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Al Hashimi M, Pinggera GM, Mostafa T, Rambhatla A, Hamoda T, Shah R, Chung E, Harraz A, Arafa M, Toprak T, Raheem O, Giulioni C, Birowo P, Boeri L, Jassim Y, Kothari P, Vishwakarma R, Sahin B, Atmoko W, Gamidov S, Rojas-Cruz C, Katz D, Fregonesi A, Gherabi N, Zini A, Ho CCK, Al-Marhoon MS, Martinez M, Russo GI, Rashed A, Busetto GM, Ko E, Park HJ, Cayan S, Saleh R, Rajmil O, Kim DS, Colpi G, Smith R, Ragab M, Kadioglu A, Nguyen Q, Bocu K, El-Sakka A, Thomas C, Alnajjar HM, Alipour H, Agarwal A. Regenerative Therapy in Erectile Dysfunction: A Survey on Current Global Practice Trends and GAF Expert Recommendations. World J Mens Health 2024; 42:42.e67. [PMID: 39028131 DOI: 10.5534/wjmh.240086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 07/20/2024] Open
Abstract
PURPOSE This study aimed to examine current global practices in regenerative therapy (RT) for erectile dysfunction (ED) and to establish expert recommendations for its use, addressing the current lack of solid evidence and standardized guidelines. MATERIALS AND METHODS A 39-question survey was developed by senior Global Andrology Forum (GAF) experts to comprehensively cover clinical aspects of RT. This was distributed globally via a secure online Google Form to ED specialists through the GAF website, international professional societies, and social media, the responses were analyzed and presented for frequencies as percentages. Consensus on expert recommendations for RT use was achieved using the Delphi method. RESULTS Out of 479 respondents from 62 countries, a third reported using RT for ED. The most popular treatment was low-intensity shock wave therapy (54.6%), followed by platelet-rich plasma (24.5%) and their combination (14.7%), with stem cell therapy being the least used (3.7%). The primary indication for RT was the refractory or adverse effects of PDE5 inhibitors, with the best effectiveness reported in middle-aged and mild-to-moderate ED patients. Respondents were confident about its overall safety, with a significant number expressing interest in RT's future use, despite pending guidelines support. CONCLUSIONS This inaugural global survey reveals a growing use of RT in ED treatment, showcasing its diverse clinical applications and potential for future widespread adoption. However, the lack of comprehensive evidence and clear guidelines requires further research to standardize RT practices in ED treatment.
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Affiliation(s)
- Manaf Al Hashimi
- Department of Urology, Burjeel Hospital, Abu Dhabi, UAE
- Department of Clinical Urology, College of Medicine and Health Science, Khalifa University, Abu Dhabi, UAE
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Germar-M Pinggera
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria
| | - Taymour Mostafa
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amarnath Rambhatla
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA
| | - Taha Hamoda
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Rupin Shah
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Eric Chung
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Ahmed Harraz
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Mansoura University Urology and Nephrology Center, Mansoura, Egypt
- Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
- Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
| | - Mohamed Arafa
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Tuncay Toprak
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Omer Raheem
- Global Andrology Forum, Moreland Hills, OH, USA
- Section of Urology, University of Chicago, Chicago, IL, USA
| | - Carlo Giulioni
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Polytechnic University of Marche Region, Ancona, Italy
| | - Ponco Birowo
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Luca Boeri
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Yassir Jassim
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Canadian Specialist Hospital, Dubai, UAE
| | - Priyank Kothari
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, B.Y.L Nair Ch Hospital, Topiwala National Medical College, Mumbai, India
| | - Ranjit Vishwakarma
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Bahadir Sahin
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Widi Atmoko
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Safar Gamidov
- Global Andrology Forum, Moreland Hills, OH, USA
- Deparment of Urology, Kulakov National Medical Research, Moscow, Russia
| | - Cesar Rojas-Cruz
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University Hospital of Rostock, Rostock, Germany
| | - Darren Katz
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Men's Health Melbourne, Victoria, Australia
- Department of Surgery, Western Precinct, University of Melbourne, Victoria, Australia
- Department of Urology, Western Health, Victoria, Australia
| | - Adriano Fregonesi
- Global Andrology Forum, Moreland Hills, OH, USA
- Discipline of Urology, Department of Surgery, School of Medicine, Universida de Estadual de Campina, Sao Paolo, Brazil
| | - Nazim Gherabi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Medicine, University of Algiers 1, Algiers, Algeria
| | - Armand Zini
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Christopher Chee Kong Ho
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, School of Medicine, Taylor's University, Selangor, Malaysia
| | - Mohamed S Al-Marhoon
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Urology, Department of Surgery, Sultan Qaboos University, Muscat, Oman
| | - Marlon Martinez
- Global Andrology Forum, Moreland Hills, OH, USA
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Giorgio Ivan Russo
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Section, University of Catania, Catania, Italy
| | - Ayman Rashed
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology and Andrology, October 6th University, Cairo, Egypt
| | - Gian Maria Busetto
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Edmund Ko
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Kaiser Permanente, Fontana, CA, USA
| | - Hyun Jun Park
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Selahittin Cayan
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University of Mersin School of Medicine, Mersin, Türkiye
| | - Ramadan Saleh
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Osvaldo Rajmil
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Fundacio Puigvert, Barcelona, Spain
| | - Dong Suk Kim
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Giovanni Colpi
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
| | - Ryan Smith
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Maged Ragab
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Department, Tanta University, Tanta, Egypt
| | - Ates Kadioglu
- Global Andrology Forum, Moreland Hills, OH, USA
- Section of Andrology, Department of Urology, Istanbul School of Medicine, Istanbul, Türkiye
| | - Quang Nguyen
- Global Andrology Forum, Moreland Hills, OH, USA
- Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam
- Department of Urology, Andrology and Sexual Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Kadir Bocu
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Niğde Omer Halisdemir University, Niğde, Türkiye
| | - Ahmed El-Sakka
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Charalampos Thomas
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, General Hospital of Corinth, Corinthia, Greece
| | - Hussain M Alnajjar
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University College London Hospital, London, UK
| | - Hiva Alipour
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ashok Agarwal
- Global Andrology Forum, Moreland Hills, OH, USA
- Cleveland Clinic Foundation, Cleveland, OH, USA.
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Rezali MS, Mohamad Anuar MF, Abd Razak MA, Chong ZL, Shaharudin AB, Kassim MSA, Mohamed Daud MA, Ismail SB, Said ZM. Prevalence and associated factors of moderate to severe erectile dysfunction among adult men in Malaysia. Sci Rep 2023; 13:21483. [PMID: 38057375 PMCID: PMC10700487 DOI: 10.1038/s41598-023-48778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Abstract
Erectile dysfunction (ED) is a pervasive problem among men, often shrouded in silence and stigma. This manuscript analysed the National Health and Morbidity Survey 2019 data to identify the prevalence of moderate to severe ED among men aged 18 and above in Malaysia and describe its associated factors. Self-administered questionnaire on ED utilised a locally validated International Index of Erectile Function. Variables on sociodemographics, risky lifestyles and comorbidities were obtained via an interviewer-administered questionnaire. The prevalence was determined using complex sampling analysis, and logistic regression was used to determine the associated factors of ED. A sample of 2403 men aged ≥ 18 participated, with a moderate to severe ED prevalence was 31.6% (95% CI 28.8, 34.6). The mean (± SD) of the total score of IIEF-5 for overall respondents was 18.16 (± 4.13). Multiple logistic regression analysis revealed a significant association between moderate to severe ED among men aged 60 years and above, single or divorcee, men without formal, primary, and secondary education, non-government employees, unemployed, and retiree, as well as physically inactive men. Focused public health interventions are necessary to improve education in sexual health, increase health promotion programs, and promote healthy ageing across the population.
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Affiliation(s)
- Muhammad Solihin Rezali
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, No.1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
| | - Mohamad Fuad Mohamad Anuar
- Biostatistic and Repository Data, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Mohamad Aznuddin Abd Razak
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, No.1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Zhuo Lin Chong
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, No.1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Azli Baharudin Shaharudin
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, No.1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Mohd Shaiful Azlan Kassim
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, No.1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | | | - Shaiful Bahari Ismail
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Gelugor, Malaysia
| | - Zakiah Mohd Said
- Adult Health Sector, Family Health Development Division, Ministry of Health Malaysia, Shah Alam, Malaysia
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Nazeera Fatimah K, Zuhra H, Hizlinda T, Noor Azimah M, Syahnaz MH, Rahmah K. Psychological morbidities among spouses of men with type 2 diabetes mellitus and erectile dysfunction in a primary care setting. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2023; 18:44. [PMID: 37575358 PMCID: PMC10423096 DOI: 10.51866/oa.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Introduction Erectile dysfunction (ED) negatively affects patients' emotions. However, its effect on spouses' psychological well-being remains largely unknown. This study aimed to examine psychological morbidities and their associated factors among spouses of men with type 2 diabetes mellitus (T2DM) and ED. Method This cross-sectional study included 115 women recruited through their husbands who were patients at a selected government health clinic in Malaysia. A self-administered questionnaire containing the Depression Anxiety and Stress Scale-21 and items on health-related information, marital history, sexual history and perception of husband's ED was used to assess possible depression, anxiety and stress. Results The prevalence of psychological morbidities was 28.7% (depression=17.4%, anxiety=25.2% and stress=10.4%). Most respondents were middle-aged [median (interquartile range)=44.0 (11.0) years], were employed (55.7%) and had a low income (81.7%). About 47.0% of the spouses had a medical problem. The mean marriage duration was 18.7 (standard deviation=7.9) years. Almost all (90.4%) had sexual intercourse (SI) within the previous month. The majority had moderate-to-high interest in SI (72.2%) with a frequency of one to two times per week (69.6%). The majority (75.7%) did not perceive their husband as having ED. Multiple logistic regression demonstrated that medical illness was significantly associated with anxiety (adjusted odds ratio=2.85, 95% confidence interval=1.11-7.29, P=0.029). Conclusion Psychological morbidities were present among the spouses of men with T2DM and ED. Psychological well-being was significantly affected by their medical illness. Despite their husband's ED, the women declared to have regular sexual relationships and did not perceive their husband as having erectile problems.
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Affiliation(s)
- Kalikuljaman Nazeera Fatimah
- MBBch BAO (Ireland), MMed (Fam Med)(UKM), Klinik Kesihatan Dengkil, Ministry of Health Malaysia, Jalan Besar, Pekan Dengkil, Dengkil, Selangor, Malaysia
| | - Hamzah Zuhra
- MBBS (UM), MMed(Fam Med) (UKM), Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia. Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia.
| | - Tohid Hizlinda
- MBChB (Manchester), MMed (Fam Med)(UKM), Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia. Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Muhammad Noor Azimah
- MBBS (Queensland), MMed (Fam Med)(UKM), PhD in Community (Adolescent) Health (UKM) Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia. Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Hashim Syahnaz
- MBBch BAO (Ireland), MMed (Fam Med)(UKM), PhD (UKM), Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Kamaludin Rahmah
- MD (USM), MMed (Fam Med)(UKM), Klinik Primer Hospital Canselor Tuanku Mukhriz, Jalan Dwitasik, Bandar Sri Permaisuri Cheras, Kuala Lumpur, Malaysia
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