Vasculogenic Erectile Dysfunction and Metabolic Syndrome

Uncovering the Potential Mechanisms and Effects of Hyperuricemia and its Associated Diseases on Male Reproduction

Male fertility and metabolic disorders, including obesity and diabetes, are closely connected. Since hyperuricemia and metabolic syndrome are strongly related, male fertility and hyperuricemia may, to some degree, be associated. According to recent studies, hyperuricemia imposes various effects on sex hormones, semen quality, and male erectile dysfunction. Some researchers claim that uric acid worsens male semen and raises the risk of erectile dysfunction (ED), while others state that it safeguards both penile erection and male semen. Additionally, it has been shown that gout and metabolic syndrome also raise the risk of ED. To clarify this controversy, the influence and potential mechanisms of hyperuricemia on ED, semen quality, sex hormone levels, and the effects of hyperuricemia-related disorders on ED will be comprehensively summarized.

Metabolic syndrome and erectile dysfunction: a systematic review and meta-analysis study

PURPOSE

The clinical significance of metabolic syndrome (MetS) versus its single components in erectile dysfunction (ED) is conflicting. Thus, the purpose is to analyze the available evidence on the relationship between MetS-along with its components-and ED.

METHODS

All prospective and retrospective observational studies reporting information on ED and MetS were included. In addition, we here reanalyzed preclinical and clinical data obtained from a previously published animal model of MetS and from a consecutive series of more than 2697 men (mean age: 52.7 ± 12), respectively.

RESULTS

Data derived from this meta-analysis showed that MetS was associated with an up to fourfold increased risk of ED when either unadjusted or adjusted data were considered. Meta-regression analysis, performed using unadjusted statistics, showed that the MetS-related risk of ED was closely associated with all the MetS components. These associations were confirmed when unadjusted analyses from clinical models were considered. However, fully adjusted data showed that MetS-associated ED was more often due to morbidities included (or not) in the algorithm than to the MetS diagnostic category itself. MetS is also associated with low testosterone, but its contribution to MetS-associated ED-as derived from preclinical and clinical models-although independent, is marginal.

CONCLUSIONS

The results of our analysis suggest that MetS is a useless diagnostic category for studying ED. However, treating the individual MetS components is important, because they play a pivotal role in determining ED.

Surgical niche for the treatment of erectile dysfunction

Penile erection implicates arterial inflow, sinusoidal relaxation and corporoveno-occlusive function. By far the most widely recognized vascular etiologies responsible for organic erectile dysfunction can be divided into arterial insufficiency, corporoveno-occlusive dysfunction or mixed type, with corporoveno-occlusive dysfunction representing the most common finding. In arteriogenic erectile dysfunction, corpora cavernosa show lower oxygen tension, leading to a diminished volume of cavernosal smooth muscle and consequential corporoveno-occlusive dysfunction. Current studies support the contention that corporoveno-occlusive dysfunction is an effect rather than the cause of erectile dysfunction. Surgical interventions have consisted primarily of penile revascularization surgery for arterial insufficiency and penile venous surgery for corporoveno-occlusive dysfunction, whatever the mechanism. However, the surgical effectiveness remained debatable and unproven, mostly owing to the lack of consistent hemodynamic assessment, standardized select patient and validated outcome measures, as well as various surgical procedures. Penile vascular surgery has been disclaimed to be the treatment of choice based on the currently available guidelines. However, reports on penile revascularization surgery support its utility in treating arterial insufficiency in otherwise healthy patients aged <55 years with erectile dysfunction of late attributable to arterial occlusive disease. Furthermore, it is noteworthy that penile venous surgery might be beneficial for selected patients with corporoveno-occlusive dysfunction, especially with a better understanding of the innovated venous anatomy of the penis. Penile vascular surgery might remain a viable alternative for the treatment of erectile dysfunction, and could have found its niche in the possibility of obtaining spontaneous, unaided and natural erection.

Metabolic syndrome and sexual function in postmenopausal women

OBJECTIVE

The purpose of this study was to evaluate whether female sexual dysfunction (FSD) is associated with metabolic syndrome (MS) and to identify factors that contribute to FSD in postmenopausal women.

SUBJECTS AND METHODS

This was a cross-sectional study in 111 sexually active women aged 45-65 years. We applied the Female Sexual Function Index (FSFI) to evaluate the participant's sexual function and a structured questionnaire to collect demographic, socioeconomic, clinical, anthropometric, and laboratory data.

RESULTS

The prevalences of MS and FSD were 68.5% and 70.3%, respectively. After logistic regression analysis, we identified the following variables associated with FSD: married status (prevalence ratio [PR] 1.69, 95% confidence interval [95% CI] 1.16-2.47, p < 0.01), 6-10 years elapsed since menopause (PR 1.60, 95% CI 1.22-2.09, p < 0.01), occurrence of climacteric symptoms (PR 1.01, 95% CI 1.00-1.02, p = 0.03), and history of sexual abuse (PR 1.40, 95% CI 1.12-1.73, p < 0.01).

CONCLUSION

We found a high prevalence of MS and FSD, but no association between both. Married status, time elapsed since menopause, climacteric symptoms, and history of sexual abuse emerged as factors associated with FSD on multivariate analysis.

Lard and/or canola oil-rich diets induce penile morphological alterations in a rat model

PURPOSE

To investigate the effect of dietary lipid quantity and/or quality on penis morphology in adult rats.

METHODS

Thirty-eight male Wistar rats were divided into 4 groups: normal lipid diet (NL), high-fat diet rich in saturated fatty acids (HF-S), high-fat diet rich in polyunsaturated fatty acids (HF-P), and high-fat diet rich in saturated and polyunsaturated fatty acids (HF-SP). Blood samples were collected and the penises were removed for histomorphometrical and immunohistochemical analysis.

RESULTS

All high-fat diets promoted an increase in the body mass (p<0.0001). The HF-S and HF-SP groups presented hyperglycemia (p=0.0060), hyperinsulinemia (p=0.0030), and hypercholesterolemia (p=0.0020). Concerning the penis, the high-fat diets led to an increase in the collagen fibers (p<0.0001) and smooth muscle cell density area (p=0.0027), and a decline in the sinusoidal space density area (p<0.0001) and corpus cavernosum cell proliferation (p=0.0003).

CONCLUSION

Diets rich in saturated and/or polyunsaturated fatty acids promoted overweight and induced penile changes in rodent models, which may lead to the development of erectile dysfunction.

Relationship between the two surgical access of aortoiliac occlusive disease and recovery of ED

Aortoiliac occlusive disease (AIOD) can occur anywhere from the distal abdominal aorta to the common femoral arteries. Patients with AIOD may be asymptomatic or may have intermittent claudication or critical limb ischemia. ED in the young males may be the first symptom of aortoiliac disease. The aims of this study were to determine the outcome of ED in patients who underwent aortoiliac surgery and evaluate the effect of revascularization upon erectile function (EF) by using the international index of EF questionnaire and color duplex Doppler ultrasonography. A total of 60 patients under 65-year-old age eligible for elective repair of AIOD s were included in this study. The patients were randomly divided into two equal groups. The first group (group A) patients were operated by minimally invasive retroperitoneal approach (RPA) and the second group (group B) patients were operated by transperitoneal approach (TPA) to the aorta. The quality of sexual function scale was evaluated preoperatively and at 6 months postoperatively. Surgical revascularization when appropriate, symptomatic AIOD and ED are often improved. As a result of our study, RPA to the aorta is superior to TPA because of recovering with the higher systolic velocity values of penile Doppler in ED cases.

Metabolic syndrome and risk for ED: a meta-analysis

There are many recent observational studies on metabolic syndrome (MS) and the risk for ED, and it is still inconclusive whether MS increases the risk for ED. This meta-analysis aims to detect a relationship between MS and ED. We identified eligible studies by searching PubMed, Embase and the Cochrane Library for articles published before August 2013. Adjusted relative risks (RR) with 95% confidence interval (CI) were calculated using random-effects or fixed-effects models. A total of 10 studies involving 4092 participants were included in the meta-analysis. MS was associated with an increased incidence of ED (RR=1.60, 95% CI=1.27-2.02, P<0.001), with significant evidence of heterogeneity among these studies (P for heterogeneity <0.001, I(2)=92.9%). The subgroup and sensitivity analyses confirmed the stability of the results and no publication bias was detected. The present meta-analysis suggests that MS is significantly associated with the risk for ED. Large-scale and well-designed prospective studies are required to further investigate the association between MS and risk for ED.

Newly diagnosed major depressive disorder and the risk of erectile dysfunction: a population-based cohort study in Taiwan

INTRODUCTION

The primary aim of this study was to explore the incidence rate of erectile dysfunction (ED) among major depressive disorder (MDD) patients in an Asian country. The second aim was to compare the risk of ED in MDD patients that were treated using antidepressants with a high risk-ED, antidepressants with a low risk-ED, or without treatment.

METHODS

We identified 4339 male patients with newly diagnosed MDD using the National Health Database. Four matched controls per case were selected for the study.

RESULTS

The mean age of the participants was 42.3 ± 16.9. A higher crude HR of 3.6 (95% CI: 2.8-4.6) was seen in the male patients with MDD. After adjusting for obesity, monthly income, urbanization level, and comorbidity, the MDD patients had a 3.2-fold higher HR for an ED diagnosis than the controls. Patients with untreated depression had the highest risk of ED, compared to the control group (HR=3.9). Patients treated with IHiRA had a medium risk of developing ED (HR=3.6), and patients treated with ILoRA had the lowest risk of ED (HR: 2.5).

CONCLUSION

This prospective cohort study found an association between ED and prior MDD. Patients with untreated depression may have the highest risk of developing ED.

The influence of different metabolic syndrome definitions in predicting vasculogenic erectile dysfunction: is there a role for the index of central obesity?

AIMS

Analyze the capacity of ICO, the ratio of waist circumference (WC) and height, in predicting hemodynamic impairment in Erectile Dysfunction (ED) patients, independently and integrated in Metabolic Syndrome (MetS) definitions.

METHODS

Four hundred and eighty-five ED patients followed in Urology consult from January 2008 until March 2012 were evaluated by a standardized protocol: health questionnaire, anthropometric measurements (AM), blood pressure and analysis, and Penile Duplex Doppler Ultrasound (PDDU) exam. Associations between AM and MetS definitions, including ATPIII, IDF and a new definition replacing WC by ICO in ATPIII MetS definition (ModATPIII), and PDDU were calculated.

RESULTS

ICO was the measure of obesity more strongly correlated with diminished mean Peak Systolic Velocity (mPSV) (r = -0.189, p < 0.001). A positive association remained when replacing WC by ICO ≥ 0.60 (a nationally obtained ratio) in ATPIII MetS definition (ModATPIII). Patients with ModATPIII had lower mPSV when compared to non-MetS patients (30.8 versus 37.1, p < 0.001). Only the IDF definition had a significant association with AD (OR = 1853; 95%CI, 1.202-2.857).

CONCLUSIONS

ICO revealed potential value to predict PDDU changes in a MetS context. However, IDF definition presented a stronger correlation with arteriogenic ED. Although longitudinal studies are necessary to confirm this hypothesis, our study highlights the importance of different MetS definitions for ED assessment.

Open-angle glaucoma and the risk of erectile dysfunction: a population-based case-control study

PURPOSE

Open-angle glaucoma (OAG) is associated with systemic metabolic and cardiovascular disorders, and both share common risk factors with erectile dysfunction (ED). However, few studies have investigated the association of ED with OAG. This study aimed to estimate the association of ED with prior OAG by using a nationwide, population-based data with a retrospective case-control cohort design in Taiwan.

DESIGN

Age-matched case-control study.

PARTICIPANTS AND CONTROLS

We identified 4605 patients with ED as the cases and randomly selected 23 025 subjects as the controls (5 controls to 1 case).

METHODS

We used conditional logistic regression analysis to estimate the odds ratio and 95% confidence interval of having previously been diagnosed with OAG according to the presence/absence of ED after adjusting for patient's monthly income, geographical location, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse.

MAIN OUTCOME MEASURES

We identified OAG cases not only based on an International Classification of Diseases, Ninth Revision, Clinical Modification code, but also by the prescription of topical antiglaucoma medication.

RESULTS

In total, prior OAG was found among 137 subjects (0.5 %); 53 individuals (1.1% of the ED patients) from the cases and 84 individuals (0.4% of patients without ED) from the controls. Conditional logistic regression analysis demonstrated that, after adjusting for potential confounders, patients with ED were more likely to have prior OAG than controls (odds ratio, 2.85; 95% confidence interval, 2.10-4.07).

CONCLUSIONS

This study identifies a novel association between ED and prior OAG.

Psoriasis and the risk of erectile dysfunction: a population-based case-control study

INTRODUCTION

Psoriasis is associated with systemic metabolic and cardiovascular disorders, both of which share risk factors with erectile dysfunction (ED). However, few studies have investigated the association between ED and psoriasis.

AIM

This study set out to estimate the association between ED and having previously been diagnosed with psoriasis by using a population-based dataset with a case-control design.

METHODS

This study used administrative claim data from the Taiwan National Health Insurance program. We identified 4,606 patients with ED as the study group and randomly selected 13,818 patients as the comparison group. Conditional logistic regression was used to examine the association between ED and having previously received a diagnosis of psoriasis.

MAIN OUTCOME MEASURE

The prevalence and risk of psoriasis between cases and controls were calculated.

RESULTS

Of the sampled patients, 136 (0.7%) had been diagnosed with psoriasis before the index date: 77 (1.7% of the cases) were from the study group and 59 (0.4% of controls) were from the control group. Conditional logistic regression analysis revealed that after adjusting for the patient's monthly income, geographic location, hypertension, diabetes, hyperlipidemia, coronary heart disease, obesity, and alcohol abuse/alcohol dependence syndrome status, patients with ED were more likely to have been diagnosed with psoriasis before the index date than controls (odds ratio = 3.85; 95% confidence interval = 2.72-5.44).

CONCLUSIONS

There was an association between ED and prior psoriasis. The results of this study highlight a need for clinicians dealing with psoriasis patients to be alert to the development of ED.

Antioxidants to enhance fertility: role of eNOS and potential benefits

The use of antioxidants is now often used as a pharmacological adjunct to limit infertility. Indeed, the lay public rightly perceives oxidative stress and, thus, antioxidant treatment as important modulators of infertility. While the direct effects of antioxidant treatment on the quality of semen and oocytes are still under investigation, a significant body of evidence points to loss of vascular tone as a root-cause of erectile dysfunction and, possibly, alterations to female reproduction. In this article, we will critically review the often neglected link between vascular dysfunction and infertility. A particular emphasis will be on the potential use of antioxidants to increase fertility and promote conception.