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Topically delivered nitric oxide acts synergistically with an orally administered PDE5 inhibitor in eliciting an erectile response in a rat model of radical prostatectomy. Int J Impot Res 2021; 34:573-580. [PMID: 34017115 PMCID: PMC8842897 DOI: 10.1038/s41443-021-00451-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/27/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022]
Abstract
Patients undergoing radical prostatectomy (RP) have a high incidence of post-operative erectile dysfunction (ED) refractory to treatment by oral phosphodiesterase-type-5-inhibitors (PDE5i). In the present studies, we investigated if a topically applied, nitric oxide microparticle delivery system (NO-MP) might act synergistically with an oral PDE5i (sildenafil) to improve erectile function outcomes in a rat model of RP. Thirty-five Sprague–Dawley rats underwent bilateral transection of the cavernous nerve (CN) for one week. After one-week, animals were orally administered 0, 0.05 or 0.005 mg sildenafil/kg and the erectile response following topical application to the penile shaft of 250mg or 100mg NO-MP, or blank-MP, was monitored over a two-hour timeframe by recording the intracorporal pressure normalized to systemic blood pressure (ICP/BP, N=5 animals/treatment group). Oral treatment with sildenafil by itself resulted in no observable erectile response. However, a combination of orally administered 0.05 sildenafil/kg with topical application of 250mg NO-MP, compared to 250 mg NO-MP by itself, resulted in significantly more spontaneous erections (4.6 compared to 2 erections per hour, t-test; p-value = 0.043), with a significantly faster onset for the first erectile response (11 compared to 22 minutes; t-test, p-value = 0.041). Our results demonstrate a synergistic effect between orally administered PDE5i and topically applied NO-MP in eliciting an erectile response. Furthermore, they suggest a potential novel therapeutic approach to treat men with ED resulting from RP, through combination therapy of a topically applied NO-MP and an orally administered PDE5i.
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Kim YK, Lee JH, Park SP, Yang DY. Choroidal Thickness Analysis in Patients with Erectile Dysfunction. World J Mens Health 2019; 37:85-92. [PMID: 30584992 PMCID: PMC6305867 DOI: 10.5534/wjmh.180038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/31/2018] [Accepted: 08/07/2018] [Indexed: 01/01/2023] Open
Abstract
Purpose To investigate the morphological features of choroidal vasculature in patients with erectile dysfunction (ED) by analyzing choroidal thickness using optical coherence tomography. Materials and Methods We enrolled 39 patients with ED and 19 controls. ED was defined as an erectile function domain score <26 on the International Index of Erectile Function (IIEF) questionnaire. Small-choroidal-vessel-layer (SCVL) thickness was calculated by subtracting large-choroidal-vessel-layer (which corresponded to Haller's layer) thickness from total choroidal thickness. Choroidal thickness was compared between the ED and control groups. Results SCVL thickness was lesser in the ED group than in the control group (control, 69.8±24.3 µm vs. ED, 55.1±19.9 µm; p=0.017). Among patients without diabetes, the ED group showed significantly lesser SCVL thickness than did the control group (control, 77.1±22.7 µm vs. ED, 56.5±20.9 µm; p=0.021). However, among patients with diabetes, choroidal thickness showed no significant intergroup difference. Multiple linear regression analysis revealed that spherical equivalent (standardized coefficient β=0.294; p=0.019) and the IIEF erectile function score (standardized coefficient β=0.315; p=0.012) were significantly associated with SCVL thickness. Conclusions SCVL thickness, including the choriocapillaris layer and medium-sized choroidal vascular layer, decreased in
proportion to ED severity, suggesting that microvascular changes in choroidal vessels may occur before specific ocular diseases
in patients with ED.
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Affiliation(s)
- Yong Kyu Kim
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jang Hoon Lee
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung Pyo Park
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Dae Yul Yang
- Department of Urology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
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Stein RA, Schmid K, Bolivar J, Swick AG, Joyal SV, Hirsh SP. Kaempferia parviflora ethanol extract improves self-assessed sexual health in men: a pilot study. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2018; 16:249-254. [PMID: 29880257 DOI: 10.1016/j.joim.2018.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/25/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sexual health positively correlates with overall wellbeing. Existing therapeutics to enhance male sexual health are limited by factors that include responsiveness, adherence and adverse effects. As the population ages, safe and effective interventions that preserve male sexual function are needed. Published research suggests that various preparations of Kaempferia parviflora, a plant in the Zingiberaceae (ginger) family, support cardiovascular health and may ameliorate erectile function. OBJECTIVE The aim of this study was to examine the effects of KaempMax™, an ethanol extract of the K. parviflora rhizome, on erectile function in healthy middle-aged and older men. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS We conducted an open-label, one-arm study on 14 generally healthy males aged 50-68 years with self-reported mild erectile dysfunction, who were not using prescription treatments. Participants took 100 mg KaempMax™ daily for 30 days. MAIN OUTCOME MEASURES Evaluations were conducted at baseline and on the final study assessment. Primary efficacy analyses included the International Index of Erectile Function (IIEF); secondary efficacy analyses included the Global Assessment Question about erectile function. RESULTS Thirteen participants completed the 30-day study. Supplementation with KaempMax™ resulted in statistically significant improvements in erectile function, intercourse satisfaction and total scores on the IIEF questionnaire. KaempMax™ was well tolerated and exhibited an excellent safety profile. CONCLUSION Our results suggest that KaempMax™ may improve erectile function in healthy middle-aged and older men. While the effects were not as pronounced as what might be seen with prescription medication, most participants found them satisfactory. Additional, longer and placebo-controlled clinical trials will be needed. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT03389867.
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Affiliation(s)
- Richard A Stein
- Life Extension, 3600 West Commercial Blvd, Fort Lauderdale, FL 33309, USA.
| | - Kira Schmid
- Life Extension, 3600 West Commercial Blvd, Fort Lauderdale, FL 33309, USA
| | - Jowell Bolivar
- Life Extension, 3600 West Commercial Blvd, Fort Lauderdale, FL 33309, USA
| | - Andrew G Swick
- Life Extension, 3600 West Commercial Blvd, Fort Lauderdale, FL 33309, USA
| | - Steven V Joyal
- Life Extension, 3600 West Commercial Blvd, Fort Lauderdale, FL 33309, USA
| | - Steven P Hirsh
- Life Extension Clinical Research, Inc., 5990 North Federal Highway, Fort Lauderdale, FL 33308, USA
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Lee YC, Huang SP, Tsai CC, Cheng KH, Juan YS, Wu WJ, Bao BY, Huang CN, Wang CJ, Liu CC. Associations of VEGF Gene Polymorphisms With Erectile Dysfunction and Related Risk Factors. J Sex Med 2017; 14:510-517. [DOI: 10.1016/j.jsxm.2017.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/27/2017] [Accepted: 02/08/2017] [Indexed: 01/08/2023]
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Adegun PT, Areo PO, Solomon A, Dada SA, Adebayo PB. Erectile Dysfunction in Men with and without Lower Urinary Tract Symptoms in Nigeria. World J Mens Health 2017; 35:107-114. [PMID: 28868819 PMCID: PMC5583367 DOI: 10.5534/wjmh.2017.35.2.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/06/2016] [Accepted: 12/06/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Much attention has been focused in recent decades on the effects of erectile dysfunction (ED) secondary to lower urinary tract symptoms (LUTS), potentially underestimating its effects in men without LUTS. This study aimed to compare the prevalence and predictors of ED in men with and without LUTS. MATERIALS AND METHODS The International Index of Erectile Function questionnaire was administered to 303 patients between January 2014 and June 2016. Within this sample, 147 patients with LUTS (cases) were compared to 156 men without LUTS who were matched for age, level of education, and occupation (controls). RESULTS The mean age was 66.03±9.64 years and 65.78±8.61 years for the cases and controls, respectively. The prevalence of ED was 64.6% and 73.7% (odds ratio [OR], 1.54; 95% confidence interval [CI], 0.94~2.51) in the case cohort and controls, respectively (p=0.086). There was no difference in the prevalence of impaired erectile function (p=0.067), impaired orgasmic function (p=0.108), impaired sexual desire (p=0.291), impaired intercourse satisfaction (p=0.869), or impaired overall satisfaction (p=0.191). Multivariate logistic regression analysis showed that being currently employed was a significant predictor of ED both in men with LUTS (OR, 8.08; 95% CI, 1.51~9.27; p=0.004) and in men without LUTS (OR, 7.00; 95% CI, 1.49~14.51; p=0.008). Being married only predicted for impaired EF in men without LUTS (OR, 6.34; 95% CI, 1.40~15.20; p<0.05). CONCLUSIONS ED was not found to be more prevalent in men with LUTS. Being employed was a predictor of ED in both groups of men, while being married was also a predictor of ED in men without LUTS.
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Affiliation(s)
- Patrick Temi Adegun
- Urology Division, Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Peter Olufemi Areo
- Urology Division, Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria.
| | - Abidemi Solomon
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Samuel Ayokunle Dada
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
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The quest for an increased genital size drives sex stimulant abuse among male subjects in Calabar, Cross River State, Nigeria. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2016. [DOI: 10.1016/j.apjr.2016.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Leye M, Faye A, Ka O, Seck I, Tal Dia A. Facteurs de risque cardiovasculaires associés au dysfonctionnement érectile dans la région de Dakar, Sénégal. Rev Epidemiol Sante Publique 2016; 64:195-200. [DOI: 10.1016/j.respe.2015.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 11/12/2015] [Accepted: 12/15/2015] [Indexed: 10/21/2022] Open
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Development and therapeutic applications of nitric oxide releasing materials to treat erectile dysfunction. Future Sci OA 2015; 1. [PMID: 27019746 PMCID: PMC4806684 DOI: 10.4155/fso.15.53] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The role of nitric oxide (NO) in erectile physiology is well documented. NO activates relaxation of corporal cavernosal smooth muscle tissue resulting in increased blood flow into the penis resulting in an erection. At present, pharmacologic treatments for erectile dysfunction, such as the phosphodiesterase-5 inhibitors, potentiate the erectile response generated by NO. However, a new class of treatments at a preclinical stage may allow localized delivery of NO to the penis via cutaneous application. These treatments may be of particular value to patients with a neurogenic component to their erectile dysfunction, and may act synergistically with phosphodiesterase-5 inhibitors to increase their efficacy.
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Chung RY, Chan D, Woo J, Kwok T, Leung JC, Lai FT, Wong SY. Erectile Dysfunction is Associated with Subsequent Cardiovascular and Respiratory Mortality in Cohort of 1,436 Chinese Elderly Men. J Sex Med 2015; 12:1568-76. [DOI: 10.1111/jsm.12918] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Dai F, Zhu L, Mi Y, Feng N. An Updated Meta-Analysis of the Effects of the Endothelial Nitric Oxide synthase Gene G894T Polymorphism and Erectile Dysfunction Risk. Cell Biochem Biophys 2015; 72:821-8. [DOI: 10.1007/s12013-015-0540-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Al Naimi A, Majzoub AA, Talib RA, Canguven O, Al Ansari A. Erectile dysfunction in qatar: prevalence and risk factors in 1,052 participants-a pilot study. Sex Med 2014; 2:91-5. [PMID: 25356303 PMCID: PMC4184678 DOI: 10.1002/sm2.26] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIM The aim of this study is to investigate the prevalence of erectile dysfunction (ED) in Qatar and to determine the risk factors associated with it. MATERIALS AND METHODS This is a cross-sectional survey study of men attending the outpatient department at Hamad Medical Corporation in Qatar between February 2012 and February 2013. The International Index of Erectile Function (IIEF)-5 questionnaire was used for data collection. In addition to the IIEF-5 score, each participant's medical history was taken, with special emphasis on risk factors for ED, including diabetes mellitus (DM), hypertension (HTN), dyslipidemia, coronary artery disease (CAD), and smoking habits, and on their body mass index. RESULTS One thousand fifty-two participants were randomly selected to fill out the IIEF-5 questionnaire. The participants' mean age (±SD) was 41.87 ± 13.24 years. Analysis of replies to the IIEF-5 showed that ED was present in 573 out of 1,052 participants (54.5%). Fifty-six (5%) participants had severe ED, 61 (6%) had moderate ED, 173 (16%) had mild to moderate ED, and 283 (27%) had mild ED. Risk factors for ED that held statistical significance were age (odds ratio [OR] = 2.9, 95% confidence interval [CI] 2.1-4.1, P < 0.001), DM (OR = 2.6, 95% CI 1.7-3.9, P < 0.001), HTN (OR = 1.6, 95% CI 1.1-2.5, P = 0.012), dyslipidemia (OR = 1.5, 95% CI 1.1-2.4, P = 0.024), and CAD (OR = 3.2, 95% CI 1.3-7.5, P = 0.009). CONCLUSION We found that the prevalence rate of ED in Qatar is quite similar to the regional reported rates. Overall, we demonstrated that nearly more than half of our participants suffered from ED. Besides age, DM, HTN, CAD, and dyslipidemia were found to be the most important risk factors for ED. Al Naimi A, Majzoub AA, Talib RA, Canguven O, and Al Ansari A. Erectile dysfunction in Qatar: Prevalence and risk factors in 1,052 participants-A pilot study. Sex Med 2014;2:91-95.
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Affiliation(s)
| | - Ahmad A Majzoub
- Department of Urology, Hamad Medical Corporation Doha, Qatar
| | - Raidh A Talib
- Department of Urology, Hamad Medical Corporation Doha, Qatar
| | - Onder Canguven
- Department of Urology, Hamad Medical Corporation Doha, Qatar
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Rosas-Vargas H, Coral-Vazquez RM, Tapia R, Borja JL, Salas RA, Salamanca F. Glu298Asp Endothelial Nitric Oxide Synthase Polymorphism Is a Risk Factor for Erectile Dysfunction in the Mexican Mestizo Population. ACTA ACUST UNITED AC 2013; 25:728-32. [PMID: 15292102 DOI: 10.1002/j.1939-4640.2004.tb02847.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Penile erection depends on the balanced action between antagonist vasoactive molecules such as nitric oxide (NO) and angiotensin. Endothelial nitric oxide synthase (eNOS) and angiotensin-converting enzyme (ACE) polymorphisms have been associated with endothelial dysfunction, which is described as a cause of erectile dysfunction (ED). Endothelial NOS and ACE are both regulators of vascular and corporal smooth muscle tone, which are connected by interaction between the NO-cyclic guanosine monophosphate pathway and the renin-angiotensin system. We analyzed the frequencies of 894 G/T (Glu298Asp) eNOS and ACE I/D polymorphisms in Mexican patients with ED (n=53) and in an age-matched control group (n=62). The populations analyzed were in Hardy Weinberg equilibrium. We found significant differences in allelic (chi2=4.42; P=.03) and genotypic frequencies (chi2=3.96; P=.04) between patients and controls for the 894 G/T eNOS polymorphism. Presence of the 894T allele in carriers increased the risk of ED (odds ratio [TT + GT versus GG] = 2.37; 95% confidence interval, 1.08 to 5.21; P=.02). Multiple logistic regression analysis showed that the Glu298Asp polymorphism was an independent factor for ED, as was diabetes mellitus, hypertension, cardiac disease, and cigarette smoking. No association was found between ACE I/D polymorphism and ED in the population studied. Therefore, our results suggest that Glu298Asp eNOS polymorphism plays a role as a genetic susceptibility factor for ED.
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Affiliation(s)
- Haydee Rosas-Vargas
- Unidad de Investigacion Medica en Genetica Humana, Hospital de Pediatria, Centro Medico Nacional Siglo XXI-IMSS, Av Cuauhtemoc No 330, Col Doctores, Delegacion Cuauhtemoc. 06725 Mexico, D.F., Mexico.
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Blum A, Balkan W, Hare JM. Advances in cell-based therapy for peripheral vascular disease. Atherosclerosis 2012; 223:269-77. [DOI: 10.1016/j.atherosclerosis.2012.03.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 03/06/2012] [Accepted: 03/12/2012] [Indexed: 01/01/2023]
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Idung AU, Abasiubong F, Ukott IA, Udoh SB, Unadike BC. Prevalence and risk factors of erectile dysfunction in Niger delta region, Nigeria. Afr Health Sci 2012; 12:160-5. [PMID: 23056022 PMCID: PMC3462533 DOI: 10.4314/ahs.v12i2.13] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Erectile Dysfunction (ED) is one of the major social problems causing significant distress in men. Despite the increasing difficulty in management, knowledge, and understanding of factors responsible for its development are important for prevention and care. OBJECTIVES To assess the prevalence and risk factors for ED among men in Niger Delta Region of Nigeria, in order to determine its contextual variables. METHODS Subjects included 400 male patients attending the general outpatients' clinic (GOPC) of the University of Uyo Teaching Hospital. Respondents completed the abridged version of the International Index of Erectile Function (IIEF-5). RESULTS A total of 166 (41.5%) subjects had ED; 66 (16.5%) had mild; 32 (8.0%) mild to moderate; 24 (6.0%) moderate; while 45 (11.3%) had severe 37 (9.2%) resulted from hypertension and its medications; 29 (7.3%) from diabetes; 49 (12.2%) from a combination of both and their therapies (P=0.044); 24 (6.0%) had history of previous surgery; while for 27 (6.8%) it was from undiagnosed medical conditions (p=0.001). The ED increases with age and is more among married and educated men. CONCLUSION ED is a common problem among men in Niger Delta region. Therefore, efforts must be made to reduce the incidence by dealing with the factors responsible for its development.
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Affiliation(s)
- A U Idung
- Departments of Family Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Uyo, Akwa Ibom State, Nigeria
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Idung AU, Abasiubong F, Udoh SB, Akinbami OS. Quality of life in patients with erectile dysfunction in the Niger Delta region, Nigeria. J Ment Health 2012; 21:236-43. [DOI: 10.3109/09638237.2012.664300] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Andersen ML, Guindalini C, Tufik S. Genetics of Erectile Dysfunction: A Review of the Interface between Sex and Molecular Biomarkers. J Sex Med 2011; 8:3030-9. [DOI: 10.1111/j.1743-6109.2011.02422.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
With the development and marketing of oral pharmacotherapy that is both noninvasive and successful in treating erectile dysfunction (ED), the quest to identify markers of organic ED lost ground. Indeed, the multi-factorial nature of ED may have led many researchers to conclude that searching for a universal marker of ED was futile. However, the realization that ED is strongly correlated with the overall health of men, and may act as a predictor for the development of cardiovascular disease (CVD) and diabetes, has stimulated interest in identifying genes that can distinguish organic ED. In addition, the potential ability to suggest to the patient that ED is reversible (i.e., psychogenic) with a simple test would be of significance to both the physician and patient, as well as for reimbursement issues for therapy by insurance companies. Such a marker may also act as a non-subjective measure of the degree of ED and the efficacy of treatment. This review discusses the importance of identifying such markers and recent work identifying potential markers in human patients.
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Affiliation(s)
- Kelvin P Davies
- Institute of Smooth Muscle Biology and Department of Urology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY10461, USA
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Chew KK, Gibson N, Sanfilippo F, Stuckey B, Bremner A. Cardiovascular Mortality in Men with Erectile Dysfunction: Increased Risk But Not Inevitable. J Sex Med 2011; 8:1761-71. [DOI: 10.1111/j.1743-6109.2011.02239.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Emarah AM, El-Haggar SM, Osman IA, Khafagy AWS. Correlation between penile cavernosal artery blood flow and retinal vascular findings in arteriogenic erectile dysfunction. Clin Ophthalmol 2010; 4:1047-51. [PMID: 20922041 PMCID: PMC2946996 DOI: 10.2147/opth.s11334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Indexed: 11/23/2022] Open
Abstract
Objectives: Arteriogenic erectile dysfunction (ED) is a target organ disease of atherosclerosis, and therefore might be a predictor of systemic atherosclerosis. Being systemic, it might be possible to evaluate the extent of atherosclerosis from retinal vascular findings. We investigated the possible correlation between penile cavernosal artery blood flow and retinal vascular findings in patients with arteriogenic ED. Patients and methods: Sixty patients with ED were divided according to the peak systolic velocity (PSV) in their penile cavernosal arteries into two groups; Group A included 30 patients with PSV less than 25 cm/sec, and Group B included 30 patients with PSV more than 35 cm/sec. Blood flow in the penile cavernosal artery was measured with color Doppler ultrasonography. All patients were assessed by ocular fundus examination under amydriatic conditions to evaluate retinal vascular atherosclerotic changes using Hyman’s classification. Results: Evidence of retinal vascular atherosclerotic changes was found in 19 patients (63.3%) in Group A and in 10 patients (33.3%) in Group B. Conclusions: Our study confirms the possibility of predicting penile arterial vascular status in patients with ED from their retinal vascular findings by using amydriatic simple, practical funduscopy.
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Affiliation(s)
- Ahmed M Emarah
- Departments of Ophthalmology, Cairo University, Cairo, Egypt.
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Évaluation des effets prosexuels des extraits de Bridelia ferruginea chez le rat mâle naïf. Basic Clin Androl 2010. [DOI: 10.1007/s12610-010-0094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Résumé
Bridelia ferruginea (BF, Euphorbiaceae) est un arbre dont les écorces du tronc et les feuilles sont utilisées en médecine traditionnelle pour remédier à plusieurs problèmes et en particulier l’impuissance masculine. La présente étude vise à identifier les effets prosexuels (fréquences d’érection, de monte, d’intromission et d’éjaculation) des extraits aqueux (100 mg/kg) et éthanolique (100 mg/kg) des écorces du tronc de BF administrés par voie orale à des rats Wistar adultes mâles (intacts ou castrés) sexuellement inexpérimentés pendant zéro, un et sept jours. Le comportement sexuel des rats normaux recevant une administration unique de l’extrait aqueux de BF (100 mg/kg) a été aussi évalué après prétraitement par le L-omega-nitro-arginine methyl ester (Lω-NAME, 10 mg/kg), l’halopéridol (10 mg/kg) ou l’atropine (10 mg/kg). Les animaux témoins ont reçu per os de l’eau distillée (10 ml/kg) pour le témoin neutre et une injection sous-cutanée de testostérone propionate (20 mg/kg par jour pendant trois jours avant le début du test) pour le témoin positif. Les résultats de l’étude montrent que la durée du traitement a un impact significatif (p < 0,05) sur les fréquences d’érection pénienne, de monte et d’intromission aussi bien chez les rats normaux que chez les animaux castrés. Une tendance à l’augmentation des paramètres de performance sexuelle a été aussi observée. La fréquence d’intromission des rats intacts était plus élevée (p < 0,05–0,01) à J1 et particulièrement chez les rats recevant l’extrait aqueux de BF. Chez les rats castrés, par contre, seuls les animaux traités par la testostérone ont présenté une augmentation statistique (p < 0,01–0,001) des paramètres copulatoires. Les effets prosexuels de l’extrait aqueux de BF étaient abolis par l’atropine et l’halopéridol, tandis qu’une préadministration de Lω-NAME était sans effet sur l’activité copulatoire des animaux. Ces effets stimulants sexuels de BF pourraient être attribués à la présence des flavonoïdes et des stérols, substances bioactives qui agiraient par voie dopaminergique et/ou cholinergique, et soutiennent l’intérêt de l’emploi de BF en médecine traditionnelle comme stimulant sexuel.
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Sinici İ, Güven EO, Şerefoğlu E, Hayran M. T-786C Polymorphism in Promoter of eNOS Gene as Genetic Risk Factor in Patients With Erectile Dysfunction in Turkish Population. Urology 2010; 75:955-60. [DOI: 10.1016/j.urology.2009.06.063] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Revised: 06/11/2009] [Accepted: 06/26/2009] [Indexed: 01/23/2023]
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Deng W, Bivalacqua TJ, Champion HC, Hellstrom WJ, Murthy SN, Kadowitz PJ. Superoxide dismutase - a target for gene therapeutic approach to reduce oxidative stress in erectile dysfunction. Methods Mol Biol 2010; 610:213-227. [PMID: 20013181 DOI: 10.1007/978-1-60327-029-8_13] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Erectile dysfunction (ED) is defined as the inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance. Oxidative stress has been demonstrated to be involved in the pathophysiology of age- or diabetes-related ED. Superoxide dismutase (SOD), an antioxidant enzyme catalyzing the conversion of superoxide anion (O(2) (-)) to hydrogen peroxide (H(2)O(2)) and molecular oxygen (O(2)), is a promising therapeutic target for ED. In vivo gene therapy and adult stem cell-based ex vivo gene therapy are two attractive current gene therapies for the treatment of ED. In this chapter we describe the use of two potent gene transfer techniques to deliver the therapeutic gene extracellular superoxide dismutase (ecSOD) into the penis of aged or diabetic rats for therapy of ED: adenoviral-mediated intracavernosal ecSOD gene transfer for gene therapy of ED and ecSOD gene-modified marrow stromal cells, also known as mesenchymal stem cells, based stem cell and gene therapy.
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Affiliation(s)
- W Deng
- Department of Pharmacology, Tulane University Health Sciences Center, New Orleans, LA, USA
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Neimark AI, Aliev RT, Muzalevskaya NI, Krainichenko SV, Vorob'eva EN, Tarasova TS. Use of impaza in the treatment of erectile dysfunction in patients with essential hypertension and CHD. Bull Exp Biol Med 2009; 148:328-31. [PMID: 20027361 DOI: 10.1007/s10517-009-0689-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Impaza treatment of erectile dysfunction in patients with essential hypertension and CHD receiving cardiotropic therapy improved erectile function and increased reserve circulation. Addition of impaza to the treatment protocol in cardiological patients considerably increased perfusion and reduced the content of desquamated epitheliocytes. No side effects of impaza were noted.
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Affiliation(s)
- A I Neimark
- Department of Urology and Nephrology, Altai State Medical University, Barnaul
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Bouwman II, Van Der Heide WK, Van Der Meer K, Nijman R. Correlations between lower urinary tract symptoms, erectile dysfunction, and cardiovascular diseases: Are there differences between male populations from primary healthcare and urology clinics? A review of the current knowledge. Eur J Gen Pract 2009; 15:128-35. [DOI: 10.3109/13814780903329536] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Jensen JB, Madsen SS, Larsen EH, Jensen KME, Kirkeby HJ. Patient and partner satisfaction with the mentor alpha-1 inflatable penile prosthesis. ACTA ACUST UNITED AC 2009; 39:66-8. [PMID: 15764274 DOI: 10.1080/00365590410018756] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the satisfaction level of patients and partners after implantation of a Mentor Alpha-1 inflatable penile prosthesis (IPP) for the treatment of erectile dysfunction (ED). MATERIAL AND METHODS A questionnaire was sent to 46 patients who had been operated on for ED with implantation of a Mentor Alpha-1 IPP. The investigation was designed to evaluate patient and partner satisfaction. RESULTS Eighty-five percent of the questionnaires were returned. Sexual desire had not changed but the quality of sexual activity had significantly improved. Acceptance by the partner was good. Overall satisfaction among both patients and partners was high. In total, 95% of patients said that they would recommend the procedure to other patients in the same situation. CONCLUSIONS Patient and partner satisfaction with the Mentor Alpha-1 IPP was high, with the exception of the minority of patients who experienced unacceptable complications. Infection and mechanical failure are important risks which patients should be informed of before agreeing to implantation surgery.
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Abstract
INTRODUCTION In Nigeria, the prevalence of erectile dysfunction (ED) among patients attending primary care clinics, age-standardized to the U.S. population in 2000 is 57.4%. This is considered high enough to warrant the attention of scientist for critical studies and analysis. The high ED prevalence is associated with etiologies such as psychosexual factors, chronic medical conditions, and some lifestyles. ED constitutes a major public health problem, influencing the patient's well-being and quality of life. It also leads to broken homes and marriages, psychological, social, and physical morbidity. AIM To give an account of various ED management options in Nigeria. METHOD Review of peer-reviewed literature, questionnaire, and ethnobotanical survey to some indigenous herb sellers and herbalists. MAIN OUTCOME MEASURES Cross cultural perspectives of ED management in Nigeria. RESULTS The review suggests that traditional (phytotherapy, zootherapy, and occultism) and nontraditional, orthodox practice (drug therapy, psychological, and behavioral counseling) are applicable to ED management in Nigeria. CONCLUSION This review should help in creating awareness into various options available for managing ED in the country, but does not recommend self medication of any form, be it the use of orthodox or herbal remedy.
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Affiliation(s)
- Anthony Jide Afolayan
- Centre for Phytomedicine Research, Department of Botany, University of Fort Hare, Alice 5700, South Africa.
| | - Musa Toyin Yakubu
- Centre for Phytomedicine Research, Department of Botany, University of Fort Hare, Alice 5700, South Africa
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Lee Y, Lin H, Wang C, Liu C, Wu W, Huang C, Chang L. ORIGINAL RESEARCH—BASIC SCIENCE: The Associations among GNB3 C825T Polymorphism, Erectile Dysfunction, and Related Risk Factors. J Sex Med 2008; 5:2061-8. [DOI: 10.1111/j.1743-6109.2008.00938.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stanworth RD, Jones TH. Testosterone for the aging male; current evidence and recommended practice. Clin Interv Aging 2008; 3:25-44. [PMID: 18488876 PMCID: PMC2544367 DOI: 10.2147/cia.s190] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
An international consensus document was recently published and provides guidance on the diagnosis, treatment and monitoring of late-onset hypogonadism (LOH) in men. The diagnosis of LOH requires biochemical and clinical components. Controversy in defining the clinical syndrome continues due to the high prevalence of hypogonadal symptoms in the aging male population and the non-specific nature of these symptoms. Further controversy surrounds setting a lower limit of normal testosterone, the limitations of the commonly available total testosterone result in assessing some patients and the unavailability of reliable measures of bioavailable or free testosterone for general clinical use. As with any clinical intervention testosterone treatment should be judged on a balance of risk versus benefit. The traditional benefits of testosterone on sexual function, mood, strength and quality of life remain the primary goals of treatment but possible beneficial effects on other parameters such as bone density, obesity, insulin resistance and angina are emerging and will be reviewed. Potential concerns regarding the effects of testosterone on prostate disease, aggression and polycythaemia will also be addressed. The options available for treatment have increased in recent years with the availability of a number of testosterone preparations which can reliably produce physiological serum concentrations.
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Affiliation(s)
- Roger D Stanworth
- Centre of Diabetes and Endocrinology, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, United Kingdom
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Chew KK, Bremner A, Jamrozik K, Earle C, Stuckey B. Male Erectile Dysfunction and Cardiovascular Disease: Is There an Intimate Nexus? J Sex Med 2008; 5:928-934. [DOI: 10.1111/j.1743-6109.2007.00714.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee YC, Huang CH, Wang CJ, Liu CC, Wu WJ, Chang LL, Lin HH. The associations among eNOS G894T gene polymorphism, erectile dysfunction and related risk factors. BJU Int 2007; 100:1116-20. [PMID: 17868426 DOI: 10.1111/j.1464-410x.2007.07110.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the possible correlations among eNOS G894T polymorphism, erectile dysfunction (ED) and related risk factors in a Taiwanese population. MATERIALS AND METHODS In all, 151 patients with ED and 77 healthy controls were enrolled. All the men had a complete clinical history taken and laboratory data was collected. To assess erectile conditions the five-item version of the International Index of Erectile Function (IIEF-5) was used. The eNOS G894T polymorphisms were determined using the polymerase chain reaction-restriction fragment length polymorphism method. RESULTS In all, 228 men were enrolled with a mean (sd) age of 58.6 (9.7) years. In a univariate analysis, age, serum testosterone level, and the prevalence of diabetes mellitus (DM) and hypertension were significantly different between patients with ED and the healthy controls (P < 0.01). In the multiple logistic regression analysis, DM, age and hypogonadism were three independent risk factors for ED (P = 0.018, P = 0.046 and P = 0.016, respectively). The prevalence of ED in T allele carriers (GT/TT) was significantly greater than in G allele carriers (GG; 80.0% vs 63.3%, P = 0.04). Also the eNOS 894T allele carriers had significantly lower IIEF-5 scores than the eNOS 894G allele carriers, at 13.2 (5.3) vs 15.7 (6.1) (P = 0.01) and it was associated with increment of T allele number (11.0 (5.6) vs 13.6 (5.2) vs 15.7 (6.1); P = 0.03). CONCLUSION Our results indicate that DM, age and hypoganadism are three significant independent risk factors for ED. Also, in the Taiwanese population, the eNOS 894T allele carriers are at greater risk of ED, both in prevalence and severity, and this might be a factor of genetic susceptibility.
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Affiliation(s)
- Yung-Chin Lee
- Departments of Urology, Kaohsiung Medical University Hospital, and Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
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Chew KK, Stuckey B, Bremner A, Earle C, Jamrozik K. Male erectile dysfunction: its prevalence in Western australia and associated sociodemographic factors. J Sex Med 2007; 5:60-9. [PMID: 17645447 DOI: 10.1111/j.1743-6109.2007.00548.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION This is a report of a population-based cross-sectional observational study in Western Australia (WA) on male erectile dysfunction (ED). AIM To assess the prevalence of ED in WA and to examine its associated sociodemographic factors. METHOD Postal questionnaires were sent to randomly selected age-stratified male population samples obtained from the WA Electoral Roll. MAIN OUTCOME MEASURES In addition to items covering sociodemographic and clinical information, the Australian Standard Classification of Occupations (ASCO), the Socioeconomic Index for Area (SEIFA), and the 5-item International Index of Erectile Function (IIEF-5) were used. RESULTS One thousand seven hundred seventy (41.9%) of 4,228 questionnaires were returned. One thousand five hundred eighty (89.3%) were completed questionnaires from men aged 20.1 to 99.6 years (mean 57.9, median 59.1, standard deviation 18.5). The prevalences of any ED and of severe ED among adult males in WA, adjusted for age distribution, were 25.1 and 8.5%, respectively. Standardized to World Health Organization (WHO) World Standard Population, the corresponding prevalences were 23.4 and 7.4%. Prevalence, as well as severity, of ED increased with age. Thirty-eight percent of the participants who were married or had partners experienced ED (severe ED 19.1%). The prevalence of ED was not significantly different between "white-collar" and "blue-collar" workers. Despite the great majority of the affected participants having experienced ED for >1 year, only 14.1% reported having ever received any treatment for ED. CONCLUSIONS The study has provided population-based epidemiological data on ED in Western Australian men covering a wide range of ages. The finding that ED is age related, highly prevalent, and grossly underdiagnosed and undertreated is pertinent to global population aging and a rapidly aging Australian population. To facilitate comparisons across populations with different age distributions, all future population-based studies on ED should be standardized to WHO World Standard Population.
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Affiliation(s)
- Kew-Kim Chew
- Keogh Institute for Medical Research, Nedlands, Western Australia, Australia.
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Abstract
Penile erection involves a complex interaction between the central nervous system and local factors. It is a neurovascular event modulated by psychological and hormonal factors. The discovery of nitric oxide (NO) as an intercellular messenger or neurotransmitter paved the way for identifying important mechanisms underlying physiological and pathophysiological events in the penis, in addition to providing the knowledge for the development of new therapeutics based on a novel concept of molecule and cell interaction. Despite the fact that sinusoidal endothelial cells also produce and release NO in response to chemical and possibly physical stimuli, roles of neurogenic NO in penile erection appear to be more attractive and convincing, since the pharmacological neuromodulation represents an essential step to attaining penile erection. Erectile dysfunction (ED) is caused by a variety of pathogenic factors, particularly impaired formation and action of NO. Hence, a thorough knowledge of the physiology of erection is essential for future pharmacological innovations in the field of male ED, particularly targeting NO or intracellular cyclic GMP, which represent the most promising therapeutic approach to treat patients with ED.
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Affiliation(s)
- Fernanda B M Priviero
- Department of Physiology, Medical College of Georgia, 1120 15th Street, CA 3101 Augusta, GA 30912-3000, USA.
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Watts GF, Chew KK, Stuckey BGA. The erectile–endothelial dysfunction nexus: new opportunities for cardiovascular risk prevention. ACTA ACUST UNITED AC 2007; 4:263-73. [PMID: 17457350 DOI: 10.1038/ncpcardio0861] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 01/12/2007] [Indexed: 12/31/2022]
Abstract
Erectile and endothelial dysfunction are common in individuals with multiple cardiovascular risk factors and are longitudinal predictors of cardiovascular events. The pathogenesis of both endothelial and erectile dysfunction is intimately linked through increased expression and activation of endothelial nitric oxide synthase, and the subsequent physiological actions of nitric oxide. Endothelial production of nitric oxide by endothelial nitric oxide synthase in the corpus cavernosum is involved in the maintenance of penile erection. Erectile dysfunction can be detected clinically using systematic questioning and could potentially be employed as an independent predictor of cardiovascular risk to target treatment of cardiovascular risk factors. Both erectile and endothelial dysfunction respond to lifestyle modifications, particularly in individuals with the metabolic syndrome. Drugs that improve endothelial dysfunction can also improve erectile dysfunction, but responses are not always concordant. Phosphodiesterase type 5 inhibitors, however, are powerful agents that commonly improve erectile and endothelial dysfunction, with potential cardiac applications. The recent Princeton consensus requires more extensive implementation and evaluation in clinical practice. The judicious diagnosis of erectile dysfunction, nevertheless, provides a unique opportunity for the prevention of cardiovascular disease.
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Affiliation(s)
- Gerald F Watts
- Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
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Temel Y, Hafizi S, Beuls E, Visser-Vandewalle V. The supraspinal network in the control of erection. Expert Opin Ther Targets 2007; 9:941-54. [PMID: 16185150 DOI: 10.1517/14728222.9.5.941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Penile erection is a complex event controlled by vascular, hormonal and neuronal systems. The neuronal system involved in erection is often divided into spinal and supraspinal networks. It is generally accepted that the spinal system directly controls erection and that the supraspinal network modulates this control mechanism through different ascending and descending pathways. In contrast to the spinal control of erection, relatively little is known about the supraspinal network. In the present review, the authors outline the supraspinal network involved in the control of penile erection. Firstly, the brain regions reported to be involved in erection are described and the brain circuit of erection is outlined. Subsequently, the neuromediators involved in erection are summarised. Finally, these data are discussed in the light of therapeutic possibilities in the management of erectile dysfunction by targeting the supraspinal system.
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Affiliation(s)
- Yasin Temel
- University Hospital Maastricht, Department of Neurosurgery, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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Sorrell JH, Brown JR. Sexual functioning in patients with end-stage liver disease before and after transplantation. Liver Transpl 2006; 12:1473-7. [PMID: 16741902 DOI: 10.1002/lt.20812] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The effects of end-stage liver disease (ESLD) on sexual functioning are complex and often overlooked in the context of chronic illness and the transplantation evaluation. The aim of the present study is to report on the prevalence of sexual dysfunction in patients with ESLD presenting for liver transplantation evaluation, as well as to examine a cohort after transplantation. Participants included 173 consecutive adult outpatients with ESLD who presented for orthotopic liver transplantation evaluation. All transplant candidates underwent a psychiatric evaluation, and a sexual history was taken by the transplant psychiatrist. Patients who received a liver transplant were contacted by telephone for follow-up (n = 39). The following domains were explored: sexual frequency, satisfaction, ability to orgasm, sexual interest, and, for men, erectile dysfunction. Before transplantation, high levels of sexual dysfunction were found, with women showing higher levels of dysfunction than men. Increased age and more severe liver disease were related to lower sexual frequency and satisfaction. Contrary to previous work, the cause of disease (alcoholic liver disease) was not related to sexual functioning before transplantation. Those with erectile dysfunction before transplantation showed continued dysfunction after transplantation. An additional finding was an age and gender bias against taking a sexual history from older women. Overall, for both men and women, the findings point to continued and persistent sexual dysfunction after transplantation. Findings may help transplant teams routinely inquire into the sensitive domain of sexual functioning early on and thereby provide an opportunity for treatment. Liver Transpl 12:1473-1477, 2006. (c) 2006 AASLD.
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Affiliation(s)
- James H Sorrell
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE 68132, USA.
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Schwarz ER, Rastogi S, Kapur V, Sulemanjee N, Rodriguez JJ. Erectile Dysfunction in Heart Failure Patients. J Am Coll Cardiol 2006; 48:1111-9. [PMID: 16978992 DOI: 10.1016/j.jacc.2006.05.052] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 04/26/2006] [Accepted: 05/01/2006] [Indexed: 11/17/2022]
Abstract
Chronic heart failure (HF) and erectile dysfunction (ED) are 2 highly prevalent disorders that frequently occur concomitantly. Coronary artery disease, HF, and ED share several common risk factors, including diabetes mellitus, hypertension, smoking, and dyslipidemia. Additionally, the distinct physiologic sequelae of HF create unique organic and psychologic factors contributing to ED in this patient population. Standard HF therapy with beta-receptor blockers, digoxin and thiazide diuretics may worsen sexual dysfunction owing to medication side effects. This may, in turn, lead to noncompliance in misguided efforts to retain satisfactory sexual activity, with secondary worsening of cardiac capacity. This review describes the unique aspects of ED in the HF population.
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Affiliation(s)
- Ernst R Schwarz
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
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Watcho P, Zelefack F, Nguelefack TB, Ngouela S, Telefo PB, Kamtchouing P, Tsamo E, Kamanyi A. Effects of the aqueous and hexane extracts of Mondia whitei on the sexual behaviour and some fertility parameters of sexually inexperienced male rats. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES : AJTCAM 2006; 4:37-46. [PMID: 20162070 PMCID: PMC2816420 DOI: 10.4314/ajtcam.v4i1.31190] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The effects of Mondia whitei Hook (Skeels) were studied on the sexual behaviour and some fertility parameters of sexually inexperienced male rats. Animals were orally administered 100 mg/kg and 500 mg/kg of body weight (b.w) of either the aqueous or the hexane extracts of Mondia whitei whilst the control group received 10 mL/kg b.w of 0.3% Tween 80 once/day for 14 days. Their sexual behaviour was monitored on days 0, 1, 7 and 14 days of treatment and 14 days post-treatment. Some fertility parameters (index libido, quantal pregnancy, fertility index) of the treated rat were evaluated on day 13 of treatment by pairing it overnight with two proestrus females. Results showed that Mondia whitei extracts significantly (p<0.001) reduced the mount latency and the hexane extract was found to be more efficient than the aqueous extract. The treatment had no significant effect (p>0.05) on intromission, ejaculation and erection. The fertility of the animals remained unaffected. It's concluded that Mondia whitei had sexual enhancement of the sexually inexperienced male rats.
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Affiliation(s)
- Pierre Watcho
- Animal Physiology and Phytopharmacology Laboratory, Faculty of Science, University of Dschang, Box 67 Dschang, Cameroon.
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Abstract
In light of the fact that internationally accepted diagnostic criteria for erectile disorder are hardly considered in prevalence studies, the Berlin Male Study (BMS) was designed to collect data both on the frequency of dysfunctional erections experienced (DSM-IV criterion A) and the concomitance of related distress (DSM-IV criterion B). As a result, the age-adjusted total prevalence for erectile disorder (17.8%) was markedly lower than in other studies with comparable samples (40-79 years of age). Likewise, the age-dependent increase in prevalence was by far less prominent than commonly reported in the literature. These findings strongly suggest the necessity to clearly differentiate between erectile disorder, indicating that the patient is experiencing some degree of distress associated with his dysfunctional erection, and erectile dysfunction, indicating that the respective individual is not too concerned about his dysfunctional erection (with respect to erectile function, there is no reason to refer to the latter as a patient). The authors suggest that the internationally used abbreviation "ED" be differentiated into "EDy" when referring to erectile dysfunction and "EDi" when referring to erectile disorder. This extended perspective on differential diagnosis would not only make future studies (more) comparable, it would also do justice to clinical experience.
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Affiliation(s)
- G A Schaefer
- Institut für Sexualwissenschaft und Sexualmedizin, Zentrum für Human- und Gesundheitswissenschaften, Charité-Universitätsmedizin Berlin, Campus Mitte, Freie und Humboldt-Universität, Luisenstrasse 57, 10117, Berlin-Mitte.
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Campos AR, Lima RCP, Uchoa DEA, Silveira ER, Santos FA, Rao VSN. Pro-erectile effects of an alkaloidal rich fraction from Aspidosperma ulei root bark in mice. JOURNAL OF ETHNOPHARMACOLOGY 2006; 104:240-4. [PMID: 16229981 DOI: 10.1016/j.jep.2005.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Revised: 08/09/2005] [Accepted: 09/06/2005] [Indexed: 05/04/2023]
Abstract
In recent years, there has been a renewed interest in the search for novel natural substances active against erectile dysfunction. Plants that belong to the genus Aspidosperma (Apocyanaceae) are known to be very rich in indole alkaloids and have an ethnomedical history of use as traditional remedies for erectile dysfunction. This study examined whether the indole alkaloidal rich fraction (F(3-5)) from Aspidosperma ulei Markgr. root bark could manifest penile erection-related behavioral responses (penile erection, erection-like and genital grooming) in mice. Intraperitoneal injection of F(3-5) (25 and 50mg/kg) elicited all the three different behavioral responses in a manner similar to yohimbine (2mg/kg, i.p.), a known indole alkaloid. Seventy-five percent of mice treated with yohimbine or F(3-5) showed penile erections, which were completely blocked by clonidine, an alpha-2-adrenoceptor agonist and haloperidol, a dopaminergic antagonist and as well as by l-NAME, a nitric oxide synthase inhibitor. These results point out that F(3-5) facilitates penile erection in mice possibly through the activation of central dopamine and blockade of presynaptic alpha-2 adrenoceptors with a subsequent enhancement in nitric oxide release from the penile nerves and arteries. This study further supports the traditional use of extracts from Aspidosperma species in erectile dysfunction.
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Affiliation(s)
- Adriana R Campos
- Department of Physiology and Pharmacology, Federal University of Ceará, Rua Cel. Nunes de Melo, 1127, C.P. 3157, Porangabussu, 60430-270 Fortaleza, CE, Brazil
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Abstract
INTRODUCTION Laboratory experiments indicate that the nitric oxide erectile pathway is testosterone-dependent. Castration induces erectile dysfunction (ED) and reduction in nitric oxide synthase and in phosphodiesterase type 5 (PDE5) in the erectile tissue. Furthermore, castration causes apoptosis adversely affecting smooth muscle content and penile hemodynamics leading to veno-occlusive dysfunction. Testosterone therapy reverses these structural, biochemical, and physiological changes. In humans, testosterone therapy improves erectile function in men with hypogonadism. However, the efficacy of testosterone monotherapy may not be adequate because of the multifactorial nature of the pathophysiology of ED. METHODS Preliminary data from a number of studies have been reviewed. RESULTS There are emerging evidence-based benefits to using the combination of testoterone and PDE5 inhibitors. A recently published multicenter, randomized, placebo-controlled study evaluated the safety and efficacy of testosterone gel 1% plus sildenafil vs. placebo gel plus sildenafil, in producing an erectile response in hypogonadal men who had failed prior sildenafil alone for ED. Screening yielded a prevalence of hypogonadism in ED patients who failed prior sildenafil. Following randomization, the double-blinded treatment phase was 12 weeks. Testosterone therapy with testosterone gel significantly improved erectile function in response to sildenafil. In addition, it significantly improved orgasmic function and patient satisfaction. CONCLUSION It is important to screen all men with ED for hypogonadism, especially those with a history of inadequate response to prior PDE5 inhibitors. The combination of testosterone plus PDE5 inhibitors may be considered for the treatment of ED in men with low to low-normal testosterone levels, who had inadequate response to prior treatment with PDE5 inhibitors alone.
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Affiliation(s)
- Ridwan Shabsigh
- Department of Urology, Columbia University, New York, NY 10032, USA.
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Nandipati KC, Raina R, Agarwal A, Zippe CD. Erectile Dysfunction Following Radical Retropubic Prostatectomy. Drugs Aging 2006; 23:101-17. [PMID: 16536634 DOI: 10.2165/00002512-200623020-00002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Radical prostatectomy has been the time-honoured and standard treatment option for prostate cancer. Erectile dysfunction (ED) is one of the common quality-of-life issues following radical prostatectomy. The recovery of potency following radical prostatectomy varies from 16% to 86%. Although major modifications in surgical technique appear to be promising, the reported ED rates are still high. The time period required for the recovery of erectile function after surgery varies from 6 to 24 months. During this period of neuropraxia lack of natural erections produces cavernosal hypoxia. This cavernosal hypoxia has been implicated as one of the most important factors in the pathophysiology of ED. Cavernosal hypoxia predisposes to cavernosal fibrosis, ultimately producing venous leak and long-term ED. Interruption of this cascade of events has been the major challenge for physicians. Physicians have several options available for the treatment of ED. However, oral treatment options have quickly become established as first-line treatment options. Sildenafil has been most extensively studied in the radical prostatectomy population. In patients who do not respond to oral therapy alone, standard treatment options (intracavernosal injections, vacuum constriction devices and intraurethral alprostadil) are useful. Use of penile prostheses is one of the oldest treatment options available for the treatment of ED but is used only as a last resort. Initial attempts to promote the earlier recovery of erectile function appear to be promising. However, further confirmatory studies are essential. The roles of gene transfer and growth factors are still in experimental stages. In this review we discuss the epidemiology, pathophysiology and treatment options available for ED following radical prostatectomy.
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Affiliation(s)
- Kalyana C Nandipati
- Glickman Urological Institute and Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Deng W, Bivalacqua TJ, Hellstrom WJG, Kadowitz PJ. Gene and stem cell therapy for erectile dysfunction. Int J Impot Res 2005; 17 Suppl 1:S57-63. [PMID: 16391545 DOI: 10.1038/sj.ijir.3901430] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Erectile dysfunction (ED) is defined as the inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance. ED is a highly prevalent health problem with considerable impact on the quality of life of men and their partners. Although the treatment of ED with oral phosphodiesterase type V (PDE5) inhibitors is effective in a wide range of individuals, it is not efficacious in all patients. The failure of PDE5 inhibitors happens mainly in men with diabetes, non-nerve sparing radical prostatectomy, and high disease severity. Therefore, improved therapies based on a better understanding of the fundamental issues in erectile physiology and pathophysiology have recently been proposed. Here, we summarize studies on ED treatment using gene and stem cell therapies. Adenoviral-mediated intracavernosal transfer of therapeutic genes, such as endothelial nitric oxide synthase (eNOS), calcitonin gene-related peptide (CGRP), superoxide dismutase (SOD), and RhoA/Rho kinase and mesenchymal stem cell-based cell and gene therapy strategy for the treatment of age- and diabetes-related ED are the focus of this review.
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Affiliation(s)
- W Deng
- Department of Pharmacology, Tulane University Health Sciences Center, New Orleans, LA 70112, USA
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Abstract
Erectile dysfunction (ED) is one of the commonest disorders of male sexual function. Penile erection depends on a complex interaction of psychological, neural, vascular and endocrine factors. Testosterone has an important role in both central and peripheral domains of this process. In this article we discuss the role of testosterone in male sexual function and endocrine causes of ED.
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Affiliation(s)
- H Soran
- Andrology Research Unit, Department of Endocrinology, Manchester Royal Infirmary, Oxford Road, Manchester, UK.
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Cappelleri JC, Althof SE, Siegel RL, Stecher VJ, Tseng LJ, Duttagupta S. Association between the Erectile Dysfunction Inventory of Treatment Satisfaction and the Self-Esteem and Relationship Questionnaire following treatment with sildenafil citrate for men with erectile dysfunction. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2005; 8 Suppl 1:S54-60. [PMID: 16336489 DOI: 10.1111/j.1524-4733.2005.00072.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Research is lacking on the correlation between treatment satisfaction and confidence, self-esteem, and relationships for men receiving treatment for erectile dysfunction (ED). We sought to correlate scores between the validated Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) index and the validated Self-Esteem And Relationship (SEAR) questionnaire following treatment with sildenafil citrate (VIAGRA). METHODS This study was based on an open-label, flexible-dose trial of 93 sildenafil-naive patients with ED. Pearson correlation coefficients between EDITS index and SEAR questionnaire scores, each of which can range from 0 to 100 (most favorable), were calculated at end of treatment (EOT). An analysis of covariance model was applied to associate changes from baseline to EOT in SEAR scores with EDITS score at EOT, controlling for baseline SEAR score. RESULTS Significant and sizable Pearson's correlations between SEAR and EDITS scores (P < or = 0.0001; range: 0.49-0.84) were observed. A 10-point higher EDITS scores at EOT corresponded to a significant and tangible average improvement in SEAR scores from baseline to EOT (P < or = 0.0001; range: 6.6-8.7). Average SEAR scores at EOT were markedly different between patients with greater treatment satisfaction at EOT (EDITS score > or = median EDITS score of 88.6; n = 50) and those with lesser treatment satisfaction at EOT (EDITS score <88.6; n = 43). CONCLUSIONS The data add to the validity of the SEAR questionnaire, suggest a tangible relationship between treatment satisfaction and psychosocial benefit among men with ED treated with sildenafil, and highlight the importance of assessing the psychosocial impact of ED in men undergoing treatment.
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Abstract
Sleep-related erections have been reported to occur from the intrauterine life to senescence. It has been speculated that the main function of nocturnal erections is to provide adequate engorgement of the corpora cavernosa, which then leads to increased tissue oxygenation. This is in turn to prevent cavernous fibrosis, the histopathological basis for corporeal venoocclusive dysfunction, which probably is the most common cause of organic erectile dysfunction. It has been suggested that sleep-related erections are triggered by the release of nitric oxide by the nitrergic nerve fibers within the cavernous nerves. Androgens regulate this mechanism as well as some other non-nitrergic processes within the corpora cavernosa and within the central nervous system. By contrast, the erectile response to tactile or visual erotic stimuli in wakefulness predominantly involves an androgen-independent system, although it may, at least to a certain degree, also be influenced by androgen-sensitive mechanisms. No doubt, androgens are key players in the physiology of nocturnal erections, and the availability of new, user-friendly testosterone preparations such as transdermal gel and intramuscularly administered testosterone undecanoate stimulates further investigations on this field. The prospect that the quality of sleep may also be improved by an androgen therapy administered to improve sleep-related erections in hypogonadal men needs further basic research and appropriate clinical studies.
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Masson P, Lambert SM, Brown M, Shabsigh R. PDE-5 Inhibitors: Current Status and Future Trends. Urol Clin North Am 2005; 32:511-25, viii. [PMID: 16291042 DOI: 10.1016/j.ucl.2005.08.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Phosphodiesterase-5 (PDE-5) inhibitors are a well-established, first-line therapy for erectile dysfunction (ED). Extensive clinical trials and clinical experience established the highly significant efficacy and the safety of this class of drugs in the treatment of ED.Furthermore, the efficacy of PDE-5 inhibitors has been established in men with ED with a broad range of etiologies and comorbidities. The future of PDE-5 inhibitors includes the expansion of indications such as the treatment of pulmonary hypertension and the potential of treatment of symptomatic BPH.
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Affiliation(s)
- Puneet Masson
- Department of Urology, College of Physicians and Surgeons, Columbia University, 161 Fort Washington Avenue, New York, NY 10032, USA
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Abstract
As the proportion of the US population over the age of 65 continues to rise, it is likely that the number of individuals with concomitant benign prostatic hyperplasia and hypertension will also increase. To reduce morbidity and mortality, it is important to treat patients with hypertension optimally. Evidence from outcome trials suggests that alpha1 blockers should not be used as first-line antihypertensive therapy. Although some clinicians previously recommended alpha1 blocker monotherapy for patients with both hypertension and benign prostatic hyperplasia, the most recent American Urologic Association and Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines recommend independent treatment with the most appropriate pharmacologic agents for each condition. When treating patients with benign prostatic hyperplasia, clinicians should be aware of the potential impacts that alpha1 blockers may have on blood pressure and potential adverse events in patients who are normotensive as well as in patients with treated hypertension.
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Affiliation(s)
- William B White
- Section of Hypertension and Clinical Pharmacology, Center for Cardiology and Cardiovascular Biology, University of Connecticut School of Medicine, Farmington, CT 06030-3940, USA.
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Jensen JB, Larsen EH, Kirkeby HJ, Jensen KME. Clinical experience with the Mentor Alpha-1 inflatable penile prosthesis: report on 65 patients. ACTA ACUST UNITED AC 2005; 39:69-72. [PMID: 15764275 DOI: 10.1080/00365590410018747] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the complications and prosthesis survival associated with implantation of the Mentor Alpha-1 inflatable penile prosthesis (IPP) for the treatment of erectile dysfunction (ED). MATERIAL AND METHODS Between August 1995 and March 2003, 65 patients underwent implantation of a Mentor Alpha-1 IPP at the Urological Departments of Skejby or Aalborg University Hospitals. Patient data were obtained retrospectively from medical files. RESULTS The follow-up period ranged from 1 to 96 months (median 48.5 months). Twenty-one patients (32%) experienced complications that required revision. The majority of complications consisted of mechanical problems, but infection was also a large contributor to the complication rate. Seven patients (11%) had the prosthesis permanently removed due to infection. Kaplan-Meier estimates of the 5-year prosthesis survival rates with and without successful revisions due to complications were 88% and 63%, respectively. CONCLUSIONS The Mentor Alpha-1 IPP is an efficient treatment for ED in situations where less invasive therapy has failed. The risk of infection or mechanical failure must not be ignored. Patients should be informed of this risk before agreeing to implantation surgery.
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Mydlo JH, Viterbo R, Crispen P. Use of combined intracorporal injection and a phosphodiesterase-5 inhibitor therapy for men with a suboptimal response to sildenafil and/or vardenafil monotherapy after radical retropubic prostatectomy. BJU Int 2005; 95:843-6. [PMID: 15794795 DOI: 10.1111/j.1464-410x.2005.05413.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report experience with combined therapy using intracorporal injection (ICI) of alprostadil and oral phosphodiesterase 5 (PDE-5) inhibitors for the minimally invasive treatment of erectile dysfunction (ED) after radical prostatectomy (RP), as PDE-5 inhibitors are effective but a few patients may have a suboptimal response. PATIENTS AND METHODS In a retrospective study, 34 men (aged 46-66 years) had a nerve-sparing retropubic RP and subsequent ED. Patients were titrated on sildenafil citrate or vardenafil to maximum doses. All had a suboptimal response after a maximum of eight doses of oral therapy and were then treated with ICI therapy using 15 or 20 microg alprostadil. Erectile function was assessed with the Sexual Health Inventory for Men (SHIM). RESULTS Of the 32 patients who continued combined therapy, 22 (68%) had an improvement in erectile function after ICI therapy, as assessed by the SHIM score. On follow-up, 36% of these patients used ICI therapy only intermittently, instead of regularly, as they felt that this was adequate enough for good results. CONCLUSIONS PDE-5 oral pharmacotherapy is the most commonly used effective therapy for ED but may not be as effective in patients who have radical surgery; the addition of testosterone patches may have side-effects or be considered a risk in patients with a history of prostate cancer. The use of ICI therapy as an adjunct or maintenance therapy to their oral medication may be another alternative in these patients.
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Affiliation(s)
- Jack H Mydlo
- Department of Urology, Temple University School of Medicine, Philadelphia, PA 19140, USA.
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Triggle DJ. Vaccines, Viagra, and Vioxx: medicines, markets, and money—when life-saving meets life-style. Drug Dev Res 2005. [DOI: 10.1002/ddr.10429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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