1
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Wang C, Zhang H, Wang F, Guo J, Yuan J, Hou G, Gao M, Li Z, Zhang Y. Efficacy and safety of PDE5 inhibitors in middle-aged and old patients with and without hypogonadism. Aging Male 2024; 27:2288347. [PMID: 38146937 DOI: 10.1080/13685538.2023.2288347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/19/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE Although several reviews have evaluated the use of PDE5 inhibitors (PDE5i) for treating erectile dysfunction (ED), their specific use in middle-aged and old patients has not been fully evaluated. Given that elderly patients with ED often have a complex combination of systemic and sexual health risk factors, the safety and efficacy of PDE5i in such a context are hereby reviewed. MATERIALS AND METHODS A thorough examination of existing literature has been conducted on PubMed. RESULTS PDE5i has good safety and efficacy, but the situation is more complex for patients with hypogonadism than those with normal testosterone levels, with reduced responsiveness to PDE5i. In this case, combination therapy with testosterone is recommended, safe and effective. CONCLUSIONS Eliminating or reducing reversible risk factors and controlling or slowing the development of irreversible factors is an important foundation for using PDE5i to treat ED in all patients, especially middle-aged and elderly ones.
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Affiliation(s)
- Chunlin Wang
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Hui Zhang
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fu Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jun Guo
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ming Gao
- Department of Andrology, Xi'an Daxing Hospital affiliated to Yan'an University, Xi'an, China
| | - Zheng Li
- Shanghai Key Laboratory of Reproductive Medicine, Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhang
- Department of Infertility and Sexual Medicine, 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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2
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Bae SG, Yin GN, Ock J, Suh JK, Ryu JK, Park J. Single-cell transcriptome analysis of cavernous tissues reveals the key roles of pericytes in diabetic erectile dysfunction. eLife 2024; 12:RP88942. [PMID: 38856719 PMCID: PMC11164535 DOI: 10.7554/elife.88942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Erectile dysfunction (ED) affects a significant proportion of men aged 40-70 and is caused by cavernous tissue dysfunction. Presently, the most common treatment for ED is phosphodiesterase 5 inhibitors; however, this is less effective in patients with severe vascular disease such as diabetic ED. Therefore, there is a need for development of new treatment, which requires a better understanding of the cavernous microenvironment and cell-cell communications under diabetic condition. Pericytes are vital in penile erection; however, their dysfunction due to diabetes remains unclear. In this study, we performed single-cell RNA sequencing to understand the cellular landscape of cavernous tissues and cell type-specific transcriptional changes in diabetic ED. We found a decreased expression of genes associated with collagen or extracellular matrix organization and angiogenesis in diabetic fibroblasts, chondrocytes, myofibroblasts, valve-related lymphatic endothelial cells, and pericytes. Moreover, the newly identified pericyte-specific marker, Limb Bud-Heart (Lbh), in mouse and human cavernous tissues, clearly distinguishing pericytes from smooth muscle cells. Cell-cell interaction analysis revealed that pericytes are involved in angiogenesis, adhesion, and migration by communicating with other cell types in the corpus cavernosum; however, these interactions were highly reduced under diabetic conditions. Lbh expression is low in diabetic pericytes, and overexpression of LBH prevents erectile function by regulating neurovascular regeneration. Furthermore, the LBH-interacting proteins (Crystallin Alpha B and Vimentin) were identified in mouse cavernous pericytes through LC-MS/MS analysis, indicating that their interactions were critical for maintaining pericyte function. Thus, our study reveals novel targets and insights into the pathogenesis of ED in patients with diabetes.
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Affiliation(s)
- Seo-Gyeong Bae
- School of Life Sciences, Gwangju Institute of Science and Technology (GIST)GwangjuRepublic of Korea
| | - Guo Nan Yin
- National Research Center for Sexual Medicine and Department of Urolog, Inha University School of MedicineIncheonRepublic of Korea
| | - Jiyeon Ock
- National Research Center for Sexual Medicine and Department of Urolog, Inha University School of MedicineIncheonRepublic of Korea
| | - Jun-Kyu Suh
- National Research Center for Sexual Medicine and Department of Urolog, Inha University School of MedicineIncheonRepublic of Korea
| | - Ji-Kan Ryu
- National Research Center for Sexual Medicine and Department of Urolog, Inha University School of MedicineIncheonRepublic of Korea
- Program in Biomedical Science & Engineering, Inha UniversityIncheonRepublic of Korea
| | - Jihwan Park
- School of Life Sciences, Gwangju Institute of Science and Technology (GIST)GwangjuRepublic of Korea
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3
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Lee JS, Hong SH, Sun HY, Jin H, Yu BY, Cho YJ, Chang JY, Yoo BW. The efficacy and safety of tadalafil in the management of erectile dysfunction with diabetes and blood circulation issues. Aging Male 2023; 26:2176484. [PMID: 36779746 DOI: 10.1080/13685538.2023.2176484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Erectile dysfunction (ED) is a common diabetes-related complication. MATERIALS AND METHODS This study examined the effect of daily low-dose tadalafil (5 mg) on patients' quality of life (including that of sex life) and blood circulation. Erectile dysfunction questionnaires were administered to 20 patients with type 2 diabetes (T2DM) and ED. The safety and efficacy of tadalafil were evaluated using laboratory tests, and the effect on blood circulation was measured through nail fold capillaroscopy. RESULTS Daily tadalafil use by patients with T2DM and ED showed a statistically significant increase in the erectile reliability score from of 1.15 to 3.20 (p < .00012). Capillary blood circulation improvement tests showed a statistically significant increase in apical limb width from 13.1 to 14.64 µm (p = .04829) and flow from 9035 to 11946 μm3/s (p = .04405). Although not significant, increased capillary width and speed (rate of blood flow) confirmed improved blood circulation. There were no significant changes in the cardiac indicators (troponin, prostate-specific antigen, or electrocardiogram tests) before and after tadalafil administration, supporting the safety of its low-dose daily administration. CONCLUSIONS A small dose of daily tadalafil was shown to safely improve erectile dysfunction and peripheral blood flow in patients with T2DM, in which peripheral arterial diseases should not be considered separately but rather as complex entities.
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Affiliation(s)
- Jong Seung Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Hong
- Department of Family Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Hwa Yeon Sun
- Department of Interdisciplinary Program in Biomidical Science, Soonchunhyang University, Asan, Republic of Korea
| | - Hyungseung Jin
- Department of Pediatrics, Gangneung Asan Hospital, Gangneung, Republic of Korea
| | - Byung Yeon Yu
- Department of Family Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Yong-Jin Cho
- Department of Family Medicine, Soonchunghyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Jin Young Chang
- Department of Biological Science, Northwestern University, Ewanston, IL, USA
| | - Byung Wook Yoo
- Department of Family Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
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4
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Navarro-Dorado J, Climent B, López-Oliva ME, Pilar Martínez M, Hernández-Martín M, Agis-Torres Á, Recio P, Victoria Barahona M, Benedito S, Fernandes VS, Hernández M. The bitter taste receptor (TAS2R) agonist denatonium promotes a strong relaxation of rat corpus cavernosum. Biochem Pharmacol 2023; 215:115754. [PMID: 37597814 DOI: 10.1016/j.bcp.2023.115754] [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: 05/29/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023]
Abstract
Bitter taste receptors (TAS2R) are found in numerous extra-oral tissues, including smooth muscle (SM) cells in both vascular and visceral tissues. Upon activation, TAS2R stimulate the relaxation of the SM. Nitric oxide (NO)/cyclic guanosine monophosphate (cGMP) signaling pathway is involved in penile erection, and type 5 phosphodiesterase (PDE5) inhibitors, a cGMP-specific hydrolase are used as first-line treatments for erectile dysfunction (ED). Nevertheless, PDE5 inhibitors are ineffective in a considerable number of patients, prompting research into alternative pharmacological targets for ED. Since TAS2R agonists regulate SM contractility, this study investigates the role of TAS2Rs in rat corpus cavernosum (CC). We performed immunohistochemistry to detect TAS2R10, isometric force recordings for TAS2R agonists denatonium and chloroquine, the slow-release H2S donor GYY 4137, the NO donor SNAP, the β-adrenoceptor agonist isoproterenol and electrical field stimulation (EFS), as well as measurement of endogenous hydrogen sulfide (H2S) production. The immunofluorescence staining indicated that TAS2R10 was broadly expressed in the CC SM and to some extent in the nerve fibers. Denatonium, chloroquine, SNAP, and isoproterenol cause potent dose-dependent SM relaxations. H2S production was decreased by NO and H2S synthase inhibitors, while it was enhanced by denatonium. In addition, denatonium increased the relaxations induced by GYY 4137 and SNAP but failed to modify EFS- and isoproterenol-induced responses. These results suggest neuronal and SM TAS2R10 expression in the rat CC, where denatonium induces a strong SM relaxation per se and promotes the H2S- and NO-mediated inhibitory gaseous neurotransmission. Thus, TAS2R10 might represent a valuable therapeutic target in ED.
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Affiliation(s)
- Jorge Navarro-Dorado
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040-Madrid, Spain
| | - Belén Climent
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040-Madrid, Spain
| | - María Elvira López-Oliva
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040-Madrid, Spain
| | - María Pilar Martínez
- Departamento de Anatomía y Embriología, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040-Madrid, Spain
| | - Marina Hernández-Martín
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040-Madrid, Spain
| | - Ángel Agis-Torres
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040-Madrid, Spain
| | - Paz Recio
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040-Madrid, Spain
| | - María Victoria Barahona
- Departamento de Farmacología y Toxicología, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040-Madrid, Spain
| | - Sara Benedito
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040-Madrid, Spain
| | - Vítor S Fernandes
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040-Madrid, Spain.
| | - Medardo Hernández
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040-Madrid, Spain.
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5
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Kucukyildiz K, Yilmaz-Oral D, Turkcan D, Oztekin CV, Gur S. Impact of COVID-19 on male urogenital health: Success of vaccines. Drug Discov Today 2022; 27:103327. [PMID: 35905935 PMCID: PMC9316714 DOI: 10.1016/j.drudis.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/01/2022] [Accepted: 07/21/2022] [Indexed: 01/31/2023]
Abstract
Throughout 2021, the scientific and medical communities were concentrated on dealing with the acute morbidity and mortality induced by the COVID-19 pandemic due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We reviewed the present data for adverse effects of COVID-19 on the different parts of the male urogenital system during the dynamic situation of the COVID-19 pandemic. With the approval of COVID-19 vaccinations, there is a ray of hope at the end of this dark tunnel and a chance to look ahead for the management of long-term consequences in males with urogenital illness. A multidisciplinary investigation of these cases could provide information for establishing and optimizing treatment protocols.
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Affiliation(s)
- Kutay Kucukyildiz
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - Didem Yilmaz-Oral
- Department of Pharmacology, Faculty of Pharmacy, Cukurova University, Adana, Turkey
| | - Damla Turkcan
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - Cetin Volkan Oztekin
- Department of Urology, Faculty of Medicine, University of Kyrenia, Girne-TRNC, Mersin 10, Turkey
| | - Serap Gur
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey,Corresponding author
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6
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Fernandes VS, López-Oliva ME, Martínez MP, Agis-Torres Á, Recio P, Navarro-Dorado J, Barahona MV, Benedito S, Prieto D, Climent B, Hernández M. In vitro inhibition of phosphodiesterase type 4 enhances rat corpus cavernosum nerve-mediated relaxation induced by gasotransmitters. Life Sci 2022; 296:120432. [PMID: 35219697 DOI: 10.1016/j.lfs.2022.120432] [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: 12/03/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 11/15/2022]
Abstract
AIMS Nitric oxide (NO) and hydrogen sulfide (H2S) are involved in nerve-mediated corpus cavernosum (CC) relaxation. Expression of phosphodiesterase type 5 (PDE5) and type 4 (PDE4), cyclic guanosine monophosphate (cGMP)- and cyclic adenosine monophosphate (cAMP)-specific, respectively, has been described and PDE5- and PDE4-inhibitors induce cavernous smooth muscle relaxation. Whereas the NO/cGMP signaling pathway is well established in penile erection, the cAMP-mediated mechanism is not fully elucidated. The aim of this study is to investigate the localization and the functional significance of PDE4 in rat CC tone regulation. MAIN METHODS We performed immunohistochemistry for the detection of the PDE4A isoenzyme. Isometric tension recordings for roflumilast and tadalafil, PDE4 and PDE5 inhibitors, respectively, electrical field stimulation (EFS) and β-adrenoceptor agonist isoproterenol and endogenous H2S production measurement. KEY FINDINGS A marked PDE4A expression was detected mainly localized in the nerve cells of the cavernous smooth muscle. Furthermore, roflumilast and tadalafil exhibited strong corpus cavernous relaxations. Endogenous H2S production was decreased by NO and H2S synthase inhibitors and increased by roflumilast. Isoproterenol- and EFS-induced relaxations were increased by roflumilast. SIGNIFICANCE These results indicate that PDE4A is mainly expressed within the nerves cells of the rat CC, where roflumilast induces a potent corpus cavernous relaxation per se and potentiates the response induced by β-adrenoceptor activation. The fact that roflumilast enhances H2S production, as well as EFS-elicited responses suggests that PDE4 inhibitors modulate, in a positive feedback fashion, nerve-mediated relaxation induced by gasotransmitters, thus indicating a key role for neuronal PDE4 in penile erection.
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Affiliation(s)
- Vítor S Fernandes
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - María Elvira López-Oliva
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - María Pilar Martínez
- Departamento de Anatomía y Anatomía Patológica Comparadas, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Ángel Agis-Torres
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Paz Recio
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Jorge Navarro-Dorado
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - María Victoria Barahona
- Departamento de Farmacología y Toxicología, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Sara Benedito
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Dolores Prieto
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Belén Climent
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Medardo Hernández
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain.
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7
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Jagdish RK, Kamaal A, Shasthry SM, Benjamin J, Maiwall R, Jindal A, Choudhary A, Rajan V, Arora V, Bhardwaj A, Kumar G, Kumar M, Sarin SK. Tadalafil improves erectile dysfunction and quality of life in men with cirrhosis: a randomized double blind placebo controlled trial. Hepatol Int 2021; 17:434-451. [PMID: 34775577 DOI: 10.1007/s12072-021-10264-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Patients with cirrhosis have high prevalence of erectile dysfunction (ED). The aim of this study was to study the efficacy and safety of tadalafil for ED in patients with cirrhosis. METHODS 140 cirrhotic males with ED were randomized into tadalafil 10 mg daily (n = 70) or placebo (n = 70) for 12 weeks. ED was diagnosed if erectile function (EF) domain score was < 25 in International Index of Erectile Function (IIEF) questionnaire. The erectile function domain consists of six questions concerning erection frequency, erection firmness, frequency of partner penetration, frequency of maintaining erection after penetration, ability to maintain erection to completion of intercourse and confidence in achieving and maintaining erection. Primary outcome was proportion of patients having an increase in > 5 points in EF domain of the IIEF. Generalized Anxiety Disorder 7 (GAD-7) questionnaire was used for screening and severity measuring of GAD. The presence of depression was screened using the Patient Health Questionnaire (PHQ-9) and the assessment of health related quality of life was done using the Short Form (36) Health Survey. RESULTS At the end of 12 weeks, more patients in tadalafil group achieved > 5 points increase in the EF domain of the IIEF when compared with the placebo group [44(62.9%) vs. 21(30%), p < 0.001]. At the end of 12 weeks, patients receiving tadalafil had significantly more change in scores on the erectile function domain, orgasmic function domain, intercourse satisfaction domain, overall satisfaction domain, erection vaginal penetration rates and successful intercourse; significantly more decline in the GAD-7 and PHQ-9 scores; significantly more improvement in scores of five of the eight domains of SF-36 (general health perception, vitality score, social functioning, role emotional and mental health) and the mental component summary rates when compared with placebo. The development of side effects and the changes in HVPG were not significantly different between the two groups. CONCLUSIONS Tadalafil therapy may enhance erectile function, improve anxiety, depression and quality of life; and is well tolerated by men with cirrhosis (CTP score < 10) and ED. However, further larger and long-term studies are needed to confirm these results and look for rarer side effects of using tadalafil in patients with cirrhosis. TRIAL REGISTRATION ClinicalTrials.gov identifier number NCT03566914; first posted date: June 25, 2018.
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Affiliation(s)
- Rakesh Kumar Jagdish
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
| | - Ahmed Kamaal
- Department of Urology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Saggere Muralikrishna Shasthry
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
| | - Jaya Benjamin
- Department of Clinical Nutrition, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rakhi Maiwall
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
| | - Ankur Jindal
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
| | - Ashok Choudhary
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
| | - Vijayaraghavan Rajan
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
| | - Vinod Arora
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
| | - Ankit Bhardwaj
- Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Guresh Kumar
- Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Manoj Kumar
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India.
| | - Shiv K Sarin
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
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8
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Imprialos K, Koutsampasopoulos K, Manolis A, Doumas M. Erectile Dysfunction as a Cardiovascular Risk Factor: Time to Step Up? Curr Vasc Pharmacol 2021; 19:301-312. [PMID: 32286949 DOI: 10.2174/1570161118666200414102556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Erectile dysfunction (ED) is a major health problem that affects a significant proportion of the general population, and its prevalence is even higher in patients with CV risk factors and/or disease. ED and cardiovascular (CV) disease share several common pathophysiological mechanisms, and thus, the potential role of ED as a predictor of CV events has emerged as a significant research aspect. OBJECTIVE The purpose of this review is to present and critically discuss data assessing the relation between ED and CV disease and the potential predictive value of ED for CV events. METHODS A comprehensive review of the literature has been performed to identify studies evaluating the association between ED and CV disease. RESULTS Several cross-sectional and prospective studies have examined the association between ED and CV disease and found an increased prevalence of ED in patients with CV disease. ED was shown to independently predict future CV events. Importantly, ED was found to precede the development of overt coronary artery disease (CAD) by 3 to 5 years, offering a "time window" to properly manage these patients before the clinical manifestation of CAD. Phosphodiesterase type 5 inhibitors are the first-line treatment option for ED and were shown to be safe in terms of CV events in patients with and without CV disease. CONCLUSION Accumulating evidence supports a strong predictive role of ED for CV events. Early identification of ED could allow for the optimal management of these patients to reduce the risk for a CV event to occur.
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Affiliation(s)
- Konstantinos Imprialos
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Konstantinos Koutsampasopoulos
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | | | - Michael Doumas
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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9
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Abstract
: Sexual health is an integral part of overall health, and an active and healthy sexual life is an essential aspect of a good life quality. Cardiovascular disease and sexual health share common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking) and common mediating mechanisms (endothelial dysfunction, subclinical inflammation, and atherosclerosis). This generated a shift of thinking about the pathophysiology and subsequently the management of sexual dysfunction. The introduction of phosphodiesterase type 5 inhibitors revolutionized the management of sexual dysfunction in men. This article will focus on erectile dysfunction and its association with arterial hypertension. This update of the position paper was created by the Working Group on Sexual Dysfunction and Arterial Hypertension of the European Society of Hypertension. This working group has been very active during the last years in promoting the familiarization of hypertension specialists and related physicians with erectile dysfunction, through numerous lectures in national and international meetings, a position paper, newsletters, guidelines, and a book specifically addressing erectile dysfunction in hypertensive patients. It was noted that erectile dysfunction precedes the development of coronary artery disease. The artery size hypothesis has been proposed as a potential explanation for this observation. This hypothesis seeks to explain the differing manifestation of the same vascular condition, based on the size of the vessels. Clinical presentations of the atherosclerotic and/or endothelium disease in the penile arteries might precede the corresponding manifestations from larger arteries. Treated hypertensive patients are more likely to have sexual dysfunction compared with untreated ones, suggesting a detrimental role of antihypertensive treatment on erectile function. The occurrence of erectile dysfunction seems to be related to undesirable effects of antihypertensive drugs on the penile tissue. Available information points toward divergent effects of antihypertensive drugs on erectile function, with diuretics and beta-blockers possessing the worst profile and angiotensin receptor blockers and nebivolol the best profile.
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10
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Cai Z, Song X, Zhang J, Yang B, Li H. Practical Approaches to Treat ED in PDE5i Nonresponders. Aging Dis 2020; 11:1202-1218. [PMID: 33014533 PMCID: PMC7505261 DOI: 10.14336/ad.2019.1028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/28/2019] [Indexed: 12/21/2022] Open
Abstract
Erectile dysfunction (ED) is a common sexual disorder in adult males and one of the most important factors affecting their quality of life and that of their partners. Although PDE5 inhibitors (PDE5is) are the first choice for improving erectile function, there is a substantial proportion of ED patients, termed PDE5i nonresponders, who do not respond to PDE5is. Because of the lack of effective therapies, these patients always have serious social and psychological problems due to ED, which should be addressed. Here, we review the available literature about ED and PDE5is and propose several strategies for mitigating ED in PDE5i nonresponders.
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Affiliation(s)
- Zhonglin Cai
- 1Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoqing Song
- 2Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Jianzhong Zhang
- 1Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Yang
- 3Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hongjun Li
- 1Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Oyeleye SI, Ojo OR, Oboh G. Moringa oleifera leaf and seed inclusive diets influenced the restoration of biochemicals associated with erectile dysfunction in the penile tissue of STZ-induced diabetic male rats treated with/without Acarbose drug. J Food Biochem 2020; 45:e13323. [PMID: 32538504 DOI: 10.1111/jfbc.13323] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 01/16/2023]
Abstract
We aim to evaluate the effect of Moringa leaf (ML) and seed (MS) inclusive diets on critical biomarkers [acetylcholinesterase (AChE), monoamine oxidase (MAO), angiotensin-I converting enzyme (ACE), adenosine deiminase (ADA) and arginase activities, and thiobarbituric acid reactive species (TBARS) level] associated with erectile dysfunction (ED) in the penile tissue of diabetic male rats treated with/without Acarbose (ACA). About 60 mg/kg BW streptozotocin (STZ)-induced diabetic rats were fed with ML and MS inclusive diets and cotreated with ACA for 14 days. The result indicated that AChE, MAO, ADA, ACE, and arginase activities, as well as TBARS level were (p < .05) restored in the diabetic rats fed with ML/MS inclusive diets treated with/without ACA compared to the untreated diabetic rats. In conclusion, the combination therapy of ML/MS inclusive diets plus ACA could be explored toward the management of diabetic-induced ED. PRACTICAL APPLICATIONS: We discovered in this study, treatments of diabetic rats with ACA and co-fed with 2% and 4% of Moringa leaf and seed inclusive diets for 14 days, could be of great benefit toward the management of ED caused by diabetes, as evidenced by the expression of some ED-related biomarkers in the penile tissue of diabetes male rats, compared to that of ACA treated alone. Thus, it seems reasonable to explore the effect of food-drug interaction on the large-scale clinical trial to manage diabetes complications, such as the potential effect of Moringa leaf and seed inclusive diets co-administered with ACA for the holistic management of diabetes-induced erectile dysfunction (ED).
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Affiliation(s)
| | - Olajide Raymond Ojo
- Department of Biochemistry, Federal University of Technology, Akure, Nigeria
| | - Ganiyu Oboh
- Department of Biochemistry, Federal University of Technology, Akure, Nigeria
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Abeway S, Dagne K, Zegeye T. Erectile Dysfunction and Correlates Among Diabetic Men at Dessie Referral Hospital: North Central Ethiopia, 2020. Diabetes Metab Syndr Obes 2020; 13:4201-4208. [PMID: 33192082 PMCID: PMC7654531 DOI: 10.2147/dmso.s278384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/13/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Erectile dysfunction is currently one of the most common sexual dysfunctions worldwide affecting the quality of life of men of all ages, but it is usually underestimated because it is not a life threatening condition. PURPOSE This study aims to determine the prevalence of erectile dysfunction and the possible correlates among diabetic men in Dessie Referral Hospital, North Central Ethiopia. METHODS An institution-based cross-sectional study was conducted among diabetic men aged greater than 18 years, at Dessie Referral Hospital. Systematic random sampling technique was used to select study participants. A pre-tested and structured questionnaire was used to collect the data. Data were entered in Epi Info version 7 and analyzed using SPSS version 21. Logistic regression was applied to identify association between explanatory variables and the outcome variable. An adjusted odds ratio with 95% confidence interval and p-value less than 0.05 was computed to determine the level of significance. RESULTS Overall, the prevalence of erectile dysfunction (ED) in this study was 58.5% at 95% CI (0.548-0.622), and specifically 10.5%, 40.9%, 6.8% respondents had mild, moderate and severe erectile dysfunction, respectively. Age, duration of diabetes diagnosis, types of medication, types of complication and body mass index were significant unadjusted factors associated with erectile dysfunction, but following adjustment only age [AOR=5.5 (95% CI 2.06-14.744), duration of diabetes [AOR=20,(95% CI 5.663-75.0096) and types of medication [AOR=2.106 (95% CI 1.112-3.988) have independently statistically significant association with erectile dysfunction. CONCLUSION This study showed that ED is high. Age, duration of diabetes mellitus and type of medication are independently associated with erectile dysfunction. Health policymakers need to consider including the training of health personnel to consider the relevant risk factors during the physical, social and psychological assessment of patients, and clinicians should pay attention to the sexual history of their client.
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Affiliation(s)
- Shiferaw Abeway
- School of Nursing and Midwifery, Department of Pediatric and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- Correspondence: Shiferaw Abeway School of Nursing and Midwifery, Department of Pediatric and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, EthiopiaTel +251931614769 Email
| | - Kefyalew Dagne
- Department of Psychiatry, College of Health Sciences and Medicine, Debre Berhan University, Debre Berhan, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tazeb Zegeye
- School of Medicine, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Trends in erectile dysfunction research from 2008 to 2018: a bibliometric analysis. Int J Impot Res 2019; 32:409-419. [PMID: 31235897 PMCID: PMC7358204 DOI: 10.1038/s41443-019-0161-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/27/2019] [Accepted: 05/16/2019] [Indexed: 12/18/2022]
Abstract
Insufficient penile erection to facilitate vaginal penetration is a medical condition referred to as erectile dysfunction (ED). By the year 2025, the number of ED cases across the world is expected to reach 322 million. There are numerous publications and studies in the field of ED over the past decades. Our aim is to comprehensively analyze the global scientific outputs of ED research and show the trends and hotspots in ED research. Data of publications were downloaded from the Web of Science Core Collection. We used CiteSpace IV and Excel 2016 to analyze literature information, including journals, countries/regions, institutes, authors, citation reports, and research frontiers. Until October 26, 2018, a total of 8880 papers in ED research were identified as published between 2008 and 2018. Journal of Sexual Medicine published the most articles. The United States contributed the most publications and occupied leading positions in H-index value and the number of ESI top papers. Maggi M owned the highest co-citations. The keyword "Oxidative stress" ranked first in the research front-line. The amount of articles published in ED research has been stable from 2008 to 2018. The United States showed enormous progress in ED research, and is still the dominant country. Oxidative stress, vardenafil, and late-onset hypogonadism were the latest research frontiers and should be paid more attention.
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Jeong HC, Bae WJ, Zhu GQ, Jeon SH, Choi SW, Kim SJ, Cho HJ, Hong SH, Lee JY, Hwang SY, Kim SW. Synergistic effects of extracorporeal shockwave therapy and modified Ojayeonjonghwan on erectile dysfunction in an animal model of diabetes. Investig Clin Urol 2019; 60:285-294. [PMID: 31294138 PMCID: PMC6607077 DOI: 10.4111/icu.2019.60.4.285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/02/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose We investigated the synergy effect of extracorporeal shock wave therapy (ESWT) with modified Ojayeonjonghwan (Korean herbal formula, KH-204) in an animal model of diabetes mellitus (DM)-induced erectile dysfunction (ED). Materials and Methods Eight-week-old male Sprague-Dawley rats were used in this study. DM was induced by an intraperitoneal injection of streptozotocin. DM rats were divided into 5 groups (n=10 per group): group 1, control; group 2, DM; group 3, DM+ESWT; group 4, DM+KH-204; and group 5, DM+ESWT+KH-204. In ESWT groups, rats were treated with ESWT at the penis 3 times a week for 2 weeks under anesthesia. The KH-204 groups were treated with a daily oral dose of KH-204 for 12 weeks. After all treatments, intracavernosal pressure (ICP) was measured, and the cavernous tissues were evaluated by Masson's trichrome, immunohistochemistry and western blot analysis. Results ICP was evaluated as a measurement of erectile function. The DM+ESWT, DM+KH-204, and DM+ESWT+KH-204 groups showed significantly restored erectile function compared with the DM group (p<0.05). Among these groups, the DM+ESWT+KH-204 group showed the highest ICP. Moreover, ESWT and KH-204 treatment restored smooth muscle contents and many parameters related to potency (vascular endothelial growth factor, neuronal nitric oxide synthase (NOS), endothelial [NOS] and platelet endothelial cell adhesion molecule-1) compared with the DM group (p<0.05). Conclusions We confirmed the potential efficacy of ESWT and KH-204 in the treatment of ED patients using an animal model. The combination treatment of KH-204 and ESWT is expected to have good potential clinical results in the future treatment of refractory ED.
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Affiliation(s)
- Hyun Cheol Jeong
- Department of Urology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Woong Jin Bae
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Guan Qun Zhu
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Hwan Jeon
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sae Woong Choi
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su Jin Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk Jin Cho
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hoo Hong
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Sae Woong Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Köktürk S, Benli E, Ayyıldız A, Cırrık S, Çetinkol Y, Ayyıldız SN, Noyan T. Positive outcomes of phosphodiesterase type 5 inhibitor on histopathologic and biochemical changes induced by ureteral obstruction. ACTA ACUST UNITED AC 2019; 65:388-393. [PMID: 30994838 DOI: 10.1590/1806-9282.65.3.388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/02/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We examined the effects of tadalafil, one of the phosphodiesterase type 5 (PDE5) inhibitors, in a rat model of with partial and complete unilateral ureteral obstruction (UUO). METHODS The rats were divided into 5 groups: sham (n=6), partial unilateral ureteral obstruction (PUUO, n=6), PUUO with tadalafil treatment (PUUO+T; Cialis, 10 mg/72 h, intragastric; Lilly, Indianapolis, Indiana, USA), complete unilateral ureteral obstruction (CUUO, n=6), and CUUO with tadalafil treatment (CUUO+T). RESULTS Fifteen days after the UUO, the ureter presented changes in the layers of urothelium and significant infiltration of inflammatory cells in the PUUO and CUUO groups. Compared with the sham, PUUO and CUUO groups had severe increased inflammatory cell infiltration. The urothelial epithelium exhibited cell degeneration and loss because of the swollen, atrophic, and denuded epithelial cells in the PUUO and CUUO groups. In the PUUO+T and CUUO+T groups, the urothelium revealed less epithelial cell degeneration and loss.The expressions of α-smooth muscle actin (α-SMA) and transforming growth factor-β (TGF-β) exhibited up-regulation in the PUUO and CUUO groups. The expression of TGF-β decreased positively correlated with that of α-SMA in the tadalafil therapy groups, PUUO+T and CUUO+T. CONCLUSION The phosphodiesterase type 5 inhibitor's tadalafil reduced expressions of α-SMA and TGF-β in the obstructed ureters, measured by biochemical examinations. In addition, tadalafil decreased urothelium degeneration due to the decreased epithelial cell loss and inflammatory cell infiltration. Our results show that tadalafil prevents or slows down the onset of ureter inflammation and urothelial degeneration in rats with UUO.
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Affiliation(s)
- Sibel Köktürk
- Department of Histology and Embryology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erdal Benli
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Ali Ayyıldız
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Selma Cırrık
- Department of Physiology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Yeliz Çetinkol
- Department of Medical Microbiology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Sema Nur Ayyıldız
- Department of Biochemistry, Ordu University Faculty of Medicine, Ordu, Turkey
| | - Tevfik Noyan
- Department of Biochemistry, Ordu University Faculty of Medicine, Ordu, Turkey
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Le TV, Tsambarlis P, Hellstrom WJG. Pharmacodynamics of the agents used for the treatment of erectile dysfunction. Expert Opin Drug Metab Toxicol 2018; 15:121-131. [DOI: 10.1080/17425255.2019.1560421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Tan V. Le
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
| | - Peter Tsambarlis
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Liao X, Qiu S, Bao Y, Wang W, Yang L, Wei Q. Comparative efficacy and safety of phosphodiesterase type 5 inhibitors for erectile dysfunction in diabetic men: a Bayesian network meta-analysis of randomized controlled trials. World J Urol 2018; 37:1061-1074. [DOI: 10.1007/s00345-018-2583-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 11/26/2018] [Indexed: 11/29/2022] Open
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Meneilly GS, Knip A, Miller DB, Sherifali D, Tessier D, Zahedi A. Diabetes in Older People. Can J Diabetes 2018; 42 Suppl 1:S283-S295. [PMID: 29650107 DOI: 10.1016/j.jcjd.2017.10.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/15/2022]
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21
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Siddiquee AAM, Adaikan PG, Lau LC, Said BB, Chong M, Chan J, Teoh SH. Endothelial colony forming cells from human umbilical cord blood improved severe erectile dysfunction in obese type II diabetic rats. Life Sci 2018; 207:272-283. [PMID: 29920249 DOI: 10.1016/j.lfs.2018.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/07/2018] [Accepted: 06/15/2018] [Indexed: 01/03/2023]
Abstract
AIM To investigate the effect of intracavernous injection of human umbilical cord blood derived endothelial colony forming cells (HUCB ECFCs) on erectile dysfunction (ED) in Zucker Diabetic Fatty (ZDF) rat model. METHODS Erectile function was assessed by cavernous nerve electrostimulation in ZDF rats aged 20-28 weeks. Following confirmation of severe ED at the age of 28 weeks, 21 ZDF rats were randomly assigned to three experimental groups: 1 million ECFCs, 2 million ECFCs, and phosphate buffered saline (PBS). Four weeks after intracavernous injection, the efficacy of ECFCs was quantified by intracavernous pressure (ICP) measurement, Masson's trichrome staining, immunohistologic and immunoblot analyses and TUNEL assay. KEY FINDINGS Intracavernous ECFC administration improved ICP in a dose-dependent manner in comparison to the age-matched PBS group. Functional improvement in ICP was accompanied by a significant restoration of the cavernosal endothelial and smooth muscle cell content and cavernosal nerve function. The percentage eNOS and nNOS positive cavernosal cells, and their respective protein expression levels and nNOS positive cells in the dorsal penile nerve in 2 million ECFCs treated groups were significantly higher than the PBS group. TUNEL stain quantification showed a significant decrease in cavernosal apoptosis following ECFC treatment. SIGNIFICANCE The results are expected to provide a scientific basis to further study the clinical application of HUCB ECFCs in ameliorating ED in human. CONCLUSIONS HUCB ECFCs significantly improved severe ED in ZDF rats through improvement of the nerve and endothelium function and restoration of smooth muscle in the cavernosum by overcoming the cavernosal apoptosis.
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Affiliation(s)
- Abrar Al-Mahmood Siddiquee
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228
| | - P Ganesan Adaikan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228.
| | - Lang Chu Lau
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228
| | - Baharudin Bin Said
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228
| | - Mark Chong
- School of Chemical & Biomedical Engineering, Nanyang Technological University, Singapore
| | - Jerry Chan
- Kandang Kerbau Women's & Children's Hospital, Singapore
| | - Swee Hin Teoh
- School of Chemical & Biomedical Engineering, Nanyang Technological University, Singapore
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Prevalence of erectile dysfunction and associated factors among diabetic men attending the diabetic clinic at Felege Hiwot Referral Hospital, Bahir Dar, North West Ethiopia, 2016. BMC Res Notes 2018; 11:130. [PMID: 29448969 PMCID: PMC5815197 DOI: 10.1186/s13104-018-3211-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/31/2018] [Indexed: 11/30/2022] Open
Abstract
Objective Even though several scholars have conducted study in different part of the world on erectile dysfunction in patients diagnosed with diabetes mellitus, it’s magnitude vary among their finding with the range between 20 and 90%. This study aimed at assessing the prevalence of erectile dysfunction and associated factors among diabetic clients. Results A cross sectional study was conducted from January 2016 to March, 2016. Systematic random sampling technique was used. Data were collected using a structured questionnaire and level of erectile dysfunction was measured using the international index of erectile function. A total of 422 diabetic patients were participated with 100% response rate. The proportion of erectile dysfunction was 85.5% and it was significantly associated with higher age (AOR: 6.46, 95% CI 2.55–16.44) and Diabetic complication (AOR: 3.97, 95% CI 1.06–17.36). Therefore, screening for ED in diabetic patients, particularly for those who are in advanced age and living with DM for more than 10 years is needed for it’s early detection, prevention and management.
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Kałka D, Gebala J, Smoliński R, Rusiecki L, Pilecki W, Zdrojowy R. Low-energy Shock Wave Therapy—A Novel Treatment Option for Erectile Dysfunction in Men With Cardiovascular Disease. Urology 2017; 109:19-26. [DOI: 10.1016/j.urology.2017.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 05/08/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
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Hackett G, Krychman M, Baldwin D, Bennett N, El-Zawahry A, Graziottin A, Lukasiewicz M, McVary K, Sato Y, Incrocci L. Coronary Heart Disease, Diabetes, and Sexuality in Men. J Sex Med 2017; 13:887-904. [PMID: 27215685 DOI: 10.1016/j.jsxm.2016.01.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 01/09/2016] [Accepted: 01/12/2016] [Indexed: 12/30/2022]
Abstract
Erectile dysfunction (ED) has been well recognized as a marker of increased cardiovascular risk for more than 15 years, especially in younger men. Early detection of ED represents an opportunity to intervene to decrease the risk of future cardiovascular events and limit the progression of ED severity. Evidence suggests there is a window of opportunity of 3 to 5 years from the onset of ED to subsequent cardiovascular events. This opportunity is usually missed if the onus is placed on the patient to seek care for his sexual problems. Unfortunately, these clear messages have not been incorporated into routine cardiovascular care. The reasons for these disparities within specialties are discussed in this article, in addition to management algorithms. Lifestyle modification is usually recommended as the first-line treatment to correct ED and lessen cardiovascular risk, but evidence suggests that this might be effective only in men without established cardiovascular comorbidities. In men with type 2 diabetes mellitus and established cardiovascular disease, lifestyle modification alone is unlikely to be effective. Cardiovascular medications are often associated with sexual dysfunction but changes in medication are more likely to be beneficial in men with milder recent-onset ED. A balanced view must be taken related to medication adverse events, taking into account optimal management of established cardiovascular disease. Testosterone deficiency has been associated with different metabolic disorders, especially metabolic syndrome and type 2 diabetes mellitus. Testosterone deficiency syndrome has been associated with an independent burden on sexual function globally and increased cardiovascular and all-cause mortality. Testosterone replacement therapy has been shown to improve multiple aspects of sexual function and, in some studies, has been associated with a decrease in mortality, especially in men with type 2 diabetes mellitus. Recent studies have suggested that phosphodiesterase type 5 inhibitors, the first-line medications to treat ED, could decrease cardiovascular and all-cause mortality, through multiple mechanisms, predominantly related to improved endothelial function.
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Affiliation(s)
| | - Michael Krychman
- Southern California Center for Sexual Health and Survivorship Medicine, Newport Beach, CA, USA
| | - David Baldwin
- Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nelson Bennett
- Department of Urology, Lahey Hospital, Burlington, MA, USA
| | - Ahmed El-Zawahry
- Division of Urology, SIU School of Medicine, Springfield, IL, USA
| | | | | | - Kevin McVary
- Division of Urology, SIU School of Medicine, Springfield, IL, USA
| | - Yoshikazu Sato
- Department of Urology, Sanjukai Hospital, Sapporo, Japan
| | - Luca Incrocci
- Erasmus MC Cancer Institute, Department of Radiation Oncology, Rotterdam, The Netherlands
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Eleazu C, Obianuju N, Eleazu K, Kalu W. The role of dietary polyphenols in the management of erectile dysfunction-Mechanisms of action. Biomed Pharmacother 2017; 88:644-652. [PMID: 28142121 DOI: 10.1016/j.biopha.2017.01.125] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 02/07/2023] Open
Abstract
The incidence of erectile dysfunction (ED) is on the increase and it is estimated that it will affect about 322 million men globally by the year 2025 if adequate measures are not taken to curb it. Natural polyphenols in plant based diets have gained public interest in recent times due to their roles in the prevention of various disease that implicate free radicals/reactive oxygen species and recently on ED. However, the role of polyphenols in the management of ED has not been explored due perhaps to limited data available. Hence this study which reviewed the role of dietary polyphenols in the management of ED and their mechanisms of action. Literature search was carried out in several electronic data bases such as Pubmed, Google Scholar, Medline, Agora and Hinari from1972 to 2016 to identify the current status of knowledge on the role of polyphenols in the management of erectile dysfunction. Progress made so far in this direction suggests inhibition of arginase, acetylcholinesterase, angiotensin converting enzyme, rho-kinase II; activation of endothelial and neuronal NO synthase; decreased synthesis of luteinizing hormone and testosterone reduction; activation of silent information regulator 2-related enzymes (sirtuin1) as well as free radical/reactive oxygen species inhibition as the mechanisms through which the polyphenols identified in this review exert beneficial roles in the management of ED.
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Affiliation(s)
- Chinedum Eleazu
- Federal University, Ndufu-Alike, Ikwo, Ebonyi State, Nigeria.
| | - Nwite Obianuju
- Federal University, Ndufu-Alike, Ikwo, Ebonyi State, Nigeria
| | - Kate Eleazu
- Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Winner Kalu
- Michael Okpara University of Agriculture, Umudike, Abia State, Nigeria
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Pharmacotherapy for Erectile Dysfunction: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med 2016; 13:465-88. [DOI: 10.1016/j.jsxm.2016.01.016] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/30/2015] [Accepted: 01/06/2016] [Indexed: 02/06/2023]
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Jepps TA, Olesen SP, Greenwood IA, Dalsgaard T. Molecular and functional characterization of Kv 7 channels in penile arteries and corpus cavernosum of healthy and metabolic syndrome rats. Br J Pharmacol 2016; 173:1478-90. [PMID: 26802314 DOI: 10.1111/bph.13444] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE KCNQ-encoded voltage-dependent potassium channels (Kv 7) are involved in the regulation of vascular tone. In this study we evaluated the influence of Kv 7 channel activation on smooth muscle relaxation in rat penile arteries and corpus cavernosum from normal and spontaneously hypertensive, heart failure-prone (SHHF) rats - a rat model of human metabolic syndrome. EXPERIMENTAL APPROACH Quantitative PCR and immunohistochemistry were used to determine the expression of KCNQ isoforms in penile tissue. Isometric tension was measured in intracavernous arterial rings and corpus cavernosum strips isolated from normal and SHHF rats. KEY RESULTS Transcripts for KCNQ3, KCNQ4 and KCNQ5 were detected in penile arteries and corpus cavernosum. KCNQ1 was only found in corpus cavernosum. Immunofluorescence signals to Kv 7.4 and Kv 7.5 were found in penile arteries, penile veins and corpus cavernosum. The Kv 7.2-7.5 activators, ML213 and BMS204352, relaxed pre-contracted penile arteries and corpus cavernosum independently of nitric oxide synthase or endothelium-derived hyperpolarization. Relaxations to sildenafil, a PDE5 inhibitor, and sodium nitroprusside (SNP), an nitric oxide donor, were reduced by blocking Kv 7 channels with linopirdine in penile arteries and corpus cavernosum. In SHHF rat penile arteries and corpus cavernosum, relaxations to ML213 and BMS204352 were attenuated, and the blocking effect of linopirdine on sildenafil-induced and SNP-induced relaxations reduced. KCNQ3, KCNQ4 and KCNQ5 were down-regulated, and KCNQ1 was up-regulated in corpus cavernosum from SHHF rats. KCNQ1-5 transcripts remained unchanged in penile arteries from SHHF rats. CONCLUSIONS AND IMPLICATIONS These data suggest that Kv 7 channels play a role in erectile function and contribute to the pathophysiology of erectile dysfunction, an early indicator of cardiovascular disease.
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Affiliation(s)
- T A Jepps
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S P Olesen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - I A Greenwood
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,The Vascular Biology Research Centre, Institute of Cardiovascular and Cell Sciences, St George's, London, UK
| | - T Dalsgaard
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Cho MC, Paick JS. A review of the efficacy and safety of mirodenafil in the management of erectile dysfunction. Ther Adv Urol 2016; 8:100-17. [PMID: 27034723 DOI: 10.1177/1756287215625408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Erectile dysfunction (ED) is a common disorder that can jeopardize quality of life and the partnership of patients and their sexual partners. The advent of oral phosphodiesterase type 5 inhibitors (PDE5Is) has revolutionized a treatment for ED, and they are recognized as the first-line therapy for ED, regardless of its etiology. Mirodenafil, a second-generation PDE5I, has biochemical profiles such as high affinity for PDE5 and high selectivity for PDE5 over other PDE isoforms, compared to other existing PDE5Is such as sildenafil, vardenafil and tadalafil. Available evidence has suggested that doses of 50 and 100 mg mirodenafil effectively improve ED [with improvements in the erectile function domain of the International Index of Erectile Function (IIEF-EF) scores, positive responses to questions 2 of the Sexual Encounter Profiles (SEP2) and questions 3 of the Sexual Encounter Profiles (SEP3): 7.6-11.6 points, 27.72-38.98% and 44.20-67.33%, respectively] in a broad range of patient populations with ED of a variety of underlying etiologies, severities and ages, without any serious treatment-related adverse effects. In the treatment of diabetic ED, a traditionally difficult-to-treat population, 100 mg mirodenafil has been reported to offer favorable efficacy (with improvements in the IIEF-EF scores, and positive responses to the SEP2 and the SEP3: 9.3 points, 36.1% and 61.8%, respectively) and tolerability (mild adverse effects of less than 19.6%), which are comparable with results from clinical studies on other PDE5Is. Mirodenafil appears to be effective, safe and well tolerated in men with both ED and hypertension or lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) who are taking concomitant antihypertensive medications or α1-blockers. Furthermore, recent evidence has indicated that mirodenafil may be a potential option for chronic dosing in the treatment of ED despite its short half-life (T 1/2). Most of the available clinical studies have reported that adverse effects (up to 53.7%) caused by 50 and 100 mg mirodenafil are mild or moderate in severity, with headache (1.8-14.8%) and flushing (6.7-24.1%) being the most common. Due to the pharmacodynamic profiles of mirodenafil, its tolerability is expected to be somewhat better than those of the other PDE5Is. However, further well designed studies with larger cohorts of different ethnicities, flexible dosing schedules and long-term follow up are necessary to confirm the favorable efficacy and tolerability profiles of mirodenafil for the treatment of ED.
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Affiliation(s)
- Min Chul Cho
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University College of Medicine, 28, Yongon-Dong, Chongno-Ku, Seoul 110-744, Korea
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Balhara YPS, Sarkar S, Gupta R. Phosphodiesterase-5 inhibitors for erectile dysfunction in patients with diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. Indian J Endocrinol Metab 2015; 19:451-461. [PMID: 26180759 PMCID: PMC4481650 DOI: 10.4103/2230-8210.159023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Patients with diabetes mellitus frequently experience erectile dysfunction. This systematic review and meta-analysis were conducted to find efficacy and tolerability of phosphodiesterase 5 (PDE5) inhibitors in patients with diabetes mellitus experiencing erectile dysfunction. METHODOLOGY Electronic searches were carried out to identify English language peer-reviewed randomized controlled trials (RCTs), which reported clinical efficacy of any PDE5 inhibitor in patients with diabetes mellitus having erectile dysfunction. Effect sizes were computed using Cohen's d, and I(2) -test was used to assess heterogeneity. Pooled mean effect sizes were computed using random-effects model. Number needed to treat (NNT), and the adverse event rates were computed. RESULTS The systematic review included a total of 17 studies yielding 25 comparisons. Three studies were open RCTs while others were double-blind RCTs. The pooled mean effect size of any PDE5 inhibitor over placebo was 0.926 (95% confidence intervals [CI]: 0.864-0.987; I(2) =26.3). The pooled mean effect size for sildenafil was 1.198 (CI: 1.039-1.357; I(2) =0), for tadalafil was 0.910 (CI: 0.838-0.981; I(2) =33.6), and for vardenafil was 0.678 (CI: 0.627-0.729; I(2) =0). In pooled analysis, the NNT for sildenafil, tadalafil, vardenafil and any PDE5 inhibitor was 2.4, 2.6, 4.1 and 3.0 respectively. The most common side effects were headache, flushing, and nasal congestion. CONCLUSIONS PDE5 inhibitors are effective and safe medications for the treatment of sexual dysfunction in patients with diabetes mellitus experiencing erectile dysfunction.
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Affiliation(s)
- Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry, Sree Balaji Medical College and Hospital (SBMCH), Chromepet, Chennai, India
| | - Rishab Gupta
- Department of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Castela A, Gomes P, Domingues VF, Paíga P, Costa R, Vendeira P, Costa C. Role of oxidative stress-induced systemic and cavernosal molecular alterations in the progression of diabetic erectile dysfunction. J Diabetes 2015; 7:393-401. [PMID: 24910190 DOI: 10.1111/1753-0407.12181] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/13/2014] [Accepted: 06/01/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Erectile dysfunction (ED) is a prevalent complication of diabetes, and oxidative stress is an important feature of diabetic ED. Oxidative stress-induced damage plays a pivotal role in the development of tissue alterations. However, the deleterious effects of oxidative stress in the corpus cavernosum with the progression of diabetes remain unclear. The aim of this study was to evaluate systemic and penile oxidative stress status in the early and late stages of diabetes. METHODS Male Wistar streptozotocin-diabetic rats (and age-matched controls) were examined 2 (early) and 8 weeks (late) after the induction of diabetes. Systemic oxidative stress was evaluated by urinary H2 O2 and the ratio of circulating reduced/oxidized glutathione (GSH/GSSG). Penile oxidative status was assessed by H2 O2 production and 3-nitrotyrosine (3-NT) formation. Cavernosal endothelial nitric oxide synthase (eNOS) was analyzed by quantitative immunohistochemistry. Dual immunofluorescence was also performed for 3-NT and α-smooth muscle actin (α-SMA) and eNOS-α-SMA. RESULTS There was a significant increase in urinary H2 O2 levels in both diabetic groups. The plasma GSH/GSSG ratio was significantly augmented in late diabetes. In cavernosal tissue, H2 O2 production was significantly increased in late diabetes. Reactivity for 3-NT was located predominantly in cavernosal smooth muscle (SM) and was significantly reduced in late diabetes. Quantitative immunohistochemistry revealed a significant decrease in eNOS levels in cavernosal SM and endothelium in late diabetes. CONCLUSIONS The findings indicate that the noxious effects of oxidative stress are more prominent in late diabetes. Increased penile protein oxidative modifications and decreased eNOS expression may be responsible for structural and/or functional deregulation, contributing to the progression of diabetes-associated ED.
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Affiliation(s)
- Angela Castela
- Department of Biochemistry (U38/FCT), Center for Medical Research, Faculty of Medicine of the University of Porto, Porto, Portugal; Institute for Molecular and Cell Biology of the University of Porto (IBMC-UP), Porto, Portugal
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Menezes A, Artham S, Lavie CJ, Milani RV, O'Keefe J. Erectile Dysfunction and Cardiovascular Disease. Postgrad Med 2015; 123:7-16. [DOI: 10.3810/pgm.2011.05.2279] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Hashish HA. Evaluation of histopathological and ultrastructural changes in the testis of tadalafil treated adult male albino rats. ACTA ACUST UNITED AC 2015. [DOI: 10.7243/2055-091x-2-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
In this chapter the role played by H2S in the physiopathology of urogenital tract revising animal and human data available in the current relevant literature is discussed. H2S pathway has been demonstrated to be involved in the mechanism underlying penile erection in human and experimental animal. Both cystathionine-β synthase (CBS) and cystathionine-γ lyase (CSE) are expressed in the human corpus cavernosum and exogenous H2S relaxes isolated human corpus cavernosum strips in an endothelium-independent manner. Hydrogen sulfide pathway also accounts for the direct vasodilatory effect operated by testosterone on isolated vessels. Convincing evidence suggests that H2S can influence the cGMP pathway by inhibiting the phosphodiesterase 5 (PDE-5) activity. All these findings taken together suggest an important role for the H2S pathway in human corpus cavernosum homeostasis. However, H2S effect is not confined to human corpus cavernosum but also plays an important role in human bladder. Human bladder expresses mainly CBS and generates in vitro detectable amount of H2S. In addition the bladder relaxant effect of the PDE-5 inhibitor sildenafil involves H2S as mediator. In conclusion the H2S pathway is not only involved in penile erection but also plays a role in bladder homeostasis. In addition the finding that it involved in the mechanism of action of PDE-5 inhibitors strongly suggests that modulation of this pathway can represent a therapeutic target for the treatment of erectile dysfunction and bladder diseases.
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Martínez-Salamanca JI, La Fuente JM, Cardoso J, Fernández A, Cuevas P, Wright HM, Angulo J. Nebivolol potentiates the efficacy of PDE5 inhibitors to relax corpus cavernosum and penile arteries from diabetic patients by enhancing the NO/cGMP pathway. J Sex Med 2014; 11:1182-92. [PMID: 24877179 DOI: 10.1111/jsm.12477] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The efficacy of oral pharmacotherapy for erectile dysfunction (ED) (i.e., type 5 phosphodiesterase[PDE5] inhibitors) is significantly reduced in diabetic patients. Nebivolol is a selective β1-blocker used for treatinghy pertension that has been shown to increase the efficacy of sildenafil to reverse ED in diabetic rats. AIM To evaluate the effects of nebivolol on the efficacy of the PDE5 inhibitors, sildenafil, tadalafil, and vardenafil to relax human corpus cavernosum (HCC) and vasodilate human penile resistance arteries (HPRA) from diabetic patients with ED (DMED). The influence of nebivolol on the capacity of these three PDE5 inhibitors to stimulate cyclic guanosine monophosphate (cGMP) production in HCC was also evaluated. METHODS HCC and HPRA were obtained from organ donors without ED (NEND; n = 18) or patients with diabetes undergoing penile prosthesis implantation (DMED; n = 19). Relaxations of HCC strips and HPRA to sildenafil,tadalafil, and vardenafil were evaluated in organ chambers and wire myographs. cGMP content in HCC was determined by ether extraction and quantification by ELISA. MAIN OUTCOME MEASURES Effects of nebivolol on PDE5 inhibitor-induced relaxation of HCC, vasodilation ofHPRA and cGMP accumulation in HCC. RESULTS Treatment with nebivolol (1 μM) significantly potentiated sildenafil-, tadalafil- and vardenafil-induced relaxations of HCC and vasodilations of HPRA from both NEND and DMED. Enhancement of relaxant capacity by nebivolol resulted in reversion of the impairment of PDE5 inhibition-induced responses in DMED and it was accompanied by enhancing the ability of PDE5 inhibitors to increase cGMP in HCC restoring reduced cGMP levelsin HCC from DMED. CONCLUSIONS Nebivolol potentiated the capacity of PDE5 inhibitors to relax vascular structures of erectile tissue from diabetic patients by enhancing the nitric oxide (NO)/cGMP pathway in these tissues. These effects suggest a potential therapeutic utility of nebivolol as an adjunct to PDE5 inhibitors for the treatment of ED associated with diabetes.
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Abstract
Erectile dysfunction (ED) is often perceived by both patients and sexual partners as a serious problem that can jeopardize quality of life, psychosocial or emotional well-being, and the partnership in the long term. Since their introduction, oral phosphodiesterase type 5 inhibitors (PDE5Is) have been found to be highly effective and well tolerated, and are available as the first-line therapy for the treatment of ED. Udenafil is one of the selective PDE5Is made available in recent years for the treatment of ED. Udenafil has clinical properties of both relatively rapid onset and long duration of action due to its pharmacokinetic profile, thereby providing an additional treatment option for ED men to better suit individual needs. There is positive evidence that udenafil is effective and well tolerated in the treatment of ED of a broad spectrum of etiologies or severity. Udenafil is as effective in the treatment of diabetes mellitus-associated ED as other PDE5Is. Due to the clinical property of relatively long duration of action, udenafil may be another option in daily dosing treatment for ED, as suggested by its favorable efficacy and safety profile. Most adverse effects reported from clinical trials are mild or moderate in severity, without any serious adverse event, with headache and flushing being the most common. Also, the concomitant use of anti-hypertensive drugs or alpha-1-blockers does not significantly affect the efficacy and safety profile of udenafil. However, additional studies with larger cohorts including prospective, multicenter, comparative studies with patients of different ethnicities are needed to further validate the favorable findings of udenafil in the treatment of ED.
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Affiliation(s)
- Min Chul Cho
- Department of Urology, Dongguk University College of Medicine, Goyang, Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Abstract
We aimed to summarize the etiology, clinical characteristics, diagnosis, and possible treatment options of sexual dysfunction in diabetic patients of both sexes. Details of dysfunction in diabetic women are less conclusive than in men due to the lack of standardized evaluation of sexual function in women. Male sexual dysfunction is a common complication of diabetes, including abnormalities of orgasmic/ejaculatory function and desire/libido in addition to penile erection. The prevalence of erectile dysfunction (ED) among diabetic men varies from 35% to 75%. Diabetes-induced ED has a multifactorial etiology including metabolic, neurologic, vascular, hormonal, and psychological components. ED should be regarded as the first sign of cardiovascular disease because it can be present before development of symptomatic coronary artery disease, as larger coronary vessels better tolerate the same amount of plaque compared to smaller penile arteries. The diagnosis of ED is based on validated questionnaires and determination of functional and organic abnormalities. First-, second- and third-line therapy may be applied. Phosphodiesterase-5 (PDE-5) inhibitor treatment from the first-line options leads to smooth muscle relaxation in the corpus cavernosum and enhancement in blood flow, resulting in erection during sexual stimulus. The use of PDE-5 inhibitors in the presence of oral nitrates is strictly contraindicated in diabetic men, as in nondiabetic subjects. All PDE-5 inhibitors have been evaluated for ED in diabetic patients with convincing efficacy data. Second-line therapy includes intracavernosal, trans- or intraurethral administration of vasoactive drugs or application of a vacuum device. Third-line therapies are the implantation of penile prosthesis and penile revascularization.
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Affiliation(s)
- Várkonyi Tamás
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary.
| | - Peter Kempler
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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Abstract
Diabetes mellitus is one of the most common chronic diseases in nearly all countries. It has been associated with sexual dysfunction, both in males and in females. Diabetes is an established risk factor for sexual dysfunction in men, as a threefold increased risk of erectile dysfunction was documented in diabetic men, as compared with nondiabetic men. Among women, evidence regarding the association between diabetes and sexual dysfunction are less conclusive, although most studies have reported a higher prevalence of female sexual dysfunction in diabetic women as compared with nondiabetic women. Female sexual function appears to be more related to social and psychological components than to the physiological consequence of diabetes. Hyperglycemia, which is a main determinant of vascular and microvascular diabetic complications, may participate in the pathogenetic mechanisms of sexual dysfunction in diabetes. Moreover, diabetic people may present several clinical conditions, including hypertension, overweight and obesity, metabolic syndrome, cigarette smoking, and atherogenic dyslipidemia, which are themselves risk factors for sexual dysfunction, both in men and in women. The adoption of healthy lifestyles may reduce insulin resistance, endothelial dysfunction, and oxidative stress - all of which are desirable achievements in diabetic patients. Improved well-being may further contribute to reduce and prevent sexual dysfunction in both sexes.
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Affiliation(s)
- Maria Ida Maiorino
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Giuseppe Bellastella
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
- Correspondence: Katherine Esposito, Endocrinology and Metabolic Diseases Unit, University Hospital at Second University of Naples, Piazza L Miraglia no 2, 80138 Napoli, Italy, Tel +39 081 566 5031, Fax +39 081 566 5054, Email
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Lee JW, Park HJ, Park NC. Serum High-Sensitivity C-Reactive Protein Levels and Response to 5 mg Tadalafil Once Daily in Patients With Erectile Dysfunction and Diabetes. Korean J Urol 2013; 54:858-64. [PMID: 24363868 PMCID: PMC3866290 DOI: 10.4111/kju.2013.54.12.858] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 08/10/2013] [Indexed: 11/22/2022] Open
Abstract
Purpose We studied the relative importance of high-sensitivity C-reactive protein (hs-CRP) concentrations in patients with erectile dysfunction (ED) and diabetes and determined whether the hs-CRP level predicts the response to treatment with 5 mg tadalafil once daily. Materials and Methods We enrolled 102 men (aged 40-60 years) with diabetes and ED. All patients completed the International Index of Erectile Function (IIEF) questionnaire and were given 5 mg tadalafil daily. The IIEF and serum hs-CRP levels in patients and healthy controls and in patient responders and nonresponders to 5 mg tadalafil once daily were compared. Results Median age was 53.2 years (range, 45 to 62 years) in patients and 55.6 years (range, 47 to 64 years) in healthy controls (p=0.158). The median duration of diabetes was 54.3 months (range, 34 to 70 months). The median IIEF and hs-CRP level were 12.1 (range, 5 to 20) and 0.21 mg/dL (range, 0.05 to 0.6 mg/dL) in patients and 28.2 (range, 13 to 31) and 0.09 mg/dL (range, 0.04 to 0.2 mg/dL) in the controls, respectively (pIIEF=0.000, pCRP=0.031). After tadalafil treatment, 71 patients (69.6%) achieved an erection sufficient for sexual intercourse, whereas 31 (30.4%) did not. The median age of the tadalafil nonresponders was 56.2 years (range, 45 to 64 years) and that of the responders was 51.3 years (range, 42 to 62 years; p=0.065). Median hs-CRP levels were 0.31 mg/dL (range, 0.18 to 0.62 mg/dL) in nonresponders and 0.14 mg/dL (range, 0.09 to 0.4 mg/dL) in responders, respectively (p=0.028). Conclusions Serum hs-CRP was significantly higher in patients with ED and diabetes mellitus than in patients without ED. A significant correlation was observed between serum hs-CRP levels, the degree of ED, and responsiveness to tadalafil.
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Affiliation(s)
- Jung Woo Lee
- Department of Urology, Pusan National University Hospital, Medical Research Institute, Pusan National University School of Medicine, Busan, Korea
| | - Hyun Jun Park
- Department of Urology, Pusan National University Hospital, Medical Research Institute, Pusan National University School of Medicine, Busan, Korea
| | - Nam Cheol Park
- Department of Urology, Pusan National University Hospital, Medical Research Institute, Pusan National University School of Medicine, Busan, Korea
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Dysfonction érectile. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.03.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Diabetes mellitus (DM) is an increasingly prevalent public health concern. A recent study projected the number of people worldwide with DM to increase from 171 million in 2000 to 366 million in 2030. Although DM is a systemic disease that often leads to end-organ dysfunction of multiple body systems, the effects of the condition on male fertility are often not fully appreciated. DM is associated with multiple risk factors for reduced male fertility potential, including erectile dysfunction, various manifestations of ejaculatory dysfunction, and hypogonadism.
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Affiliation(s)
- Geoffrey Gaunay
- Sol and Margaret Berger Department of Urology, Beth Israel Medical Center, Phillips Ambulatory Care Center, 10 Union Square Suite 3A, New York, NY 10003, USA
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Meneilly GS, Knip A, Tessier D. Le diabète chez les personnes âgées. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Brock G, Harper W. Dysfonction érectile. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ferguson JE, Carson CC. Phosphodiesterase type 5 inhibitors as a treatment for erectile dysfunction: Current information and new horizons. Arab J Urol 2013; 11:222-9. [PMID: 26558086 PMCID: PMC4443003 DOI: 10.1016/j.aju.2013.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 07/28/2013] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Over the past 15 years, the discovery and development of oral medications that selectively inhibit the enzyme phosphodiesterase type 5 (PDE5) have revolutionised the treatment of erectile dysfunction (ED). Currently, three PDE5 inhibitors are widely available clinically, i.e., sildenafil, vardenafil and tadalafil. New PDE5 inhibitors, including avanafil and udenafil, are now in clinical use in a few countries, and other compounds are under development. METHODS We describe the current use and future direction of PDE5 inhibitors in the treatment of ED. RESULTS AND CONCLUSION Each PDE5 inhibitor has an excellent and comparable efficacy and tolerability. These drugs are highly effective for ED of various causes, and are effective in preventing ED after radical prostatectomy. However, whilst being at least 60% effective, PDE5 inhibitors are still ineffective in at least 30% of patients, prompting current research into other pharmacological targets for ED.
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Key Words
- Cmax, maximum serum concentration
- ED, erectile dysfunction
- Erectile dysfunction
- FDA, USA Food and Drug Administration
- GTP, guanosine triphosphate
- IIEF, International Index of Erectile Function
- NO, nitric oxide
- PDE5(i), phosphodiesterase type 5 (inhibitors)
- Penile disorders
- Phosphodiesterase type 5 inhibitors
- RCT, randomised controlled trial
- SHIM, Sexual Health Inventory in Men
- Tmax, time to Cmax
- cGMP, cyclic guanosine monophosphate
- sGC, soluble guanylyl cyclase
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Affiliation(s)
- James E. Ferguson
- Division of Urology, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
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Ryu JK, Cho KS, Kim SJ, Oh KJ, Kam SC, Seo KK, Shin HS, Kim SW. Korean Society for Sexual Medicine and Andrology (KSSMA) Guideline on Erectile Dysfunction. World J Mens Health 2013; 31:83-102. [PMID: 24044105 PMCID: PMC3770856 DOI: 10.5534/wjmh.2013.31.2.83] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/20/2013] [Accepted: 06/04/2013] [Indexed: 11/20/2022] Open
Abstract
In February 2011, the Korean Society for Sexual Medicine and Andrology (KSSMA) realized the necessity of developing a guideline on erectile dysfunction (ED) appropriate for the local context, and established a committee for the development of a guideline on ED. As many international guidelines based on objective evidence are available, the committee decided to adapt these guidelines for local needs instead of developing a new guideline. Considering the extensive research activities on ED in Korea, data with a high level of evidence among those reported by Korean researchers have been collected and included in the guideline development process. The latest KSSMA guideline on ED has been developed for urologists. The KSSMA hopes that this guideline will help urologists in clinical practice.
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Affiliation(s)
- Ji Kan Ryu
- Department of Urology, Inha University School of Medicine, Incheon, Korea
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Kayiran O, Cuzdan SS, Uysal A, Kocer U. Tadalafil significantly reduces ischemia reperfusion injury in skin island flaps. Indian J Plast Surg 2013; 46:75-81. [PMID: 23960309 PMCID: PMC3745126 DOI: 10.4103/0970-0358.113714] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Introduction: Numerous pharmacological agents have been used to enhance the viability of flaps. Ischemia reperfusion (I/R) injury is an unwanted, sometimes devastating complication in reconstructive microsurgery. Tadalafil, a specific inhibitor of phosphodiesterase type 5 is mainly used for erectile dysfunction, and acts on vascular smooth muscles, platelets and leukocytes. Herein, the protective and therapeutical effect of tadalafil in I/R injury in rat skin flap model is evaluated. Materials and Methods: Sixty epigastric island flaps were used to create I/R model in 60 Wistar rats (non-ischemic group, ischemic group, medication group). Biochemical markers including total nitrite, malondialdehyde (MDA) and myeloperoxidase (MPO) were analysed. Necrosis rates were calculated and histopathologic evaluation was carried out. Results: MDA, MPO and total nitrite values were found elevated in the ischemic group, however there was an evident drop in the medication group. Histological results revealed that early inflammatory findings (oedema, neutrophil infiltration, necrosis rate) were observed lower with tadalafil administration. Moreover, statistical significance (P < 0.05) was recorded. Conclusions: We conclude that tadalafil has beneficial effects on epigastric island flaps against I/R injury.
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Affiliation(s)
- Oguz Kayiran
- Department of Plastic and Reconstructive Surgery Clinic, Izmir Ekol KBB Hospital, Ankara, Turkey
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Porst H, Burnett A, Brock G, Ghanem H, Giuliano F, Glina S, Hellstrom W, Martin-Morales A, Salonia A, Sharlip I. SOP conservative (medical and mechanical) treatment of erectile dysfunction. J Sex Med 2013; 10:130-71. [PMID: 23343170 DOI: 10.1111/jsm.12023] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is the most frequently treated male sexual dysfunction worldwide. ED is a chronic condition that exerts a negative impact on male self-esteem and nearly all life domains including interpersonal, family, and business relationships. AIM The aim of this study is to provide an updated overview on currently used and available conservative treatment options for ED with a special focus on their efficacy, tolerability, safety, merits, and limitations including the role of combination therapies for monotherapy failures. METHODS The methods used were PubMed and MEDLINE searches using the following keywords: ED, phosphodiesterase type 5 (PDE5) inhibitors, oral drug therapy, intracavernosal injection therapy, transurethral therapy, topical therapy, and vacuum-erection therapy/constriction devices. Additionally, expert opinions by the authors of this article are included. RESULTS Level 1 evidence exists that changes in sedentary lifestyle with weight loss and optimal treatment of concomitant diseases/risk factors (e.g., diabetes, hypertension, and dyslipidemia) can either improve ED or add to the efficacy of ED-specific therapies, e.g., PDE5 inhibitors. Level 1 evidence also exists that treatment of hypogonadism with total testosterone < 300 ng/dL (10.4 nmol/L) can either improve ED or add to the efficacy of PDE5 inhibitors. There is level 1 evidence regarding the efficacy and safety of the following monotherapies in a spectrum-wide range of ED populations: PDE5 inhibitors, intracavernosal injection therapy with prostaglandin E1 (PGE1, synonymous alprostadil) or vasoactive intestinal peptide (VIP)/phentolamine, and transurethral PGE1 therapy. There is level 2 evidence regarding the efficacy and safety of the following ED treatments: vacuum-erection therapy in a wide range of ED populations, oral L-arginine (3-5 g), topical PGE1 in special ED populations, intracavernosal injection therapy with papaverine/phentolamine (bimix), or papaverine/phentolamine/PGE1 (trimix) combination mixtures. There is level 3 evidence regarding the efficacy and safety of oral yohimbine in nonorganic ED. There is level 3 evidence that combination therapies of PDE5 inhibitors + either transurethral or intracavernosal injection therapy generate better efficacy rates than either monotherapy alone. There is level 4 evidence showing enhanced efficacy with the combination of vacuum-erection therapy + either PDE5 inhibitor or transurethral PGE1 or intracavernosal injection therapy. There is level 5 evidence (expert opinion) that combination therapy of PDE5 inhibitors + L-arginine or daily dosing of tadalafil + short-acting PDE5 inhibitors pro re nata may rescue PDE5 inhibitor monotherapy failures. There is level 5 evidence (expert opinion) that adding either PDE5 inhibitors or transurethral PGE1 may improve outcome of penile prosthetic surgery regarding soft (cold) glans syndrome. There is level 5 evidence (expert opinion) that the combination of PDE5 inhibitors and dapoxetine is effective and safe in patients suffering from both ED and premature ejaculation.
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Affiliation(s)
- Hartmut Porst
- Private Urological/Andrological Practice, Hamburg, Germany.
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Kalsi J, Muneer A. Erectile dysfunction - an update of current practice and future strategies. JOURNAL OF CLINICAL UROLOGY 2013; 6:210-219. [PMID: 26097710 PMCID: PMC4467226 DOI: 10.1177/2051415813491862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jas Kalsi
- Department of Urology, Wexham Park Hospital, UK
| | - Asif Muneer
- Department of Andrology, University College London Hospital, UK
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Erectile Dysfunction. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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González-Corrochano R, La Fuente J, Cuevas P, Fernández A, Chen M, Sáenz de Tejada I, Angulo J. Ca2+ -activated K+ channel (KCa) stimulation improves relaxant capacity of PDE5 inhibitors in human penile arteries and recovers the reduced efficacy of PDE5 inhibition in diabetic erectile dysfunction. Br J Pharmacol 2013; 169:449-61. [PMID: 23441682 PMCID: PMC3651669 DOI: 10.1111/bph.12143] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/31/2013] [Accepted: 02/17/2013] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND PURPOSE We have evaluated the influence of calcium-activated potassium channels (KCa ) activation on cGMP-mediated relaxation in human penile tissues from non-diabetic and diabetic patients, and on the effects of PDE5 inhibitors on erectile responses in control and diabetic rats. EXPERIMENTAL APPROACH Cavernosal tissues were collected from organ donors and from patients with erectile dysfunction (ED). Relaxations of corpus cavernosum strips (HCC) and penile resistance arteries (HPRA) obtained from these specimens were evaluated. Intracavernosal pressure (ICP) increases to cavernosal nerve electrical stimulation were determined in anaesthetized diabetic and non-diabetic rats. KEY RESULTS Concentration-dependent vasodilation to the PDE5 inhibitor, sildenafil, in HPRA was sensitive to endothelium removal, NO/cGMP pathway inhibition and KCa blockade. Accordingly, activation of KCa with NS-8 (10 μM) significantly potentiated sildenafil-induced relaxations in HPRA (EC50 0.49 ± 0.22 vs. 5.21 ± 0.63 μM). In HCC, sildenafil-induced relaxation was unaffected by KCa blockade or activation. Potentiating effects in HPRA were reproduced with an alternative PDE5 inhibitor (tadalafil) and KCa activator (NS1619) and prevented by removing the endothelium. Large-conductance KCa (BK) and intermediate-conductance KCa (IK) contribute to NS-8-induced effects and were immunodetected in human and rat penile arteries. NS-8 potentiated sildenafil-induced enhancement of erectile responses in rats. Activation of KCa recovered the impaired relaxation to sildenafil in diabetic HPRA while sildenafil completely reversed diabetes-induced ED in rats only when combined with KCa activation. CONCLUSIONS AND IMPLICATIONS Activation of KCa improves vasodilatory capacity of PDE5 inhibitors in diabetic and non-diabetic HPRA, resulting in the recovery of erectile function in diabetic rats. These results suggest a therapeutic potential for KCa activation in diabetic ED.
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Affiliation(s)
- R González-Corrochano
- Servicio de Histología-Investigación, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Madrid, Spain
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