemia and diabetes (OR 2.27, p < .001), and prostate volume (OR 0.99, p = .041). The NLR does appear to be a surrogate marker of chronic inflammation that causes baseline ED in patients with localised prostate cancer.
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Affiliation(s)
- Alexandre Alcaidinho
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Guila Delouya
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Kevin C Zorn
- Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Fred Saad
- Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Daniel Taussky
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Daniel Liberman
- Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
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Selvi I, Baydilli N, Akinsal EC. The effect of cardiovascular morbidity on clinical response provided by tadalafil in patients with erectile dysfunction. Andrologia 2020; 53:e13904. [PMID: 33244832 DOI: 10.1111/and.13904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/13/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022] Open
Abstract
We aimed to investigate the association between erectile dysfunction and severity of cardiovascular morbidity and to assess clinical responses to tadalafil of patients in different cardiovascular risk groups. Between November 2019 and August 2020, a total of 258 male patients aged 45-70 years with ED were included. They were divided into three groups according to the Framingham risk score: low-risk (n: 86, 33.3%), intermediate-risk (n: 103, 39.9%) and high-risk (n: 69, 26.8%). At admission, all domains of the International Index of Erectile Function score were worse in high-risk group compared to other risk groups (p < .001). After a 12-week follow-up, a more significant improvement was observed in all domains of erectile function in all risk groups, but high-risk group had lower sexual scores (p < .001). The lowest rate for complete responsiveness to tadalafil was observed in the high-risk group (37.7%). The rate of failure in complete responsiveness was found to be 4.127 times greater with higher Framingham score and 3.102 times greater with higher erectile dysfunction severity at admission. Our preliminary findings show that more severe sexual disorders are observed in high-risk patients with cardiovascular morbidity. Individualised treatment may be important in high-risk group since they may benefit less from tadalafil, and failure in complete responsiveness can be more common in this group.
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Affiliation(s)
- Ismail Selvi
- Department of Urology, Karabük University Training and Research Hospital, Karabük, Turkey.,Department of Urology, Başakşehir Çam ve Sakura City Hospital, Istanbul, Turkey
| | - Numan Baydilli
- Department of Urology, Erciyes University Medical School, Kayseri, Turkey
| | - Emre Can Akinsal
- Department of Urology, Erciyes University Medical School, Kayseri, Turkey
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14
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Comparison of hormone profile and systemic inflammation in patients presenting with sexual dysfunction: Which is important? Rev Int Androl 2020; 19:242-248. [PMID: 32888890 DOI: 10.1016/j.androl.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/14/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is the inability to achieve or maintain erection sufficient for satisfactory sexual performance. Although the definition is well known, there are controversial issues about the effects of hormones and inflammation on ED. OBJECTIVES We aimed to compare the clinical value of the hormonal and inflammation parameters in sexual dysfunction. MATERIALS AND METHODS A total of 152 patients diagnosed with erectile dysfunction between September 2018 and March 2019 and 101 healthy males were included in this prospective study as case group and control group, respectively. The 152 patients were divided into three groups based on their total International Index of Erectile Function (IIEF) scores: (I) severe ED, (II) mild-moderate ED and (III) mild ED. All groups were compared in terms of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and total testosterone (TT), estradiol, prolactin, testosterone-to-estradiol ratio and 25 (OH) vitamin D. RESULTS Patient and control groups differed significantly in term of NLR, PLR, prolactin and vitamin D (p<0.001, p=0.004, p=0.002, p<0.001, p<0.001, respectively). NLR was more significant in determining the severity of ED (p<0.001). It was observed that libido score (the total score of IIEF items #11 and #12) was negatively associated with prolactin and NLR (p<0.001, p=0.023, respectively), was positively associated with vitamin D and TT (p<0.001, p=0.02, respectively), and was lower in severe ED patients. CONCLUSIONS Although more clinical studies are needed, we think that our findings may be useful on these controversial issues of ED.
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Authors' reply. Int J Impot Res 2020; 33:126-127. [PMID: 32152471 DOI: 10.1038/s41443-020-0245-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 11/08/2022]
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Özbir S, Değirmentepe RB, Atalay HA, Alkan I, Çakır SS, Ötünçtemur A, Canat HL. The role of inflammatory parameters (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-eosinophil ratio) in patients with Peyronie's disease. Andrology 2019; 8:348-352. [PMID: 31512411 DOI: 10.1111/andr.12702] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/07/2019] [Accepted: 08/12/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the ability of the systemic inflammatory parameters to predict the discrimination of the phases of Peyronie's disease (PD). MATERIALS AND METHODS Demographic, clinical, and laboratory data from 156 patients with PD were analyzed. A complete blood count (CBC) was obtained for every patient, and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-eosinophil ratio (MER) were calculated for every men. Subsequently, patients were divided into two groups based upon the phase of the disease. RESULTS The mean age was 51.9 ± 9.6 in all study population. The mean duration between symptom onset and patient evaluation was 4.2 ± 3.2 months in acute phase group, while it was 32.7 ± 31.7 months in chronic phase group (p < 0.001). There were no significant differences between the groups according to comorbidities such as diabetes, hypertension, lipid abnormalities, ischemic heart disease, smoking, and alcohol consumption. There was a statistically significant difference in NLR and PLR between two groups (p = 0.008, p = 0.008, respectively). NLR and PLR were significantly correlated with discrimination status in univariate analysis (p = 0.003, p = 0.005, respectively). Multivariate regression analysis revealed that NLR was the only independent risk factor for discrimination of the phases of PD (p < 0.001). The ROC analysis revealed a cutoff value of 1.8 (AUC 0.712, p < 0.001; sensitivity 61.1%; specificity 75.0%) for the NLR. CONCLUSION Our study demonstrated that NLR could be helpful to differentiate the chronic phase from the acute phase in patients with PD. Therefore, NLR could be used as an objective biomarker to the management of the disease and choosing the appropriate treatment.
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Affiliation(s)
- S Özbir
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - R B Değirmentepe
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - H A Atalay
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - I Alkan
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - S S Çakır
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - A Ötünçtemur
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
| | - H L Canat
- Department of Urology, Okmeydanı Training and Research Hospital, Şişli-İstanbul, Turkey
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Gok B, Hamidi N, Koc E, Cakici OU, Asil E, Atmaca AF. Complete blood count and penile colour doppler ultrasonography findings in erectile dysfunction: Is there a relationship? Andrologia 2019; 51:e13365. [PMID: 31273827 DOI: 10.1111/and.13365] [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: 04/21/2019] [Revised: 05/21/2019] [Accepted: 06/06/2019] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to evaluate the relationship between penile colour doppler ultrasonography (PCDUS) and complete blood count parameters in patients with erectile dysfunction (ED). The data of the patients who applied to our outpatient clinic with ED (IIEF-5 score <22 or IIEF-EF score <26) between January 2007 and May 2017 were retrospectively analysed. The patients who had available PCDUS results and complete blood count (CBC) values were included in the study. Patients were divided into two groups having normal (n = 530 [68.9%]) or abnormal (n = 240 [31.1%]) PCDUS findings (group 1 versus group 2 respectively). Subsequently, group 2 was divided into three subgroups according to presence of arterial insufficiency (group 2a; n = 85 [11%]), venous insufficiency (group 2b; n = 140 [18.2%]) and both of arterial and venous insufficiency (group 2c; n = 15 [1.9%]), and the four groups were compared in terms of CBC parameters. There was no statistically significant difference between the 4 groups, and between the patients with normal and abnormal PCDUS findings in terms of CBC values. CBC values were not associated with PCDUS findings in patients with ED.
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Affiliation(s)
- Bahri Gok
- Department of Urology, Ankara Yildirim Beyazit University, School of Medicine affiliated with Ankara City Hospital, Ankara, Turkey
| | - Nurullah Hamidi
- Department of Urology, Ankara Abdurrahman Yurtaslan Oncology Hospital, Ankara, Turkey
| | - Erdem Koc
- Department of Urology, Ankara Yildirim Beyazit University, School of Medicine affiliated with Ankara City Hospital, Ankara, Turkey
| | - Ozer Ural Cakici
- Department of Urology, Ankara Medical Park Hospital, Ankara, Turkey
| | - Erem Asil
- Department of Urology, Ankara City Hospital, Ankara, Turkey
| | - Ali Fuat Atmaca
- Department of Urology, Ankara Yildirim Beyazit University, School of Medicine affiliated with Ankara City Hospital, Ankara, Turkey
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Demirci A, Ozgur BC. The effect of using tadalafil 5 mg/day on neutrophil–lymphocyte and platelet–lymphocyte ratios in mild‐medium and severe erectile dysfunction patients; and comparison of clinical response. Andrologia 2019; 51:e13347. [DOI: 10.1111/and.13347] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 01/25/2023] Open
Affiliation(s)
- Aykut Demirci
- Urology Department Aksaray University Training and Research Hospıtal Aksaray Turkey
| | - Berat Cem Ozgur
- Urology Department University of Medical Health Science Ankara Research and Training Hospital Ankara Turkey
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