Erectile dysfunction, metabolic syndrome, and cardiovascular risks: facts and controversies

Management of Male Infertility with Coexisting Sexual Dysfunction: A Consensus Statement and Clinical Recommendations from the Asia-Pacific Society of Sexual Medicine (APSSM) and the Asian Society of Men's Health and Aging (ASMHA)

Male infertility (MI) and male sexual dysfunction (MSD) can often coexist together due to various interplay factors such as psychosexual, sociocultural and relationship dynamics. The presence of each form of MSD can adversely impact male reproduction and treatment strategies will need to be individualized based on patients' factors, local expertise, and geographical socioeconomic status. The Asia Pacific Society of Sexual Medicine (APSSM) and the Asian Society of Men's Health and Aging (ASMHA) aim to provide a consensus statement and practical set of clinical recommendations based on current evidence to guide clinicians in the management of MI and MSD within the Asia-Pacific (AP) region. A comprehensive, narrative review of the literature was performed to identify the various forms of MSD and their association with MI. MEDLINE and EMBASE databases were searched for the following English language articles under the following terms: "low libido", "erectile dysfunction", "ejaculatory dysfunction", "premature ejaculation", "retrograde ejaculation", "delayed ejaculation", "anejaculation", and "orgasmic dysfunction" between January 2001 to June 2022 with emphasis on published guidelines endorsed by various organizations. This APSSM consensus committee panel evaluated and provided evidence-based recommendations on MI and clinically relevant MSD areas using a modified Delphi method by the panel and specific emphasis on locoregional socio-economic-cultural issues relevant to the AP region. While variations exist in treatment strategies for managing MI and MSD due to geographical expertise, locoregional resources, and sociocultural factors, the panel agreed that comprehensive fertility evaluation with a multidisciplinary management approach to each MSD domain is recommended. It is important to address individual MI issues with an emphasis on improving spermatogenesis and facilitating reproductive avenues while at the same time, managing various MSD conditions with evidence-based treatments. All therapeutic options should be discussed and implemented based on the patient's individual needs, beliefs and preferences while incorporating locoregional expertise and available resources.

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

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

A systematic review and meta-analysis of animal and human studies demonstrates the beneficial effects of Kaempferia parviflora on metabolic syndrome and erectile dysfunction

Kaempferia parviflora (KP) has traditionally been used for centuries to promote health and well-being. Scant evidence is available to explain the relationship between KP and metabolic syndrome and impotence. We sought to test the hypothesis that administration of KP extract enriched with active ingredients, such as polymethoxyflavone, could improve metabolic syndrome, erectile dysfunction, and related outcomes in in vivo. We performed a systematic review and meta-analysis to evaluate the in vivo effects of KP extract on metabolic syndrome, erectile dysfunction, and related outcomes. Studies from 4 databases (i.e., PubMed, Scopus, Embase, and Cochrane Library) were searched from inception up to December 2022. Animal experiment studies and randomized controlled trials comparing KP extract to a placebo control were retrieved and analyzed using RevMan 5.4.1 software. The effect estimate was presented as the standardized mean difference along with its 95% confidence interval (CI). Of 664 articles, a total of 57 articles met our prespecified criteria. KP extract significantly decreased fasting blood glucose in both animal and human studies with standardized mean difference of -0.88 (95% CI, -1.63 to -0.14) and -0.51 (95% CI, -0.98 to -0.05), respectively. Furthermore, KP extract also markedly improved sexual function and physical performance. In sum, KP extract is shown to have effects beneficial to metabolic syndrome, erectile dysfunction, and physical performance.

Comparison of the gut microbiome composition between men with erectile dysfunction and a matched cohort: a pilot study

BACKGROUND

To-date there have been minimal studies to investigate an association between the gut microbiome and erectile dysfunction. There have been many inflammatory diseases linked to gut microbiome dysbiosis; such as cardiovascular disease and metabolic syndrome. These same inflammatory diseases have been heavily linked to erectile dysfunction. Given the correlations between both conditions and cardiovascular disease and the metabolic syndrome, we believe that it is worthwhile to investigate a link between the two.

OBJECTIVE

To investigate the potential association between the gut microbiome and erectile dysfunction.

METHODS

Stool samples were collected from 28 participants with erectile dysfunction and 32 age-matched controls. Metatranscriptome sequencing was used to analyze the samples.

RESULTS

No significant differences were found in the gut microbiome characteristics, including Kyoto Encyclopedia of Genes and Genomes richness (p = 0.117), Kyoto Encyclopedia of Genes and Genomes diversity (p = 0.323), species richness (p = 0.364), and species diversity (p = 0.300), between the erectile dysfunction and control groups.

DISCUSSION

The association of gut microbiome dysbiosis and pro-inflammatory conditions has been well studied and further literature continues to add to this evidence. Our main limitation for this study was our small-sample size due to recruitment issues. We believe that a study with a larger population size may find an association between the gut microbiome and erectile dysfunction.

CONCLUSIONS

The results of this study do not support a significant association between the gut microbiome and erectile dysfunction. Further research is needed to fully understand the relationship between these two conditions.

Investigating the risk factors of penile arterial insufficiency and veno-occlusive dysfunction in patients with erectile dysfunction

Objective

To investigate the risk factors for penile arterial insufficiency (PAI), which is a known cause of erectile dysfunction (ED).

Methods

Patients who attended our urology clinic complaining of ED for more than 6 months were prospectively enrolled in this study over 1-year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie's disease (PD) and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile and glycated haemoglobin (HA1c). A penile duplex ultrasound study (PDU) was done for all patients after intracavernosal injection (ICI) with alprostadil. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured after 15 min. Statistical analysis was done using SPSS.

Results

A total of 440 patients were enrolled in this analysis. The mean age was 48(23-81), and the mean BMI was 30 (18-51). Older patients had lower PSV (r = -0.361, P = 0.000) and higher EDV (r = 0.174, P = 0.001), and both correlations were highly statistically significant. Diabetics had lower PSV (r = -0.318, P = 0.000) and higher EDV (r = 0.139, P = 0.008), which were also highly statistically significant. Smokers had lower PSV (r = -0.140, P = 0.008) and higher EDV (r = 0.178, P = 0.001), which were highly statistically significant. Men with larger penises measured skin to tip had lower EDV (r = -0.119, P = 0.024), which was less significant. Interestingly, there was neither a significant correlation between BMI and PSV (0.16, P = 0.745) nor a significant correlation between testosterone and PSV (0.029, P = 0.552). Also, there was no correlation between PSV and both dyslipidaemia and penile PD.

Conclusions

Ageing, tobacco consumption, DM and hypertension seem to have a negative impact on penile haemodynamics, which was statistically significant. In our patients, there was no statistically significant effect on penile haemodynamics in patients with increased BMI, low testosterone or PD or according to the size of the penis.

Diagnoses and medications associated with delayed ejaculation

Background

Delayed ejaculation (DE) is a disorder that can cause significant distress for sexually active men. The etiology of DE is largely idiopathic, with even less being known about clinical factors associated with the condition.

Aim

We sought to use data mining techniques to examine a broad group of health conditions and pharmaceutical treatments to identify factors associated with DE.

Methods

Using an insurance claims database, we evaluated all men with a diagnosis of DE and matched them to a cohort (1:1) of men with other male sexual disorders of urologic origin (ie, erectile dysfunction [ED] and Peyronie's disease [PD]). Given the low prevalence of DE, we incorporated the random forest approach for classification of DE vs controls, with a plethora of predictors and cross-validation with the least absolute shrinkage and selection operator (LASSO). We used both a high-performance generalized linear model and a multivariate logistic model. The area under the curve was reported to demonstrate classifier performance, and odds ratios were used to indicate risks of each predictor. We also evaluated for differences in the prevalence of conditions in DE by race/ethnicity.

Outcomes

Clinical factors (ie, diagnoses and medications) associated with DE were identified.

Results

In total, 11 602 men with DE were matched to a cohort of men with PD and ED. We focused on the 20 factors with the strongest association with DE across all models. The factors demonstrating positive associations with DE compared to other disorders of male sexual dysfunction (ie, ED and PD) included male infertility, testicular dysfunction, anxiety, disorders of lipid metabolism, alpha adrenergic blocker use, anemia, antidepressant use, and psychoses such as schizophrenia or schizoaffective disorder. In addition, the prevalence of several conditions varied by race/ethnicity. For example, male infertility was present in 5% of Asian men compared to <2% of men of other races.

Clinical Implications

Several medical conditions and pharmacologic treatments are associated with DE, findings that may provide insight into the etiology of DE and offer treatment options.

Strengths and Limitations

This study is to our knowledge the first to use using data mining techniques to investigate the association between medical conditions/pharmacologic agents and the development of subsequent DE. The generalizability of our findings is limited given that all men were commercially insured.

Conclusion

DE is associated with multiple medical conditions, a finding that may help identify the etiology for this disorder.

The Assessment of Male Erectile Dysfunction Characteristics in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis and Hemodialysis Using the International Index of Erectile Function (IIEF-5) Combined with Hospital Anxiety and Depression Scales

Purpose

To determine the differences in mean scores of erectile dysfunctions (EDs) assessed by the International Index of Erectile Function (IIEF-5) questionnaire between patients with chronic kidney disease (CKD) undergoing hemodialysis and patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

Patients and Methods

This is an analytic observational study with a cross-sectional design that was conducted from June to December 2022 at the Urology Center of Haji Adam Malik General Hospital and Rasyida Kidney Specialized Hospital. The sample of this study were male CKD-patients who underwent regular hemodialysis (HD) and who underwent CAPD, and met the inclusion and exclusion criteria. Psychological disorders experienced during therapy session are considered as risk factors and assessed via the Hospital Anxiety and Depression Scale (HADS). These disorders assessment was used to evaluate the severity of the patients' anxiety and depressive symptoms. Statistical data analysis was carried out.

Results

Both groups had HADS-A and HADS-D scores with an average <7, classified as normal anxiety and depression. Most of the patients in the HD group had mild-to-moderate ED (28.6%), while in the CAPD group had mild severity of ED (38.1%). There were no significant differences in severity of ED between patients undergoing HD and CAPD (p > 0.05). However, there was a significant difference in ED scores (IIEF-5) between patients undergoing HD and those with CAPD (p < 0.05), in which patients in the CAPD group had a higher IIEF-5 score. In addition, there was a significant positive correlation with moderate strength (p<0.001; r=0.494) between anxiety disorders and ED disorders in patients undergoing HD and CAPD, whereas there is no significant correlation between depressive disorders and ED conditions (p > 0.05).

Conclusion

There was a significant difference in IIEF-5 scores between patients undergoing HD and CAPD.

The Temporal Association of Depression and Anxiety in Young Men With Erectile Dysfunction

BACKGROUND

Erectile dysfunction (ED) is a multidimensional sexual disorder that is being increasingly diagnosed in younger men. Although mental illnesses such as depression and anxiety are known risk factors for ED, the association between these conditions and ED has been understudied in young men.

AIM

To explore the temporal association between depression, anxiety, and ED in a population-based cohort of young men.

METHODS

Using 2009-2018 MarketScan Commercial Claims data, we identified all men with ED aged 18-40 years (cases). Using ICD-9/-10 codes and prescription data, we evaluated the prevalence and incidence of depression and anxiety in this cohort. Cases were matched with men without a diagnosis of ED (controls) based on age, Charlson Comorbidity Index, history of hypertension, geographic region, and year of presentation. We examined the prevalence of depression and anxiety within 12 months prior to ED diagnosis and incidence of depression and anxiety up to 36 months after ED diagnosis in cases vs controls. Differences between cases and controls were tested with Wilcoxon rank-sum test for numerical covariates, and chi-square test for categorical covariates. Significance was set at P < .05.

OUTCOMES

Prevalence and incidence of depression and anxiety in young men with and without ED.

RESULTS

Within the 12-month period preceding ED diagnosis, the prevalence of depression and anxiety in cases vs controls were 17.1% vs 12.9%, respectively (P < .001). The incidence of depression and anxiety were higher amongst cases vs controls at 12- (11.7% vs 6.3%), 24- (14.5% vs 9.0%,) and 36- (15.9% vs 10.6%) months following ED diagnosis (P < .001).

CLINICAL IMPLICATIONS

High incidence and prevalence of depression and anxiety in young men diagnosed with ED highlight the importance of normalizing mental health screenings and routine psychiatric follow-up in this population.

STRENGTHS & LIMITATIONS

Our contemporary, case-control study utilizes a population-based cohort of young men with ED to study the temporal association between depression, anxiety, and ED, which is understudied to date. The MarketScan commercial claims database used in this analysis includes men covered by private insurers only and lacks data on symptoms and treatments.

CONCLUSION

Young men with ED had significantly higher rates of depression and anxiety both before and after ED diagnosis in comparison to young men without ED. Manalo TA, Biermann HD, Patil DH, et al. The Temporal Association of Depression and Anxiety in Young Men With Erectile Dysfunction. J Sex Med 2022;19:201-206.

Type 2 diabetes mellitus increases risk of erectile dysfunction independent of obesity and dyslipidemia: A Mendelian randomization study

BACKGROUND

The causal effects of individual risk factors of metabolic syndrome on erectile dysfunction (ED) are still unclear.

OBJECTIVES

To evaluate the causal effect of risk factors of metabolic syndrome on ED through Mendelian randomization (MR).

MATERIALS AND METHODS

Data for risk factors were obtained from multiple databases with 173,082-757,601 individuals, and that for ED were collected from a genome-wide association study including 223,805 Europeans. We performed univariate MR analysis using inverse-variance weighted, MR-Egger, weighted-median, weighted mode methods and multivariable MR analysis to evaluate the total and direct causal effects.

RESULTS

The univariable MR supported that type 2 diabetes mellitus (odds ratios [OR] = 1.14, 95% confidence intervals [CI]: 1.08-1.21, p < 0.001) and body mass index (BMI) (OR = 1.27, 95% CI: 1.12-1.44, p < 0.001) were associated with ED. After excluding the SNPs associated with BMI and other risk factors, the results of multivariable MR for T2D (OR = 1.15, 95% CI: 1.05-1.25, p = 0.001) remained consistent. However, the results of multivariable MR provided limited evidence for the causality between BMI and ED (OR = 1.06, 95% CI: 0.88-1.29, p = 0.532). For systolic blood pressure and lipid components (low-density lipoprotein, high-density lipoprotein and triglycerides), both univariable and multivariable MR failed to offer sufficient evidence to confirm their causal effect on ED.

CONCLUSION

T2D showed a direct causal effect on ED independent of obesity and dyslipidemia.

Natural Aporphine Alkaloids with Potential to Impact Metabolic Syndrome

The incidence and prevalence of metabolic syndrome has steadily increased worldwide. As a major risk factor for various diseases, metabolic syndrome has come into focus in recent years. Some natural aporphine alkaloids are very promising agents in the prevention and treatment of metabolic syndrome and its components because of their wide variety of biological activities. These natural aporphine alkaloids have protective effects on the different risk factors characterizing metabolic syndrome. In this review, we highlight the activities of bioactive aporphine alkaloids: thaliporphine, boldine, nuciferine, pronuciferine, roemerine, dicentrine, magnoflorine, anonaine, apomorphine, glaucine, predicentrine, isolaureline, xylopine, methylbulbocapnine, and crebanine. We particularly focused on their impact on metabolic syndrome and its components, including insulin resistance and type 2 diabetes mellitus, endothelial dysfunction, hypertension and cardiovascular disease, hyperlipidemia and obesity, non-alcoholic fatty liver disease, hyperuricemia and kidney damage, erectile dysfunction, central nervous system-related disorder, and intestinal microbiota dysbiosis. We also discussed the potential mechanisms of actions by aporphine alkaloids in metabolic syndrome.

Improvement of testosterone deficiency by fermented Momordica charantia extracts in aging male rats

This study evaluated the efficacy of Momordica charantia (MC; bitter melon) extracts against andropause symptoms. We fermented MC with Lactobacillus plantarum and verified the ability of the fermented MC extracts (FMEs) to control testosterone deficiency by using aging male rats as an animal model of andropause. FME administration considerably increased total and free testosterone levels, muscle mass, forced swimming time, and total and motile sperm counts in aging male rats. In contrast, sex hormone-binding globulin, retroperitoneal fat, serum cholesterol, and triglyceride levels were significantly reduced in the treated groups compared to the non-treated control aging male rats. Furthermore, we observed that FME enhanced the expression of testosterone biosynthesis-related genes but reduced the expression of testosterone degradation-related genes in a mouse Leydig cell line. These results suggest that FME has effective pharmacological activities that increase and restore free testosterone levels and that FME may be employed as a promising natural product for alleviating testosterone deficiency syndrome.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10068-020-00872-x.

Enzymatic preparation of Crassostrea oyster peptides and their promoting effect on male hormone production

ETHNOPHARMACOLOGICAL RELEVANCE

Crassostrea gigas Thunberg and other oysters have been traditionally used in China as folk remedies to invigorate the kidney and as natural aphrodisiacs to combat male impotence.

AIM OF THE STUDY

Erectile dysfunction (ED) has become a major health problem for the global ageing population. The aim of this study is therefore to evaluate the effect of peptide-rich preparations from C. gigas oysters on ED and related conditions as increasing evidence suggests that peptides are important bioactive components of marine remedies and seafood.

MATERIALS AND METHODS

Crassostrea oyster peptide (COP) preparations COP1, COP2 and COP3 were obtained from C. gigas oysters by trypsin, papain or sequential trypsin-papain digestion, respectively. The contents of testosterone, cyclic adenosine monophosphate (cAMP) and nitric oxide (NO) and the activity of nitric oxide synthase (NOS) in mice and/or cells were measured by enzyme-linked immunosorbent assays. Real-time PCR was used to assess the expression of genes associated with sex hormone secretion pathways. The model animal Caenorhabditis elegans was also used to analyze the gene expression of a conserved steroidogenic enzyme. In silico analysis of constituent peptides was performed using bioinformatic tools based on public databases.

RESULTS

The peptide-rich preparation COP3, in which >95% peptides were <3000 Da, was found to increase the contents of male mouse serum testosterone and cAMP, both of which are known to play important roles in erectile function, and to increase the activity of mouse penile NOS, which is closely associated with ED. Further investigation using mouse Leydig-derived TM3 cells demonstrates that COP3 was able to stimulate the production of testosterone as well as NO, a pivotal mediator of penile erection. Real-time PCR analysis reveals that COP3 up-regulated the expression of Areg and Acvr2b, the genes known to promote sex hormone secretion, but not Fst, a gene involved in suppressing follicle-stimulating hormone release. Furthermore, COP3 was also shown to up-regulate the expression of let-767, a well-conserved C. elegans gene encoding a protein homologous to human 17-β-hydroxysteroid dehydrogenases. Preliminary bioinformatic analysis using the peptide sequences in COP3 cryptome identified 19 prospective motifs, each of which occurred in more than 10 peptides.

CONCLUSIONS

In this paper, Crassostrea oyster peptides were prepared by enzymatic hydrolysis and were found for the first time to increase ED-associated biochemical as well as molecular biology parameters. These results may help to explain the ethnopharmacological use of oysters and provide an important insight into the potentials of oyster peptides in overcoming ED-related health issues.

Clinical features of and couple's attitudes towards premature ejaculation: a multicenter cross-sectional study

INTRODUCTION

The current study aimed to investigate the clinical features of and couple's attitudes towards premature ejaculation (PE).

METHODS

Qualified patients were continuously enrolled from 15 medical centers in different regions of China. Patient data were collected from March 1 2017 to July 31 2017. All men were assessed by the Premature Ejaculation Diagnostic Tool (PEDT) and Intravaginal Ejaculation Latency Time (IELT). Besides, sexual desire, force of ejaculation, and the five-item International Index of Erectile Function (IIEF-5) score were recorded. The couple's attitudes towards PE were evaluated by a self-designed questionnaire.

RESULTS

In total, 1033 males diagnosed with PE and their sexual partners and 3176 males without PE were enrolled. The mean PEDT and IELT scores of the patients with PE were 14.38 ± 3.68 and 1.59 ± 0.85, respectively. IIEF-5, sexual desire, and force of ejaculation significantly decreased in patients with PE. Among the 1033 couples, 44.3%, 21.39%, and 33.98% of the couples were seeking PE because of the dissatisfaction of the males, the females or both partners, respectively. In terms of the males who were dissatisfied with PE, 49.51% and 17.86% complained of short IELT and inability to control ejaculation. In terms of the females dissatisfied with PE, 41.61%, 19.93%, 21.68%, and 14.51% complained of arousal difficulty, weak sexual desire, failing to have organism and poor relationship, respectively.

CONCLUSIONS

PE has a negative impact on erectile function, sexual desire, and force of ejaculation. Sexual partners play important roles in the medical procedures for addressing PE.

Prevalence of erectile dysfunction in Egyptian males with metabolic syndrome

Objectives: Determination of the potential effect of metabolic syndrome (MetS) on erectile function in Egyptian men and description of the sociodemographic characteristics of these men.Materials and methods: A cohort of 615 patients presenting to urology department aged between 30 and 75 years were prospectively assessed and divided into two groups. Group I (n = 325) diagnosed with MetS and mean age of 56.07 ± 8.51 years. Group II (n = 290) subjects with no MetS and mean age 54.97 ± 8.14 years. Patients filled the IIEF questionnaire, medical, personal history, and BMI data were tabulated. Metabolic syndrome was determined when three or more of the five risk factors were present according to the NCEP.Results: In Group I (79.4%) of the patients had erectile dysfunction (ED). Of these, 20.3% had mild, 22.5% had moderate, and 36.6% had severe ED and 30% of patients without MetS had ED. Of these, 17.2% had mild, 5.9% had moderate, and 6.9% had severe ED (p < .001; odds ratio 5.549; 95% CI 3.101-9.928). Patients with metabolic syndrome had lower IIEF-EF domain scores. Logistic regression analysis revealed that DM, dyslipidemia, age, and HTN were the most important criteria for ED in the MetS group (p < .01). While in the group without MetS, DM, HTN, HDL, and age were the most important risk factors (p < .01), and TG and BMI were less important.Conclusions: MetS is a potential risk factor for ED in Egyptian men. Patients with MetS should be questioned about ED. The diabetic patients are most risky for ED.

Pathobiology of ischiocavernosus and bulbospongiosus muscles in long-term diabetic male rats and its implication on erectile dysfunction

OBJECTIVE

To analyze pathobiology of ischiocavernosus (IC) and bulbospongiosus (BS) muscles in long-term diabetic male rats and its implication on erectile dysfunction (ED).

METHODS

Male rats were grouped into control and diabetic rats (received single injection of 60 mg/kg bw. of streptozotocin [STZ]). At 120th day, the animals were subjected to various analyses like serum hormone, penile reflex, electromyography of IC and BS muscles, after euthanasia IC and BS muscles were processed for morphological, histology, histometric analysis, immunostaining and immunoblotting synaptophysin, nNOS and NADPH diaphorase histochemistry.

RESULTS

Significant reduction in serum hormone level, penile reflex, reduced action potential or activity in both these muscles and wide range of histological alterations were observed in STZ rats. Muscles showed significant reduction in the diameter, volume and numerical density of the fiber in both muscles of STZ rats. Synaptophysin, nNOS and NADPH diaphorase were significantly reduced in diabetic animal IC and BS.

CONCLUSION

Severe neuromuscular circuitry alteration in IC and BS. Study concludes that degenerative changes in IC and BS may play a major role in ED in diabetic condition. Indicating diabetic-induced postsynaptic neuronal degeneration along with impaired motor action of the muscle and severe muscle degeneration affecting ED.

Outcomes of combination therapy with daily tadalafil 5 mg plus tamsulosin 0.4 mg to treat lower urinary tract symptoms and erectile dysfunction in men with or without metabolic syndrome

BACKGROUND

The aim of this study was to assess the impact of tadalafil 5 mg/die plus tamsulosin 0.4 mg/die combination therapy on lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), according to presence vs. absence of metabolic syndrome (MetS).

METHODS

Seventy-five consecutive men presenting with ED and LUTS were enrolled. Patients were divided into two groups according to MetS presence. All subjects were treated with combination therapy for 12 weeks. Patients were re-evaluated after treatment with uroflowmetry and post-void residual volume (PVR), International Prostate Symptoms Score (IPSS), IPSS Quality of Life (QoL), overactive bladder questionnaire (OAB-q) and International Index Erectile Function-5 (IIEF-5) Score.

RESULTS

After enrollment, 50 patients were included: 31 (62.0%) with MetS and 19 (38.0%) without MetS. At baseline, patients without MetS showed a significantly better IPSS, IIEF and OAB-q, as compared to those with MetS. After 12 weeks of combination therapy LUTS, ED and flowmetry significantly improved in both groups (P<0.001). The improvement after 12 weeks was similar between groups in all parameters (P>0.05), except for ∆OAB-q that was significantly better for patients with MetS (P=0.028). Nevertheless, total IPSS, all IPSS subscores and OAB-q were significantly better at 12 weeks in men without MetS (P<0.05). Despite IIEF-5 was significantly different at baseline, after 12 weeks of combination therapy, erectile function was similar in men with or without METS: 16.3±3.8 vs. 17.7±4.7 (P=0.238). No serious adverse event (AE) was reported, and complications were comparable between groups (P>0.05).

CONCLUSIONS

Patients with MetS have worse LUTS and ED profiles. However, tadalafil plus tamsulosin combination treatment provided them a similar ED profile and a greater relief of overactive bladder (OAB) symptoms at the end of the trial. Combination therapy had the same safety profile in men besides MetS. Further randomized controlled trials are needed.

Perfil cardiovascular en pacientes con disfunción eréctil tratados en un centro de alta complejidad en la ciudad de Medellín, Colombia

Objetivo Determinar el perfil cardiovascular de los pacientes con disfunción eréctil en un centro de alta complejidad de Medellín.

Métodos Estudio descriptivo, retrospectivo, en el que se incluyeron pacientes con diagnóstico de disfunción eréctil confirmado por el departamento de Urología, tratados en un centro de alta complejidad de Medellín entre 2010 y 2017; excluyendo aquellos con historia clínica con información incompleta o con desenlace cardiovascular previo al diagnóstico de disfunción eréctil. Los datos se obtuvieron de fuentes secundarias y se realizó su registro en una base de datos para su análisis mediante paquete estadístico (SPSS 24 Inc, Chicago, IL).

Resultados Se captaron, durante el periodo de estudio, 67 pacientes con disfunción eréctil que cumplieron los criterios de elegibilidad. Con una media de edad de 47,5 años. El 82% presentó disfunción eréctil severa, que estuvo asociada con el antecedente de angina, enfermedad coronaria y síndrome coronario agudo. Así mismo, más del 80% de los pacientes con diabetes, hipertensión, dislipidemia, tabaquismo, enfermedad renal crónica, obesidad y alcoholismo considerados como marcadores importantes de riesgo cardiovascular, presentaron disfunción eréctil severa.

Conclusión La comorbilidad cardiovascular en pacientes con DE es alta, existiendo una relación al compartir factores de riesgo y vías fisiopatológicas. Los pacientes con DE severa presentan mayor número de patologías asociadas, volviéndolos más propensos a desenlaces cardio-cerebrovasculares.

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.

Male Obesity Associated Gonadal Dysfunction and the Role of Bariatric Surgery

Obesity is an ever growing pandemic and a prevalent problem among men of reproductive age that can both cause and exacerbate male-factor infertility by means of endocrine abnormalities, associated comorbidities, and direct effects on the precision and throughput of spermatogenesis. Robust epidemiologic, clinical, genetic, epigenetic, and preclinical data support these findings. Clinical studies on the impact of medically induced weight loss on serum testosterone concentrations and spermatogenesis is promising but may show differential and unsustainable results. In contrast, literature has demonstrated that weight loss after bariatric surgery is correlated with an increase in serum testosterone concentrations that is superior than that obtained with only lifestyle modifications, supporting a further metabolic benefit from surgery that may be specific to the male reproductive system. The data on sperm and semen parameters is controversial to date. Emerging evidence in the burgeoning field of genetics and epigenetics has demonstrated that paternal obesity can affect offspring metabolic and reproductive phenotypes by means of epigenetic reprogramming of spermatogonial stem cells. Understanding the impact of this reprogramming is critical to a comprehensive view of the impact of obesity on subsequent generations. Furthermore, conveying the potential impact of these lifestyle changes on future progeny can serve as a powerful tool for obese men to modify their behavior. Healthcare professionals treating male infertility and obesity need to adapt their practice to assimilate these new findings to better counsel men about the importance of paternal preconception health and the impact of novel non-medical therapeutic interventions. Herein, we summarize the pathophysiology of obesity on the male reproductive system and emerging evidence regarding the potential role of bariatric surgery as treatment of male obesity-associated gonadal dysfunction.

Prevalence of Asymptomatic Coronary Artery Stenosis Based on Coronary Computed Tomography Angiography in Adults with Erectile Dysfunction: A Cross-Sectional Study

OBJECTIVES

To investigate the prevalence of asymptomatic coronary artery stenosis (CAS) using coronary computed tomography angiography (CCTA) in Korean men with erectile dysfunction (ED).

SUBJECTS AND METHODS

A cross-sectional study was conducted on 108 men who underwent CCTA at a health promotion center in Pusan National University Yangsan Hospital. Each subject who was evaluated for ED using the International Index of Erectile Dysfunction (IIEF) questionnaire did not have a past history or symptoms of coronary artery disease (CAD). We assessed the association between ED and CCTA-based CAS.

RESULTS

The overall prevalence of ED was 57.4%; furthermore, age (p = 0.001) and fasting blood glucose (p =0.035) were the metabolic risk factors that were most significantly associated with the presence of ED. The overall frequency of CAS was 31.5%, and ED (p = 0.022), age (p < 0.001), fasting blood glucose (p = 0.021), and total cholesterol/high-density lipoprotein cholesterol (p = 0.029) were significantly associated with the presence of CAS. The prevalence of CAS was 40.3 and 19.6% in the ED and non-ED groups, respectively. Men with ED were 2.778 times more likely to present with CAS than those without ED (OR 2.778, 95% CI 1.143-6.749, p = 0.024); however multivariate logistic regression analysis, while controlling for age, total cholesterol/high-density lipoprotein cholesterol, and fasting blood glucose, suggested the absence of a significant association between ED and CCTA-based CAS.

CONCLUSION

This study shows that CCTA-based CAS is a common phenomenon in men who have ED. Furthermore, ED patients without cardiac symptoms need to be investigated for the possibility of hidden CAD.

Relationships between eating disorder psychopathology, sexual hormones and sexual behaviours

A growing body of evidences demonstrated that sexuality is an important topic in the clinical research of eating disorders (EDs), due to its association with specific psychopathological features, and etiological factors. The present review took into consideration the complex relationship between sexual behaviours, hormonal alterations and EDs psychopathology. Studies pertaining sexual behaviours in EDs were divided into those focusing on sexual dysfunctions, and those related to risky sexual behaviours. The limited number of studies on sexual dysfunctions, reported a controversial association with weight status and hormonal alterations, and a clear relationship with severity of specific psychopathology (e.g. body image disturbance). Risky sexual behaviours have been associated with impulsivity and dissociation, as well as with abnormal stress response. Finally, both restriction and uncontrolled eating have been found to be responsible for several complex metabolic alterations, determining varied sexual and gynecologic problems, such as amenorrhea, hypogonadism, genital vascular problems, infertility, and miscarriage, although it is also possible that alterations in feeding and stress hormones contribute to altered eating behaviour.

Upcoming Aging Society and Men's Health: Focus on Clinical Implications of Exercise and Lifestyle Modification

Recent epidemiological research has indicated that men have increased health risks due to biological and social factors. Research in the area of men's health has been focused on disease events and subsequent disabilities. In future aging societies, more attention should be paid to the importance of men's health because a decreased quality of life and increased social burden are impending unless proper maneuvers are taken to slow the development and progression of morbidity through the use of preventive strategies. The adoption of a healthier lifestyle and the early identification and management of risk factors are very important and can be an initiative for prevention and for slowing the progression of morbidities with related quality of life issues. Males are rather vulnerable in terms of health, and conscious and active efforts are required to promote their health in an aging society. Here, we hope to shed light on the influence of lifestyle modifications and their clinical implications on men's health.

The role of metabolic syndrome variant in the malignant tumors progression

Metabolic syndrome (MS) is one of the leading risk factors for the development of some common cancers (endometrial cancer, postmenopausal breast cancer, colorectal cancer). Currently, a drug-induced metabolic syndrome related with androgen deprivation therapy in patients with prostate cancer represents a serious medical problem. Not only MS, or its individual components, but MS variants with different levels of leptin, adiponectin, visfatin, resistin are associated with tumor invasion, metastasis and survival rates in patients with MS-associated malignancies.

Use of single-question screening for erectile dysfunction: a study of at-risk Asian men in primary health care

This study assesses the validity of a single-question screener for erectile dysfunction (ED) in men at risk in comparison to a standard validated tool - the five-item version of the International Index of Erectile Function (IIEF-5). A total of 174 men with at least one risk factor for ED were studied, with 58.0% and 10.9% of the study respondents meeting the criteria for their erectile impairment by IIEF-5 and single-question screener respectively. Our results suggest that in spite of high feasibility, a simplified, single-question screener has low sensitivity in capturing ED prevalence, even in an at-risk population, within the Asian context.

Erectile dysfunction and risk of cardiovascular and all-cause mortality in the general population: a meta-analysis of cohort studies

PURPOSE

Studies on the association of erectile dysfunction (ED) with cardiovascular or all-cause mortality have yielded conflicting findings. We conducted this meta-analysis to evaluate the association of ED with cardiovascular or all-cause mortality in the general population.

METHODS

Pubmed and Embase databases were searched for prospective studies that evaluated the association of ED with cardiovascular or all-cause mortality in the general population up to 15 December, 2017. The overall combined risk ratio (RR) and 95% confidence intervals (CI) were pooled for the men with or without ED.

RESULTS

A total of 7 studies involving 111,440 participants were included in the meta-analysis. When compared to the men with or without ED, the overall pooled RR was 1.24 (95% CI 1.11-1.39) for all-cause mortality and 1.11 (95% CI 0.92-1.35) for cardiovascular mortality. Subgroup analyses indicated that only men with severe ED significantly increased all-cause mortality risk (RR 1.58; 95% CI 1.37-1.82), but not in the mild (RR 1.07; 95% CI 0.93-1.24) ED and the moderate (RR 1.16; 95% CI 1.00-1.35) ED.

CONCLUSIONS

This meta-analysis suggests that severe ED is significantly associated with increased all-cause mortality in the general population. However, the association of ED with cardiovascular mortality should be further investigated.

Sex hormone-binding globulin is associated with androgen deficiency features independently of total testosterone

OBJECTIVE

It is recognized that total testosterone (TT) does not sufficiently describe androgen status when sex hormone-binding globulin (SHBG) is altered. However, in humans, evidence supporting the existence of a hypogonadism due to low T bioactivity is scanty. The aim of the study was to assess whether changes in SHBG levels, independently of TT, are associated with subjective and objective androgen-dependent parameters.

DESIGN

Cross-sectional observation.

PATIENTS

Two thousand six hundred and twenty-two men (aged 51.1 ± 13.5 years) attending a Sexual Medicine and Andrology Outpatient Clinic for sexual dysfunctions.

MEASUREMENTS

All patients underwent a standardized diagnostic protocol before starting any treatment. Clinical and biochemical parameters have been collected. Higher ANDROTEST score has been used as a comprehensive marker of more severe hypogonadal symptoms. Prostate-specific antigen (PSA) and haematocrit have been used as objective surrogate markers of T bioactivity.

RESULTS

After adjusting for TT and lifestyle, SHBG showed a significant positive association with ANDROTEST score (B = 0.79 [0.61; 0.96], P < .0001). Conversely, higher SHBG, independently of TT, was negatively related to PSA (B = -0.86 [-0.83; -0.89]; P < .0001) and haematocrit (B = -0.64 [-0.88; -0.40]; P < .0001), after adjustment for the aforementioned confounders along with age and body mass index. Furthermore, a relationship between SHBG and lipids or blood pressure was found, with lower SHBG levels associated with a worse metabolic profile, independently of TT.

CONCLUSIONS

Higher SHBG, independently of TT, is associated with either subjective or objective androgen deficiency features. This indicates that besides a hypogonadism due to an impaired T production, a hypogonadism due to a lower biological activity of T does exist.

Entrenamiento de la musculatura del piso pélvico como parte del tratamiento para la disfunción eréctil después de prostatectomía radical: serie de casos, experiencia en un centro médico de alta complejidad

Introducción La disfunción eréctil se ha reconocido como una complicación de la prostatectomía radical. El entrenamiento de los músculos del piso pélvico puede ser una opción terapéutica, sin embargo, existe poca evidencia sobre el efecto del entrenamiento en la función eréctil.

Objetivo Describir el efecto de la rehabilitación de la musculatura de piso pélvico en la función eréctil en hombres > 40 años con disfunción eréctil después de prostatectomía radical.

Métodos Estudio retrospectivo basado en la revisión de historias clínicas de pacientes con disfunción eréctil después de prostatectomía radical, sometidos a un protocolo de rehabilitación con ejercicios de músculos de piso pélvico, biofeedback y electroestimulación. La función eréctil se evaluó por el índice internacional de la función eréctil (IIEF-5). La presión de los elevadores del ano se midió con el equipo Myomed134 y la fuerza muscular con la escala modificada de Oxford.

Resultados Se incluyeron 13 hombres con edad promedio de 63,2 ± 8 años, sin historia de consumo de tabaco y con índice de masa corporal de 24,9 ± 2,6 kg/m2. Antes de la intervención, se encontraron 10 casos con disfunción severa y 3 de leve a moderada, según el cuestionario IIEF-5. Después de la intervención, se encontró mejoría en 11 pacientes en la función eréctil: 7 con mejoría completa, 4 con disfunción eréctil leve. En 2 casos no se presentó mejoría.

Conclusión El estudio muestra que el efecto del entrenamiento de la musculatura de piso pélvico es beneficioso en la recuperación de la función eréctil después de prostatectomía radical.

Urologic symptoms and burden of frailty and geriatric conditions in older men: the Aging Study of PyeongChang Rural Area

Purpose

Frailty is an important consideration in the management of lower urinary tract symptoms and erectile dysfunction in older men; frailty increases vulnerability to treatment-related adverse outcomes, but its burden is not known. The authors aimed to examine the burden of frailty and associated geriatric conditions in community-dwelling older men.

Patients and methods

A cross-sectional study was conducted with 492 community-dwelling older men (mean age, 74.2 years; standard deviation, 5.6 years). All the participants were administered the International Prostate Symptom Score (IPSS) (range: 0-35) and a five-item version of the International Index of Erectile Function (IIEF-5) (range: 5-25). Frailty phenotype was assessed based on exhaustion, inactivity, slowness, weakness, and weight loss. Prevalence of frailty phenotype and geriatric conditions were assessed by the IPSS severity category (mild, 0-7; moderate, 8-19; severe, 20-35 points) and the first IIEF-5 question, which assesses the confidence in erectile function (low, 1-2; moderate, 3; high, 4-5 points).

Results

Older men with severe urologic symptoms had a high prevalence of frailty. According to the IPSS questionnaire, the prevalence of frailty was 7.3% (21/288) in the mild category, 16.3% (26/160) in the moderate category, and 43.2% (19/44) in the severe category. Participants in the severe IPSS category showed high prevalence of dismobility (45.5%), multimorbidity (43.2%), malnutrition risk (40.9%), sarcopenia (40.9%), and polypharmacy (31.8%). According to erectile confidence based on the first IIEF-5 question, the prevalence of frailty was 18.7% (56/300) for low confidence, 5.3% (6/114) for moderate confidence, and 5.1% (4/78) for high confidence. Participants with low confidence in erectile function showed high prevalence of sarcopenia (39.0%), multimorbidity (37.7%), dismobility (35.7%), malnutrition risk (33.3%), and polypharmacy (23.0%).

Conclusion

The prevalence of frailty and geriatric conditions was higher in older men with severe urologic symptoms. A frailty screening should be routinely administered in urology practices to identify older men who are vulnerable to treatment-related adverse events.

Molecular targets for the therapy of cancer associated with metabolic syndrome (transcription and growth factors)

Metabolic syndrome (MS) is one of the leading risk factors for the development of cardiovascular diseases, type II diabetes mellitus and reproductive system diseases. Currently, not only cardiovascular disease and reproductive history risks related with MS are frequently discussed, but it has been also shown that MS is associated with increased risk of some common cancers (endometrial cancer, postmenopausal breast cancer, colorectal cancer, biliary tract cancers and liver cancer for men). Further studies are required to understand the mechanisms of the involvement of MS components in the pathogenesis of malignant neoplasms. Changes in the expression of transcription and growth factors in the peripheral tissues as well as in cancer tissues of patients with MS were revealed. Transcription factors (AMP-activated protein kinase-1, STAT3, sterol regulatory element-binding protein-1 and peroxisome proliferator-activated receptor-γ), leptin and adiponectin receptors seem to be the most promising molecular targets for the therapy of cancers associated with MS.