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Slowikowska-Hilczer J, Walczak-Jedrzejowska R, Adamczewska D, Byczkiewicz P, Marchlewska K, Katarzynska J, Gebicki J. A New Approach to the Assessment of Erectile Dysfunction Based on Vasomotion Monitored by the Flow-Mediated Skin Fluorescence (FMSF) Technique-A Preliminary Study. J Clin Med 2024; 13:3210. [PMID: 38892921 PMCID: PMC11173337 DOI: 10.3390/jcm13113210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/29/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Erectile dysfunction (ED) most often has vascular etiology and usually is the earliest symptom of vascular dysfunction. The aim of this study was to evaluate vascular dysfunction with the use of the Flow-Mediated Skin Fluorescence (FMSF) technique in men with and without ED. Methods: Included were 39 men (median age 53) with ED and 40 men (median age 41.5) without ED. Medical interview, physical examination, and anthropometrical measurements were performed for all participants. The serum total testosterone, LH, and SHBG determinations were performed in patients with ED, and the Free Testosterone Index (FTI) was calculated. The FMSF technique was used to measure the microcirculatory oscillations at the baseline and to determine the flowmotion (FM) and vasomotion (VM) parameters. The Normoxia Oscillatory Index (NOI) was calculated, which represents the contribution of the endothelial (ENDO) and neurogenic (NEURO) oscillations relative to all oscillations detected at low-frequency intervals (<0.15 Hz): NOI = (ENDO + NEURO)/(ENDO + NEURO + VM). Results: In men with ED were found significantly lower FM and VM parameters, but the NOI was significantly higher in comparison to men without ED. VM and FM correlated significantly positively with erectile function, orgasmic function, and general sexual satisfaction in the whole group and the FTI in the ED group. The thresholds of 53.5 FM (AUC = 0.7) and 8.4 VM (AUC = 0.7) were predictive values for discriminating men with ED. Conclusions: It was shown that the FMSF diagnostic technique may be helpful in the early diagnosis of microcirculation dysfunction due to impaired vasomotion caused by decreased testosterone activity.
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Affiliation(s)
- Jolanta Slowikowska-Hilczer
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | - Renata Walczak-Jedrzejowska
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | - Daria Adamczewska
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | - Piotr Byczkiewicz
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | - Katarzyna Marchlewska
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | | | - Jerzy Gebicki
- Angionica Ltd., 90-924 Lodz, Poland; (J.K.); (J.G.)
- Institute of Applied Radiation Chemistry, Lodz University of Technology, 90-924 Lodz, Poland
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Li L, Zhang Y, Ma M, Liu F, Shang Y, Yuan Q, Li X, Ju B. Does erectile dysfunction predict cardiovascular risk? A cross-sectional study of clinical characteristics in patients with erectile dysfunction combined with coronary heart disease. Front Cardiovasc Med 2024; 11:1341819. [PMID: 38562188 PMCID: PMC10984325 DOI: 10.3389/fcvm.2024.1341819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
Background Erectile Dysfunction (ED) is a common sexual dysfunction in men who are unable to consistently obtain and maintain sufficient penile erection to accomplish a satisfactory sexual life. ED is currently considered to be a predictor of cardiovascular disease (CVD), but few studies have observed the association between ED and clinical features of coronary heart disease (CHD). An investigation of the association between ED and clinical characteristics of CHD was carried out using a cross-sectional study design. Methods This cross-sectional single-center study was conducted in the Department of Cardiology and included 248 patients. Associations between patients' general information, underlying disease information, coronary heart disease information, and ED severity were statistically and analytically analyzed using SPSS 26.0 software. Patients with comparable clinical characteristics were grouped together using K-means clustering. Finally, ordered logistic regression analysis was performed for general and underlying disease information. Results In the comparison of general data, age, education, and weekly exercise were associated with the distribution of ED severity. In the comparison of underlying disease information, the number of underlying diseases, hypertension, diabetes, hyperlipidemia, anxiety state, and depressive state were associated with the distribution of ED severity. In the comparison of CHD information, the degree of ED severity was associated with CHD subtypes, lesion sites, number of stenoses, degree of stenosis, and interventional interventions. The time from ED to CHD onset was associated with the subtypes of CHD and the number of stenoses. We clustered the main characteristics of low-risk and high-risk patients and ordered logistic regression analysis found that BMI, smoking, alcoholism, number of underlying diseases, diabetes, anxiety state, and depression state were all risk factors for CHD severity (P < 0.05); the higher the value of the above factors, the more severe the degree of CHD. Age was a protective factor for CHD severity; the younger the patient, the lower the likelihood of myocardial infarction. Conclusion ED severity and the time from ED to CHD onset may be predictive of coronary heart disease severity. Reducing smoking and alcohol consumption, maintaining a healthy body weight, and regular physical activity are important in preventing CVD in ED patients.
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Affiliation(s)
- Luyu Li
- The First School of Clinical Medicine, The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yongtao Zhang
- The First School of Clinical Medicine, The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Miaomiao Ma
- The First School of Clinical Medicine, The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Feng Liu
- The First School of Clinical Medicine, The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yihan Shang
- The First School of Clinical Medicine, The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Quan Yuan
- The First School of Clinical Medicine, The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Xiao Li
- Department of Andrology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Baojun Ju
- Department of Andrology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
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Kloner RA, Burnett AL, Miner M, Blaha MJ, Ganz P, Goldstein I, Kim NN, Kohler T, Lue T, McVary KT, Mulhall JP, Parish SJ, Sadeghi-Nejad H, Sadovsky R, Sharlip ID, Rosen RC. Princeton IV consensus guidelines: PDE5 inhibitors and cardiac health. J Sex Med 2024; 21:90-116. [PMID: 38148297 DOI: 10.1093/jsxmed/qdad163] [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: 09/06/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND In 1999, 1 year after the approval of the first oral phosphodiesterase type 5 (PDE5) inhibitor for the treatment of erectile dysfunction (ED), the first Princeton Consensus Conference was held to address the clinical management of men with ED who also had cardiovascular disease. These issues were readdressed in the second and third conferences. In the 13 years since the last Princeton Consensus Conference, the experience with PDE5 inhibitors is more robust, and recent new data have emerged regarding not only safety and drug-drug interactions, but also a potential cardioprotective effect of these drugs. AIM In March 2023, an interdisciplinary group of scientists and practitioners met for the fourth Princeton Consensus Guidelines at the Huntington Medical Research Institutes in Pasadena, California, to readdress the cardiovascular workup of men presenting with ED as well as the approach to treatment of ED in men with known cardiovascular disease. METHOD A series of lectures from experts in the field followed by Delphi-type discussions were developed to reach consensus. OUTCOMES Consensus was reached regarding a number of issues related to erectile dysfunction and the interaction with cardiovascular health and phosphodiesterase-5 inhibitors. RESULTS An algorithm based on recent recommendations of the American College of Cardiology and American Heart Association, including the use of computed tomography coronary artery calcium scoring, was integrated into the evaluation of men presenting with ED. Additionally, the issue of nitrate use was further considered in an algorithm regarding the treatment of ED patients with coronary artery disease. Other topics included the psychological effect of ED and the benefits of treating it; the mechanism of action of the PDE5 inhibitors; drug-drug interactions; optimizing use of a PDE5 inhibitors; rare adverse events; potential cardiovascular benefits observed in recent retrospective studies; adulteration of dietary supplements with PDE5 inhibitors; the pros and cons of over-the-counter PDE5 inhibitors; non-PDE5 inhibitor therapy for ED including restorative therapies such as stem cells, platelet-rich plasma, and shock therapy; other non-PDE5 inhibitor therapies, including injection therapy and penile prostheses; the issue of safety and effectiveness of PDE5 inhibitors in women; and recommendations for future studies in the field of sexual dysfunction and PDE5 inhibitor use were discussed. CLINICAL IMPLICATIONS Algorithms and tables were developed to help guide the clinician in dealing with the interaction of ED and cardiovascular risk and disease. STRENGTHS AND LIMITATIONS Strengths include the expertise of the participants and consensus recommendations. Limitations included that participants were from the United States only for this particular meeting. CONCLUSION The issue of the intersection between cardiovascular health and sexual health remains an important topic with new studies suggesting the cardiovascular safety of PDE5 inhibitors.
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Affiliation(s)
- Robert A Kloner
- Department of Cardiovascular Research Pasadena, Huntington Medical Research Institutes, CA 91105, United States
- Department of Medicine, Keck School of Medicine at University of Southern California, Los Angeles, CA, United States
| | - Arthur L Burnett
- Department of Urology, Johns Hopkins University, Baltimore, MD, United States
| | - Martin Miner
- Men's Health Center, Miriam Hospital, Providence, RI, United States
| | - Michael J Blaha
- Cardiology and Epidemiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States
| | - Peter Ganz
- Department of Medicine (PG); Department of Urology (TL, IDS); Department of Psychiatry and Behavioral Sciences, (RCR), University of California, San Francisco, San Francisco, CA, United States
| | - Irwin Goldstein
- Department of Sexual Medicine, Institute for Sexual Medicine, Alvarado Hospital, San Diego, CA, United States
| | - Noel N Kim
- Department of Sexual Medicine, Institute for Sexual Medicine, Alvarado Hospital, San Diego, CA, United States
| | | | - Tom Lue
- Department of Medicine (PG); Department of Urology (TL, IDS); Department of Psychiatry and Behavioral Sciences, (RCR), University of California, San Francisco, San Francisco, CA, United States
| | - Kevin T McVary
- Center for Male Health, Stritch School of Medicine at Loyola University Medical Center, Maywood, IL, United States
| | - John P Mulhall
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Sharon J Parish
- Weill Cornell Medicine, New York, NY, United States
- Department of Medicine and Psychiatry White Plains, Westchester Behavioral Health Center, NewYork-Presbyterian Hospital, NY, United States
| | - Hossein Sadeghi-Nejad
- Department of Urology NY, NYU Langone Grossman School of Medicine, NY, United States
| | - Richard Sadovsky
- Department of Family and Community Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | - Ira D Sharlip
- Department of Medicine (PG); Department of Urology (TL, IDS); Department of Psychiatry and Behavioral Sciences, (RCR), University of California, San Francisco, San Francisco, CA, United States
| | - Raymond C Rosen
- Department of Medicine (PG); Department of Urology (TL, IDS); Department of Psychiatry and Behavioral Sciences, (RCR), University of California, San Francisco, San Francisco, CA, United States
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Xi Y, Yin X, Zhou J, Shen R, Qi L, Zhang S. Genetically predicted cardiovascular diseases could increase the risk of erectile dysfunction: a bidirectional Mendelian randomization. World J Urol 2023; 41:3187-3194. [PMID: 37782322 DOI: 10.1007/s00345-023-04630-6] [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: 01/29/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE Erectile dysfunction (ED) often appears concomitantly with cardiovascular diseases (CVDs). However, the causal relationship between ED and CVDs is still unclear. This study aimed to investigate the causal effects between CVDs and ED using bidirectional Mendelian randomization (MR). METHODS ED data (6175 cases and 217,630 controls) were obtained from the IEU OpenGWAS project. Seven types of CVDs were acquired in our study, including stroke (Sample size = 440,328), myocardial infection (Sample size = 184,305), coronary heart disease (Sample size = 86,995), hypertension (Sample size = 36,683), heart failure (Sample size = 208,178), atrial fibrillation (Sample size = 1,030,836), and coronary artery disease (Sample size = 141,217). Inverse variance weighted (IVW) was selected as the primary method for MR analysis. RESULTS IVW results indicated that stroke (OR = 1.14, 95% CI = 1.02-1.29, P = 0.025), coronary artery disease (OR = 1.09, 95% CI = 1.02-1.16, P = 0.013), coronary heart disease (OR = 1.07, 95% CI = 1.01-1.13, P = 0.017), myocardial infection (OR = 1.09, 95% CI = 1.02-1.17, P = 0.011), and atrial fibrillation (OR = 1.06, 95% CI = 1.00-1.12, P = 0.04) were causally associated with ED. The reverse MR analysis suggested that ED did not influence the prevalence of CVDs. CONCLUSION These findings highlighted CVDs as causal risk factors for ED, but ED did not directly result in the development of CVDs. Regular monitoring of the erectile function of individuals with CVDs, along with implementing appropriate preventive measures, might help reduce the incidence of ED and enhance the sexual well-being of patients with CVDs.
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Affiliation(s)
- Yujia Xi
- Department of Urology, Second Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, People's Republic of China
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, Shanxi Province, People's Republic of China
- Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi Province, People's Republic of China
| | - Xinyu Yin
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, Shanxi Province, People's Republic of China
- Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi Province, People's Republic of China
| | - Jing Zhou
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, Shanxi Province, People's Republic of China
- Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi Province, People's Republic of China
| | - Ruotong Shen
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, Shanxi Province, People's Republic of China
- Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi Province, People's Republic of China
| | - Likun Qi
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, Shanxi Province, People's Republic of China
- Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi Province, People's Republic of China
| | - Shengxiao Zhang
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, Shanxi Province, People's Republic of China.
- Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi Province, People's Republic of China.
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi Province, 030001, People's Republic of China.
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Shigehara K, Kato Y, Konaka H, Kawaguchi S, Nohara T, Izumi K, Kadono Y, Namiki M, Mizokami A. The correlation between erectile function and adiponectin levels in men with late-onset hypogonadism. Aging Male 2022; 25:249-254. [PMID: 36190764 DOI: 10.1080/13685538.2022.2119955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Aim: This study investigated the relationship between erectile dysfunction (ED) and adiponectin levels in hypogonadal men.Methods: In this study, 218 patients with hypogonadism (mean age: 65.1 ± 8.3 years) were enrolled. All patients underwent physical examinations, with measurement of body mass index, body fat ratio, and waist circumference. The erectile function was assessed using the sexual health inventory for men (SHIM) scoring system. Blood biochemical profiles such as free testosterone, fasting blood glucose, and lipid profile including adiponectin levels were measured. All patients were divided into two groups based on their SHIM score: normal to moderate ED (SHIM score ≥ 12) and severe ED (SHIM score < 12), and the factors associated with severe ED were determined. Patients with severe ED were divided into two groups based on adiponectin levels (cutoff value of 7.0 μg/mL), and their basic characteristics were compared between these two groups.Results: The severe ED group was older and had higher adiponectin levels. In patients with severe ED, various metabolic parameters were significantly worse in the low adiponectin groups than in the non-low adiponectin group.Conclusions: The risk of developing cardiovascular diseases is extremely high in hypogonadal men with severe ED who had lower serum adiponectin levels.
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Affiliation(s)
- Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yuki Kato
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroyuki Konaka
- Department of Urology, Kanazawa Red Cross Hospital, Kanazawa, Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Mikio Namiki
- Department of Urology, Hasegawa Hospital, Toyama, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Menafra D, de Angelis C, Garifalos F, Mazzella M, Galdiero G, Piscopo M, Castoro M, Verde N, Pivonello C, Simeoli C, Auriemma RS, Colao A, Pivonello R. Long-term high-dose L-arginine supplementation in patients with vasculogenic erectile dysfunction: a multicentre, double-blind, randomized, placebo-controlled clinical trial. J Endocrinol Invest 2022; 45:941-961. [PMID: 34973154 PMCID: PMC8995264 DOI: 10.1007/s40618-021-01704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 11/03/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE The current randomized, double-blind, placebo-controlled clinical trial addressed the effects on penile erectile function of relatively high daily oral doses (6 g/day) of L-ARG for 3 months (N = 51) compared to placebo (N = 47), in patients with vasculogenic ED, with comparison between mild-moderate and severe vasculogenic ED. METHODS The outcome measures included IIEF-6 score and cavernous arteries peak systolic flow velocity (PSV) at dynamic penile duplex ultrasonography (PDU). RESULTS L-ARG supplementation for 3 months significantly increased IIEF-6 score in the overall cohort (p < 0.0001) and in subgroups of patients with mild-moderate (p < 0.0001) and severe (p = 0.007) vasculogenic ED; PSV was significantly increased in the overall cohort (p < 0.0001) and in patients with mild-moderate (p < 0.0001), but not severe vasculogenic ED. At study completion, 74% of patients improved ED degree category, although only 24% of patients, mainly belonging to the baseline category of mild ED, reached IIEF-6 scores compatible with absence of ED; moreover, 20% of patients, exclusively belonging to the baseline category of mild-moderate vasculogenic ED, reached PSV values compatible with absence of ED. CONCLUSION The results of the current study demonstrated that supplementation with relatively high doses of L-ARG as a single compound for 3 months significantly improved penile erectile function, assessed by both IIEF-6 score and PSV at dynamic PDU in patients with mild-moderate, and improved IIEF-6 score, but not PSV, in patients with severe vasculogenic ED, therefore suggesting that L-ARG might be an alternative treatment in mild-moderate vasculogenic ED patients experiencing adverse effects or with contraindications for chronic treatment with PDE5i compounds.
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Affiliation(s)
- D. Menafra
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Via Sergio Pansini 5, 80131 Naples, Italy
| | - C. de Angelis
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Via Sergio Pansini 5, 80131 Naples, Italy
| | - F. Garifalos
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Via Sergio Pansini 5, 80131 Naples, Italy
| | - M. Mazzella
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Via Sergio Pansini 5, 80131 Naples, Italy
| | - G. Galdiero
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Via Sergio Pansini 5, 80131 Naples, Italy
| | - M. Piscopo
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Via Sergio Pansini 5, 80131 Naples, Italy
| | - M. Castoro
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Via Sergio Pansini 5, 80131 Naples, Italy
| | - N. Verde
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Via Sergio Pansini 5, 80131 Naples, Italy
| | - C. Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Via Sergio Pansini 5, 80131 Naples, Italy
| | - C. Simeoli
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Via Sergio Pansini 5, 80131 Naples, Italy
| | - R. S. Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Via Sergio Pansini 5, 80131 Naples, Italy
| | - A. Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Via Sergio Pansini 5, 80131 Naples, Italy
- Unesco Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - R. Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Via Sergio Pansini 5, 80131 Naples, Italy
- Unesco Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
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Interactions between erectile dysfunction, cardiovascular disease and cardiovascular drugs. Nat Rev Cardiol 2022; 19:59-74. [PMID: 34331033 DOI: 10.1038/s41569-021-00593-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 02/06/2023]
Abstract
Sexual health has a fundamental role in overall health and well-being, and a healthy and dynamic sex life can make an important contribution to a good quality of life. Sexual dysfunction, and especially erectile dysfunction (ED) in men, is highly prevalent in patients with cardiovascular disease (CVD). CVD and ED have shared risk factors and pathophysiological links, such as endothelial dysfunction, inflammation and low plasma testosterone levels. ED has been shown to be an independent and early harbinger of future CVD events, providing an important window to initiate preventive measures. Therefore, screening and diagnosing ED is essential for the primary and secondary prevention of CVD because the assessment of ED offers an easy and low-cost prognostic tool that is an alternative to other investigational cardiovascular biomarkers. Moreover, ED is a major contributing factor to the discontinuation of, or poor adherence to, cardiovascular therapy. Cardiovascular drugs have divergent effects on erectile function, with diuretics and β-blockers having the worst profiles, and renin-angiotensin-aldosterone system inhibitors and nebivolol having the best profiles. Pharmacological treatment of ED has an equivocal effect on the risk of CVD, suggesting a complex interaction between ED and drugs for CVD. In this Review, we discuss how sexual function could be incorporated into the patient history taken by physicians treating individuals with CVD, not merely as part of the diagnostic work-up but as a means to pursue tangible and essential benefits in quality of life and cardiovascular outcomes.
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Nunes AP, Seeger JD, Stewart A, Gupta A, McGraw T. Cardiovascular Outcome Risks in Patients With Erectile Dysfunction Co-Prescribed a Phosphodiesterase Type 5 Inhibitor (PDE5i) and a Nitrate: A Retrospective Observational Study Using Electronic Health Record Data in the United States. J Sex Med 2021; 18:1511-1523. [PMID: 37057443 DOI: 10.1016/j.jsxm.2021.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/23/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Phosphodiesterase type 5 inhibitors (PDE5i) are first-line therapy for erectile dysfunction (ED). Approximately 1-4% of PDE5i recipients co-possess nitrates, despite this combination potentially producing clinically significant hypotension. Real-world data in these patients and insights into prescriber rationales for co-prescription are limited. AIM This study investigated whether PDE5i and nitrate co-possession is associated with increased rates of cardiovascular (CV) outcomes. METHODS Adult males with ED and PDE5i prescription and males with nitrate prescription were identified from a U.S. electronic health record database (2012-2016). Quantitative comparisons were made between patients with ED and co-possession (ED + PDE5i + nitrate), only nitrate possession (ED + nitrate and nitrate only [without ED]), and only PDE5i possession (ED + PDE5i). OUTCOMES We quantified incidence of CV outcomes in co-possession and comparator periods, calculating incidence rate ratios after propensity score matching. Prescriber rationales were derived by reviewing virtual patient records. RESULTS Over 168,000 patients had ≥1 PDE5i prescription (∼241,000 possession periods); >480,000 patients had ≥1 nitrate prescription (∼486,000 possession periods); and 3,167 patients had 3,668 co-possession periods. Non-significantly different or lower rates of CV outcomes were observed for co-possession periods vs ED + nitrate and nitrate only periods. Most CV outcome rates were non-significantly different between co-possession and ED + PDE5i periods (myocardial infarction, hospitalized unstable angina and fainting were higher with co-possession). From qualitative assessment of patient records with co-possession, 131 of 252 (52%) documented discussion with a physician regarding co-possession; 69 of 131 (53%) warned or instructed on safely managing these contraindicated medications. CLINICAL IMPLICATIONS Findings from this real-world study indicate that co-possession of nitrate and PDE5i prescriptions is not associated with increased rates of CV outcomes, relative to possession of nitrates alone. Physicians should and often do discuss the risks of using both medications together with their patients. STRENGTHS & LIMITATIONS Strengths of this study are the large size of the U.S. real-world patient cohort with data available for analysis, and our ability to utilize natural language processing to explore co-prescription rationales and patient-physician interactions. Limitations are the retrospective nature of the analysis and inability to establish whether recorded prescriptions were filled or the medication was consumed. CONCLUSION Co-exposure of PDE5i and nitrates should continue to be avoided; however, co-possession of PDE5i and nitrate prescriptions is not necessarily associated with increased CV risk. Co-possession can be successfully managed in suitable circumstances. Nunes AP, Seeger JD, Stewart A, et al. Cardiovascular Outcome Risks in Patients With Erectile Dysfunction Co-Prescribed a Phosphodiesterase Type 5 Inhibitor (PDE5i) and a Nitrate: A Retrospective Observational Study Using Electronic Health Record Data in the United States. J Sex Med 2021;18:1511-1523.
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9
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Anatomy, Pathophysiology, Molecular Mechanisms, and Clinical Management of Erectile Dysfunction in Patients Affected by Coronary Artery Disease: A Review. Biomedicines 2021; 9:biomedicines9040432. [PMID: 33923709 PMCID: PMC8074129 DOI: 10.3390/biomedicines9040432] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 12/17/2022] Open
Abstract
Erectile dysfunction (ED) has been defined as the inability to attain or maintain penile erection sufficient for successful sexual intercourse. ED carries a notable influence on life quality, with significant implications for family and social relationships. Because atherosclerosis of penile arteries represents one of the most frequent ED causes, patients presenting with it should always be investigated for potential coexistent coronary or peripheral disease. Up to 75% of ED patients have a stenosis of the iliac-pudendal-penile arteries, supplying the male genital organ’s perfusion. Recently, pathophysiology and molecular basis of male erection have been elucidated, giving the ground to pharmacological and mechanical revascularization treatment of this condition. This review will focus on the normal anatomy and physiology of erection, the pathophysiology of ED, the relation between ED and cardiovascular diseases, and, lastly, on the molecular basis of erectile dysfunction.
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10
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Mostafaei H, Mori K, Hajebrahimi S, Abufaraj M, Karakiewicz PI, Shariat SF. Association of erectile dysfunction and cardiovascular disease: an umbrella review of systematic reviews and meta-analyses. BJU Int 2020; 128:3-11. [PMID: 33260254 PMCID: PMC8359379 DOI: 10.1111/bju.15313] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectives To present an overall picture of the evidence regarding the association of erectile dysfunction (ED) with cardiovascular disease (CVD). Methods Systematic reviews and meta‐analyses that studied the association of ED with any CVD were included in this umbrella review. We did not restrict the population to a particular group or age. PubMed, Embase, the Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, and the PROSPERO register were searched to find relevant systematic reviews, with or without meta‐analyses, from inception to April 2020. The JBI Checklist for Systematic Reviews and Research Syntheses was used for the critical appraisal. Only studies with acceptable quality were included. Two independent reviewers extracted the data using the JBI data extraction tool for qualitative and quantitative data extraction. Results The summary estimate showed a higher risk of CVD (relative risk [RR] 1.45, 95% confidence interval [CI] 1.36–1.54; P < 0.001), coronary heart disease (RR 1.50, 95% CI 1.37–1.64; P < 0.001), cardiovascular‐related mortality (RR 1.50, 95% CI 1.37–1.64; P < 0.001), all‐cause mortality (RR 1.25, 95% CI 1.18–1.32; P < 0.001), myocardial infarction (RR 1.55, 95% CI 1.33–1.80; P < 0.001) and stroke (RR 1.36, 95% CI 1.26–1.46; P < 0.001) in patients with ED than in other patients. Conclusions Our results confirm that ED is an independent predictor of CVD and their outcomes. ED and CVD are two presentations of the same physiological phenomenon. ED normally precedes symptomatic CVD, providing a window of opportunity for healthcare practitioners to screen and detect high‐risk patients early to prevent avoidable morbidity and mortality.
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Affiliation(s)
- Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Research Centre for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Sakineh Hajebrahimi
- Research Centre for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern, Dallas, TX, USA.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Urology, University of Jordan, Amman, Jordan.,European Association of Urology Research Foundation, Arnhem, The Netherlands
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11
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Corona G, Sansone A, Pallotti F, Ferlin A, Pivonello R, Isidori AM, Maggi M, Jannini EA. People smoke for nicotine, but lose sexual and reproductive health for tar: a narrative review on the effect of cigarette smoking on male sexuality and reproduction. J Endocrinol Invest 2020; 43:1391-1408. [PMID: 32323225 DOI: 10.1007/s40618-020-01257-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/11/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To systematically review the impact of smoking habits on cardiovascular (CV) as well as on male sexual and reproductive function and to provide updated evidence on the role of electronic cigarettes (e-Cig) on the same topics. METHODS A comprehensive Medline, Embase, and Cochrane search was performed including the following words: smoking, CV system, CV risk, erectile dysfunction (ED), and male fertility. Publications from January 1, 1969 up to February 29, 2020 were included. RESULTS Smoking has a tremendous negative impact on CV mortality and morbidity. Current smoking behavior is also negatively associated with erectile dysfunction (ED) and impaired sperm parameters. E-Cig can release significantly lower concentrations of harmful substances when compared to regular combustible cigarettes. Whether or not the latter can result in positive CV, sexual, and fertility outcomes is still under study. Preliminary studies showed that exposure to e-Cig leads to lower vascular damage when compared to the traditional cigarette use. However, data on the long-term effects of e-Cig are lacking. Similarly, preliminary data, obtained in animal models, have suggested a milder effect of e-Cig on erectile function and sperm parameters. CONCLUSION Available evidence showed that e-Cig are much less dangerous when compared to the traditional tobacco use. However, it should be recognized that the risk related to e-Cig is still higher when compared to that observed in non-smoking patients. Hence, e-Cig should be considered as a potential tool, in the logic of harm reduction, to reduce the CV, sexual and fertility risk in patients refractory to the fundamental, healthy choice to definitively quit smoking.
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Affiliation(s)
- G Corona
- Medical Department, Endocrinology Unit, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, Bologna, Italy
| | - A Sansone
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - F Pallotti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Ferlin
- Unit of Endocrinology and Metabolism, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - R Pivonello
- Division of Endocrinology, Università Degli Studi Di Napoli "Federico II", Naples, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Maggi
- Department of Experimental, Clinical and Biomedical Sciences, Endocrinology Unit, University of Florence, Florence, Italy
| | - E A Jannini
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy.
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12
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Shiferaw WS, Akalu TY, Petrucka PM, Areri HA, Aynalem YA. Risk factors of erectile dysfunction among diabetes patients in Africa: A systematic review and meta-analysis. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2020; 21:100232. [PMID: 32685380 PMCID: PMC7358381 DOI: 10.1016/j.jcte.2020.100232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/18/2020] [Accepted: 06/27/2020] [Indexed: 12/21/2022]
Abstract
Background Erectile dysfunction in men is a common underestimated complication of diabetes mellitus, which is becoming a significant public health problem both in developing and developed countries. Erectile dysfunction threatens the well-being of clients, hence determining its risk factors and controlling it at an early stage is vital to preventing serious consequences and the burden of the disease. Therefore, this study aimed to systematically evaluate erectile dysfunction risk factors in patients with diabetes mellitus in Africa. Methods PubMed, Web of Science, Scopus, African Journals Online, Wiley Online Library and Google Scholar were searched and complemented by manual searches. Egger's regression test was used to determine publication bias. The I2 statistic was used to check heterogeneity between the studies. DerSimonian and Laird random-effects model was applied to estimate pooled effect size, odds ratios, and 95% confidence interval across studies. STATA version 14 statistical software was used for the meta-analysis. Result Overall, 17 studies with 6002 study participants were included to identify risk factors of erectile dysfunction among diabetic patients. Duration of diabetes mellitus >10 years (AOR = 2.63; 95% CI 1.27, 5.43), age >40 years (AOR = 1.24; 95% CI: 1.03, 1.51), peripheral neuropathy (AOR = 2.34; 95% CI: 1.51, 10.72), no physical exercise (AOR = 1.63; 95% CI: 1.49, 1.78), testosterone level <8 nmol/l (AOR = 2.83; 95% CI: 1.06, 12.86), and peripheral vascular disease (AOR = 2.85, 95% CI: 1.54–5.27) were significantly associated with erectile dysfunction among diabetic patients. Conclusions This study found that long duration of diabetes mellitus, age >40 years, testosterone deficiency, peripheral neuropathy, not involved in physical exercise, peripheral vascular disease, were significantly associated with increased risk of erectile dysfunction among diabetic patients Therefore, situation-based interventions and country context-specific preventive strategies should be developed to decrease the risk factors of erectile dysfunction among patients with diabetes mellitus.
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Affiliation(s)
- Wondimeneh Shibabaw Shiferaw
- Department of Nursing, College of Health Science, Debre Berhan University, Ethiopia
- Corresponding author at: P.O. Box 445, Debre Berhan, Ethiopia.
| | - Tadesse Yirga Akalu
- Department of Nursing, College of Health Science, Debre Markos University, Ethiopia
| | | | - Habtamu Abera Areri
- School of Nursing and Midwifery, College of Health Science, Addis Ababa University, Ethiopia
| | - Yared Asmare Aynalem
- Department of Nursing, College of Health Science, Debre Berhan University, Ethiopia
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13
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Sangiorgi G, Pizzuto A, Diehm N, Greco F, Fusco F, Chiricolo G, Vismara A, Altieri VM, Cereda A, Bongo S. Endovascular therapy for erectile dysfunction: current knowledge and future perspectives. Minerva Cardiol Angiol 2020; 69:579-595. [PMID: 32492987 DOI: 10.23736/s2724-5683.20.05136-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Erectile dysfunction (ED) is defined as the inability to attain or maintain penile erection sufficient for successful sexual intercourse. ED carries a notable influence on quality of life, with significant implications for family and social relationships. Because atherosclerosis of penile arteries represents one of the most frequent causes of ED, patients presenting with it should always be investigated for potential coexistent coronary or peripheral disease. Up to 75% of patients with ED have a stenosis of the iliac-pudendal-penile arteries, supplying perfusion of the male genital organ. Recently the potential treatment of this pathological condition by percutaneous approaches has emerged with good angiographic results and with a significant improvement in symptoms and quality of life. This review will focus on the normal anatomy and physiology of erection, the pathophysiology of ED, the relation between ED and cardiovascular diseases and, lastly, on new treatment modalities aimed at restoration of normal erectile function.
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Affiliation(s)
- Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy -
| | - Alessandra Pizzuto
- Division of Cardiology, Department of Systemic Medicine, Tor Vergata University, Rome, Italy
| | - Nicolas Diehm
- Vascular Institute Central Switzerland, Aarau, Switzerland
| | | | - Ferdinando Fusco
- Department of Urology, Luigi Vanvitelli University, Caserta, Italy
| | - Gaetano Chiricolo
- Division of Cardiology, Department of Systemic Medicine, Tor Vergata University, Rome, Italy
| | - Alberto Vismara
- Department of Urology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | | | - Alberto Cereda
- Division of Cardiology, San Gaudenzio Clinic, Novara, Italy
| | - Sante Bongo
- Division of Cardiology, San Gaudenzio Clinic, Novara, Italy
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14
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Kim KS, Jeong TY, Moon HS. Effect of daily tadalafil on reported outcomes in patients with erectile dysfunction and depressive symptoms: STROBE, a case-control study. Medicine (Baltimore) 2020; 99:e20546. [PMID: 32502017 PMCID: PMC7306377 DOI: 10.1097/md.0000000000020546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022] Open
Abstract
Erectile dysfunction (ED) and depression are closely related. We sought to determine ED and depression were improved by tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor, at 5 mg daily, in this case-control study.Participants were men aged 20 to 65 years with ED for >3 months, International Index of Erectile Function-5 (IIEF) score <21 points, and Zung Self-Rating Depression Scale (SDS) survey result >50 points who were willing to participate.On first visit (V1) and after 1 (V2) and 2 months (V3), clinical features were examined using IIEF-5 for diagnosing and evaluating ED, SDS for evaluating depression, and International Prostate Symptom Score and Quality of Life (IPSS/QoL) survey for examining lower urinary tract symptoms (LUTS). Tadalafil 5 mg was administered daily for 2 months.A total of 60 participants were an average age of 58.68 ± 6.71 years. Patient overall average IIEF was 8.76 ± 5.98, showing mild ED symptoms, and total average IPSS 13.74 ± 7.55 showed moderate LUTS. Average overall SDS index was 58.93 ± 9.21, indicating moderate-to-severe findings. Average change in IIEF among all patients revealed significant improvement from V1 to V2 (-2.69 ± 1.22, P = .03) and V1 to V3 (-4.38 ± 1.20, P < 0.01). IPSS also significantly improved from V1 to V3 (3.48 ± 1.37, P = .01), as did SDS index (V1, V2: 4.69 ± 1.89, P = 0.02), (V1, V3: 5.43 ± 1.89, P < .01). Patients with severe IIEF scores (group 1, n = 27) experienced significantly greater improvement in IIEF from V1 to V2 and V1 and V3, compared to those with mild-to-moderate IIEF scores. Both groups improved in SDS index from V1 to V2 and V1 to V3, with the greatest improvement between V1 and V3 for group 1 and V1 and V2 for group 2.Daily tadalafil 5 mg could be helpful for ED patients with depressive symptoms and improved LUTS and quality of life.
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Affiliation(s)
- Kyu Shik Kim
- Department of Urology, Myongji Hospital, Hanyang University College of Medicine, Goyang
| | - Tae Yoong Jeong
- Department of Urology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Hong Sang Moon
- Department of Urology, Myongji Hospital, Hanyang University College of Medicine, Goyang
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15
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Sangiorgi G, Chiricolo G, Nocella C, Carnevale R. Erectile and diastolic dysfunction: two sides of the same coin or same sides of two different coins? Minerva Cardioangiol 2020; 68:291-294. [PMID: 32326682 DOI: 10.23736/s0026-4725.20.05283-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Gaetano Chiricolo
- Department of Systemic Medicine, Tor Vergata University, Rome, Italy
| | - Cristina Nocella
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Roberto Carnevale
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
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16
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Corona G, Rastrelli G, Isidori AM, Pivonello R, Bettocchi C, Reisman Y, Sforza A, Maggi M. Erectile dysfunction and cardiovascular risk: a review of current findings. Expert Rev Cardiovasc Ther 2020; 18:155-164. [PMID: 32192361 DOI: 10.1080/14779072.2020.1745632] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: A large body of evidence has clearly documented that erectile dysfunction (ED) represents not only a complication of cardiovascular (CV) diseases (CVD) but often an early sign of forthcoming CVD.Areas covered: All the available data from meta-analyses evaluating the association between ED and CV risk were collected and discussed. Similarly, all available meta-analyses investigating the significance of ED as a possible early marker for major adverse cardiovascular events (MACE) were analyzed. In addition, data originally obtained in a Florence cohort, dealing with a large series of patients seeking medical care for sexual dysfunction, will be also reported.Expert opinion: Available evidence indicates that ED represents a risk factor of CV mortality and morbidity. Not only conventional CV risk factors but also unconventional ones, derived from a perturbation of the relational and intrapsychic domains of ED, might play a possible role in CV risk stratification of ED subjects. Finally, penile doppler ultrasound can give important information on CV risk, especially in younger and low risk subjects. The presence of ED should become an opportunity - for the patient and for the physician - to screen for the presence of comorbidities improving not only sexual health but, more importantly, men's overall health.
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Affiliation(s)
- G Corona
- Endocrinology Unit, Medical Department, Azienda-Usl Bologna, Maggiore-Bellaria Hospital, Bologna, Italy
| | - G Rastrelli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - R Pivonello
- Division of Endocrinology, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - C Bettocchi
- Department of Urology, University of Bari, Bari, Apulia, Italy
| | - Y Reisman
- Department of Urology, Amstelland Hospital, Amsterdam, The Netherlands
| | - A Sforza
- Endocrinology Unit, Medical Department, Azienda-Usl Bologna, Maggiore-Bellaria Hospital, Bologna, Italy
| | - M Maggi
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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17
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Lee JY, Jung DC, Lee S, Kang NG, Oh YT, Han K. Stiffness of the Central Corpus Cavernosum on Shear-Wave Elastography Is Inversely Correlated with the Penile Rigidity Score in Patients with Erectile Dysfunction. World J Mens Health 2020; 39:123-130. [PMID: 32009308 PMCID: PMC7752512 DOI: 10.5534/wjmh.190094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/01/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose To perform real-time quantitative measurements of penile rigidity for patients with erectile dysfunction (ED) using shear-wave elastography (SWE). Materials and Methods A total of 92 patients with clinically diagnosed ED filled out an abridged five-item version of the International Index of Erectile Function (IIEF-5) questionnaire and underwent SWE as well as penile color Doppler ultrasound (CDUS) after intracavernosal injection for penile erection. Elasticity measurements were repeated on two sites of the corpus cavernosum (central and peripheral elasticity of corpus cavernosum [ECC]) and the glans penis during the erection phase. Correlations between penile elasticity and rigidity scores or IIEF-5 were evaluated statistically. Penile elasticity was also compared with the ED types based on CDUS. Results The mean age of all patients was 53.5±13.4 years, and the mean IIEF-5 score was 9.78±5.01. The rigidity score and central ECC value demonstrated a significant correlation (r=−0.272; 95% confidence interval: −0.464 to −0.056; p=0.015). The IIEF-5 score was not significantly correlated with penile elasticity. Vascular ED patients showed significantly higher central ECC values than nonvascular ED patients (p<0.001). At a cut-off value of 8.05 kPa, the central ECC had a specificity of 41.5%, a sensitivity of 84.6%, and an area under the ROC curve of 0.720 with a standard error of 0.059 (p=0.019) for predicting vascular ED. Conclusions Quantitatively measuring Young's modulus of the corpus cavernosum using SWE could be an objective technique for assessing penile erectile rigidity and the vascular subtype in patients with ED.
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Affiliation(s)
- Joo Yong Lee
- Department of Urology, Yonsei Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Chul Jung
- Department of Radiology, Yonsei Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
| | - Seungsoo Lee
- Department of Radiology, Yonsei Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Gyu Kang
- Department of Radiology, Yonsei Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.,Korea & Armed Forces Capital Hospital, Seongnam, Korea
| | - Young Taik Oh
- Department of Radiology, Yonsei Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology, Yonsei Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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18
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Male Sexual and Reproductive Health-Does the Urologist Have a Role in Addressing Gender Inequality in Life Expectancy? Eur Urol Focus 2019; 6:791-800. [PMID: 31711931 DOI: 10.1016/j.euf.2019.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/09/2019] [Accepted: 10/17/2019] [Indexed: 12/21/2022]
Abstract
Despite considerable public health initiatives in the past century, there remains a significant gender inequality in life expectancy. The Global Burden of Diseases study has highlighted that the life expectancy for men is 70.5years, compared with 75.6years for women. This discrepancy in mortality appears to be related to a disproportionately higher number of preventable and premature male deaths. Whilst there has been an increased focus on men's health, as evidenced by the establishment of men's health charities and governmental legislation promoting equality, a recent World Health Organization report has highlighted that there is still a prevailing misconception that the higher rate of premature mortality amongst men is a natural phenomenon. We explore the association of male sexual and reproductive health-related diseases and the potential role of a urologist in addressing gender inequality in life expectancy. PATIENT SUMMARY: In this report, we discuss the causes for the gender gap in life expectancy and highlight that men continue to have a higher rate of premature death than women, which is associated with diseases of the male reproductive system. Furthermore, this not only appears to be related to a number of metabolic and lifestyle factors, but may also be the result of the increased risk of cancer in men with sexual and reproductive health-related diseases.
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19
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Capogrosso P, Ventimiglia E, Boeri L, Cazzaniga W, Chierigo F, Pederzoli F, Frego N, Abbate C, Dehò F, Montorsi F, Salonia A. Age at First Presentation for Erectile Dysfunction: Analysis of Changes over a 12-yr Period. Eur Urol Focus 2019; 5:899-905. [DOI: 10.1016/j.euf.2018.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 01/29/2018] [Accepted: 02/20/2018] [Indexed: 01/05/2023]
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Rastrelli G, Lotti F, Reisman Y, Sforza A, Maggi M, Corona G. Metabolically healthy and unhealthy obesity in erectile dysfunction and male infertility. Expert Rev Endocrinol Metab 2019; 14:321-334. [PMID: 31464531 DOI: 10.1080/17446651.2019.1657827] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022]
Abstract
Introduction: Metabolically unhealthy obesity (MUHO) is the most important preventable cardiovascular (CV) risk factor. Recently, the significance of metabolically healthy obesity (MHO) as a CV risk factor has raised increasing interest. MUHO is a known risk factor for erectile dysfunction (ED); however, the effect of MHO on ED has barely been investigated. This review aims at summarizing the evidence supporting the relation of MUHO and MHO to male sexual functioning and fertility. Areas covered: An extensive Medline search on obesity and ED or male infertility was conducted to summarize the role of MUHO or MHO on male sexual dysfunction and infertility. Expert opinion: Longitudinal studies have demonstrated that MHO causes vascular damage, which is consistent with the impairment in penile blood flows found in ED subjects. In this population, MHO is a predictor of CV events. The relationship between male infertility and MUHO is currently debated and data on MHO are almost completely lacking. The only available study did not find an association between obesity classes and semen parameters. Although the andrological correlates of MHO must be better assessed, in the current state, evidence suggests that MHO does not represent a benign condition and measures for improving lifestyle are mandatory.
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Affiliation(s)
- Giulia Rastrelli
- Department of Experimental and Clinical Biomedical Sciences, University of Florence , Florence , Italy
| | - Francesco Lotti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence , Florence , Italy
| | - Yacov Reisman
- Department of Urology, Amstelland Hospital , Amsterdam , The Netherlands
| | - Alessandra Sforza
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital , Bologna , Italy
| | - Mario Maggi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence , Florence , Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital , Bologna , Italy
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Klimas C, Ehlert U, Lacker TJ, Waldvogel P, Walther A. Higher testosterone levels are associated with unfaithful behavior in men. Biol Psychol 2019; 146:107730. [PMID: 31326436 DOI: 10.1016/j.biopsycho.2019.107730] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 05/22/2019] [Accepted: 07/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Infidelity in romantic relationships is a common, but severe issue often causing breakup and severe psychological impairment. Higher levels of testosterone are related to mating-behavior, sexual desire, and infidelity in men with sexual dysfunctions. Previous studies, have insufficiently addressed the potential role of testosterone in infidelity in healthy men. METHODS A sample of 224 middle-aged self-reporting healthy men being currently in a relationship completed questionnaires on relationship characteristics, infidelity, and provided overnight-fasting saliva samples for testosterone quantification. RESULTS In the sample, 37.5% men answered having been unfaithful in the current relationship, while 29% were identified as fulfilling criteria for a sexual dysfunction. Adjusting for covariates, a significant positive association for the frequency of unfaithful behavior and testosterone levels emerged. Subsample analysis indicates a positive association between testosterone and infidelity only to be present in men without sexual dysfunction. CONCLUSION Unfaithful behavior in males is associated with higher testosterone levels.
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Affiliation(s)
- C Klimas
- Biological Psychology, TU Dresden, Dresden, Germany
| | - U Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; Dynamics of Healthy Aging, University Research Priority Program, University of Zurich, Zurich, Switzerland
| | - T J Lacker
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; Dynamics of Healthy Aging, University Research Priority Program, University of Zurich, Zurich, Switzerland
| | - P Waldvogel
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - A Walther
- Biological Psychology, TU Dresden, Dresden, Germany; Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; Dynamics of Healthy Aging, University Research Priority Program, University of Zurich, Zurich, Switzerland.
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22
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Morgado A, Moura ML, Dinis P, Silva CM. Misdiagnosis And Undertreatment Of Erectile Dysfunction In The Portuguese Primary Health Care. Sex Med 2019; 7:177-183. [PMID: 30880000 PMCID: PMC6522934 DOI: 10.1016/j.esxm.2019.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/06/2019] [Accepted: 01/12/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction The importance of erectile dysfunction (ED) diagnosis and treatment has been highlighted since the early 2000s. However, nearly 20 years after the first phosphodiesterase 5 inhibitor (PDE5i) was marketed, underdiagnosis and undertreatment of ED in the primary health care setting may still be present. Aim To assess the relative frequency of patients who are medically treated for ED before referral to specialized urology care. The secondary objectives were to evaluate possible reasons for non-treatment prior to referral and other signs of undertreatment, namely cardiovascular risk assessment and antihypertensive treatment. Methods 200 male patients referred for ED to specialist urology care by general practitioners were screened after consent between January 2016–December 2018. A full standardized medical and sexual history were taken. Previous medical treatment of ED, namely pharmacologic name and dosages, and cardiovascular risk factors were noted. Main Outcome Measures Of the 115 included patients, only 33.9% of patients had already taken PDE5i before referral, and none had taken alprostadil by intracavernous route. Results The mean patient age was 58.68 ± 10.01 years old. Only 45.2% had been prescribed the highest dose of PD5i. From the remaining untreated patients, only 19.7% had ≥3 cardiovascular risk factors, including 5.6% of patients who also presented moderate-to-severe stable or unstable angina requiring a stress test or cardiology assessment before treatment. Regarding the 54 patients with medical history of arterial hypertension, 43.4% and 30.2% were treated for hypertension with a diuretic and a beta blocker, respectively. Conclusion More focus on the primary healthcare continuous medical education regarding sexual dysfunction, namely ED, is needed because major undertreatment of ED is still present because low prescription of PD5i before referral is noted. Morgado A, Moura ML, Dinis P, et al. Misdiagnosis And Undertreatment Of Erectile Dysfunction In The Portuguese Primary Health Care. Sex Med 2019;7:177–183.
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Affiliation(s)
- Afonso Morgado
- Serviço de Urologia, Centro Hospitalar São João, Porto, Portugal; Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | | | - Paulo Dinis
- Serviço de Urologia, Centro Hospitalar São João, Porto, Portugal; Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Carlos Martins Silva
- Serviço de Urologia, Centro Hospitalar São João, Porto, Portugal; Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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23
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Effect of testosterone replacement therapy on sexual function and glycemic control among hypogonadal men with type 2 diabetes mellitus. Int J Impot Res 2018; 31:25-30. [PMID: 30135606 DOI: 10.1038/s41443-018-0065-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/11/2018] [Accepted: 08/06/2018] [Indexed: 12/11/2022]
Abstract
We investigated the effect of testosterone replacement therapy (TRT) on glycemic control and sexual function among hypogonadal men with type 2 diabetes mellitus (T2DM). From the EARTH study, 86 patients (47 in the TRT and 39 in the non-TRT groups) with a diagnosis of T2DM were extracted. We collected data on waist circumference, body mass index, body fat volume, free testosterone, hemoglobin (Hb), fasting blood sugar, and hemoglobin A1c (HbA1c) at baseline and after 12 months. Aging Male Symptoms (AMS) score and International Prostate Symptom Score were obtained. Sexual function was assessed by questions 15 (sexual ability), 16 (morning erections), and 17 (sexual desire) of AMS subscores. The TRT group received intramuscular testosterone enanthate (250 mg) injections every 4 weeks for 12 months. Body fat percentage, Hb, and HbA1c were significantly improved in the TRT group. In addition, sexual ability and frequency, and sexual desire showed a significant improvement in the TRT group after 1 year TRT. On the other hand, any parameters including glycemic control and sexual functions were not significantly improved in non-TRT groups. One-year TRT can improve sexual function and glycemic control among hypogonadal men with T2DM.
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24
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Zhao B, Zhang W. Does erectile dysfunction independently predict cardiovascular events? It's time to act on the evidence. Eur J Prev Cardiol 2018; 25:1307-1311. [PMID: 29808761 DOI: 10.1177/2047487318778994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Binghao Zhao
- 1 Department of Cardio-Thoracic Surgery, The second affiliated hospital of Nanchang University, China.,2 Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenxiong Zhang
- 1 Department of Cardio-Thoracic Surgery, The second affiliated hospital of Nanchang University, China
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25
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Ventimiglia E, Cazzaniga W, Pederzoli F, Frego N, Chierigo F, Capogrosso P, Boeri L, Dehò F, Abbate C, Moretti D, Piemonti L, Montorsi F, Salonia A. The role of neutrophil-to-lymphocyte ratio in men with erectile dysfunction-preliminary findings of a real-life cross-sectional study. Andrology 2018; 6:559-563. [DOI: 10.1111/andr.12489] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/01/2018] [Accepted: 03/08/2018] [Indexed: 11/27/2022]
Affiliation(s)
- E. Ventimiglia
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - W. Cazzaniga
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - F. Pederzoli
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - N. Frego
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - F. Chierigo
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - P. Capogrosso
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - L. Boeri
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
- Department of Urology; University of Milan; Milan Italy
| | - F. Dehò
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - C. Abbate
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - D. Moretti
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - L. Piemonti
- Università Vita-Salute San Raffaele; Milan Italy
- Diabetes Research Institute; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - F. Montorsi
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - A. Salonia
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
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26
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García-Cruz E, Carrión A, Ajami T, Álvarez M, Correas MÁ, García B, García JV, González C, Portillo JA, Romero-Otero J, Simón C, Torremadé J, Vigués F, Alcaraz A. The Patient's Comorbidity Burden Correlates with the Erectile Dysfunction Severity. Actas Urol Esp 2018. [PMID: 28641871 DOI: 10.1016/j.acuro.2017.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To explore the potential relationship between erectile dysfunction (ED), low testosterone levels, and the Charlson Comorbidity Index (CCI). MATERIAL AND METHODS Cross-sectional study on patients referred to the andrology unit in 7 Spanish centers. The ED was diagnosed and graded using the International Index of Erectile Function (IIEF-5) score. Total testosterone, the prevalence of each comorbidity, and the CCI were compared between patients with different grades of ED. Besides, the correlation between total testosterone and the CCI score, the influence of each comorbidity, and the ED severity on the CCI was assessed in a multiple linear regression. RESULTS The study included 430 men with a mean age of 61 years. The mean CCI was 3.5, and mean total testosterone 15.2 nmol/L; 389 (91%) subjects had some grade of ED: 97 (23%) mild, 149 (35%) mild-to-moderate, 86 (20%) moderate, and 57 (13%) severe. The increase in ED severity was significantly associated with a decrease in total testosterone (P=.002), and an increase in the CCI score (P<.001). Testosterone levels were significantly lower in patients with obesity, diabetes, hypercholesterolemia, and hypertriglyceridemia (P<.05). However, only the prevalence of diabetes and hypertension was significantly associated with the severity of ED. The multivariate analysis including variables related to all assessed comorbidities, total testosterone levels, and the DE severity significantly predicted the CCI score (P<.001, R2=.426). The severity of ED significantly contributed to this model (P=.011), but total testosterone did not (P=.204). CONCLUSIONS The CCI is significantly associated with the ED severity, but it shows a weak correlation with the testosterone levels.
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Affiliation(s)
- E García-Cruz
- Departamento de Urología, Hospital Plató, Barcelona, España; Departamento of Urología, Hospital Clínic de Barcelona, Barcelona, España.
| | - A Carrión
- Departamento of Urología, Hospital Clínic de Barcelona, Barcelona, España
| | - T Ajami
- Departamento of Urología, Hospital Clínic de Barcelona, Barcelona, España
| | - M Álvarez
- Deparatmento de Urología, Hospital Universitario Infanta Sofía, Madrid, España
| | - M Á Correas
- Departamento de Urología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - B García
- Unidad de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - J V García
- Departamento de Urología, Hospital Universitario Infanta Elena, Valdemoro, Madrid, España; Departamento de Urología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - C González
- Departamento de Urología, Hospital Universitario Infanta Elena, Valdemoro, Madrid, España; Departamento de Urología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - J A Portillo
- Departamento de Urología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J Romero-Otero
- Unidad de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - C Simón
- Departamento de Urología, Hospital Universitario Infanta Elena, Valdemoro, Madrid, España; Departamento de Urología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - J Torremadé
- Departamento de Urología, Hospital de Bellvitge, Barcelona, España
| | - F Vigués
- Departamento de Urología, Hospital de Bellvitge, Barcelona, España
| | - A Alcaraz
- Departamento of Urología, Hospital Clínic de Barcelona, Barcelona, España
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27
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Sambel M, Kilic M, Demirbas M, Onen E, Oner S, Erdogan A, Aydos MM. Relationship between erectile dysfunction and the neutrophil to lymphocyte and platelet to lymphocyte ratios. Int J Impot Res 2017; 30:27-35. [DOI: 10.1038/s41443-017-0007-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 06/30/2017] [Accepted: 08/25/2017] [Indexed: 12/22/2022]
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28
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Capogrosso P, Ventimiglia E, Boeri L, Capitanio U, Gandaglia G, Dehò F, Pederzoli F, Cazzaniga W, Scano R, Montorsi F, Salonia A. Sexual functioning mirrors overall men's health status, even irrespective of cardiovascular risk factors. Andrology 2017; 5:63-69. [PMID: 27989023 DOI: 10.1111/andr.12299] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/23/2016] [Accepted: 10/05/2016] [Indexed: 12/21/2022]
Abstract
Erectile dysfunction has been described as a sentinel marker of co-existing and undetected cardiovascular disease. Beside cardiovascular diseases, a correlation between erectile dysfunction and other major comorbidities has been also reported. The study was aimed to analyze the association between sexual functioning and overall men's health in sexually active, Caucasian-European men with new-onset sexual dysfunction. Data from the last 881 consecutive patients seeking first medical help for sexual dysfunction were cross-sectionally analyzed. The International Classification of Diseases, 9th revision, Clinical Modification was used to classify health-significant comorbidities, which were scored with the Charlson Comorbidity Index (CCI). A modified CCI score from which all potential cardiovascular risk factors (CCI-CV) were subtracted was then calculated for every patient. Patients were requested to complete the International Index of Erectile Function (IIEF). The main outcome of the study was the association between the IIEF domain scores and CCI, which scored health-significant comorbidities even irrespective of cardiovascular risk factors (CCI-CV). The final sample included 757 patients (85.9%) (Median age: 48 years; IQ range: 37-59). Overall, erectile dysfunction was found in 540 (71.4%) patients. Of these, 164 (21.6%) had a CCI ≥ 1 and 138 (18.2%) had a CCI-CV ≥ 1, respectively. At the analysis of variance, IIEF-Erectile Function (EF) scores significantly decreased as a function of incremental CCI and CCI-CV scores (all p < 0.01). At multivariable logistic regression analysis, both IIEF-EF and IIEF-total score achieved independent predictor status for either CCI ≥ 1 or CCI-CV ≥ 1, after accounting for potential confounders (p < 0.01). We report novel findings of a significant association between erectile dysfunction severity and overall men's health, even irrespective of cardiovascular risk factors. Thereof, erectile dysfunction severity could serve as a proxy for general men's health, thus encouraging physicians to comprehensively assess patients complaining of sexual dysfunction in the real-life everyday clinical practice.
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Affiliation(s)
- P Capogrosso
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - E Ventimiglia
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - L Boeri
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University of Milan, Milan, Italy
| | - U Capitanio
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - G Gandaglia
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - F Dehò
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - F Pederzoli
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - W Cazzaniga
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - R Scano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - F Montorsi
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - A Salonia
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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Tian GX, Li S, Liu TZ, Zeng XT, Wei WL, Wang XH. Association between coronary heart disease and erectile dysfunction in Chinese Han population. Oncotarget 2017; 8:55562-55566. [PMID: 28903442 PMCID: PMC5589681 DOI: 10.18632/oncotarget.15654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/13/2017] [Indexed: 11/25/2022] Open
Abstract
To investigate the association between coronary heart disease (CHD) and erectile dysfunction (ED) in Chinese Han population. Patients who went to the andrological out-patient clinic of our hospital between August 1, 2015 and May 1, 2016 and met all eligible criteria were enrolled in this study. The patients diagnosed as ED using self-administered International Index of Erectile Function-5 (IIEF-5) questionnaire were considered as case group and others were considered as control. The cases were categorized as mild, moderate, and severe ED. Subjects were interviewed for the history of CHD. Uni- and multivariate logistic regression models were used to calculate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) using the SPSS 18.0 software. A total of 240 participants (56 ED patients and 184 controls) were enrolled. CHD prevalence was higher in cases without statistical significance (OR = 1.20, 95%CI = 0.63-2.29; p = 0.58). Results of adjusted analysis also showed a non-significantly increased risk (OR = 1.25, 95%CI = 0.55-2.85; p = 0.59). Stratified analysis by severity of ED revealed similar results. This study suggests no significant association exists between CHD and ED in Chinese Han population.
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Affiliation(s)
- Guo-Xiang Tian
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Cardiology and 4th Cadres Ward, General Hospital of Beijing Military Command, Beijing, China
| | - Sheng Li
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tong-Zu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wan-Lin Wei
- Department of Cardiology and 4th Cadres Ward, General Hospital of Beijing Military Command, Beijing, China
| | - Xing-Huan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
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30
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Barber TJ, Moyle G, Hill A, Jagjit Singh G, Scourfield A, Yapa HM, Waters L, Asboe D, Boffito M, Nelson M. A cross-sectional study to evaluate the association of hyperbilirubinaemia on markers of cardiovascular disease, neurocognitive function, bone mineral density and renal markers in HIV-1 infected subjects on protease inhibitors. HIV CLINICAL TRIALS 2017; 17:123-30. [PMID: 27125367 DOI: 10.1080/15284336.2016.1176305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ongoing inflammation in controlled HIV infection contributes to non-AIDS comorbidities. High bilirubin appears to exhibit an anti-inflammatory effect in vivo. We therefore examined whether increased bilirubin in persons with HIV was associated with differences in markers of inflammation and cardiovascular, bone, renal disease, and neurocognitive (NC) impairment. METHODS This cross-sectional study examined inflammatory markers in individuals with stable HIV infection treated with two nucleoside reverse transcriptase inhibitors and a boosted protease inhibitor. Individuals recruited were those with a normal bilirubin (NBR; 0-17 μmol/L) or high bilirubin (>2.5 × upper limit of normal). Demographic and anthropological data were recorded. Blood and urine samples were taken for analyses. Pulse wave velocity (PWV) measurement, carotid intimal thickness (CIT), and calcaneal stiffness (CSI) were measured. Males were asked to answer a questionnaire about sexual function; NC testing was performed using CogState. RESULTS 101 patients were screened, 78 enrolled (43 NBR and 35 HBR). Atazanavir use was significantly higher in HBR. Whilst a trend for lower CIT was seen in those with HBR, no significant differences were seen in PWV, bone markers, calculated cardiovascular risk (Framingham), or erectile dysfunction score. VCAM-1 levels were significantly lower in the HBR group. HBR was associated with lower LDL and triglyceride levels. NBR was associated with a calculated FRAX significantly lower than HBR although no associations were found after adjusting for tenofovir use. No difference in renal markers was observed. Component tests of NC testing revealed differences favouring HBR but overall composite scores were similar. DISCUSSION High bilirubin in the context of boosted PI therapy was found not to be associated with differences in with the markers examined in this study. Some trends were noted and, on the basis of these, a larger, clinical end point study is warranted.
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Affiliation(s)
- T J Barber
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - G Moyle
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - A Hill
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - G Jagjit Singh
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - A Scourfield
- b University College London Hospitals NHS Foundation Trust , London , UK
| | - H M Yapa
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - L Waters
- c Mortimer Market Centre , Central and North West London NHS Foundation Trust, London , UK
| | - D Asboe
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - M Boffito
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK.,d Imperial College School of Medicine , London , UK
| | - M Nelson
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK.,d Imperial College School of Medicine , London , UK
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31
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Abstract
Erectile dysfunction (ED) is one of the most common disorders in male and is often associated with other age-related comorbidities. The aging process affects the structural organization and function of penile erectile components such as smooth muscle cell and vascular architecture. These modifications affect penile hemodynamics by impairing cavernosal smooth muscle cell relaxation, reducing penile elasticity, compliance and promoting fibrosis. This review aims to identify the mechanisms of ED in the penile aging process in experimental and clinical data. It also highlights areas that are in need of more research. The search strategies yielded total records screened from PubMed. Clarification of the molecular mechanisms that accompanies corpus cavernosum aging and aging-associated ED will aid new perspectives in the development of novel mechanism-based therapeutic approaches. Age is not a limiting factor for ED medical management, and it is never too late to treat. Hypogonadism should be managed regardless of age, and synergistic effects have been found during testosterone (T) replacement therapy when used along with oral phosphodiesterase-5 (PDE-5) inhibitors. Therefore, the clinical management of ED related to aging can be done by therapeutic interventions that include PDE-5 inhibitors, and other pharmacological treatments.
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Affiliation(s)
- Ecem Kaya
- a Department of Biochemistry and Pharmacology , Faculty of Pharmacy, Ankara University , Ankara , Turkey and
| | - Suresh C Sikka
- b Department of Urology and Pharmacology , Tulane University Health Sciences Center , New Orleans , LA , USA
| | - Philip J Kadowitz
- b Department of Urology and Pharmacology , Tulane University Health Sciences Center , New Orleans , LA , USA
| | - Serap Gur
- a Department of Biochemistry and Pharmacology , Faculty of Pharmacy, Ankara University , Ankara , Turkey and
- b Department of Urology and Pharmacology , Tulane University Health Sciences Center , New Orleans , LA , USA
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Andrade WS, Oliveira P, Laydner H, Ferreira EJP, Barreto-Filho JAS. Severity of erectile dysfunction is highly correlated with the syntax score in patients undergoing coronariography. Int Braz J Urol 2017; 42:123-31. [PMID: 27136478 PMCID: PMC4811237 DOI: 10.1590/s1677-5538.ibju.2015.0002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 07/17/2015] [Indexed: 12/05/2022] Open
Abstract
Objective To investigate the association between the severity of erectile dysfunction (ED) and coronary artery disease (CAD) in men undergoing coronary angiography for angina or acute myocardial infarct (AMI). Material and Methods We studied 132 males who underwent coronary angiography for first time between January and November 2010. ED severity was assessed by the international index of erectile function (IIEF-5) and CAD severity was assessed by the Syntax score. Patients with CAD (cases) and without CAD (controls) had their IIEF-5 compared. In the group with CAD, their IIEF-5 scores were compared to their Syntax score results. Results We identified 86 patients with and 46 without CAD. The IIEF-5 score of the group without CAD (22.6±0.8) was significantly higher than the group with CAD (12.5±0.5; p<0.0001). In patients without ED, the Syntax score average was 6.3±3.5, while those with moderate or severe ED had a mean Syntax score of 39.0±11.1. After adjustment, ED was independently associated to CAD, with an odds ratio of 40.6 (CI 95%, 14.3-115.3, p<0.0001). The accuracy of the logistic model to correctly identify presence or absence of CAD was 87%, with 92% sensitivity and 78% specificity. The average time that ED was present in patients with CAD was 38.8±2.3 months before coronary symptoms, about twice as high as patients without CAD (18.0±5.1 months). Conclusions ED severity is strongly and independently correlated with CAD complexity, as assessed by the Syntax score in patients undergoing coronariography for evaluation of new onset coronary symptoms.
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Affiliation(s)
| | - Paulo Oliveira
- Universidade Estadual de Feira de Santana, Feira de Santana, Bahia, Brasil
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Shigehara K, Konaka H, Ijima M, Nohara T, Narimoto K, Izumi K, Kadono Y, Kitagawa Y, Mizokami A, Namiki M. The correlation between highly sensitive C-reactive protein levels and erectile function among men with late-onset hypogonadism. Aging Male 2016; 19:239-243. [PMID: 27841078 DOI: 10.1080/13685538.2016.1233960] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We investigated the correlation between highly sensitive C-reactive protein (hs-CRP) levels and erectile function, and assessed the clinical role of hs-CRP levels in men with late-onset hypogonadism (LOH) syndrome. For 77 participants, we assessed Sexual Health Inventory for men (SHIM) score, Aging Male Symptoms (AMS) score and International Prostate Symptom Score (IPSS). We also evaluated free testosterone (FT), hs-CRP, total cholesterol, triglyceride levels, high density lipoprotein cholesterol, hemoglobin A1c, body mass index, waist size and blood pressure. We attempted to identify parameters correlated with SHIM score and to determine the factors affecting cardiovascular risk based on hs-CRP levels. A Spearman rank correlation test revealed that age, AMS score, IPSS and hs-CRP levels were significantly correlated with SHIM score. Age-adjusted analysis revealed that hs-CRP and IPSS were the independent factors affecting SHIM score (r= -0.304 and -0.322, respectively). Seventeen patients belonged to the moderate to high risk group for cardiovascular disease, whereas the remaining 60 belonged to the low risk group. Age, FT value and SHIM score showed significant differences between the two groups. A multivariate regression analysis demonstrated that SHIM score was an independent factor affecting cardiovascular risk (OR: 0.796; 95%CI: 0.637-0.995).
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Affiliation(s)
- Kazuyoshi Shigehara
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
| | - Hiroyuki Konaka
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
| | - Masashi Ijima
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
| | - Takahiro Nohara
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
| | - Kazutaka Narimoto
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
| | - Koji Izumi
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
| | - Yoshifumi Kadono
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
| | - Yasuhide Kitagawa
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
| | - Atsushi Mizokami
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
| | - Mikio Namiki
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
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Azab S, Aoud H, Nabil N. The correlation between high sensitivity C-reactive protein and erectile dysfunction patients with hypertension treated with vardenafil. Int J Impot Res 2016; 29:82-85. [DOI: 10.1038/ijir.2016.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/16/2016] [Accepted: 10/28/2016] [Indexed: 11/09/2022]
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Abdelhamed A, Hisasue SI, Nada EA, Kassem AM, Abdel-Kareem M, Horie S. Relation Between Erectile Dysfunction and Silent Myocardial Ischemia in Diabetic Patients: A Multidetector Computed Tomographic Coronary Angiographic Study. Sex Med 2016; 4:e127-34. [PMID: 27375006 PMCID: PMC5005292 DOI: 10.1016/j.esxm.2016.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/05/2016] [Accepted: 04/21/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Erectile dysfunction (ED) can precede coronary artery disease. In addition, silent myocardial ischemia (SMI) is more common in diabetic patients and is a strong predictor of cardiac events and death. AIM To evaluate the presence of SMI in patients with diabetes and ED using multidetector computed tomographic coronary angiography (MDCT-CA). METHODS This study evaluated patients with diabetes and ED without any history of cardiac symptoms or signs. Erectile function was evaluated with the Sexual Health Inventory for Men score, erection hardness score (EHS), and maximal penile circumferential change by an erectometer. MDCT-CA was used for the detection of coronary artery stenosis. MAIN OUTCOME MEASURES Sexual Health Inventory for Men score, EHS, maximal penile circumferential change, and coronary artery stenosis by MDCT-CA. RESULTS Of 20 patients (mean age = 61.45 ± 10.7 years), MDCT-CA showed coronary artery stenosis in 13 (65%) in the form of one-vessel disease (n = 6, 30%), two-vessel disease (n = 2, 10%), and three-vessel disease (n = 5, 25%). Fifty percent of patients showed at least 50% vessel lumen obstruction of the left anterior descending coronary artery, which was the most commonly affected vessel (55%). Fifteen percent (3 of 20) of patients had greater than 90% stenosis, and two of them underwent an immediate coronary angioplasty with stenting to prevent myocardial infarction. Maximum coronary artery stenosis was positively correlated with age (P = 0.016, r = 0.529) and negatively correlated with EHS (P = .046, r = -0.449). Multivariate regression analysis using age and EHS showed that age was the only independent predictor of SMI (P = .04). CONCLUSION MDCT-CA can be a useful tool to identify SMI in diabetic patients with ED, especially in those of advanced age and/or with severe ED.
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Affiliation(s)
- Amr Abdelhamed
- Department of Urology, Juntendo University, Tokyo, Japan; Department of Dermatology, Venereology, and Andrology, Sohag University, Nasr City, Sohag, Egypt
| | | | - Essam A Nada
- Department of Dermatology, Venereology, and Andrology, Sohag University, Nasr City, Sohag, Egypt
| | - Ali M Kassem
- Department of Internal Medicine, Sohag University, Nasr City, Sohag, Egypt
| | - Mohammed Abdel-Kareem
- Department of Dermatology, Venereology, and Andrology, Sohag University, Nasr City, Sohag, Egypt
| | - Shigeo Horie
- Department of Urology, Juntendo University, Tokyo, Japan.
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Abstract
Erectile dysfunction is a multidimensional but common male sexual dysfunction that involves an alteration in any of the components of the erectile response, including organic, relational and psychological. Roles for nonendocrine (neurogenic, vasculogenic and iatrogenic) and endocrine pathways have been proposed. Owing to its strong association with metabolic syndrome and cardiovascular disease, cardiac assessment may be warranted in men with symptoms of erectile dysfunction. Minimally invasive interventions to relieve the symptoms of erectile dysfunction include lifestyle modifications, oral drugs, injected vasodilator agents and vacuum erection devices. Surgical therapies are reserved for the subset of patients who have contraindications to these nonsurgical interventions, those who experience adverse effects from (or are refractory to) medical therapy and those who also have penile fibrosis or penile vascular insufficiency. Erectile dysfunction can have deleterious effects on a man's quality of life; most patients have symptoms of depression and anxiety related to sexual performance. These symptoms, in turn, affect his partner's sexual experience and the couple's quality of life. This Primer highlights numerous aspects of erectile dysfunction, summarizes new treatment targets and ongoing preclinical studies that evaluate new pharmacotherapies, and covers the topic of regenerative medicine, which represents the future of sexual medicine.
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Raheem OA, Su JJ, Wilson JR, Hsieh TC. The Association of Erectile Dysfunction and Cardiovascular Disease: A Systematic Critical Review. Am J Mens Health 2016; 11:552-563. [PMID: 26846406 DOI: 10.1177/1557988316630305] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Despite strong association between erectile dysfunction (ED) and cardiovascular disease (CVD), there is a paucity of clear clinical guidelines detailing when and how to evaluate for ED in patients with known CVD, or vice versa. This systematic review discuss the role of cardiologists and urologists in the characterization of risk and management of CVD in the setting of ED, as well as contrasting the current evaluation of CVD and ED from the standpoint of published consensus statements. A comprehensive literature review utilizing MEDLINE®, the Cochrane Library® Central Search, and the Web of Science was performed to identify all published peer-reviewed articles in the English language describing ED and CVD across various disciplines. There is strong consensus that men with ED should be considered at high risk of CVD. Available risk assessment tools should be used to stratify the coronary risk score in each patient. The 2012 Princeton III Consensus Conference expanded on existing cardiovascular recommendations, proposing an approach to the evaluation and management of cardiovascular risk in men with ED and no known CVD. This systematic review highlights the similarities and differences of the existing clinical guidelines and recommendations regarding assessment and management of ED and CVD, as well as the pathophysiological linkage between ED and CVD, which may permit physicians, including urologists, to perform opportunistic screening and initiate secondary prophylaxis with regard to cardiovascular risk factors, particularly in young, nondiabetic men with ED.
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Affiliation(s)
- Omer A Raheem
- 1 University of California, San Diego, Department of Urology, San Diego, CA, USA
| | - Jeannie J Su
- 2 Yale School of Medicine, Department of Urology, New Haven, CT, USA
| | - Joel R Wilson
- 3 University of California, San Diego, Department of Medicine, Division of Cardiovascular Medicine, San Diego, CA, USA
| | - Tung-Chin Hsieh
- 1 University of California, San Diego, Department of Urology, San Diego, CA, USA
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Musicki B, Bella AJ, Bivalacqua TJ, Davies KP, DiSanto ME, Gonzalez-Cadavid NF, Hannan JL, Kim NN, Podlasek CA, Wingard CJ, Burnett AL. Basic Science Evidence for the Link Between Erectile Dysfunction and Cardiometabolic Dysfunction. J Sex Med 2015; 12:2233-55. [PMID: 26646025 DOI: 10.1111/jsm.13069] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Although clinical evidence supports an association between cardiovascular/metabolic diseases (CVMD) and erectile dysfunction (ED), scientific evidence for this link is incompletely elucidated. AIM This study aims to provide scientific evidence for the link between CVMD and ED. METHODS In this White Paper, the Basic Science Committee of the Sexual Medicine Society of North America assessed the current literature on basic scientific support for a mechanistic link between ED and CVMD, and deficiencies in this regard with a critical assessment of current preclinical models of disease. RESULTS A link exists between ED and CVMD on several grounds: the endothelium (endothelium-derived nitric oxide and oxidative stress imbalance); smooth muscle (SM) (SM abundance and altered molecular regulation of SM contractility); autonomic innervation (autonomic neuropathy and decreased neuronal-derived nitric oxide); hormones (impaired testosterone release and actions); and metabolics (hyperlipidemia, advanced glycation end product formation). CONCLUSION Basic science evidence supports the link between ED and CVMD. The Committee also highlighted gaps in knowledge and provided recommendations for guiding further scientific study defining this risk relationship. This endeavor serves to develop novel strategic directions for therapeutic interventions.
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Affiliation(s)
- Biljana Musicki
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anthony J Bella
- Division of Urology, Department of Surgery and Department of Neuroscience, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, ON, Canada
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kelvin P Davies
- Department of Urology, Albert Einstein College of Medicine, New York, NY, USA
| | - Michael E DiSanto
- Department of Surgery/Division of Urology, Cooper University Hospital, Camden, NJ, USA
| | - Nestor F Gonzalez-Cadavid
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA.,Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Johanna L Hannan
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA, USA
| | - Carol A Podlasek
- Departments of Urology, Physiology, and Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Christopher J Wingard
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
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Loprinzi PD, Nooe A. Erectile Dysfunction and Mortality in a National Prospective Cohort Study. J Sex Med 2015; 12:2130-3. [PMID: 26559652 DOI: 10.1111/jsm.13032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Emerging work has shown erectile dysfunction (ED) to be an important indicator of cardiovascular risk via its shared pathophysiology. Yet limited research has examined if a direct relationship between ED and mortality risk exists. AIM The purpose of this brief report was to better define the relationship between ED and mortality risk. METHODS Prevalent ED was assessed with the question: "How would you describe your ability to get and keep an erection adequate for satisfactory intercourse?" Participant data from the population-based 2003-2004 National Health and Nutrition Examination Survey (NHANES) was linked to death certificates from the National Death Index for mortality assessment. MAIN OUTCOME MEASURES Increased risk of premature all-cause mortality among those with ED (vs. those without). RESULTS Of 1,790 adult men providing complete data (age range: 20-85 years; mean = 45.4 year), with 557 having ED, over a 93-month follow-up, 244 deceased over this time. After adjustments, those with ED (vs. those without) had a 70% increased risk of premature all-cause mortality (hazards ratio = 1.70; 95% confidence interval; 1.01-2.85; P = 0.04). CONCLUSIONS ED is associated with increased premature mortality risk. The present findings have major public health and clinical implications in that ED is a strong indicator of premature mortality. Therefore, patients with ED should be screened and possibly treated for complications that may increase the risk of premature death.
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Affiliation(s)
- Paul D Loprinzi
- Center for Health Behavior Research, School of Applied Sciences, The University of Mississippi, University, MS, USA
| | - Allison Nooe
- Department of Health, Exercise Science and Recreation Management, School of Applied Sciences, The University of Mississippi, University, MS, USA
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Djordjevic D, Vukovic I, Milenkovic Petronic D, Radovanovic G, Seferovic J, Micic S, Kisic Tepavcevic D. Erectile dysfunction as a predictor of advanced vascular age. Andrology 2015; 3:1125-31. [PMID: 26446405 DOI: 10.1111/andr.12105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 07/20/2015] [Accepted: 08/14/2015] [Indexed: 12/18/2022]
Abstract
Vascular age (VA) represents chronological age (CA) adjusted for individual's atherosclerotic burden. The presence of erectile dysfunction (ED) has been considered as a clinical sentinel of premature atherosclerosis. The objective of this study was to explore the predictive value of ED in assessing the discrepancy between VA and CA. In the period from 1 January 2014 to 1 January 2015, all consecutive men referring to the outpatient departments of the Clinics of Urology and Cardiology in Belgrade (Serbia) were considered for enrolment in this cross-sectional study. General exclusion criteria were: age below 18, heart failure, history of myocardial infarction, impaired renal and liver function, acute infection, history of endocrine disease other than type 2 diabetes, pelvic surgery or trauma, and acute coronary syndrome within the last 6 months. According to the presence of ED, hypertension, type 2 diabetes and history of coronary artery disease participants were assigned into five study groups. Hierarchical multiple regression analysis was conducted to identify the predictive value of ED in detection of advanced VA. The mean age of males enrolled in the study was 52.9 ± 7.7 years. The predominance of VA over CA was statistically significantly higher in the group of participants with coexistence of ED and hypertension compared to the group of patients with ED and type 2 diabetes (p = 0.027) and the group of patients with ED (p = 0.014) and control group (p < 0.01). Regression analysis highlighted that ED represented a highly important marker (p < 0.01) of advanced VA, which independently accounted for 6.1% of the variance in the discrepancy between VA and CA. Our study suggests that assessment of ED could be a part of a more comprehensive prediction of patients' advanced VA. Screening among such a highly selected population may help identify those that would most benefit from drug treatments and life style changes.
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Affiliation(s)
- D Djordjevic
- Clinic of Urology, Clinical Centre of Serbia, Belgrade, Serbia
| | - I Vukovic
- Clinic of Urology, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - G Radovanovic
- Clinic of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - J Seferovic
- Clinic of Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - S Micic
- Clinic of Urology, Clinical Centre of Serbia, Belgrade, Serbia
| | - D Kisic Tepavcevic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Corona G, Rastrelli G, Filippi S, Vignozzi L, Mannucci E, Maggi M. Erectile dysfunction and central obesity: an Italian perspective. Asian J Androl 2015; 16:581-91. [PMID: 24713832 PMCID: PMC4104087 DOI: 10.4103/1008-682x.126386] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Erectile dysfunction (ED) is a frequent complication of obesity. The aim of this review is to critically analyze the framework of obesity and ED, dissecting the connections between the two pathological entities. Current clinical evidence shows that obesity, and in particular central obesity, is associated with both arteriogenic ED and reduced testosterone (T) levels. It is conceivable that obesity-associated hypogonadism and increased cardiovascular risk might partially justify the higher prevalence of ED in overweight and obese individuals. Conversely, the psychological disturbances related to obesity do not seem to play a major role in the pathogenesis of obesity-related ED. However, both clinical and preclinical data show that the association between ED and visceral fat accumulation is independent from known obesity-associated comorbidities. Therefore, how visceral fat could impair penile microcirculation still remains unknown. This point is particularly relevant since central obesity in ED subjects categorizes individuals at high cardiovascular risk, especially in the youngest ones. The presence of ED in obese subjects might help healthcare professionals in convincing them to initiate a virtuous cycle, where the correction of sexual dysfunction will be the reward for improved lifestyle behavior. Unsatisfying sexual activity represents a meaningful, straightforward motivation for consulting healthcare professionals, who, in turn, should take advantage of the opportunity to encourage obese patients to treat, besides ED, the underlying unfavorable conditions, thus not only restoring erectile function, but also overall health.
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Affiliation(s)
| | | | | | | | | | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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Evaluation of high sensitive troponin in erectile dysfunction. DISEASE MARKERS 2015; 2015:548951. [PMID: 25960595 PMCID: PMC4415735 DOI: 10.1155/2015/548951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/15/2014] [Accepted: 09/08/2014] [Indexed: 12/14/2022]
Abstract
Background. Evidence is accumulating in favour of a link between erectile dysfunction (ED) and coronary artery diseases. We investigated the presence of cardiac injury in patients who have had arteriogenic and nonarteriogenic ED using the hs-Tn levels. Methods. The diagnosis of ED was based on the International Index of Erectile Function 5-questionnaire (IIF-5) and patients were classified as arteriogenic (A-ED, n = 40), nonarteriogenic (NA-ED, n = 48), and borderline (BL-ED, n = 32) patients in relation to the results of echo-color-Doppler examination of cavernous arteries. The level of hs-TnT and hs-TnI was measured in 120 men with a history of ED of less than one year with no clinical evidence of cardiac ischemic disease. Results. The levels of both hs-TnT and hs-TnI were within the reference range and there was no significant (P > 0.05) difference between patients of the three groups. The hs-CRP values were higher in A-ED men compared with NA-ED (P = 0.048) but not compared with BL-ED (P = 0.136) and negatively correlated with IIF-5 (r = −0.480; P = 0.031). Conclusions. In ED patients of the three groups the measurement of hs-Tn allows us to exclude the presence of cardiac involvement at least when the history of ED is less than one year and the men are without atherosclerotic risk factors.
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Pastuszak AW, Hyman DA, Yadav N, Godoy G, Lipshultz LI, Araujo AB, Khera M. Erectile dysfunction as a marker for cardiovascular disease diagnosis and intervention: a cost analysis. J Sex Med 2015; 12:975-84. [PMID: 25728904 DOI: 10.1111/jsm.12848] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a risk factor for cardiovascular disease (CVD). We examine the costs of screening men with ED for CVD risk factors and the cost savings of treating these at risk men. AIM This study aims to evaluate the effect of screening men presenting with ED for CVD risk factors and to determine the cost effectiveness of this screening protocol. METHODS The known incidence and prevalence of ED and CVD, the rate of undiagnosed CVD, and the effects of CVD treatment were used to model the change in prevalence of acute CVD events and ED as a function of the number of men with ED and CVD. The cost savings associated with reduction in acute cardiovascular (CV) events and ED prevalence was estimated over 20 years. MAIN OUTCOME MEASURES Acute CVD event rate reduction and associated cost savings were modeled over 20 years. RESULTS The relative risk of ED in men with CVD is 1.47 and the coprevalence of both ED and CVD was estimated at 1,991,520 men. Approximately 44% of men with CVD risk factors are unaware of their risk. If all men presenting with ED were screened for CVD, 5.8 million men with previously unknown CVD risk factors would be identified over 20 years, costing $2.7 billion to screen. Assuming a 20% decrease in CV events as a result of screening and treatment, 1.1 million cardiovascular events would be avoided, saving $21.3 billion over 20 years. Similarly, 1.1 million cases of ED would be treated, saving $9.7 billion. Together, the reduction in acute CVD and ED treatment cost would save $28.5 billion over 20 years. CONCLUSIONS Screening for CVD in men presenting with ED can be a cost-effective intervention for secondary prevention of both CVD and, over the longer term, ED.
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Affiliation(s)
- Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Kalka D, Domagala ZA, Kowalewski P, Rusiecki L, Koleda P, Marciniak W, Dworak J, Adamus J, Wojcieszczyk J, Pyke E, Pilecki W. Effect of Endurance Cardiovascular Training Intensity on Erectile Dysfunction Severity in Men With Ischemic Heart Disease. Am J Mens Health 2014; 9:360-9. [PMID: 25077728 DOI: 10.1177/1557988314544156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The protective effect of physical activity on arteries is not limited to coronary vessels, but extends to the whole arterial system, including arteries, in which endothelial dysfunction and atherosclerotic changes are one of the key factors affecting erectile dysfunction development. The objective of this study was to report whether the endurance training intensity and training-induced chronotropic response are linked with a change in erectile dysfunction intensity in men with ischemic heart disease. A total of 150 men treated for ischemic heart disease, who suffered from erectile dysfunction, were analyzed. The study group consisted of 115 patients who were subjected to a cardiac rehabilitation program. The control group consisted of 35 patients who were not subjected to any cardiac rehabilitation. An IIEF-5 (International Index of Erectile Function) questionnaire was used for determining erectile dysfunction before and after cardiac rehabilitation. Cardiac training intensity was objectified by parameters describing work of endurance training. The mean initial intensity of erectile dysfunction in the study group was 12.46 ± 6.01 (95% confidence interval [CI] = 11.35-13.57). Final erectile dysfunction intensity (EDI) assessed after the cardiac rehabilitation program in the study group was 14.35 ± 6.88 (95% CI = 13.08-15.62), and it was statistically significantly greater from initial EDI. Mean final training work was statistically significantly greater than mean initial training work. From among the parameters describing training work, none were related significantly to reduction of EDI. In conclusion, cardiac rehabilitation program-induced improvement in erection severity is not correlated with endurance training intensity. Chronotropic response during exercise may be used for initial assessment of change in cardiac rehabilitation program-induced erection severity.
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Affiliation(s)
- Dariusz Kalka
- Wroclaw Medical University, Wroclaw, Poland Centre of Men's Health, Wroclaw, Poland
| | | | | | | | | | | | - Jacek Dworak
- 105th Military Hospital, General Surgery and Urology Unit, Zagan, Poland
| | - Jerzy Adamus
- Wroclaw Medical University, Wroclaw, Poland Centre of Men's Health, Wroclaw, Poland Dietrich Bonhoeffer Klinikum, Neubrandenburg, Germany Magodent Medical Centre, Warsaw, Poland 105th Military Hospital, General Surgery and Urology Unit, Zagan, Poland University School of Physical Education, Wroclaw, Poland
| | | | - Edel Pyke
- Wroclaw Medical University, Wroclaw, Poland
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Abstract
Erectile dysfunction (ED) affects a growing number of men in the USA and abroad, with significant impacts on sexual function and overall quality of life. The risk factors for ED are numerous and include a strong link to cardiovascular disease, such that men with ED should be screened for cardiovascular disease. The evaluation of men presenting with ED includes a comprehensive history and physical exam to aid in the identification of comorbidities as well as laboratory testing to evaluate hormone and lipid levels and sugar metabolism. Adjunct studies are also available, though their utility is often limited to specific subtypes of ED. Once the etiology of ED is established, treatment can be initiated using appropriate medical therapies, including phosphodiesterase type 5 (PDE5) inhibitors, and transurethral or intracavernosal therapies, with surgical intervention via revascularization or penile prosthesis placement in men demonstrating a lack of response to medical therapy. In all cases of ED, a psychogenic component is present and referral for psychological intervention with or without medical therapy should be considered.
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Corona G, Rastrelli G, Monami M, Maseroli E, Jannini EA, Balercia G, Sforza A, Forti G, Mannucci E, Maggi M. Frequency of sexual activity and cardiovascular risk in subjects with erectile dysfunction: cross-sectional and longitudinal analyses. Andrology 2013; 1:864-71. [DOI: 10.1111/j.2047-2927.2013.00139.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 08/30/2013] [Accepted: 09/06/2013] [Indexed: 12/25/2022]
Affiliation(s)
- G. Corona
- Sexual Medicine and Andrology Unit; Department of Experimental, Clinical and Biomedical Sciences; University of Florence; Florence Italy
- Endocrinology Unit; Medical Department; Azienda Usl; Maggiore-Bellaria Hospital; Bologna Italy
| | - G. Rastrelli
- Sexual Medicine and Andrology Unit; Department of Experimental, Clinical and Biomedical Sciences; University of Florence; Florence Italy
| | - M. Monami
- Diabetes Section Geriatric Unit; Department of Critical Care; University of Florence; Florence Italy
| | - E. Maseroli
- Sexual Medicine and Andrology Unit; Department of Experimental, Clinical and Biomedical Sciences; University of Florence; Florence Italy
| | - E. A. Jannini
- Department of Experimental Medicine; School of Sexology; University of L'Aquila; L'Aquila Italy
| | - G. Balercia
- Division of Endocrinology; Department of Clinical and Molecular Sciences; Umberto I Hospital; Polytechnic University of Marche; Ancona Italy
| | - A. Sforza
- Endocrinology Unit; Medical Department; Azienda Usl; Maggiore-Bellaria Hospital; Bologna Italy
| | - G. Forti
- Endocrinology Unit; Department of Experimental, Clinical and Biomedical Sciences; University of Florence; Florence Italy
| | - E. Mannucci
- Diabetes Agency; Careggi Hospital; Florence Italy
| | - M. Maggi
- Sexual Medicine and Andrology Unit; Department of Experimental, Clinical and Biomedical Sciences; University of Florence; Florence Italy
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Salonia A, Capogrosso P, Clementi MC, Castagna G, Damiano R, Montorsi F. Is erectile dysfunction a reliable indicator of general health status in men? Arab J Urol 2013; 11:203-11. [PMID: 26558083 PMCID: PMC4443011 DOI: 10.1016/j.aju.2013.07.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 07/25/2013] [Indexed: 12/19/2022] Open
Abstract
Introduction Erectile dysfunction (ED) is a common risk factor in men and its incidence increases with age. Ageing and older men frequently have comorbidities such as cardiovascular diseases (CVD), diabetes mellitus (DM), hypertension, chronic obstructive pulmonary disease and dyslipidaemia; likewise, they concurrently refer to a clinician for impairments in sexual function, mostly for ED. The association of ED and other organic, multi-organic or even systemic diseases is widely described, with a specific emphasis on the fact that they often share common pathophysiological factors and mechanisms. Thus we reviewed previous reports assessing the role of ED as a sentinel marker of overall men’s health. Discussion ED is considered an important sentinel marker for CVD. Numerous studies have highlighted the predictive role of ED for subsequent CV events in patients with a silent history of coronary artery disease. Indeed, ED might be considered as a clinical manifestation of a generalised vascular disease, and it should provoke clinicians to check for CVDs in those patients complaining of impaired erectile function. This concept appears to be even more important for men with DM, where ED has already been shown to have a significant predictive ability for major vascular complications. Moreover, data from large population-based studies showed that ED is a significant predictor of all-cause mortality, in addition to CV outcomes. The severity of erectile function is assessed with the International Index of Erectile Function-Erectile Function domain score, and this has emerged as a proxy for men’s general health status, as assessed with the Charlson Comorbidity Index score. Conclusions Patients complaining of ED should be evaluated with a comprehensive medical and sexual history, and a thorough physical examination, regardless of their age, considering ED as an opportunity to screen for the presence of health-threatening concomitant comorbidities.
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Key Words
- CAD, coronary artery disease
- CCI, Charlson Comorbidity Index
- CHD, coronary heart disease
- COPD, chronic obstructive pulmonary disease
- CVD, cardiovascular disease
- Clinical practice
- Comorbidities
- DM, diabetes mellitus
- ED, erectile dysfunction
- EF, erectile function
- Erectile dysfunction
- HF, heart failure
- Health status
- IIEF, International Index of Erectile Function
- International Index of Erectile Function
- MMAS, Massachusetts Male Aging Study
- MeS, metabolic syndrome
- QoL, quality of life
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Affiliation(s)
- Andrea Salonia
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Paolo Capogrosso
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | | | - Giulia Castagna
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Rocco Damiano
- Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Francesco Montorsi
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
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Lee KCJ, Fahmy N, Brock GB. Sexual dysfunction in 2013: Advances in epidemiology, diagnosis and treatment. Arab J Urol 2013; 11:194-202. [PMID: 26558082 PMCID: PMC4442993 DOI: 10.1016/j.aju.2013.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/05/2013] [Accepted: 06/09/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To provide a contemporary review of the epidemiology, diagnosis and treatment of premature ejaculation (PE) and erectile dysfunction (ED). METHODS We searched for English-language articles published in the past 12 months using the PubMed database. Relevant articles on the subjects of sexual dysfunction, ED and PE were selected for review. CONCLUSIONS Recent studies on male sexual dysfunction have provided new therapeutic possibilities. Tramadol, a well-used analgesic, has a new role in the treatment of PE. Super-selective targeting of dorsal penile nerves by surgery or cryoablative technologies might become a viable treatment option for refractory PE in the future. The role of ED as a harbinger of important comorbidities allows for the early detection and intervention of these conditions, which can optimise therapeutic outcomes. The long-term effect of chronic phosphodiesterase-5 inhibitors on endothelial dysfunction, the angiogenic potential of low-intensity extracorporeal shock wave therapy, and further advances in drug-eluting endovascular stents might in future allow clinicians to treat ED more definitively.
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Affiliation(s)
| | - Nader Fahmy
- Division of Urology, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Gerald B Brock
- Division of Urology, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
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De Ryck I, Van Laeken D, Apers L, Colebunders R. Erectile Dysfunction, Testosterone Deficiency, and Risk of Coronary Heart Disease in a Cohort of Men Living with HIV in Belgium. J Sex Med 2013; 10:1816-22. [DOI: 10.1111/jsm.12175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham GR, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis J, Montorsi P, Ramsey M, Rosen RC, Sadovsky R, Seftel AD, Vlachopoulos C, Wu FC. Diagnosis and Treatment of Erectile Dysfunction for Reduction of Cardiovascular Risk. J Urol 2013; 189:2031-8. [DOI: 10.1016/j.juro.2012.12.107] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2012] [Indexed: 01/10/2023]
Affiliation(s)
- Ajay Nehra
- Rush University Medical Center, Chicago, Illinois
| | - Graham Jackson
- Guys and St. Thomas Hospitals London, London, United Kingdom
| | - Martin Miner
- Family Medicine and Urology, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Kevin L. Billups
- University of Minnesota, Minneapolis, Minnesota
- The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Arthur L. Burnett
- The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Jacques Buvat
- Centre d'Etude et de Traitement de la Pathologie de l'Appareil Reproducteur et de la Psychosomatique, Lille, France
| | | | - Glenn R. Cunningham
- Baylor College of Medicine and St. Luke's Episcopal Hospital, Houston, Texas
| | | | - Andre T. Guay
- Center for Sexual Function/Endocrinology, Lahey Clinic Medical Center, Peabody, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Geoff Hackett
- Good Hope Hospital, Birmingham and Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Robert A. Kloner
- Good Samaritan Hospital and Department of Medicine, Keck School of Medicine at University of Southern California, Los Angeles, California
| | - John Kostis
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Piero Montorsi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Cardiology University of Milan, Milan, Italy
| | - Melinda Ramsey
- Complete Healthcare Communications, Inc., Chadds Ford, Pennsylvania
| | | | - Richard Sadovsky
- State University of New York-Downstate Medical Center, Brooklyn, New York
| | - Allen D. Seftel
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Cooper University Hospital, Camden, New Jersey
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