Organic causes of erectile dysfunction in men under 40

Cold hypersensitivity in the hands and feet is associated with erectile dysfunction in young Taiwanese men

Cold hypersensitivity in the hands and feet (CHHF) is a protective or predisposing factor for many diseases; however, the relationship between CHHF and erectile dysfunction (ED) remains unclear. We aimed to investigate associations between CHHF and ED among young men of Southeast Asian origin. In this cross-sectional study, sexually active Taiwanese men aged 20-40 years were enrolled via an online questionnaire comprising general demographic information, comorbidities, subjective thermal sensations of their hands and feet in the past 6 months, and their erectile function using the International Index of Erectile Function-5 (IIEF-5). Participants who reported cold sensation of hands and feet were classified to have CHHF; those with IIEF-5 score ≤ 21 were considered to have ED. Total 54.2% and 27.9% of participants had ED and CHHF, respectively. Men with CHHF were significantly younger, had lower body mass index and IIEF-5 scores (p < 0.001), and a lower prevalence of diabetes mellitus (p = 0.033) along with higher prevalence of ED, psychiatric disorders, and insomnia (p < 0.001). After adjusting for predisposing factors of ED, CHHF (odds ratio 1.410, 95% confidence interval 1.159-1.714; p = 0.001) remained an independent predictor of ED. Thus, CHHF is independently associated with ED, affecting more than a quarter of young Taiwanese men. Autonomic dysregulation and subclinical endothelial dysfunction may be common pathophysiologies of CHHF and ED.

Association between testosterone levels and RigiScan parameters of patients with erectile dysfunction

Background

It is difficult to diagnose hypogonadism because of the lack of objective assessments of erectile dysfunction (ED), which is caused by hypogonadism.

Aim

To provide a new approach for diagnosing hypogonadism, this study evaluated the efficacy of nocturnal penile tumescence and rigidity (NPTR) testing with RigiScan for patients with ED with and without hypogonadism.

Methods

From June 2021 to February 2023, 133 patients with ED (62 with hypogonadism and 71 without) underwent NPTR testing at the Department of Andrology. A detailed history of all participants was obtained. All participants also underwent a physical examination, sex hormone testing, and ultrasound examination of the cavernous vessels of the penis.

Outcomes

Patient characteristics, sex hormone serum levels, and RigiScan Plus data of NPTR testing of patients with ED were obtained and evaluated.

Results

Between the groups, there were no significant differences in age, body mass index, or erectile function score or in the prevalence of smoking, drinking, diabetes, hypertension, and hyperlipidemia. RigiScan data revealed differences in erection episodes per night, average event rigidity, erection durations, and percentage of tumescence greater than baseline, which were significantly lower in the testosterone-deficient group than in the normal testosterone group. The average event rigidity of the tip displayed the largest area under the curve value, with a sensitivity of 67.6%, a specificity of 85.5%, and a cutoff value of 52.50.

Clinical Implications

Our findings may allow appropriate patients to receive testosterone replacement therapy, which has been shown to be an effective treatment for hypogonadism.

Strengths and Limitations

This is the first study of its kind to perform a comprehensive review of the association between hypogonadism and RigiScan parameters. This study was limited by its small sample size.

Conclusion

RigiScan parameters of patients with ED and testosterone deficiency were significantly lower than those of patients with normal testosterone; therefore, RigiScan is useful for the differential diagnosis of patients with ED caused by hypogonadism.

Do oral antiviral drugs used in the treatment of chronic hepatitis B cause erectile dysfunction?

OBJECTIVE

The effect of antiviral drugs on the erectile dysfunction (ED) problem expressed by some patients using antiviral drugs due to chronic hepatitis B infection (HBV) was investigated.

METHODS

A total of 102 male patients receiving antiviral therapy for HBVinfection without any known non-cirrhotic and comorbid disease that may cause ED and whodon't use any drugs with an ED formation potential were analyzed through the InternationalIndex of Erectile Function test.

RESULTS

Among the patients admitted to the study, anxiety disorder was detected as 24.5% (n = 25) and depression as 46.1% (n = 47). 70.6% (n = 72) of the patients suffered ED. Severe ED was only detected in 3 (n = 2.9%) patients. ED was detected in 70.6% of the entecavir, 64.2% of tenofovir, and 80% of Tenofovir alafenamide users ( P  = 0.287). On the other hand, the logistics regression analysis revealed that the most important factors that increase the risk of ED are age (>55 age; RR: 2.66; P  < 0.001), and anxiety disorder (RR: 2.30; P  < 0.0001). The cumulative effect of antiviral drugs on ED was 5.7% (RR: 0.8; P  = 0.156).

CONCLUSION

We could not find any mounting evidence relating to the effect ofcommonly used antiviral drugs for hepatitis B causing ED. The incidence rate of ED on ourpatients was at a similar rate with population studies in the literature based on society. It is notappropriate to terminate antiviral therapy in hepatitis B for this reason.

Association between MTHFR c.677C>T variant and erectile dysfunction among males attending fertility clinic

Genetic risk factors have been shown to contribute to the development of sexual dysfunction. However, the role of methylenetetrahydrofolate reductase ( MTHFR ) gene variants in the risk of erectile dysfunction (ED) remains unclear. In this study, we recruited 1254 participants who underwent ED assessed by the International Index of Erectile Function-5. The MTHFR c.677C>T variant was also measured by fluorescence polymerase chain reaction (PCR). No significant difference in the genotypic frequency of the MTHFR C677T polymorphism (CC, CT, and TT) was observed between men from the ED and non-ED groups. In addition, on binary logistic regression analysis, both crude and adjusted models showed that the risk of ED was not significantly associated with the C677T polymorphism. Interestingly, a significantly higher frequency of the 677TT polymorphism was found in severe and moderate ED (P = 0.02). The positive correlation between the MTHFR 677TT polymorphism and severe ED was confirmed by logistic regression analysis, even after adjusting for potential confounders (odds ratio [OR] = 2.46, 95% confidence interval [CI] 1.15-5.50, P = 0.02). These findings suggest a positive correlation between the MTHFR 677TT polymorphism and the risk of severe ED. Identification of MTHFR gene polymorphisms may provide complementary information for ED patients during routine clinical diagnosis.

Correlation between visceral fat metabolism score and erectile dysfunction: a cross-sectional study from NHANES 2001-2004

Backgrounds

The factors associated with erectile dysfunction (ED) are diverse, and obesity is a significant component. Metabolic Score for Visceral Fat (METS-VF) can assess obesity more accurately than body mass index (BMI). However, the association between METS-VF and ED remains unclear.

Objective

This study aimed to investigate the association between the METS-VF and ED using National Health and Nutrition Examination Survey (NHANES) 2001-2004 data.

Methods

Data were sourced from NHANES 2001-2004. The relationship between METS-VF and ED was analyzed using multivariate logistic regression, followed by subgroup analyses to identify sensitive populations. Nonlinear correlation was evaluated through smoothed curve fitting, and a threshold effect analysis validated the findings. Comparative logistic regression of the Receiver Operating Characteristic (ROC) curve assessed the diagnostic capability of METS-VF against the classical obesity index for ED.

Results

The study enrolled 3625 participants, of whom 961 self-reported ED history and 360 reported severe ED. After adjusting for confounders, METS-VF exhibited a positive association with asthma prevalence (OR= 3.47, 95% CI: 2.83, 14.24). Stratification based on median METS-VF revealed higher ED prevalence in participants with elevated METS-VF (OR= 2.81,95% CI:2.32, 3.41). Nonlinear correlation was observed, with a significant association between METS-VF and ED when METS-VF exceeded 6.63. Subgroup analysis highlighted a stronger correlation in participants aged 50-85 years, Caucasians, hypertensive individuals, diabetics, and those with coronary heart disease. Sensitivity analysis using severe ED as the outcome reaffirmed the nonlinear positive association with METS-VF (OR=3.86, 95% CI:2.80,5.33), particularly when METS-VF surpassed 6.68.

Conclusion

Elevated METS-VF was nonlinearly correlated with increased ED incidence. Individuals with METS-VF above 6.63 should be vigilant about heightened ED risk. Special attention should be given to participants aged 50-85 years, Caucasians, hypertensive individuals, diabetics, and those with coronary heart disease.

Penile revascularization using the descending branch of the lateral circumflex femoral artery: An alternative vascular graft

INTRODUCTION AND RELEVANCE

Microsurgical revascularization stands as the preferred method for addressing erectile dysfunction (ED) resulting from traumatic penile arterial insufficiency. Traditional microarterial bypass surgery (MABS) techniques have typically relied on utilizing the inferior epigastric artery (IEA) as the graft vessel. However, issues such as endothelial dysfunction in the vessel and alterations in abdominal tissue can negatively impact surgical outcomes. MABS using the descending branch of the lateral circumflex artery of the femur (DLCFA) should be proposed as a surgical option for penile arterial revascularization.

CASE PRESENTATION

A 29-year-old who experienced ED after a pelvic bone fracture with hypogastric vascular injury was referred to our center. Preoperatory penile Doppler ultrasound (PDU) examination documented the presence of arterial insufficiency. Selective hypogastric angiography pointed out the interruption of arterial blood flow at the level of the distal right internal pudendal artery.

CASE DISCUSSION

Access to the dorsal penile artery was gained through an infrapubic incision, the DLCFA pedicle was isolated through an incision along the anterolateral right thigh. After its transposition, the arterial bundle was anastomosed to the dorsal penile artery in an end-to-end fashion. Intraoperative PDU has been used to verify the patency of the anastomosis. At 6 months follow-up, optimal flow parameters on PDU were persistently registered, and the patient had consistent clinical improvement on the IIEF-5 score.

CONCLUSION

DLCFA grafting for penile revascularization is a suitable therapeutic option in traumatic ED due to its size and accessibility. Further experience is necessary to compare clinical outcomes among different revascularization techniques.

Stigmatization as a Barrier to Urologic Care: A Review

Heavy societal stigma of certain conditions has created an environment where individuals may be hesitant to seek professional care. Urology is a specialized field that focuses on many of these conditions that society has deemed taboo to discuss. In this review, we address barriers that have prevented patients from seeking urologic care in order to better understand and elucidate important concerns within development of the physician-patient relationship. Recognizing these concerns can also assist in public health outreach approaches to motivate patients for seeking urologic care. The scope of this review was limited to three highly prevalent conditions affecting both men and women, including urinary incontinence, erectile dysfunction, and genitourinary syndrome of menopause.

Review of potential spermatogenic and aphrodisiac effects of the Ferula genus

OBJECTIVE

Men's sexual health plays an important role in male fertility and childbearing, as it is associated with factors such as sexual desire, healthy spermatogenesis, and erectile function. In various cultures, medicinal plants have been utilized to address male sexual issues, including infertility and erectile dysfunction. Despite recent advancements in medical science for treating male impotence, some men opt for herbal supplements as an alternative, given that numerous herbs have the potential to enhance male sexual performance. The Apiaceae family is one of the oldest plant families used for medicinal purposes. Ferula, a genus within this family, comprises approximately 170 different species worldwide. Members of this genus possess numerous therapeutic properties due to the presence of various compounds. This article aims to explore the potential impacts of Ferula plants on the male reproductive system.

METHODS

This review article was prepared by searching for terms including Ferula and "aphrodisiac," Ferula and "spermatogenesis," and Ferula and "male reproductive system." Relevant information was gathered through electronic databases, including ISI Web of Knowledge, PubMed, and Google Scholar.

RESULTS

The findings indicated that relatively comprehensive studies have been conducted in this area, revealing that certain Ferula species have been employed in folk medicine to boost fertility and libido. Recent research has corroborated these effects.

CONCLUSION

It is hoped that new aphrodisiac compounds with fewer side effects can be isolated from Ferula plants in the future.

MRI-Cavernosography: A New Diagnostic Tool for Erectile Dysfunction Due to Venous Leakage: A Diagnostic Chance

Erectile dysfunction caused by venous leakage is a vascular disease in which blood fails to accumulate in the corpora cavernosa due to the abrupt drainage of blood from the penis secondary to an abnormal venous network that affects 1 to 2% of men under 25 years old and about 10 to 20% over 60 years old, who do not raise a sufficient erection for penetrative sex. The study of the venous leak and its characterization in young patients with erectile dysfunction represent a diagnostic challenge, and imaging remains the best way to diagnose this condition. In the article, it is described the methods of execution and the diagnostic role of the cavernous MRI in the study of vasogenic erectile dysfunction from the venous leak, proposing it as a good alternative to the cavernous CT, considering the satisfactory results in terms of diagnostic interpretation, the absence of ionizing radiation, the higher soft tissue resolution of the imaging method and the lower administration of contrast agent.

An Evaluation of Psychogenic Predictors of Non-Organic Erectile Dysfunction

Background and Objectives: Erectile dysfunction is a significant problem, which diminishes the quality of life. The aim of this study was to investigate the relationship of childhood trauma and attachment styles in the aetiology of psychogenic erectile dysfunction. Materials and Methods: The study included 80 participants (40 patients who presented with the complaint of erectile dysfunction, were not determined with an organic pathology, and were diagnosed with erectile dysfunction according to the DSM-5 criteria; and a control group of 40 healthy subjects.) The structured clinical interview form for DSM-5 (SCID-5) was applied to all the participants, together with the International Erectile Function Index (IIEF), the Childhood Trauma Questionnaire (CTQ), the Relationship Scale Questionnaire (RSQ), and the Beck Depression Inventory (BDI). Results: The emotional abuse (p = 0.002), physical abuse (p = 0.049), emotional neglect (p = 0.004), physical neglect (p = 0.002), and total scale points of the CTQ were determined to be significantly higher in the patient group than in the control group. Secure (p = 0.022) and dismissive (p = 0.009) attachment styles were found to be higher in the control group. As the time together with the current sexual partner increased, so the severity of erectile dysfunction increased, and sexual function, orgasmic function, sexual satisfaction, and general satisfaction decreased. As emotional abuse, sexual abuse, and physical neglect increased, the severity of erectile dysfunction increased. Childhood trauma (β = -0.275, t (73) = -2.704, p = 0.009) and the duration together with the partner (β = -0.249, t (73) = -2.512, p = 0.014) were found to be predictive of erectile dysfunction. Conclusions: The results of this study demonstrated that childhood trauma and the time elapsed without treatment are predictors of psychogenic erectile dysfunction severity, and secure attachment style and self-esteem play an important role in the aetiology of psychogenic erectile dysfunction.

Investigating self-reported efficacy of lifestyle medicine approaches to tackle erectile dysfunction: a cross-sectional eSurvey based study

BACKGROUND

Erectile dysfunction (ED) is the most common sexual dysfunction in men. Some types of ED are amenable to treatment using lifestyle medicine approaches with or without pharmacotherapy.

AIM

Investigate self-reported efficacy of lifestyle medicine approaches to tackle ED.

METHODS

A cross-sectional online survey of 1177 community dwelling adults explored the prevalence and methods used to tackle ED in the community setting. We examined differences between participants with and without ED. Variables associated with ED in univariable analyses were included in a multivariable logistic regression to identify variables independently associated with the condition.

OUTCOMES

Self-reported measure: perceived effectiveness of lifestyle medicine interventions to tackle ED.

RESULTS

Most respondents (76.5%) had experienced ED, and this was associated with having a long-term condition, taking anti-hypertensive medication, hypercholesterolaemia and obesity. Medication was the most common management strategy overall (65.9%), followed by stress management (43.5%) and weight loss (40.4%). Over half (53.9%) did not use any lifestyle modification strategies to tackle ED. Only 7.0% of ED sufferers received a mental health assessment and 29.2% received other tests (e.g., blood test, medical imaging) by GPs. Cardiovascular training was identified as the best rated strategy by its users (37.8%). Supplements (35.1%) and weight training/physical activity (32.6%) were also positively rated.

CLINICAL IMPLICATIONS

Structured education to general practitioners and community dwelling adults about the impact of lifestyle behaviour modification and how this could influence the appearance or trajectory of ED could help improve personal choice when tackling ED.

STRENGTHS AND LIMITATIONS

To our knowledge, this is the first study to collect eSurvey responses from community dwelling adults to gauge their reliance and perceived effectiveness of lifestyle medicine approaches to tackle ED. The principal limitation was the lack of follow-up, and not recording other information including lifestyle factors such as nutrition, smoking, and the use of alcohol and recreational drugs, which may have enabled a fuller exploration of the factors that could influence the primary outcome measures examined.

CONCLUSION

Despite the high prevalence of ED, there is not enough awareness in the community setting about effective and low-cost lifestyle medicine strategies, including cardiovascular training and the use of supplements and weight training, to help tackle this common condition.

Impact of body composition analysis on male sexual function: A metabolic age study

Introduction

Metabolic Age (MetAge) and body composition analysis may reflect an individual's metabolic status, which is believed to influence male sexual and gonadal functions. Although erectile dysfunction (ED) and hypogonadism are increasingly prevalent with age, they are also detected among younger men. This study aims to assess the impact of MetAge and body composition on male sexual and gonadal status overall, and particularly in men younger than 40 years of age.

Methods

This was a cross-sectional study of 90 male healthcare workers, between the ages of 18-55, randomly selected based on their corporation numbers. In addition to Bioelectric Impedance Analysis, subjects were requested to fill the International Index of Erectile Function questionnaire (IIEF-5) and to provide an early morning serum testosterone (T) sample.

Results

The mean participants' age was 39.4 ± 9.4 years, MetAge was 45.54 ± 10.35 years, serum T level was 13.68 ± 4.49 nmol/L and BMI was 28.8 ± 4.7 kg/m2. Significant negative correlations were obtained between serum T, MetAge, body weight and fat composition. Significant negative correlations between the IIEF-5 score, MetAge, and fat composition, were only reported in subjects <40 years of age. Significantly lower T levels (p=0.002), significantly older MetAge (p=0.034), and higher BMI (p=0.044) and degree of obesity (p=0.042) were observed in participants <40 years with erectile dysfunction (ED) compared to their counterparts without ED.

Discussion

MetAge and body composition parameters significantly impact the androgenic state. ED in men <40 years is associated with lower T levels, older MetAge and higher BMI and degree of obesity.

Mean platelet volume as a predictive marker of erectile dysfunction: a meta-analysis

Erectile dysfunction (ED) is a global health problem that commonly occurs due to multiple factors, particularly by a vascular abnormality with the activation of platelet (PLT). Mean platelet volume (MPV), a PLT activity marker, has been hypothesized to be associated with ED. The present meta-analysis aims to evaluate the MPV and its contribution to ED diagnosis. A systematic searching to summarize the association of MPV as a predictive marker for ED was conducted on two databases, including MEDLINE (PubMed) and CINAHL (EBSCOhost). We included all English studies that measured MPV levels in ED and non-ED subjects. A total of 168 publications were initially retrieved and screened systematically. 12 studies with 1643 subjects were included for both qualitative and quantitative analysis. The MPV mean difference between ED patients and healthy subjects; vasculogenic and non-vasculogenic ED showed significant differences. Our findings show PLT is associated with the development of ED. Higher MPV level was found in the ED subjects compared to the healthy controls. Nevertheless, the evidence is still limited due to the small number of studies and further investigations are required to support the utilization of MPV for ED diagnosis.

The Efficacy and Safety of Thrice vs Twice per Week Low-Intensity Pulsed Ultrasound Therapy for Erectile Dysfunction: A Randomized Clinical Trial

BACKGROUND

A recent sham-controlled clinical study has shown that low-intensity pulsed ultrasound twice per week can safely and effectively treat patients with mild-to-moderate erectile dysfunction (ED). However, large-scale clinical trials are needed to verify its efficacy and safety and determine a reasonable treatment interval.

AIM

To study whether low-intensity pulsed ultrasound therapy thrice per week is non-inferior to twice per week in patients with mild-to-moderate ED.

METHODS

A randomized, open-label, parallel-group, non-inferiority clinical trial was conducted in 7 hospitals in China. A total of 323 patients with mild-to-moderate ED were randomized (1:1) into thrice per week (3/W) and twice per week (2/W) groups. Low-intensity pulsed ultrasound was applied on each side of the penis for 16 sessions.

OUTCOMES

The primary outcome was response rate using the minimal clinically important difference in the International Index of Erectile Function (IIEF-EF) score at week 12. Secondary outcomes included Erection Hardness Score (EHS), Sexual Encounter Profile, Global Assessment Question, and Self Esteem and Relationship Questionnaire.

RESULTS

Response rates in 3/W and 2/W groups were 62.0% and 62.5%, respectively. Treatment effect in the 3/W group was noninferior to that of the 2/W group, with rate difference lower bound of -0.01% [95% confidence interval -0.11 to 0.10%] within the acceptable margin (-14.0%). No significant difference was found among secondary outcomes. IIEF-EF score showed a significant increase from baseline in the 3/W group (16.8 to 20.7) and 2/W group (17.8 to 21.7), and the percentage of patients with EHS ≥3 increased in the 3/W (54.9% to 84.0%) and 2/W (59.5% to 83.5%) groups. There was no significant difference in response rate between the 2 groups after controlling for strata factors and homogeneous tests. No treatment-related adverse events were reported.

CLINICAL IMPLICATIONS

Low-intensity pulsed ultrasound therapy displays similar efficacy and safety for mild-to-moderate ED when administered thrice or twice per week for 16 sessions. This study provides two options to suit patients' needs.

STRENGTHS & LIMITATIONS

This is a large-sample, randomized, controlled, noninferiority trial study. Short-term follow-up and mostly younger patients are the main limitations.

CONCLUSION

Low-intensity pulsed ultrasound therapy thrice and twice per week showed equivalent therapeutic effects and safety for mild-to-moderate ED in a young and generally healthy population. This therapy warrants further investigation of its potential value in rehabilitation of ED.

Nebivolol protects erectile functions compared to Metoprolol in hypertensive men with atherogenic, venogenic, psychogenic erectile dysfunction: A prospective, randomized, cross-over, clinical trial

INTRODUCTION

Both hypertension and β-blocker drugs used for treating hypertension (HT) can cause erectile dysfunction (ED). Nebivolol, unlike other β-blockers, may not cause impotence since it increases the release of Nitric Oxide (NO), which is the main mediator of erection. This study investigated the effect of Nebivolol and Metoprolol on erectile functions in hypertensive men.

MATERIALS AND METHODS

Married men whose blood pressure were >140/90 mmHg were included in the study. All patients were assessed for ED, and the cause of ED was then investigated. Nebivolol or Metoprolol was started for one month in all patients. After one-month drugless period, the β-blockers were switched. Blood pressures, pulses and sexual function tests were evaluated, and plasma NO levels were measured at the end of the treatments and during the drugless period.

RESULTS

There was no difference in antihypertensive efficacy between the two drugs (p = 0.828;0.194 for systolic and diastolic BP). Metoprolol caused a significant decrease in IIEF-5 score, whereas Nebivolol did not cause a decrease in IIEF-5 score on patients with psychogenic, arteriogenic, and venous failure related ED (respectively, p<0.001,0.004,0.005 for Metoprolol; p = 0.201,0.598,0.088 for Nebivolol). In the non-ED group, both drugs decreased the IIEF-5 score, but the decrease for Metoprolol (p = 0.001) was more than that for Nebivolol (p = 0.012). Plasma NO levels did not change with Metoprolol (p = 0.268) but increased with Nebivolol (p<0.001). There was a positive correlation between plasma NO values and IIEF-5 score used for the assessment of sexual functions (r = 0.284, p = 0.026).

CONCLUSION

Nebivolol may be advantageous in terms of preserving sexual functions because of increasing NO in eligible hypertensive male patients.

An update on the current status and future prospects of erectile dysfunction following radical prostatectomy

BACKGROUND

Radical prostatectomy (RP) and radiation treatment are standard options for localized prostate cancer. Even though nerve-sparing techniques have been increasingly utilized in RP, erectile dysfunction (ED) due to neuropraxia remains a frequent complication. Erectile function recovery rates after RP remain unsatisfactory, and many men still suffer despite the availability of various therapies.

OBJECTIVE

This systematic review aims to summarize the current treatments for post-RP-ED, assess the underlying pathological mechanisms, and emphasize promising therapeutic strategies based on the evidence from basic research.

METHOD

Evaluation and review of articles on the relevant topic published between 2010 and 2021, which are indexed and listed in the PubMed database.

RESULTS

Phosphodiesterase type 5 inhibitors, intracavernosal and intraurethral injections, vacuum erection devices, pelvic muscle training, and surgical procedures are utilized for penile rehabilitation. Clinical trials evaluating the efficacy of erectogenic drugs in this setting are conflicting and far from being conclusive. The use of androgen deprivation therapy in certain scenarios after RP further exacerbates the already problematic situation and emphasizes the need for effective treatment strategies.

CONCLUSION

This article is a detailed overview focusing on the pathophysiology and mechanism of the nerve injury developed during RP and a compilation of various strategies to induce cavernous nerve regeneration to improve erectile function (EF). These strategies include stem cell therapy, gene therapy, growth factors, low-intensity extracorporeal shockwave therapy, immunophilins, and various pharmacological approaches that have induced improvements in EF in experimental models of cavernous nerve injury. Many of the mentioned strategies can improve EF following RP if transformed into clinically applicable safe, and effective techniques with reproducible outcomes.

Erectile dysfunction in young patients and elderly patients by sexual encounter profile: A comparative study

OBJECTIVE

Demand for erectile dysfunction treatments has increased not only in elderly patients but also in young patients. Reports indicate that frequent causes of erectile dysfunction in Japan are organic disorders in elderly patients and psychogenetic disorders in young patients.

METHODS

We defined patients under the age of 40 as young erectile dysfunction patients, and those over 65 as elderly erectile dysfunction patients. We divided these two groups and conducted a retrospective comparative study based on medical questionnaires. We selected 215 cases of patients under the age of 40, and 176 cases of patients over the age of 65, and created a group of young patients and a group of elderly patients. We implemented the erectile hardness score, Sexual Health Inventory for Men, and sexual encounter profile questions 2 and 3 as the patient's daily clinical journal.

RESULTS

The median age of young patients was 36 years, and that of elderly patients was 70 years. With respect to Sexual Health Inventory for Men, the average score was a significantly higher score in the young patients (9.26 vs 7.10, P < 0.001). Concerning erectile hardness score, young patients showed significantly higher scores in erectile hardness score (3.15 vs 2.06, P < 0.001). In terms of sexual encounter profile question 2, 50.9% of young patients responded "yes," but 24.3% of elderly patients responded, thus indicating a significantly higher score in young patients. In terms of sexual encounter profile question 3, 6.1% of young patients responded "yes," and 0.7% of elderly patients responded "yes," indicating a significantly higher in young patients.

CONCLUSIONS

The results showed that many young patients with erectile dysfunction were able to perform insertion, but were unable to maintain erection.

Cardiovascular/Stroke Risk Assessment in Patients with Erectile Dysfunction-A Role of Carotid Wall Arterial Imaging and Plaque Tissue Characterization Using Artificial Intelligence Paradigm: A Narrative Review

PURPOSE

The role of erectile dysfunction (ED) has recently shown an association with the risk of stroke and coronary heart disease (CHD) via the atherosclerotic pathway. Cardiovascular disease (CVD)/stroke risk has been widely understood with the help of carotid artery disease (CTAD), a surrogate biomarker for CHD. The proposed study emphasizes artificial intelligence-based frameworks such as machine learning (ML) and deep learning (DL) that can accurately predict the severity of CVD/stroke risk using carotid wall arterial imaging in ED patients.

METHODS

Using the PRISMA model, 231 of the best studies were selected. The proposed study mainly consists of two components: (i) the pathophysiology of ED and its link with coronary artery disease (COAD) and CHD in the ED framework and (ii) the ultrasonic-image morphological changes in the carotid arterial walls by quantifying the wall parameters and the characterization of the wall tissue by adapting the ML/DL-based methods, both for the prediction of the severity of CVD risk. The proposed study analyzes the hypothesis that ML/DL can lead to an accurate and early diagnosis of the CVD/stroke risk in ED patients. Our finding suggests that the routine ED patient practice can be amended for ML/DL-based CVD/stroke risk assessment using carotid wall arterial imaging leading to fast, reliable, and accurate CVD/stroke risk stratification.

SUMMARY

We conclude that ML and DL methods are very powerful tools for the characterization of CVD/stroke in patients with varying ED conditions. We anticipate a rapid growth of these tools for early and better CVD/stroke risk management in ED patients.

A Natural History of Erectile Dysfunction in Elderly Men: A Population-Based, Twelve-Year Prospective Study

There is a wide variation in the development and course of erectile dysfunction (ED) in men, which confirms the need for prospective studies. We conducted a cross-sectional analysis among the general male population at the baseline (n = 359) and in a follow-up survey (n = 218) 12 years later. The prospective 12-year study included 189 men. ED was assessed using the International Index of Erectile Function questionnaire. The mean age of the participants was 62.0 years at the baseline, while at the 12-year follow-up it was 71.6 years. The crude prevalence of ED was 61.6% at the baseline and 78.9% at the follow-up, and the prevalence tended to increase with age. All of the men aged 75 years or more had at least mild ED. The incidence of ED in every thousand person years was 53.5. A total of 54.5% of the men experienced ED progression, while 39.2% reported no changes in erectile function, and 6.3% experienced ED regression during the 12-year study. The likelihood of ED progression was higher in the older compared with younger age group (odds ratio, OR 5.2 (95% CI: 1.1-26.2)), and the likelihood of ED regression was lower among men with increased depression symptoms (OR 0.3 (95% CI: 0.1-0.6)) and among men with a decreased interest in their sexual life (OR 0.1 (95% CI: 0.0-0.6)). Lifestyle factors such as the consumption of alcohol and smoking were not significantly associated with ED.

Association Between Chronic Periodontal Disease and Erectile Dysfunction: A Case-Control Study

Erectile dysfunction (ED) and chronic periodontal disease (CPD) share mutual risk factors, and the incidence of ED is increasing among young adults. The relation of CPD and ED remains obscure due to inconsistent clinical evidence. This study aimed to further assess the relationship between CPD and ED using the Community Periodontal Index of Treatment Need (CPITN) and the International Index of Erectile Function (IIEF). Totally, 202 adult men were included, with 100 subjects with ED in the case group and 102 subjects without ED undergoing routine dental examinations in the control group. The IIEF questionnaire was used to assess the severity of ED, and CPD was assessed through the Community Periodontal Index (CPI) score. Periodontal assessments were performed by one single calibrated examiner. Logistic regression analysis was performed for the association between CPD and ED. After adjustment for age, smoking status, tooth brushing time, education level, monthly income, tooth brushing frequency, and gum bleeding, higher CPI score was identified to be associated with a greater risk of ED (odds ratio [OR] = 2.755, 95% confidence interval [CI] = [1.400, 5.423], p = .003), suggesting that CPD was positively associated with the odds of ED. CPD was getting more severe with the progress of ED (p < .05). Men with ED could be encouraged to receive routine dental examinations and appropriate preventive dental measures to maintain oral and periodontal health.

Prevalence and Characteristics of Erectile Dysfunction in Obstructive Sleep Apnea Patients

BACKGROUND

Obstructive sleep apnea (OSA) is a common and severe social problem. Erectile dysfunction (ED) is an important health concern. The prevalence of OSA with ED is increasing, which significantly affects the quality of life and work efficiency of patients. However, the mechanism underlying the comorbidity of these two diseases remains unclear.

OBJECTIVES

(1) Investigate the prevalence of OSA with ED; (2) analyze the correlation between OSA and ED; and (3) explore the treatment response to and possible mechanism of uvulapalatopharyngoplasty (UPPP) in patients with OSA and ED. This study aims to provide a theoretical basis for the clinical diagnosis and comprehensive treatment of OSA with ED and improve prevention and treatment strategies.

MATERIALS AND METHODS

In total, 135 subjects were enrolled in the study. Clinical data, polysomnography, the ESS score, Beck anxiety score, Beck depression score, IIEF-5 score and ASEX score were recorded before UPPP and 6 months after UPPP. Sex hormones were measured for all subjects using a Roche electrochemiluminescence analyzer.

RESULT

The prevalence of OSA with ED was 64.52%, and the prevalence of severe OSA with ED was 73.02%. The prevalence of OSA with ED increased with age, BMI and apnea-hypopnea index (AHI) value. Among polysomnography indicators, minimum oxygen saturation and average oxygen saturation may predict the occurrence of OSA with ED. Improving the patient's anxiety and depression is very important for treating OSA with ED. Sex hormone levels were not significantly correlated with the occurrence of OSA with ED.

CONCLUSION

ED is a common symptom of OSA patients. This study showed that sex hormone levels in OSA patients with ED were not significantly correlated with the condition, but further investigation of this relationship is worthwhile. It is recommended that the free and combined types of sex hormones be further distinguished during testing because the free type is the active form. UPPP surgical treatment is effective for OSA with ED, and its possible mechanism is protection of the peripheral nerves of the sex organs by improving nighttime hypoxia and arousal.

Erectile Dysfunction in Men on the Rise: Is There a Link with Endocrine Disrupting Chemicals?

Erectile dysfunction (ED) is one of the most prevalent chronic conditions affecting men. ED can arise from disruptions during development, affecting the patterning of erectile tissues in the penis and/or disruptions in adulthood that impact sexual stimuli, neural pathways, molecular changes, and endocrine signalling that are required to drive erection. Sexual stimulation activates the parasympathetic system which causes nerve terminals in the penis to release nitric oxide (NO). As a result, the penile blood vessels dilate, allowing the penis to engorge with blood. This expansion subsequently compresses the veins surrounding the erectile tissue, restricting venous outflow. As a result, the blood pressure localised in the penis increases dramatically to produce a rigid erection, a process known as tumescence. The sympathetic pathway releases noradrenaline (NA) which causes detumescence: the reversion of the penis to the flaccid state. Androgen signalling is critical for erectile function through its role in penis development and in regulating the physiological processes driving erection in the adult. Interestingly, estrogen signalling is also implicated in penis development and potentially in processes which regulate erectile function during adulthood. Given that endocrine signalling has a prominent role in erectile function, it is likely that exposure to endocrine disrupting chemicals (EDCs) is a risk factor for ED, although this is an under-researched field. Thus, our review provides a detailed description of the underlying biology of erectile function with a focus on the role of endocrine signalling, exploring the potential link between EDCs and ED based on animal and human studies.

Erectile dysfunction in patients undergoing multiple attempts at hypospadias repair: Etiologies and concerns

INTRODUCTION

One-third of adult patients presenting for the repair of persistent penile defects after failing multiple hypospadias repair attempts during childhood will complain of erectile dysfunction (ED). The goal of this paper is to identify possible etiological causes of its onset.

MATERIALS AND METHODS

Five selection criteria were used for entrance into the study: 1) Patients had to have failed ≥ three prior hypospadias repair attempts. 2) Present for evaluation between 18 and 40 years of age. 3) No known congenital or medical anomaly could be present that could have predisposed to erectile dysfunction. 4) Sexual history inventory for men (SHIM-5 score) completed. 5) All patients with moderate to severe ED (SHIM scores ≤ 16) underwent psychological screening; individuals with good quality spontaneous or self-stimulated erections, experiencing major life events, or had documented psychological problems were excluded from the study. One hundred consecutive patients meeting these criteria were assessed. We evaluated multiple factors to discern if they were associated with the onset of ED: the initial location of the urethral meatus, if a corporoplasty was performed, the type of corporoplasty used, if the urethral plate was divided or resected, the use of a ventral corporal graft, the total number of open reparative procedures performed before referral, the number of direct visual internal urethrotomies (DVIU) performed, the length of a urethral stricture at the time of the referral and whether lichen sclerosus was present. Statistical evaluations used chi-square analysis, two-tailed t-tests, or a logistic regression model where indicated, p-values < 0.05 were considered significant.

RESULTS

37% (37/100) of our patients complained of moderate to severe ED (SHIM score ≤16). Statistical analysis comparing patients with ED to those without ED (63%:63/100), revealed patients with ED were older, median age 34 yrs (range 20-40) vs 26 yrs (range 18-40) p = 0.0212, had undergone division of the urethral plate 70.3% (26/37) vs 47.6% (30/63), p = 0.0276, had placement of a ventral corporal graft, 24% (8/33) vs 1.5% (1/67), p = 0.0003 or had undergone repetitive DVIU's to manage urethral stricture disease, median number 4 (range 0-15) vs 0 (range 0-6), p < 0.0001, see table.

CONCLUSIONS

The early onset of ED in patients that failed multiple attempts at hypospadias repair in childhood is associated with advancing age, division of the urethral plate, and prior ventral corporal grafting. Especially significant is the association of ED to the use of repetitive internal urethrotomy to manage urethral stricture disease.

The impact of extracorporeal shock wave therapy for the treatment of young patients with vasculogenic mild erectile dysfunction: A prospective randomized single-blind, sham controlled study

BACKGROUND

Low-intensity extracorporeal shock wave therapy (ESWT) for the treatment of vasculogenic erectile dysfunction (ED) has emerged as a promising method directly targeting the underlying pathophysiology of the disease.

OBJECTIVES

To compare outcomes in ED patients after ESWT and placebo treatment.

MATERIALS AND METHODS

Prospective randomized placebo-controlled single-blinded trial on 66 patients with mild ED. The study comprised a 4-week washout phase, a 4-week treatment phase, and a 48-week follow-up. Inclusion criteria included age between 18 and 75 years and diagnosis of mild ED (IIEF-EF score = 17-25) being made at least six months prior to study inclusion and being confirmed by Penile Doppler ultrasonography (US) at baseline examination. Efficacy endpoints were changes from baseline in patient-reported outcomes of erectile function (International Index of Erectile Function domain scores [IIEF-EF]), as well as erection hardness and duration (Sexual Encounter Profile diary [SEP] and Global Assessment Questions [GAQ]). Safety was assessed throughout the study.

RESULTS

A total of 66 enrolled patients were allocated to ESWT (n = 44) or placebo (n = 22). Mean age of ESWT and placebo group was 42.32 ± 9.88 and 39.86 ± 11.64 (p = 0.374), respectively. Mean baseline IIEF-EF scores of ESWT group and placebo were 20.32 ± 2.32 and 19.68 ± 1.55 respectively (p = 0.34). At 3-months follow-up, mean IIEF-EF scores were significantly higher in ESWT patients than in placebo patients (23.10 ± 2.82 vs. 20.95 ± 2.19, p = 0.003), and IIEF-EF scores of ESWT patients remained high during the 6 months (22.67 ± 3.35 vs. 19.82 ± 1.56) follow-up. The percentage of patients reporting both successful penetration (SEP2) and intercourse (SEP3) in more than 50% of attempts was significantly higher in ESWT-treated patients than in placebo patients (p = 0.001). A minimal clinically important difference between the IIEF = EF baseline and 3-months follow-up was found in 74% of ESWT and 36% of placebo. No serious adverse events were reported.

DISCUSSION AND CONCLUSION

ESWT significantly improved the erectile function of relatively young patients with vasculogenic mild ED when compared to placebo and the beneficial effect of this treatment up to 6 months. These findings suggest that ESWT could be a useful treatment option in vasculogenic ED.

Relationship between the risk factors of cardiovascular disease by testing biochemical markers and young men with erectile dysfunction: a case-control study

Background

Erectile dysfunction (ED) shares common risk factors with cardiovascular disease (CVD), such as diabetes mellitus (DM) and dyslipidemia, but the relationship between the risk factors of CVD in biochemical markers and young men with ED age 20–40 years is not fully clarified.

Methods

A total of 289 ED outpatients (20–40 years old) were allocated under ED group, based on patients’ complaints and physical examinations. According to the frequency matching ratio of 1:4, 1,155 male individuals (20–40 years old) without ED were set as control group. All participants were tested for lipid profiles including total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), blood glucose (BG), homocysteine (HCY), liver function including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and renal function including uric acid (UA) and creatinine (CR). The study was designed to compare the two groups using an established binary logistic regression analysis model. The ED group was then subdivided into a younger ED group (20–30 years old) and an older ED group (31–40 years old) for further comparisons.

Results

After comparison, no obvious differences were found in medians of age, TC, TG, HDL, HCY, UA, and ALT in the two groups. Median LDL, BG, and CR were significantly higher and AST was much lower in the ED group (P<0.01). In binary logistic regression analysis, odds ratios (OR) for LDL, BG, CR, and AST were 1.279, 1.237, 1.026, and 0.978, respectively. The sensitivity value and specificity value were 43.25% and 72.56%, respectively. The medians of LDL, TG, and TC were higher and HDL was much lower in the older ED group, as compared with the younger group (P<0.05). No significant differences were displayed in medians of other biochemical markers in the above comparisons.

Conclusions

Elevated LDL, BG, and CR were related factors of ED in young men. Lipid profile was significantly different between young men with ED aged 20–30 and 31–40 years.

Erectile Dysfunction Treatment Using Stem Cells: A Review

Erectile dysfunction (ED) is a disorder that affects the quality of life and the sexual relations of more than half of the male population aged over 40 years. The prediction regarding the incidence of ED is devastating as it is expected that this disorder will affect more than 300 million men in the next five years. Several studies have suggested the use of stem cells for the treatment of ED and showed that this type of treatment is promising in terms of damaged tissue repair as well as of clinical efficacy; however, there are several gaps in the knowledge and evidence is lacking. In order to highlight a few of them in this review, we performed a research of the literature focusing on currently available clinical studies regarding the clinical efficacy of stem cell administration for the treatment of ED. We reviewed the methods of administration, the cell types used in the performed clinical trials and the safety and efficiency of such procedures. We conclude that there are rapidly expanding and promising results from the reported clinical studies indicating that stem cells could indeed be a potential treatment for patients with ED although more studies are necessary.

Erectile Dysfunction in Young Men: Testosterone, Androgenic Polymorphisms, and Comorbidity With Premature Ejaculation Symptoms

BACKGROUND

The association between erectile dysfunction (ED), free testosterone (T), and androgenic genetic polymorphisms is still unclear. As most studies in the field have focused on older (>40 y.o.) men, data from young men is scarce. In addition, the clinically observed comorbidity between ED and premature ejaculation (PE) has not been explained.

AIM

The aim of the present study was 3-fold: to assess in a sample of young men (1) the association between ED and T; (2) the role of androgenic genetic polymorphisms in the aforementioned association; and (3) comorbidity between ED and PE symptoms.

METHODS

Statistical analyses were performed on a population-based sample of 2,302 Finnish men, (M_age = 26.8 years). Hormone samples were available from 317 men, and genotype information was available from a minimum of 1,144 men depending on genetic locus. For twin analyses, the sample contained 533 male individuals from opposite-sex fraternal twin pairs, 491 identical male individuals (110 complete pairs), 493 male individuals from male fraternal twin pairs (92 complete pairs), and 658 siblings of twins.

OUTCOMES

The main outcome measure includes association between levels of salivary T and ED, main effects of the androgen-related genetic polymorphisms on ED scores. Bivariate twin models of PE and ED were fitted to elucidate possible shared etiology.

RESULTS

We found no significant association between T levels and ED and no significant main effects of the androgenic genetic polymorphisms on ED. We found no evidence suggesting that any of the genetic polymorphisms would moderate the association between T and ED symptoms. We found shared unique environmental influences between PE and ED (r_E = .28).

CLINICAL TRANSLATION

Obtained data suggest that ED has T-independent causes and that any comorbidity between PE and ED is not explained by a set of genes affecting both phenotypes.

STRENGTHS & LIMITATIONS

First, the sample size for both parts of the study was relatively small, which may make some statistical analyses underpowered. Furthermore, as the sample was a population-based sample of relatively young men, the number of clinically relevant ED cases was low. Second, some concerns about T derived from saliva exist because saliva sampling comes with increased risks of error particularly because saliva samples are more vulnerable to contamination.

CONCLUSION

We found no significant association between free T levels, androgenic genetic polymorphisms, and ED in the younger age cohort. Twin analysis suggested a common nonshared environmental component in PE and ED. Zhuravleva1 ZD, Johansson A, Jern P. Erectile Dysfunction in Young Men: Testosterone, Androgenic Polymorphisms, and Comorbidity With Premature Ejaculation Symptoms. J Sex Med 2021;18:265-274.

Self-Nanoemulsifying System Loaded with Sildenafil Citrate and Incorporated within Oral Lyophilized Flash Tablets: Preparation, Optimization, and In Vivo Evaluation

Sildenafil citrate is a drug used throughout the world primarily to treat erectile dysfunction. Several problems with the commercially available product decrease its efficacy, such as limited solubility, delayed onset of action, and low bioavailability with a large variability in the absorption profile. This study aimed to develop an optimized self-nanoemulsifying lyophilized tablet for the drug to conquer the foresaid problems. Sildenafil solubility in various surfactants, oils, and cosurfactants was attempted. An optimized formulation of a loaded self-nanoemulsion with a small droplet size was developed by applying a special cubic model of the mixture design. Sixteen formulations were prepared and characterized for droplet size. On the basis of solubility studies, a clove oil/oleic acid mixture, polysorbate 20 (Tween 20), and propylene glycol were selected as the proposed oil, surfactant, and cosurfactant, respectively. On the basis of desirability, an optimized sildenafil citrate-loaded self-nanoemulsifying delivery system containing 10% of the oil mixture, 60% of the surfactant, and 30% of the cosurfactant had a droplet size of 65 nm. Subsequently, the tablet form was fabricated with optimum ratios of 0.4% fumed silica, 0.1% hydroxypropyl methylcellulose, and 0.4% sodium starch glycolate. This formula showed satisfactory results in both disintegration and dissolution studies. In vivo pharmacokinetic studies indicated a higher bioavailability (1.44 times) and rapid absorption profile for the study’s tablets compared with commercially available tablets. In conclusion, highly bioavailable oral lyophilized flash tablets of sildenafil were successfully prepared. They will be a good alternative to the conventional solid-dosage form.

Erectile Dysfunction Resistant to Medical Treatment Caused by Cavernovenous Leakage: An Innovative Surgical Approach Combining Pre-operative Work Up, Embolisation, and Open Surgery

OBJECTIVE

Thirty per cent of cases of erectile dysfunction (ED)/male impotence are resistant to oral treatment. Half of these cases are due to blood drainage from the corpora cavernosa occurring too soon, due to cavernovenous leakage (CVL). The aim of this study was to report on an innovative treatment scheme combining pre- and post-operative haemodynamic assessment, venous embolisation, and open surgery for drug resistant ED caused by CVL.

METHODS

An analysis of prospectively collected data, with clinical and haemodynamic pre- and post-operative assessment, was carried out. Forty-five consecutive patients operated on for drug resistant ED caused by CVL were evaluated pre-operatively and three months post-operatively by pharmacologically challenged penile duplex sonography (PC-PDS), pharmacologically challenged Erection Hardness Score (PC-EHS), and pharmacologically challenged computed caverno tomography (PC-CCT). Follow up consisted of patient interview, PC-PDS, PC-EHS and if needed PC-CCT.

RESULTS

Mean patient age was 43.9 ± 12.0 years (range 20-67). Forty-nine per cent of patients had primary ED. Patients with diabetes, a smoking habit, hypercholesterolaemia, and hypertension were 18%, 11%, 9%, and 4%, respectively. Three months post-operatively, PC-EHS increased from 2.0 ± 0.7 to 3.1 ± 0.74 (p < .001), with an EHS of 3 being the threshold allowing for penetration. Deep dorsal vein velocity, a haemodynamic marker of CVL, decreased from 14.2 ± 13.0 to 0.9 ± 3.5 cm/s (p < .001). After a 14.0 ± 10.7 month follow up, the primary success rate (clinical EHS ≥ 3, possible sexual intercourse with penetration, no vascular re-operation, no penile prosthesis implant) was 73.3%. Four patients (9%) underwent successful re-operation for persistent ED and CVL. Accordingly, compared with a possible penetration rate of 8.9% before surgery, 37 patients (secondary success rate: 82.2%) were able to achieve sexual intercourse with penetration. Type of ED (primary vs. secondary) and diabetes had no influence on the results. Thirty-two per cent of patients with secondary success achieved penetration with no medication.

CONCLUSIONS

After a 14 month follow up, pre-operative work up, embolisation, and open surgery during the same procedure allowed patients with ED resistant to oral medical to achieve intercourse with penetration.

Ionic Channels as Potential Therapeutic Targets for Erectile Dysfunction: A Review

Erectile dysfunction (ED) is a prevalent condition, especially in men over 40 years old, characterized by the inability to obtain and/or maintain penile erection sufficient for satisfactory sexual intercourse. Several psychological and/or organic factors are involved in the etiopathogenesis of ED. In this context, we gathered evidence of the involvement of Large-conductance, Ca2+-activated K+ channels (BKCa), Small-conductance, Ca2+-activated K+ channels (SKCa), KCNQ-encoded voltage-dependent K+ channels (KV7), Transient Receptor Potential channels (TRP), and Calcium-activated Chloride channels (CaCC) dysfunctions on ED. In addition, the use of modulating agents of these channels are involved in relaxation of the cavernous smooth muscle cell and, consequent penile erection, suggesting that these channels are promising therapeutic targets for the treatment of erectile dysfunction.

Clinical Profile of Young Patients with Erectile Dysfunction: Preliminary Findings of a Real-life Cross-sectional Study

BACKGROUND

Erectile dysfunction (ED) is an increasingly common complaint among men aged <40 yr.

OBJECTIVE

To assess clinical factors potentially associated with impaired erectile function (EF) in a cohort of young men seeking first medical help for ED as their primary complaint.

DESIGN, SETTING, AND PARTICIPANTS

Complete sociodemographic and clinical data for 307 consecutive patients aged <40 yr were analysed. Health-significant comorbidities were scored using the Charlson comorbidity index. Patients completed the International Index of Erectile Function (IIEF) and Beck's Inventory for Depression (BDI) and were categorised into two groups: those with impaired EF (IIEF-EF <26) and those with normal IIEF-EF scores.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Descriptive statistics and logistic regression analyses were used to test the association between risk factors and impaired EF.

RESULTS AND LIMITATIONS

Overall, 78 patients (25%) had normal and 229 (75%) had impaired IIEF-EF scores. Among ED patients, 90 (29%) had IIEF-EF scores suggestive of severe ED. The two cohorts did not differ in terms of median age, body mass index, prevalence of hypertension, general health status, smoking history, or alcohol use. No differences were reported for serum sex hormones and lipid profiles. Patients with ED reported higher median BDI scores (7, interquartile range [IQR] 3-13) than those with normal EF (5, IQR 1-9). Overall, the higher the BDI score, the lower was the IIEF-EF domain score (odds ratio 1.08, 95% confidence interval 1.02-1.15; p=0.01). The single-centre cohort is the main study limitation.

CONCLUSIONS

Overall, young men with impaired EF showed comparable clinical characteristics to those with normal IIEF-EF; conversely, young individuals with worse EF had BDI scores suggestive of significant mood deflection.

PATIENT SUMMARY

Young men complaining of erectile dysfunction show significant mood deflection in comparison to patients with normal erectile function. Conversely, the clinical characteristics are similar between the two groups.

Sexual life and medication taking behaviours in young men: An online survey of 92 620 respondents in China

OBJECTIVES

To assess sexual life and medication taking behaviours in young Chinese men.

METHODS

An online survey was conducted across China between January 2017 and April 2017. Among the participants, men aged 19-40 years were included in the analysis. The respondents filled in the online questionnaire assessing sexual life and medication taking behaviours by themselves, including general information, cognition of erectile dysfunction (ED) and treatment-related questions. Erection hardness score (EHS) was used to measure the erection hardness status.

RESULTS

Among the young respondents, 20.54% had grade I-II EHS, 58.14% searched the internet for online ED-related information, 26.49% took an ED medication and 50.89% took an ED medication without the advice of a physician or pharmacist. The respondents who took medication had less sexual intercourse per week (P < .001) and worse EHS (P < .001), and were more willing to seek information from physicians, pharmacists, friends and relatives instead of online sources (P < .001), compared with those not taking medication. The most common comorbidities in patients with grade I-II EHS were hyperlipidaemia, cardiovascular disease (CVD), prostate diseases and diabetes mellitus.

CONCLUSION

About 20% of young Chinese men needed further assessment for ED. The majority of respondents obtained ED-related information by online search and took an ED medication without professional advice. These data could help clinicians understand the current status of sexual life and medication taking behaviours of young Chinese men.

Erectile Dysfunction Treatment Using Focused Linear Low-Intensity Extracorporeal Shockwaves: Single-Blind, Sham-Controlled, Randomized Clinical Trial

INTRODUCTION

Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a new treatment modality for erectile dysfunction (ED). Our aim was to evaluate the treatment outcome of Li-ESWT for ED in single-blind, placebo controlled, randomized clinical trial.

METHODS

Sixty patients were randomized into 2 age-matched groups: Group A - treatment and Group B - placebo. Treatment consisted of 4 sessions on the PiezoWave2 unit (R. Wolf and ELvation Medical). Effectiveness was assessed according to the International Index of Erectile Function 5 (IIEF-5), Erectile Hardness Score (EHS), questions 2 and 3 of the Sexual Encounter Profile (SEP 2, SEP 3), and Global Assessment Question (GAQ) scores at baseline and 4 and 12 weeks after treatment. We evaluated patient's and partner's subjective satisfaction.

RESULTS

A statistically significant difference between the groups was found at 4 and 12 weeks after treatment with regard to the quality of erection as measured by the IIEF-5 (p = 0.049 and p < 0.001, respectively), the EHS after week 12 (p < 0.001), an increase in the EHS after 4 and 12 weeks (p = 0.030 and p < 0.001, respectively), after 12 weeks in GAQ (p < 0.001), SEP 2 (p = 0.05), SEP 3 (p < 0.001), and patient's satisfaction (p < 0.001) and partner's satisfaction (p < 0.001).

CONCLUSIONS

The randomized single-blind study confirms that Li-ESWT significantly improves erectile function.

Evaluation of the Mistakes in Self-Diagnosis of Sexual Dysfunctions in 11,000 Male Outpatients: A Real-Life Study in An Andrology Clinic

Purpose: The aim of this study was to compare the initial request for sexual consultation with the final diagnosis and to evaluate the limits of the active andrological anamnesis concerning unclassified male sexual dysfunction. Methods: In this 12-year observational retrospective study, we collected data from patients referring to an andrological outpatient clinic, evaluating the requests, perceptions, needs, and self-diagnosis at their first visit and comparing them with the final diagnosis reached after a complete clinical, laboratory, and instrumental investigation. Results: A total of 11,200 patients were evaluated. The main request of andrological consultation was erectile dysfunction (ED) (52%), followed by premature ejaculation (PE) (28%), and low sexual desire (11.5%). Among the patients seeking help for ED, about 30% were ultimately found to have a different type of dysfunction and 24% were diagnosed with an “unmet need”, which included issues not present in the current nosography nonetheless affecting sexual and relational life. Among the patients referring for PE, the final diagnosis was lifelong PE for the large majority of them, regardless of whether initially they thought to have an acquired form. Several of those who sought consultation for acquired PE were frequently found to be able to compensate for lifelong PE by a subsequent coitus or were able to induce orgasm in the partner with different modalities. Among the patients referring for low sexual desire, only 57.5% were confirmed to have it; 23% had ED and 18.5% showed a raised threshold of penile sensitivity. Conclusions: The results of this study show that the reason for consultation is frequently misleading and raise the relevance of being aware of the so-called “unmet needs” and to discuss with the patient and the couple to explore the sexual history behind the self-diagnosis. These findings also suggest the need to expand the current taxonomy of male sexual dysfunctions.

The Role of Nocturnal Penile Tumescence and Rigidity (NPTR) Monitoring in the Diagnosis of Psychogenic Erectile Dysfunction: A Review

INTRODUCTION

Nocturnal penile tumescence and rigidity (NPTR) monitoring with RigiScan was considered one of the most reliable methods to differentiate psychogenic erectile dysfunction (pED) from organic ED. However, its reliability has been questioned because of some limitations in the practice.

AIM

To present contemporary views on the role of NPTR monitoring in the diagnosis of pED.

METHOD

We performed a comprehensive review of English-language literature on NPTR and pED by a PubMed search.

MAIN OUTCOME MEASURES

Studies were included if the mechanisms of pED and nocturnal erection and the practice of NPTR monitoring in ED were the main research contents.

RESULTS

The pED results from not only psychosocial factors but also physiological changes containing central nervous abnormality. NPTR monitoring with RigiScan is still considered a useful method for the diagnosis of pED. A normal NPTR recording in a man with ED complaints probably suggests pED, whereas an abnormal recording may represent organic ED. Radial rigidity of no more than 60% is correlated well with axial rigidity, but, when it is more than 60%, the correlation between them is questioned. The consistency between NPTR and sex-stimulated erection is questionable, and the correlation of NPTR with different patient-reported outcome scoring systems is different. A normal NPTR recording in patients with ED does not necessarily mean pED, especially in patients with spinal cord injury. NPTR recordings can be influenced by depression, smoking, aging, negative dream content, and sleep disorders.

CONCLUSION

NPTR monitoring with the RigiScan is still considered a useful diagnostic tool for pED at the present stage. However, there are some disputes regarding the correlation between penile radial rigidity and axial rigidity and between NPTR and sex-related erection, as well as normative evaluation criteria for ED and the possibility of a false NPTR result, that need to be further studied. Zou Z, Lin H, Zhang Y, et al. The Role of Nocturnal Penile Tumescence and Rigidity (NPTR) Monitoring in the Diagnosis of Psychogenic Erectile Dysfunction: A Review. Sex Med Rev 2019;7:442-454.

Lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction: from physiology to clinical aspects

Erectile dysfunction, prostatic hyperplasia and lower urinary tract symptoms hare important pathogenetic links. Endothelial dysfunction and hormonal alterations represent the main aspects. The present article examines the anatomical, physiological, and pathophysiological characteristics of this association, finalizing the text to an interpretation of the clinical management of these patients based on these functional considerations.

Predictors of Erectile Function Normalization in Men With Erectile Dysfunction Treated With Placebo

BACKGROUND

Clinical study and practice data have shown sildenafil improves sexual function in men with erectile dysfunction (ED). However, some men treated with placebo in double-blind, placebo-controlled sildenafil studies also report improved erectile function as measured by International Index of Erectile Function (IIEF)-Erectile Function Domain (EFD) scores.

AIM

This analysis estimated the relationship between post-baseline IIEF-EFD scores and demographic variables, including co-morbidities, in men with ED receiving placebo in flexible-dose sildenafil studies.

METHODS

Placebo-treated participants in the intent-to-treat population of 42 double-blind, placebo-controlled, flexible-dose, sildenafil studies were included. A participant was classified as a placebo responder if the IIEF-EFD score was ≥26 at the last visit.

OUTCOMES

Variables assessed were age (<45, 45-64, ≥65 years), race, body mass index, co-morbidities (cardiovascular disease/hypertension, diabetes mellitus, depression), date the last study dose was taken, study completion date, ED etiology (psychogenic, organic, mixed), history of cigarette smoking, ED duration, baseline IIEF-EFD score (≤10, 11-16, ≥17), and treatment duration. Stepwise multivariate logistic regression models assessed the odds of being a responder vs a non-responder for each variable.

RESULTS

A total of 4,360 men were included; 13.5% were responders. Odds estimates indicated the largest likelihood of placebo response occurred in men who were black (odds = 20.2, P < .0001), were younger than 45 years (odds = 7.3, P < .0001), had mild ED (baseline IIEF-EFD ≥17; odds >100, P < .0001), and did not have diabetes (odds = 4.5, P < .0001). The likelihood of a placebo response decreased as ED duration increased (odds = 0.74, P < .0001). The frequency of common adverse events was similar between placebo responders and non-responders.

CLINICAL TRANSLATION

These findings contribute to the improved understanding of predictors of placebo response in sildenafil clinical studies. Elucidation of these factors may contribute to the development of further interventions and treatment strategies and best practices for clinical trials.

STRENGTHS AND CONCLUSIONS

Strengths of this analysis include the large and diverse population and the duration of follow-up. Limitations include those associated with retrospective analyses and the inability to ascertain to what extent other demographic factors might have contributed to the placebo responses or how these placebo responses might be related to the natural course of ED.

CONCLUSIONS

Certain demographics, co-morbidities, and condition characteristics predicted the odds of a placebo response in sildenafil clinical studies of ED. Underlying reasons behind a placebo response warrant further evaluation. Mulhall JP, Carlsson M, Stecher V, et al. Predictors of Erectile Function Normalization in Men With Erectile Dysfunction Treated With Placebo. J Sex Med 2018;15:866-872.

Sublingual Administration of Sildenafil Oro-dispersible Film: New Profiles of Drug Tolerability and Pharmacokinetics for PDE5 Inhibitors

Objective: Type 5 phosphodiesterase inhibitors (PDE5i) are efficient drugs used for treatment of erectile dysfunction (ED); however, a large discontinuation rate due to major side effects is reported. The aim of this study was to evaluate the possible improvement of sildenafil (Sild) pharmacokinetics associated to the sublingual administration of the new available oro-dispersible film (ODF), compared to both the oro-dispersible tablet (ODT) and the film-coated tablet (FCT) as original per os formulation.

Methods:In vitro disaggregation test, dissolution test, and permeation test in specific devices to estimate the trans-mucosal absorption. In vivo analysis of serum Sild levels, by high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), was performed in 20 patients with psychogenic ED receiving alternatively per os FCT or sublingual ODT or ODF, at an equal dosage (50 mg). Pharmacokinetic parameters of Sild and adverse drug reactions experienced after the dosing of each formulation were compared.

Results:In vitro, ODF showed the highest time to disaggregation and an increased rate of permeation compared to both ODT and FCT (P = 0.017 and P = 0.008, respectively). In vivo, compared to both FCT and ODT, ODF showed a faster increase of serum Sild levels (serum levels at 15 min from dosing, respectively: 2.24 ± 1.4 ng/ml FCT, 0.5 ± 0.3 ng/ml ODT, and 13.5 ± 9.1 ng/ml ODF; P < 0.01 and P < 0.05 vs. ODF) together with a higher drug bioavailability within 60 min from dosing (relative AUC_60min vs. FCT, respectively: 100.0 ± 44.9% FCT, 183.8 ± 75.4% ODT, and 304.2 ± 156.0% ODF). A trend toward lower peak serum levels was observed for ODF. Finally, ODF showed a lower prevalence of headache compared to FCT (1 vs. 35%; P < 0.05) and improved pattern of flushing and nasal congestion.

Conclusion: Sublingual Sild ODF improves the drug tolerability through a likely modified pharmacokinetic, suggesting a possible implication also in the clinical efficacy profile. Sublingual administration of oro-dispersible formulations may represent a strategy to ameliorate the adherence to therapy with PDE5i, particularly in patients discouraged by side effects.

Activation of the NGF/TrkA signaling pathway attenuates diabetic erectile dysfunction

Erectile dysfunction (ED) is a common complication of diabetes mellitus (DM). The exact role of the NGF/TrkA signaling pathway in the pathogenesis of diabetic ED is largely unknown. In the present study, we investigated the role of the NGF/TrkA signaling pathway in Sprague-Dawley rats with diabetic ED. Animals were divided into 2 groups: the normal group and the DM ED model group. The model group included the blank subgroup, the negative control (NC) subgroup, the TrkA subgroup and the TrkA + NGF subgroup. Erectile function, intracavernous pressure (ICP) and mean arterial pressure were measured respectively. Immunohistochemistry was used to examine the number of neuronal nitric oxide synthase (nNOS) expressing nerve fibers. The quantitative real-time polymerase chain reaction was applied to detect the mRNA expressions of NGF and TrkA in the cavernous tissue. Further, Western blotting was conducted to detect the expressions of NGF, TrkA and its downstream ERK pathway-related proteins. Higher erectile frequency, ICP values and diastolic function, more nNOS-positive nerve fibers, and decreased systolic function of the corpus cavernosum smooth muscle were found in the TrkA and TrkA+NGF groups when compared with the blank and the NC groups. Moreover, significantly higher mRNA expressions of NGF and TrkA, and upregulated protein expressions of NGF, TrkA, c-raf, ERK1/2 and CREB1 were found in the TrkA and the TrkA + NGF groups. In conclusion, downregulation in the NGF/TrkA signaling pathway may contribute to the pathogenesis of diabetic ED.

Differences in Cavernosal Artery Parameters According to Different Anatomic Sampling Locations During the Diagnosis of Vascular Erectile Dysfunction Using Duplex Ultrasound

OBJECTIVE

To establish a standard location for examining penile cavernosal arteries (CAs) using dynamic duplex Doppler ultrasound (PDDU) examination in the diagnosis of non-arterial erectile dysfunction (ED) or arterial insufficiency.

PATIENTS AND METHODS

Two groups of 105 patients each were enrolled. The first group (age 56.3 ± 6.0 years) displayed clinical patterns of arterial insufficiency; the second group (age 35.2 ± 4.7 years) displayed clinical patterns of non-arterial ED. The patients had their peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI = PSV - EDV/PSV × 100), and acceleration time of the CAs measured using PDDU at the crura and at the midpoint between the penoscrotal junction and the coronal sulcus (mid penis). Intra- and interoperator variability were assessed. The PSV, RI, acceleration time, and EDV data obtained from the penoscrotal junction or from the "mid penis" in group 1 and in group 2 were compared using analysis of variance.

RESULTS

The PSV, EDV, and acceleration time were significantly higher when measured at the crura penis than when measured at the "mid penis" in both groups, whereas the RI was higher at the "mid penis" than at the "crura." Thus, arterial ED was better diagnosed with the data from the mid penis, whereas non-arterial ED was better diagnosed at the "crura."

CONCLUSION

The location of the sampling site of the CAs using PDDU is critical for a correct diagnosis of ED.

Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors

INTRODUCTION

Erectile dysfunction (ED) is an important health concern that can significantly affect a man's psychosocial well-being. ED has traditionally been considered a disease of old age; however, contemporary evidence suggests a growing incidence of ED in men younger than 40 years. The process of achieving an erection is multifaceted; there are many potential mechanisms that can be disrupted. It is critical to identify the specific causes of ED before proceeding with potentially costly and invasive therapeutic options. Advances in diagnostic and treatment modalities offer opportunities to identify and manage young men with ED.

AIM

To provide an update on the prevalence and risk factors of ED in young men and to provide a framework to guide clinicians in identifying and managing the affected young man.

METHODS

Comprehensive review of the literature pertaining to ED in young men.

MAIN OUTCOME MEASURES

ED in young men was assessed by outlining the prevalence according to recent epidemiologic studies. The pathophysiology, diagnostic considerations, risk factors, and etiologies were reviewed.

RESULTS

Large multinational studies have estimated the prevalence of ED in young men to be as high as 30%. Several studies have stratified the etiologies of ED into psychogenic and organic causes. Psychogenic etiologies of ED include depression, anxiety, and partner-related difficulties. These patients tend to experience sudden onset of symptoms, with decreased libido and good quality of spontaneous or self-stimulated erections. Organic etiologies include vasculogenic, endocrinologic, neurogenic, iatrogenic, and structural components. These patients usually experience gradual onset of symptoms and a low to normal libido. Conservative treatments such as phosphodiesterase type 5 inhibitors continue to be the mainstay treatment.

CONCLUSIONS

ED in young men is an increasingly common condition. A careful diagnostic evaluation should focus on the identification of any underlying etiology to ensure appropriate management of patients. Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors. Sex Med Rev 2017;5:508-520.

Evaluation of young men with organic erectile dysfunction

Erectile dysfunction (ED) in men under the age of 40 was once thought to be entirely psychogenic. Over the last few decades, advances in our understanding of erectile physiology and improvements in diagnostic testing have restructured our understanding of ED and its etiologies. Although psychogenic ED is more prevalent in the younger population, at least 15%-20% of these men have an organic etiology. Organic ED has been shown to be a predictor of increased future morbidity and mortality. As such, a thorough work-up should be employed for any man with complaints of sexual dysfunction. Oftentimes a treatment plan can be formulated after a focused history, physical exam and basic lab-work are conducted. However, in certain complex cases, more testing can be employed. The major organic etiologies can be subdivided into vascular, neurologic, and endocrine. Specific testing should be directed by clinical clues noted during the preliminary evaluation. These tests vary in degree of invasiveness, precision, and at times may not affect treatment. Results should be integrated into the overall clinical picture to assist in diagnosis and help guide therapy.