Association of type and duration of diabetes with erectile dysfunction in a large cohort of men

Does Diabetes Have a Negative Impact on Erectile Function Recovery After Radical Prostatectomy?

OBJECTIVE

To quantify the risk of long-term post-radical prostatectomy (RP) erectile dysfunction (ED) in men with diabetes mellitus (DM).

METHODS

We included men who underwent RP and were followed for ≥24 months at our institution; men were excluded if they received androgen deprivation therapy or radiation therapy. Erectile function recovery (EFR) was assessed using the International Index of Erectile Function (IIEF) Erectile Function Domain (EFD) score pre-RP and serially during follow-up. We performed logistic regression analysis to investigate a potential association between erectile function 24 months post-RP.

RESULTS

Of 2261 men included, 8% were diabetic. Men in the diabetic group tended to present with more vascular comorbidities. For men with DM, the median time from diagnosis was 4 years pre-RP, and the median hemoglobin A1c pre-RP was 6.7%. After 24 months post-RP, EFR was significantly lower among the diabetic group. The median EFD was 7. Men with DM had a lower proportion of functional EFR (17%) and a greater proportion of severe ED (57%). In the univariable logistic regression model to analyze DM diagnosis was a significant predictor of functional EFR (OR 0.43, P <.001) and severe ED (OR 1.85, P <.001) 24 months post-RP. Furthermore, this was not observed for a multivariable analysis.

CONCLUSION

Twenty-four months after RP, EFR is compromised in individuals with DM.

Cardiometabolic Disorder and Erectile Dysfunction

Erectile dysfunction (ED), which is defined as the inability to attain and maintain a satisfactory penile erection to sufficiently permit sexual intercourse, is a consequence and also a cause of cardiometabolic disorders like diabetes mellitus, systemic hypertension, central obesity, and dyslipidemia. Although there are mounting and convincing pieces of evidence in the literature linking ED and cardiometabolic disorders, impairment of nitric oxide-dependent vasodilatation seems to be the primary signaling pathway. Studies have also implicated the suppression of circulating testosterone, increased endothelin-1, and hyperactivation of Ang II/ATIr in the pathogenesis of ED and cardiometabolic disorders. This study provides comprehensive details of the association between cardiometabolic disorders and ED and highlights the mechanisms involved. This would open areas to be explored as therapeutic targets in the management of ED and cardiometabolic disorders. It also provides sufficient evidence establishing the need for the management of cardiometabolic disorders as an adjunct therapy in the management of ED.

Global prevalence of erectile dysfunction and its associated risk factors among men with type 1 diabetes: a systematic review and meta-analysis

Various observational studies have examined the prevalence and determinants of erectile dysfunction (ED) in men with type 1 diabetes across different geographical areas. Nevertheless, a comprehensive systematic review and meta-analysis to consolidate the worldwide prevalence and risk factors remains lacking. Hence, the primary study objective was to perform an extensive systematic review and meta-analysis that specifically examined ED prevalence and determinants in men with type 1 diabetes. A thorough exploration was conducted by examining electronic databases, such as PubMed, Embase, and Web of Science. The general ED prevalence and a 95% confidence interval (CI) in men with type 1 diabetes were summarized. The relevant risk factors were analyzed by deriving a comprehensive odds ratio (OR) from merging the ORs using fixed- or random-effects models. The sources of heterogeneity were investigated using subgroup analyses and meta-regression. This systematic review and meta-analysis included 19 articles involving 3788 men with type 1 diabetes. The meta-analysis revealed that men with type 1 diabetes had a combined ED prevalence of 42.5% (95% CI: 34.3%-50.8%). This prevalence showed significant heterogeneity (I2 = 96.2%, P < 0.01). Meta-regression revealed that age (P = 0.016) and type 1 diabetes duration (P = 0.004) were significant causes of heterogeneity. Furthermore, the ED risk in men with type 1 diabetes was significantly influenced by age, type 1 diabetes duration, body mass index, glycated hemoglobin (HbA1c), retinopathy, and smoking habits (all P < 0.05). In summary, this systematic review and meta-analysis revealed a significant prevalence of ED in men with type 1 diabetes, highlighting the importance of clinicians addressing concerns regarding ED in this specific group of individuals.

The Effects of a Red-Light Controllable Nitric Oxide Donor, NORD-1, on Erectile Dysfunction in Rats with Streptozotocin Induced Diabetes Mellitus

PURPOSE

Patients with diabetes mellitus (DM) often exhibit refractory erectile dysfunction (ED). Red-light-controllable nitric oxide donor (NORD-1) and red-light irradiation have successfully enhanced erectile function in intact rats. In this study, we investigated whether the combination of NORD-1 and red-light irradiation effectively treated ED in streptozotocin (STZ)-treated rats with DM.

MATERIALS AND METHODS

Seven-week-old male Sprague-Dawley rats were used in this study. Rats in the DM and sham groups received intravenous STZ (50 mg/kg) and saline, respectively. One week after treatment, the blood glucose level of rats in the DM group was >250 mg/dL. Five weeks after the treatment, we performed a functional study by measuring intracavernous pressure (ICP) under cavernous nerve stimulation before and after NORD-1 treatment with and without light irradiation. Additionally, we performed an isometric tension study using the corpus cavernosum of rats treated with NORD-1 or the control compound, SiR650.

RESULTS

The ICP/mean arterial pressure (MAP) ratio was significantly lower in the DM group than in the sham group before and after NORD-1 treatment without light irradiation (both p<0.05). After NORD-1 treatment with light irradiation, the ICP/MAP ratio in the sham and DM groups was significantly enhanced than before and after NORD-1 treatment without light irradiation (all p<0.05). The ICP/MAP ratio in the DM group after NORD-1 with light irradiation was similar to that in the sham group under normal conditions before NORD-1 treatment. Moreover, the systemic blood pressure was not affected by NORD-1 or light irradiation. In the tension study, the corpus cavernosum of rats treated with SiR650 was not changed by red light in the sham or DM groups. However, the rats treated with NORD-1 were strongly relaxed by red light in both groups.

CONCLUSIONS

NORD-1 and red-light irradiation could improve ED in the presence of DM without lowering blood pressure.

Risk factors for erectile dysfunction in diabetes mellitus: a systematic review and meta-analysis

Background

Previous studies have established that diabetes mellitus (DM) markedly raises the risk of developing erectile dysfunction (ED). Despite extensive investigations, the risk factors associated with ED in diabetic men have yet to be unequivocally determined, owing to incongruent and inconclusive results reported in various studies.

Objective

The objective of this systematic review and meta-analysis was to assess the risk factors for ED in men with DM.

Methods

A comprehensive systematic review was conducted, encompassing studies published in the PubMed, Scopus and Embase databases up to August 24th, 2023. All studies examining the risk factors of ED in patients with DM were included in the analysis. To identify significant variations among the risk factors, odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were employed. The risk of bias was evaluated using the Newcastle-Ottawa Scale(NOS) for longitudinal studies and the Agency for Healthcare Research and Quality Scale(AHRQ) for cross-sectional studies.

Results

A total of 58 studies, including a substantial participant pool of 66,925 individuals diagnosed with DM, both with or without ED, were included in the meta-analysis. Mean age (OR: 1.31, 95% CI=1.24-1.37), smoking status (OR: 1.32, 95% CI=1.18-1.47), HbA1C (OR: 1.44, 95% CI=1.28-1.62), duration of DM (OR: 1.39, 95% CI=1.29-1.50), diabetic neuropathy (OR: 3.47, 95% CI=2.16-5.56), diabetic retinopathy (OR: 3.01, 95% CI=2.02-4.48), diabetic foot (OR: 3.96, 95% CI=2.87-5.47), cardiovascular disease (OR: 1.92, 95% CI=1.71-2.16), hypertension (OR: 1.74, 95% CI=1.52-2.00), microvascular disease (OR: 2.14, 95% CI=1.61-2.85), vascular disease (OR: 2.75, 95% CI=2.35-3.21), nephropathy (OR: 2.67, 95% CI=2.06-3.46), depression (OR: 1.82, 95% CI=1.04-3.20), metabolic syndrome (OR: 2.22, 95% CI=1.98-2.49), and diuretic treatment (OR: 2.42, 95% CI=1.38-4.22) were associated with increased risk factors of ED in men with DM.

Conclusion

Our study indicates that in men with DM, several risk factors for ED have been identified, including mean age, HbA1C, duration of DM, diabetic neuropathy, diabetic retinopathy, diabetic foot, cardiovascular disease, hypertension, microvascular disease, vascular disease, nephropathy, depression, metabolic syndrome, and diuretic treatment. By clarifying the connection between these risk factors and ED, clinicians and scientific experts can intervene and address these risk factors, ultimately reducing the occurrence of ED and improving patient management.

Efficacy of adipose-derived mesenchymal stem cell therapy in the treatment of chronic micro- and macrovascular complications of diabetes

Diabetes mellitus is a highly prevalent disease characterized by hyperglycaemia that damages the vascular system, leading to micro- (retinopathy, neuropathy, nephropathy) and macrovascular diseases (cardiovascular disease). There are also secondary complications of diabetes (cardiomyopathy, erectile dysfunction or diabetic foot ulcers). Stem cell-based therapies have become a promising tool targeting diabetes symptoms and its chronic complications. Among all stem cells, adipose-derived mesenchymal stem cells (ADMSCs) are of great importance because of their abundance, non-invasive isolation and no ethical limitations. Characteristics that make ADMSCs good candidates for cell-based therapy are their wide immunomodulatory properties and paracrine activities through the secretion of an array of growth factors, chemokines, cytokines, angiogenic factors and anti-apoptotic molecules. Besides, after transplantation, ADMSCs show great ex vivo expansion capacity and differentiation to other cell types, including insulin-producing cells, cardiomyocytes, chondrocytes, hepatocyte-like cells, neurons, endothelial cells, photoreceptor-like cells, or astrocytes. Preclinical studies have shown that ADMSC-based therapy effectively improved visual acuity, ameliorated polyneuropathy and foot ulceration, arrested the development and progression of diabetic kidney disease, or alleviated the diabetes-induced cardiomyocyte hypertrophy. However, despite the positive results obtained in animal models, there are still several challenges that need to be overcome before the results of preclinical studies can be translated into clinical applications. To date, there are several clinical trials or ongoing trials using ADMSCs in the treatment of diabetic complications, most of them in the treatment of diabetic foot ulcers. This narrative review summarizes the most recent outcomes on the usage of ADMSCs in the treatment of long-term complications of diabetes in both animal models and clinical trials.

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

Backgrounds

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

Objective

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

Methods

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

Results

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

Conclusion

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

Comparison of Risk Factors for Erectile Dysfunction (ED) in Type 2 Diabetics and Nondiabetics: A Retrospective Observational Study

BACKGROUND AND AIMS

We aim to compare the various risk factors for erectile dysfunction (ED) in type 2 diabetes mellitus (DM) and nondiabetic patients.

MATERIALS AND METHODS

We retrospectively collected and evaluated the data of 175 OPD patients with ED. We included 138 patients of ED from endocrinology and urology OPD after exclusion. ED was assessed by using a questionnaire adapted from the abridged five-item version of the International Index of Erectile Function (IIEF-5) score.

RESULTS

A total of 96 (69.56%) were diabetic, and 42 (30.43%) were nondiabetic. The majority of patients (62.31 %) were in the age group of 40-60 years. Thirty-nine (28.26%) were alcoholics, and 55 (40%) were smokers. The average duration of diabetes was 6.6±1.5 years. Hypertension was present in 49 (35.5%). Diabetic patients were significantly older (47.9±8.2 vs. 40.2±7.6 years, p=0.0001) and obese (BMI (kg/m2), 27.3±5.4 vs. 24.6±3.9, p=0.004). Waist circumference in diabetics was 95.3±10.9, as compared to nondiabetics, which was 89.6±9.2 cm (p=0.0037). The IIEF-5 score was significantly lower in diabetic subjects in comparison to nondiabetics (9.4±3.2 vs. 12.1±3.6 p=0.0001). Moderate-to-severe ED was more common in diabetic patients (76%) in comparison to nondiabetics (59.5%). The prevalence of mild and mild-to-moderate ED was 11.45 % and 12.5 % in diabetic patients in comparison to 16.7% and 23.5% in nondiabetics, respectively. The prevalence of hypertension and coronary artery was higher in diabetics in comparison with nondiabetics. Hypertension was significantly higher in diabetic patients with ED (42.7% vs. 19.04%, p=0.0075), but coronary artery disease was not statistically significant (8.3% vs. 2.3%, p=0.1925). LH (2.6±0.7 vs. 3.5±0, p=0.0001) and testosterone (312.1±110.7 vs. 367.8±115.1, p=0.0081) were significantly lower in diabetics in comparison to nondiabetics.

CONCLUSIONS

The IIEF-5 score was lower in diabetic cases as compared to those without diabetes. The factors that significantly contributed to ED in type 2 DM patients, as compared to nondiabetic patients, were age, BMI, waist circumference, hypertension, poor glycemic control, LH, and testosterone levels.

Erectile dysfunction associated with undiagnosed prediabetes and type 2 diabetes in young adult males: A retrospective cohort study

Erectile dysfunction (ED) is a common comorbidity in type 2 diabetes (T2D). ED has been studied as an outcome in diabetes, but it is not known if ED is a risk factor for T2D. We determined if patients with ED have an increased risk for prediabetes and/or T2D and measured the duration between ED and prediabetes/T2D diagnosis. Retrospective cohort study using de-identified medical record data from a large mid-western health care system to measure ED, T2D and potential confounding factors. Patients were 18 to 40 years of age because we were interested in early onset pre-diabetes/T2D. Eligible patients had ED and were free of prediabetes, hyperglycemia and T2D at index. Entropy balancing controlled for confounding. Modified Poisson regression models with robust error variances calculated relative risk (RR) and 95% confidence intervals for the association of ED and pre-diabetes/T2D. Patients' mean age was 28.3 (±7.0) years, 81.7% were White and 14.0% were Black. After controlling for confounding, ED was associated with increased risk for prediabetes/T2D (RR = 1.34; 95%CI:1.16-1.55). This association was similar to that between ED and T2D alone (RR = 1.38; 95% CI: 1.10-1.74). About 30% had ED and prediabetes/T2D diagnosed on the same day and nearly 75% were diagnosed within a year of ED. ED is a marker for undiagnosed prediabetes/T2D and a risk factor for near term onset of prediabetes/T2D. ED may offer the opportunity for earlier detection and diagnoses of T2D, particularly in younger men. Younger patients presenting with ED should be screened for hyperglycemia.

Gaps in the management of diabetes in Asia: A need for improved awareness and strategies in men's sexual health

Sexual dysfunction, which is defined as 'difficulty during any stage of the sexual encounter that prevents or impairs the individual or couple from enjoying sexual activity', is globally prevalent in males with prediabetes and diabetes. It is an early harbinger of cardiovascular diseases and has a profound impact on one's physical, mental, and social health. Among patients with either prediabetes or diabetes, the most common male sexual dysfunctions are hypogonadism, erectile dysfunction, and premature ejaculation. In Asia, although sexual health is an important factor of men's health, it is rarely discussed freely in real-life practice. Addressing sexual health in Asian males has always been challenging with multiple barriers at the levels of patients and health care providers. Therefore, the assessment and management of sexual dysfunction in routine clinical practice should involve a holistic approach with effective patient-provider communication. In this review, we discuss the epidemiology, pathophysiology, and the management of hypogonadism, erectile dysfunction, and premature ejaculation among males with either prediabetes or diabetes (type 1 and type 2), as well as the evidence gaps across Asia.

Urologic complications in diabetes

Urologic complications such as bladder and sexual dysfunction among men and women with diabetes have received relatively little attention. This is despite emerging evidence that demonstrates that urologic complications increase with age in the general population and are more common in individuals with diabetes compared to those without diabetes. Here we summarize the latest information about the epidemiology of urologic complications in the setting of diabetes and the most recent findings regarding pathophysiology. In addition, we identify knowledge gaps and need for future funding to address these gaps that will reduce the burden of urologic complications in diabetes and optimize quality of life for all individuals affected by it.

Traditional chinese medicine to prevent and treat diabetic erectile dysfunction

Diabetic erectile dysfunction (DED) is one of the most common complications of diabetes mellitus. However, current therapeutics have no satisfactory effect on DED. In recent years, traditional Chinese medicine (TCM) has shown good effects against DED. By now, several clinical trials have been conducted to study the effect of TCM in treating DED; yet, the underlying mechanism is not fully investigated. Therefore, in this review, we briefly summarized the pathophysiological mechanism of DED and reviewed the published clinical trials on the treatment of DED by TCM. Then, the therapeutic potential of TCM and the underlying mechanisms whereby TCM exerts protective effects were summarized. We concluded that TCM is more effective than chemical drugs in treating DED by targeting multiple signaling pathways, including those involved in oxidation, apoptosis, atherosclerosis, and endothelial function. However, the major limitation in the application of TCM against DED is the lack of a large-scale, multicenter, randomized, and controlled clinical trial on the therapeutic effect, and the underlying pharmaceutical mechanisms also need further investigation. Despite these limitations, clinical trials and further experimental studies will enhance our understanding of the mechanisms modulated by TCM and promote the widespread application of TCM to treat DED.

Analysis of the Factors Associated With ED in Type 2 Diabetics at the University Hospital of Libreville

INTRODUCTION

Erectile dysfunction (ED) is very common in diabetic males, especially type 2 diabetes mellitus (T2DM). Many factors and complications of diabetes such as macro- and micro-angiopathy are associated with risks leading to ED in male patients.

AIM

Analysis of factors associated with ED in T2DM. The purpose of this study is to shed light on potential associations between ED, type 2 diabetes, and some risks factors.

MATERIAL AND METHODS

This was a prospective analytic study of T2DM over 18. The study population consisted of diabetic patients seen at the endocrinology and urology departments of the University Hospital during the study period. Evaluation of ED was made by IIEF 5 score.

OUTCOMES

A total of 333 patients were selected for the study. The mean age was 56.6 ± 9.8 and the prevalence of ED was 82.6% (n = 275).

RESULTS

In univariate analysis, several associated factors were identified such as micro-angiopathic type complications including diabetic retinopathy (OR 4.88 [2.31-10.33], P < .001), diabetic nephropathy (OR 12.67 [1.71-93.66], P = .002) and macro-angiopathic type including arterial hypertension (OR 3.12 [1.69-5.75], P < .001). In multivariate analysis, duration of diabetes, micro and macroangiopathic complications, and hyperuricemia were independent risk factors for the occurrence of ED (P < .05).

CLINICAL IMPLICATIONS

The presence of certain complications of diabetes such as micro or macro angiopathy or hyperuricemia should lead to a search for a ED. The presence of these associated factors identified in type 2 diabetic patients should systematically prompt an ED diagnosis which is often moderate or severe. That diagnosis would help design a protocol for the management and improvement of the life quality of these patients.

STRENGTHS AND LIMITATIONS

The strength of this work is that it was conducted in the biggest hospital in the country which gives us a good idea of the trend of this ailment in the country. But the limitation of the study is that it only included patients who visited the hospital. This is monocentric hospital study was also transversal which does allow to establish a causal link.

CONCLUSION

ED has a significant prevalence in T2DM. Several associated factors identified in uni and multivariate analyses, including duration of diabetes, micro and macro angiopathic complications, and hyperuricemia, increase ED risk. Therefore, it is essential to investigate the existence of these factors to improve the management of ED, which may allow the patient to regain a better overall health status. SNN Milama, A Mougougou, S G Olagui, et al. Analysis of the Factors Associated With ED in Type 2 Diabetics at the University Hospital of Libreville. Sex Med 2022;10:100564.

The Role of Angiotensin Receptor Blockers in the Personalized Management of Diabetic Neuropathy

Neuropathy is a frequent complication of diabetes mellitus (DM) and is associated with the increased risk ofamputation and vascular events. Tight glycemic control is an important component inthe prevention of diabetic neuropathy. However, accumulating data suggest that angiotensin receptor blockers (ARBs) might also be useful in this setting. We discuss the findings of both experimental and clinical studies that evaluated the effects of ARBs on indices of diabetic neuropathy. We also review the implicated mechanisms of the neuroprotective actions of these agents. Overall, it appears that ARBs might be a helpful tool for preventing and delaying the progression of diabetic neuropathy, but more data are needed to clarify their role in the management of this overlooked complication of DM.

Testosterone replacement therapy and erectile dysfunction

Testosterone (T) deficiency and erectile dysfunction (ED) are independently functionally and socially impairing, and their concurrence in men can be challenging to treat. Successful management requires an understanding of the mechanisms through which T underlies normal erectile function. While the literature elucidating some of these mechanisms is vast (e.g., androgen regulation of the activity of nitric oxygen synthase and phosphodiesterase type 5) for others it is scarce (e.g., catalysts of castration-induced corporal fibrosis). The randomized controlled trial data for the efficacy of T replacement as mono- or combination therapy to treat ED has been conflicting. Positive results were frequently not clinically meaningful. Meta-analyses have been helpful in illuminating trends that seem to be promising. Consensus is still lacking in several areas, such as the threshold of low T severity for which replacement therapy is most beneficial; the timing for initiating combination therapy; and the duration of treatment.

Erectile Dysfunction as a Cardiovascular Risk Factor: Time to Step Up?

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.

Extracorporeal shock wave therapy combined with engineered mesenchymal stem cells expressing stromal cell-derived factor-1 can improve erectile dysfunction in streptozotocin-induced diabetic rats

Background

For erectile dysfunction (ED) in diabetes mellitus (DM) patients who have poor response to drugs, extracorporeal shock wave therapy (ESWT) and engineered mesenchymal stem cell (MSC) therapy have been studied as alternative treatment options. The objective of this study is to investigate whether ESWT in combination with stromal cell-derived factor-1 expressing engineered mesenchymal stem cell (SDF-1 eMSC) therapy can have synergistic effects on ED in streptozotocin-induced diabetic rats.

Methods

Fifty 8-week-old male Sprague-Dawley rats were randomly divided into five groups (N=10 per group): (I) Normal group, (II) DM ED, (III) DM ED + ESWT group, (IV) DM ED + SDF-1 eMSC group, and (V) DM ED + ESWT + SDF-1 eMSC group. Each groups were treated with bilateral injections of SDF-1 eMSC or ESWT following the experiment protocol for eight weeks.

Results

The ratio of ICP/MAP was distinctly higher in the DM ED + ESWT + SDF-1 eMSC group than that in the DM ED group. Concentration of α-smooth muscle actin (α-SMA) was elevated the highest in the DM ED + ESWT + SDF-1 eMSC group. Additionally, ESWT increased the intensity of SDF-1 expression in the corpus cavernosum. ESWT + SDF-1 eMSC treatment also induced neuronal nitric oxide synthase (nNOS) and NO/cGMP expression in the corpus cavernosum. Furthermore, numbers of penile progenitor cells were increased in DM ED rats.

Conclusions

Combined treatment of ESWT with SDF-1 eMSC treatment is more effective than by a single therapy. It could be used as a potential and effective synergistic treatment for DM ED.

Autonomic neuropathies

Autonomic neuropathies represent a complex group of disorders that preferentially target autonomic fibers and can be classified as either acute/subacute or chronic in onset. Acute-onset autonomic neuropathies manifest with such conditions as paraneoplastic syndromes, Guillain-Barre syndrome, Sjögren syndrome, infection, or toxins/chemotherapy. When the presentation is acute, immune-mediated, and without a secondary cause, autoimmune autonomic ganglionopathy is likely, and should be considered for immunotherapy. Of the chronic-onset forms, diabetes is the most widespread and disabling, with autonomic impairment portending increased mortality and cardiac wall remodeling risk. Acquired light chain (AL) and transthyretin (TTR) amyloidosis represent two other key etiologies, with TTR amyloidosis now amenable to newly-approved gene-modifying therapies. The COMPASS-31 questionnaire is a validated outcome measure that can be used to monitor autonomic severity and track treatment response. Symptomatic treatments targeting orthostatic hypotension, among other symptoms, should be individualized and complement disease-modifying therapy, when possible.

Penile implant infection prevention part 1: what is fact and what is fiction? Wilson's Workshop #9

Inflatable penile prosthesis (IPP) infections are undeniably devastating for patient and surgeon alike. While less common in this modern era, the landscape of prosthesis infection is shifting. Continued examination of risk factors for infection and re-evaluation of common practices remain critical should we aim to advance the field. Quality research on this topic is limited by several factors, among which small sample size and lack of coordinated effort pose the most precarious of challenges. Nonetheless, careful analysis of available data in conjuncture with judicious utilization of established research from other prosthetic fields can help us better grasp the issue at hand. In this review, we aim to do exactly that-to examine available evidence in an effort to discern fact from fiction. In this first part of the three part series, we aim to summarize our understanding of the pathogenesis behind prosthesis infections, explore known preoperative risk factors, and discuss intraoperative considerations for infection prevention. In the second part of this series, we will examine the game changing effect of infection retardant implant coatings. Part three of the series details postoperative prevention strategies, reviews salvage techniques, and discusses additional key considerations.

Risk factors of erectile dysfunction among diabetes patients in Africa: A systematic review and meta-analysis

Background

Erectile dysfunction in men is a common underestimated complication of diabetes mellitus, which is becoming a significant public health problem both in developing and developed countries. Erectile dysfunction threatens the well-being of clients, hence determining its risk factors and controlling it at an early stage is vital to preventing serious consequences and the burden of the disease. Therefore, this study aimed to systematically evaluate erectile dysfunction risk factors in patients with diabetes mellitus in Africa.

Methods

PubMed, Web of Science, Scopus, African Journals Online, Wiley Online Library and Google Scholar were searched and complemented by manual searches. Egger's regression test was used to determine publication bias. The I² statistic was used to check heterogeneity between the studies. DerSimonian and Laird random-effects model was applied to estimate pooled effect size, odds ratios, and 95% confidence interval across studies. STATA version 14 statistical software was used for the meta-analysis.

Result

Overall, 17 studies with 6002 study participants were included to identify risk factors of erectile dysfunction among diabetic patients. Duration of diabetes mellitus >10 years (AOR = 2.63; 95% CI 1.27, 5.43), age >40 years (AOR = 1.24; 95% CI: 1.03, 1.51), peripheral neuropathy (AOR = 2.34; 95% CI: 1.51, 10.72), no physical exercise (AOR = 1.63; 95% CI: 1.49, 1.78), testosterone level <8 nmol/l (AOR = 2.83; 95% CI: 1.06, 12.86), and peripheral vascular disease (AOR = 2.85, 95% CI: 1.54–5.27) were significantly associated with erectile dysfunction among diabetic patients.

Conclusions

This study found that long duration of diabetes mellitus, age >40 years, testosterone deficiency, peripheral neuropathy, not involved in physical exercise, peripheral vascular disease, were significantly associated with increased risk of erectile dysfunction among diabetic patients Therefore, situation-based interventions and country context-specific preventive strategies should be developed to decrease the risk factors of erectile dysfunction among patients with diabetes mellitus.

Epidemiology of erectile dysfunction in men with diabetes mellitus: a study in a primary health care center in Indonesia

BACKGROUND Diabetes mellitus (DM) is one of the factors causing erectile dysfunction (ED) and may affect a person's quality of life. This study was aimed to describe the epidemiology of ED in men with DM in a primary health care. METHODS The study used a cross-sectional study design conducted from January to March 2017 at the Tlogosari Kulon Health Center, Semarang. There were 122 diabetic men who were all included in the study. The data were collected using interviewerassisted questionnaires. The status of ED was measured by the erectile dysfunction intensity scale adapted to the International Index of Erectile Function. RESULTS The results showed that the prevalence of diabetic men with ED was 84.4%. Most men with ED had age of ≥46 years (91.0%), experienced work stress (88.5%), had low physical activity (93.1%), had obesity (88.0%) of which 86.3% had central obesity, smoking (84.6%), had DM >5 years (91.2%), and took antihypertensive drugs (90.0%). The fasting blood glucose level of respondents ≥126 mg/dl was 86.0%, and 91.7% had sexual desire disorder. The duration of DM and aging are contributing factors of ED in males with DM, with a p-value of 0.016 and 0.013, respectively. CONCLUSIONS The prevalence of ED in primary health care is still high, and the determining factors were the duration of DM and aging. Public health centers are advised to undertake health promotion on the prevention of factors that can lead to sexual dysfunction in males with DM.

Pharmacology and perspectives in erectile dysfunction in man

Penile erection is a perfect example of microcirculation modulated by psychological factors and hormonal status. It is the result of a complex neurovascular process that involves the integrative synchronized action of vascular endothelium; smooth muscle; and psychological, neuronal, and hormonal systems. Therefore, the fine coordination of these events is essential to maintain penile flaccidity or allow erection; an alteration of these events leads to erectile dysfunction (ED). ED is defined as the consistent or recurrent inability of a man to attain and/or maintain a penile erection sufficient for sexual activity. A great boost to this research field was given by commercialization of phosphodiesterase-5 (PDE5) inhibitors. Indeed, following the discovery of sildenafil, research on the mechanisms underlying penile erection has had an enormous boost, and many preclinical and clinical papers have been published in the last 10 years. This review is structured to provide an overview of the mediators and peripheral mechanism(s) involved in penile function in men, the drugs used in therapy, and the future prospective in the management of ED. Indeed, 30% of patients affected by ED are classified as "nonresponders," and there is still an unmet need for therapeutic alternatives. A flowchart suggesting the guidelines for ED evaluation and the ED pharmacological treatment is also provided.

Prevalence of Erectile Dysfunction in Patients with Diabetes Mellitus and Its Association with Body Mass Index and Glycated Hemoglobin in Africa: A Systematic Review and Meta-Analysis

BACKGROUND

Mortality and morbidity in patients with diabetes mellitus (DM) are attributed to both microvascular and macrovascular complications. However, there is a significant amount of variation in the primary studies on DM regarding the prevalence of erectile dysfunction (ED) in Africa. Therefore, this study was aimed to estimate the pooled prevalence of ED patients with DM and its association with body mass index (BMI) and glycated hemoglobin in Africa.

METHODS

PubMed, Web of Science, Cochrane Library, Scopus, PsycINFO, African Journals Online, and Google Scholar were searched for studies that looked at ED in DM patients. A funnel plot and Egger's regression test were used to determine publication bias. The I ² statistic was used to check heterogeneity between the studies. DerSimonian and Laird random-effects model was applied to estimate the pooled effect size. The subgroup and meta-regression analyses were conducted by country, sample size, and year of publication. Sensitivity analysis was deployed to see the effect of a single study on the overall estimation. STATA version 14 statistical software was used for the meta-analysis.

RESULT

A total of 13 studies with 3,501 study participants were included in this study. We estimated that the pooled prevalence of ED in patients with DM in Africa was 71.45% (95% CI: 60.22-82.69). Diabetic patients whose BMI was ≥30 kg/m² were 1.26 times more likely to develop ED (AOR = 1.26; 95% CI: 0.73-2.16) and whose glycated hemoglobin was <7% were 7% less likely to develop ED (AOR = 0.93; 95% CI: 0.5-5.9), although they were not significantly associated with ED.

CONCLUSIONS

The prevalence of ED in DM patients in Africa remains high. Therefore, situation-based interventions and country context-specific preventive strategies should be developed to reduce the prevalence of ED among patients with DM.

Prevalence of sexual dysfunction and related factors among diabetes mellitus patients in Southwest Ethiopia

BACKGROUND

Diabetes mellitus causes multiple medical, psychological and sexual problems in both men and women. Sexual dysfunction is one of those problems that lead to a strong social and psychological problem which adversely affect marital relation and treatment outcome. The issue has not been well studied in Ethiopia; therefore, this study aimed to evaluate the prevalence and factors related to sexual dysfunction in adult patients with diabetes mellitus.

METHODS

Facility-based cross-sectional study was conducted among adults with diabetes mellitus on follow-up at diabetic clinics of Mizan-Tepi University Teaching Hospital and Tepi General Hospital. A consecutive sampling technique was employed to select 423 study participants, and data were collected through interviewer-administered questionnaire and patients' medical chart review. Changes in Sexual Functioning Questionnaire-fourteen items (CSFQ-14) was used to measure sexual dysfunction. Descriptive statistics and binary logistic regression analyses were performed. Two tail tests at α of less 0.05 were used as a level of significance.

RESULTS

A total of 398 diabetic patients were interviewed, with a 94% response rate. The prevalence of sexual dysfunction was 53.3%. Age of above 41 years (AOR: 3.98, 95% CI 2.32-6.85), lack of formal education (AOR: 3.20, 95% CI 1.60-6.39), divorced or widowed (AOR: 5.28, 95% CI 2.35-11.86), type 2 DM (AOR: 4.52, 95% CI 2.17-9.42), depression (AOR: 4.05, 95% CI 2.32-7.10), complications or co-morbidity (AOR: 2.05, 95% CI 1.18-3.58), and not doing physical activity (AOR: 1.62, 95% CI; 1.47-1.77) were significantly associated with sexual dysfunction among diabetes patients.

CONCLUSIONS

The prevalence of sexual dysfunction was as high as reports from other studies. Therefore, health care providers should include the issue of sexual health in their routine discussions with adult diabetes mellitus patients. Presence of depression, not doing physical activity and having complications or co-morbidity are modifiable factors associated with sexual dysfunction; therefore, they should be attended during care addressing sexual dysfunction.

Prevalence and risk factors of erectile dysfunction in patients with hepatitis B virus or hepatitis C virus or chronic liver disease: results from a prospective study

Background Approximately 300million people are affected by hepatitis B virus (HBV) or hepatitis C virus (HCV) infection worldwide. Erectile dysfunction (ED) is a frequent condition that impairs the quality of life and can be associated with several chronic disorders (type 2 diabetes mellitus, atherosclerosis, depression). Few studies have evaluated the prevalence of ED in patients with HBV and HCV chronic infection. The aim of this study was to evaluate the prevalence and the risk factors of ED in a cohort of patients with HBV or HCV-related chronic liver diseases.

METHODS

Consecutive patients with HCV and HBV chronic infection were enrolled.

RESULTS

In total, 89 out (49 with cirrhosis, 21 with HBV and 68 with HCV infection) were included in this study. ED was diagnosed in 76.4% of patients. The use of phosphodiesterase type 5 inhibitors was reported by 21.3% of patients. Patients with ED were older and had a higher rate of cirrhosis and diabetes mellitus compared with patients without ED. At multivariate analysis, diabetes mellitus and stage of liver disease (cirrhosis vs chronic hepatitis) were the only independent predictors of ED.

CONCLUSION

Due to the high rate of ED in outpatients with viral-related liver disease and the underuse of phosphodiesterase type 5 inhibitors, a larger study focussed on these patients is needed.

Pancreatic kininogenase improves erectile function in streptozotocin-induced type 2 diabetic rats with erectile dysfunction

Erectile dysfunction (ED) associated with type 2 diabetes is a severe problem that requires effective treatment. Pancreatic kininogenase (PK) has the potential to improve the erectile function of ED patients. This study aims to investigate the effect of PK on erectile function in streptozotocin-induced type 2 diabetic ED rats. To achieve this goal, we divided male Sprague-Dawley rats into five groups. One group was not treated, and the other four groups were treated with saline, sildenafil, PK or sildenafil, and PK, respectively, for 4 weeks after the induction of type 2 diabetic ED. Then, intracavernous pressure under cavernous nerve stimulation was measured, and penile tissue was collected for further study. Endothelial nitric oxide synthase levels, smooth muscle content, endothelium content, cyclic guanosine monophosphate (cGMP) levels in the corpus cavernosum, and neuronal nitric oxide synthase levels in the dorsal penile nerve were measured. Improved erectile function and endothelium and smooth muscle content in the corpus cavernosum were observed in diabetic ED rats. When treating diabetic ED rats with PK and sildenafil at the same time, a better therapeutic effect was achieved. These data demonstrate that intraperitoneal injection of PK can improve erectile function in a rat model of type 2 diabetic ED. With further research on specific mechanisms of erectile function improvement, PK may become a novel treatment for diabetic ED.

Does Chronic Hyperglycemia Affect Female Rat Sexual Behavior? Differences in Paced and Non-Paced Mating

INTRODUCTION

Diabetes mellitus has been associated with sexual dysfunction; however, in women this relationship is controversial. A study using a model of type 2 diabetes mellitus (DM2) failed to find a reduced receptivity in the non-paced mating (NPM), but the appetitive aspects of female sexual behavior have not been evaluated, for example, in the paced mating (PM) paradigm.

AIM

To evaluate all components of female sexual behavior (in NPM and PM) in a model of DM2 using ovariectomized (OVX) (treated with steroids) or intact female rats (non-OVX) in natural proestrus.

METHODS

Neonatal females (3-4 days) were administered streptozotocin (STZ, 70 mg/kg, intraperitoneally) or citrate buffer. At week 8, a glucose tolerance test was performed. At week 10, half of the females were OVX, and in the other half (non-OVX) the estrous cycle was monitored. At the twelfth week, the sexual behavior tests were conducted; OVX females were treated with estradiol benzoate (10 μg, -24 hours) and progesterone (3 mg, -4 hours), whereas the non-OVX were evaluated on vaginal proestrus.

MAIN OUTCOME MEASURES

We registered in NPM and PM receptivity (lordosis quotient and intensity), as well as the number of proceptive and aggressive behaviors. Additionally, in PM we calculated the percentage of exits and the return latencies after receiving stimulation and the time the female remained in the male's compartment.

RESULTS

The STZ-treated females presented glucose intolerance and were hyperglycemic. Neonatal STZ treatment provoked changes in the females' sexual behavior depending on the paradigm and the hormonal condition. In the NPM, STZ-OVX females had decreased lordosis quotient and intensity and increased aggression, whereas, in the STZ-non-OVX females, there was a decrease in proceptivity; such changes were not observed in PM. Regardless of whether the STZ-treated females were OVX, they failed to perform the pacing behavior.

CLINICAL IMPLICATION

These data support the idea that chronic mild hyperglycemia, like that observed in DM2 (which represents 90% of the clinical cases), provokes marginal changes in most aspects of female sexual behavior.

STRENGTHS & LIMITATIONS

The main strength of this work is the evaluation of consummatory and motivational aspects of female sexual behavior in a model of DM2. The main limitation is the duration of the experimental design that does not resemble the course of the disease in humans. No histologic or biochemical analyses were performed.

CONCLUSION

These results suggest that chronic hyperglycemia produces decreases in sexual behavior. Hernández-Munive AK, Rebolledo-Solleiro D, Fernández-Guasti A. Does Chronic Hyperglycemia Affect Female Rat Sexual Behavior? Differences in Paced and Non-Paced Mating. J Sex Med 2019;16:1130-1142.

Sexual Dysfunction in Men with Prediabetes

INTRODUCTION

Previous studies have shown a strong association between diabetes mellitus (DM) and the frequency and severity of some aspects of male sexual dysfunction (SD). The same relationship with prediabetes (preDM) has been less well investigated.

AIM

To systematically review the current literature on the association between preDM and SD, focusing on erectile dysfunction (ED), sex steroid hormone alterations, and premature ejaculation (PE).

METHODS

The present review was conducted in accordance with the PRISMA declaration standards for systematic reviews. A systematic search for the terms "male sexual dysfunction," "prediabetes," "IFG or IGT," "glycemia," "ED," "ejaculation," and "hypoactive sexual desire disorder" was carried out in the PubMed and Embase databases.

MAIN OUTCOME MEASURE

Prevalence of SD in men with preDM and severity of ED, PE, and hormone alterations in men with preDM compared with controls.

RESULTS

12 studies reporting data on the association between SD and preDM were found in the literature. According to these studies, ED is more prevalent in men with preDM compared with controls, the severity of ED increases progressively as a function of impaired glucose metabolism, testosterone values and preDM are strongly correlated, men with preDM are at increased risk of testosterone deficiency and hypogonadism, men with hypogonadism have a higher prevalence of preDM, and the association between PE and preDM is controversial.

CONCLUSION

PreDM is a common and underdiagnosed clinical condition that is strongly associated with male SD. A detailed glucose metabolism investigation should be performed in every patient with SD to screen for glucose abnormalities and eventually to implement prevention program to decrease their chances of developing life-changing chronic illnesses. Boeri L, Capogrosso P, Ventimiglia E, et al. Sexual Dysfunction in Men with Prediabetes. Sex Med Rev 2019;8:622-634.

Measuring the burden of multimorbidity among Medicare beneficiaries via condition counts and cumulative duration

OBJECTIVE

The study's purpose was to describe the cumulative duration of 19 chronic conditions among Medicare fee-for-service (FFS) beneficiaries and examine variation in total expenditures explained by cumulative duration and condition counts.

DESIGN, SETTING, STUDY DESIGN, AND DATA EXTRACTION

In a retrospective cohort of FFS beneficiaries age ≥68, 2015 Medicare enrollment and claims data (N = 20 124 230) were used to identify the presence or absence of 19 diagnosed chronic conditions, and to construct MCC categories (0-1, 2-3, 4-5, 6+) and cumulative duration of each of 19 conditions from the date of first possible occurrence in claims (1/1/1999) to the end of follow-up (date of death or 12/31/2015). Total Medicare expenditures were estimated using linear models adjusted for demographic characteristics.

PRINCIPAL FINDINGS

Multimorbidity was common (71.7 percent with 2+ conditions). The mean cumulative duration of all 19 conditions was 23.6 person-years, which varied greatly by age and number of conditions. Condition counts were more predictive of Medicare expenditures than cumulative duration (R-squared for continuous measures = 0.461 vs 0.272; R-squared for quartiles = 0.408 vs 0.266).

CONCLUSIONS

The cumulative duration of chronic conditions varied widely for Medicare beneficiaries, especially for those with 6+ conditions, but was less predictive of total expenditures than condition counts.

Measuring the burden of multimorbidity among Medicare beneficiaries via condition counts and cumulative duration

OBJECTIVE

The study's purpose was to describe the cumulative duration of 19 chronic conditions among Medicare fee-for-service (FFS) beneficiaries and examine variation in total expenditures explained by cumulative duration and condition counts.

DESIGN, SETTING, STUDY DESIGN, AND DATA EXTRACTION

In a retrospective cohort of FFS beneficiaries age ≥68, 2015 Medicare enrollment and claims data (N = 20 124 230) were used to identify the presence or absence of 19 diagnosed chronic conditions, and to construct MCC categories (0-1, 2-3, 4-5, 6+) and cumulative duration of each of 19 conditions from the date of first possible occurrence in claims (1/1/1999) to the end of follow-up (date of death or 12/31/2015). Total Medicare expenditures were estimated using linear models adjusted for demographic characteristics.

PRINCIPAL FINDINGS

Multimorbidity was common (71.7 percent with 2+ conditions). The mean cumulative duration of all 19 conditions was 23.6 person-years, which varied greatly by age and number of conditions. Condition counts were more predictive of Medicare expenditures than cumulative duration (R-squared for continuous measures = 0.461 vs 0.272; R-squared for quartiles = 0.408 vs 0.266).

CONCLUSIONS

The cumulative duration of chronic conditions varied widely for Medicare beneficiaries, especially for those with 6+ conditions, but was less predictive of total expenditures than condition counts.

PnPP-19 Peptide Restores Erectile Function in Hypertensive and Diabetic Animals Through Intravenous and Topical Administration

INTRODUCTION

With the aim of overcoming the high toxicity of PnTx2-6 (or δ-CNTX-Pn2a), a toxin from the venom of the armed spider (Phoneutria nigriventer), the 19-aminoacid peptide, PnPP-19 (P nigriventer potentiator peptide), was synthesized based on molecular modeling studies of PnTx2-6. PnPP-19 improved the erectile function of normotensive rats and mice, without eliciting side effects, and no signs of toxicity were observed. In addition, PnPP-19 was able to potentiate the effect of sildenafil.

AIM

To evaluate the efficacy of PnPP-19 in hypertensive and diabetic mouse/rat models in restoring erectile function, after topical administration; verify the biodistribution of PnPP-19 administration (topical and intravenous), permeation, and cyclic guanosine monophosphate (cGMP)/nitric oxide via implication.

METHODS

Corpus cavernosum relaxation was evaluated using cavernous strips from male spontaneous hypertensive rats (SHR) and from streptozotocin (STZ)-diabetic mice contracted with phenylephrine and submitted to electrical field stimulation before and after incubation with PnPP-19 (10^-8 mol/L, 10 minutes) or vehicle. This procedure was also used to determine cGMP/nitric oxide levels, at 8 Hz and to check the effect of PnPP-19 with sildenafil citrate. Biodistribution assays were performed using iodine 123-radiolabeled PnPP-19. In vivo erectile function was evaluated using intracavernosal pressure/main arterial pressure ratio in STZ-diabetic rats after PnPP-19 topical administration.

MAIN OUTCOME MEASURES

PnPP-19 may become a new drug able to fill the gap in the pharmacologic treatment of erectile dysfunction, especially for hypertensive and diabetic individuals RESULTS: PnPP-19 potentiated corpus cavernosum relaxation, in both control and SHR rats. SHR-cavernosal tissue treated with PnPP-19 (1-32 Hz) reached the same relaxation levels as control Wistar rats (16 and 32 Hz). PnPP-19 treatment improved cavernosal tissue relaxation in STZ-diabetic mice and rats. PnPP-19 enhanced cGMP levels in STZ-diabetic mice corpus cavernosum strips. After topical or intravenous administration in rats, ¹²³I-PnPP-19 was mainly recruited to the penis. When topically administered (400 μg/rat), PnPP-19 restores erectile function in STZ-diabetic rats, also improving it in healthy rats by increasing the intracavernosal pressure/main arterial pressure ratio. PnPP-19 exhibited an additive effect when co-administered with sildenafil, showing a novel mode of action regardless of phosphodiesterase type 5 inhibition.

CLINICAL IMPLICATIONS

PnPP-19 seems to be an indicated drug to be tested to treat ED in diabetic and hypertensive patients.

STRENGTH & LIMITATIONS

PnPP-19, although active by topical application and showing safety to human beings (not shown), has low permeability, about 10% of the applied dose.

CONCLUSION

Our results showed that PnPP-19 may emerge as a potent new drug that can be topically administered, becoming a promising alternative for erectile dysfunction treatment. Nunes da Silva C, Pedrosa Nunes K, De Marco Almeida F, et al. PnPP-19 Peptide Restores Erectile Function In Hypertensive And Diabetic Animals Through Intravenous And Topical Administration. J Sex Med 2019;16:365-374.

Engineered Mesenchymal Stem Cells Expressing Stromal Cell-derived Factor-1 Improve Erectile Dysfunction in Streptozotocin-Induced Diabetic Rats

Effective therapies for erectile dysfunction (ED) associated with diabetes mellitus (DM) are needed. In this study, the effects of stromal cell-derived factor-1 (SDF-1)-expressing engineered mesenchymal stem cells (SDF-1 eMSCs) and the relevant mechanisms in the corpus cavernosum of a streptozotocin (STZ)-induced DM ED rat model were evaluated. In a randomized controlled trial, Sprague–Dawley (SD) rats (n = 48) were divided into four groups (n = 12/group): Normal (control), DM ED (diabetes induced by STZ), DM ED + BM-MSC (treated with bone marrow [BM]-derived MSCs), and DM ED + SDF-1 eMSC (treated with SDF-1-expressing BM-MSCs). After four weeks, intracavernosal pressure (ICP), an indicator of erectile function, was 0.75 ± 0.07 in the normal group, 0.27 ± 0.08 in the DM ED group, 0.42 ± 0.11 in the DM ED + BM-MSC group, and 0.58 ± 0.11 in the DM ED + SDF-1 eMSC group. BM-MSCs, especially SDF-1 eMSCs, improved ED (p < 0.05). SDF-1 eMSC treatment improved the smooth muscle content in the corpus cavernosum (p < 0.05). As SDF-1 expression increased, ED recovery improved. In the SDF-1 eMSC group, levels of neuronal nitric oxide synthase (nNOS) and phosphorylated endothelial NOS (p-eNOS) were higher than those in other groups (p < 0.05). In addition, high stromal cell-derived factor-1 (SDF-1) expression was associated with increased vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in DM ED rats (p < 0.05). Higher levels of phosphorylated protein kinase B (p-AKT)/protein kinase B (AKT) (p < 0.05) and B-cell lymphoma-2 (Bcl-2) and lower levels of the apoptosis factors Bcl2-associated x (Bax) and caspase-3 were observed in the MSC-treated group than in the DM ED group (p < 0.05). SDF-1 eMSCs showed beneficial effects on recovery from erectile function.

Autonomic disturbances in diabetes: Assessment and anaesthetic implications

Diabetes mellitus is the most common medical condition and with increased awareness of heath and related issues, several patients are getting diagnosed with diabetes. The poor control of sugar and long-standing status of disease affects the autonomic system of body. The autonomic nervous system innervates cardiovascular, gastrointestinal, and genitourinary system, thus affecting important functions of the body. The cardiovascular system involvement can manifest as mild arrhythmias to sudden death. Our search for this review included PubMed, Google Search and End Note X6 version and the key words used for the search were autonomic neuropathy, diabetes, anesthesia, tests and implications. This review aims to highlight the dysfunction of autonomic system due to diabetes and its clinical presentations. The various modalities to diagnose the involvement of different systems are mentioned. An estimated 25% of diabetic patients will require surgery. It has been already established that mortality rates in diabetic patients are higher than in nondiabetic patients. Hence, complete workup is needed prior to any surgery. Diabetic autonomic neuropathy and its implications may sometimes be disastrous and further increase the incidence of in hospital morbidity and mortality. Overall, complete knowledge of diabetes and its varied effects with anaesthetic implications and careful perioperative management is the key guiding factor for a successful outcome.

Increased visceral adiposity index associated with sexual dysfunction in men

OBJECTIVE

Visceral adipose index (VAI) is a novel parameter for the evaluation of visceral obesity. As we know that obesity is a risk factor for erectile dysfunction (ED). So, in this study, we compared the VAI levels between the men with ED and without ED.

MATERIALS AND METHOD

A total of 177 men were included in the study. Ninety-five men with ED and 82 men without ED (control). All men were evaluated for ED by Index of Erectile Function-5 items (IIEF-5). VAI levels were calculated using body mass index, high density lipoprotein and tryglyceride levels.

RESULTS

Mean age was 53.5 (38-69) in men who have ED and 53.1 (34-69) in control. The men with ED had higher body mass index (BMI), triglyceride (TG) levels, higher waist circumference (WC) and lower high-density lipoprotein-cholesterol (HDL-C) levels. Mean VAI level was 5.18 ± 2.50 in study group and 3.47 ± 1.76 in control goup, respectively. VAI levels were statistically higher in men with ED (p < .001).

DISCUSSION

The simplicity of WC and BMI measurement and TG and HDL assessment, make VAI an easily applicable index for the evaluation of visceral fat dysfunction. VAI can be useful index for the evaluation and calculation of erectile dysfunction risk.

Erectile dysfunction: A hidden epidemic

Erectile dysfunction is commonly faced by men with cardiovascular disease. We aimed to determine the prevalence of erectile dysfunction in patients with cardiovascular disease risk factors in Singapore. We conducted a cross-sectional survey on patients with cardiovascular disease risk factors from June 2014 to July 2014 at the outpatient cardiology clinics of our tertiary institution. The survey included patient demographics, comorbidities and an abridged version of the International Index of Erectile Function (IIEF-5). Erectile dysfunction severity was categorized as absent (IIEF-5 score: 22–25), mild (IIEF-5 score: 17–21), moderate (IIEF-5 score: 8–16) and severe (IIEF-5 score: <8). Independent variables were demographic factors (i.e. age, race, occupation, etc.) and comorbidities (i.e. diabetes, hypertension, etc.). Primary dependent variable was the presence of erectile dysfunction and secondary dependent variable was the severity of erectile dysfunction. A total of 468 male respondents (mean age 57±11.2 years) were included. Sixty-nine per cent of respondents reported the presence of erectile dysfunction, with further breakdown into 29% with mild, 30% with moderate and 10% with severe erectile dysfunction. Multivariate analysis revealed that significant predictive risk factors of erectile dysfunction were old age (odds ratio (OR) 1.073, 95% confidence interval (CI) 1.050–1.097, p<0.001), the presence of diabetes (OR 2.127, 95% CI 1.186–3.81, p=0.001) and a lower level of education (OR 2.392, 95% CI 1.387–4.125, p=0.002). These three factors were significant predictors for severity of erectile dysfunction ( p-values of 0.000). Prevalence of erectile dysfunction is high in patients with cardiovascular disease risk factors. Cardiologists should screen for erectile dysfunction particularly in patients with older age, diabetes and lower education levels.

Erectile dysfunction among patients with chronic brucellosis

OBJECTIVE

Only a single study investigated erectile dysfunction (ED) among patients with chronic brucellosis without including a control group. Our study objective was to determine the prevalence of ED among patients with chronic brucellosis compared to normal subjects, and to explore the predictors of ED.

MATERIALS AND METHODS

We included 93 chronic brucellosis patients and 92 subjects as a control, from June 2013 to August 2017. Chronic brucellosis was diagnosed based on persistent symptoms for ≥1 year with positive immunoglobulin G antibody titer (≥1:160) by standard tube agglutination test; the mean duration was 21 ± 6.2 months. Clinical evaluation (including an Arabic validated version of the five-item International Index of Erectile Function to diagnose ED; score of 5-21 was diagnostic), imaging studies (including scrotal ultrasonography) and laboratory investigations (including estimation of fasting serum level of glucose (after fasting for 8 h), lipids profile (after fasting for 14 h), and serum level of testosterone) were conducted. A fasting serum glucose level of ≥ 7 mmol/L defined diabetes mellitus (DM). Predictors of ED were identified using multivariate analysis (binary logistic regression).

RESULTS

The mean age of patients was 35.4 ± 13.7 years; 24.7% of them had DM, while low serum level of testosterone was detected among 54.8%. Among the patients, ED was significantly more frequent compared to the control subjects (69.9% vs. 19.6%, p < 0.001). Low serum level of testosterone (OR 4.8, 95% CI 1.7-29.3, p 0.008), and DM (OR 3.5, 95% CI 1.2-34.6, p 0.011) were the predictors of ED among the patients.

CONCLUSIONS

The prevalence of ED among patients with chronic brucellosis is high. Low serum level of testosterone and DM are associated with ED among such patients.

Sexual functioning and depressive symptoms in men with various types of prediabetes: a pilot study

No study has compared sexual functioning and depressive symptoms in male subjects with various types of prediabetes. Our study included four age- and weight-matched groups of apparently healthy men (25-50 years old): subjects with isolated impaired fasting glucose (IFG) (n = 16), men with isolated impaired glucose tolerance (n = 17), individuals with the presence of both IFG and impaired glucose tolerance (n = 16), as well as men with normal glucose tolerance (n = 18). All included men completed questionnaires evaluating male sexual functioning (IIEF-15) and assessing the presence and severity of depressive symptoms (BDI-II). Men with both IFG and impaired glucose tolerance obtained lower domain scores for erectile function, sexual desire, and overall satisfaction, as well as the higher overall BDI-II score. Individuals with isolated impaired glucose tolerance (IGT) and IFG were characterized by lower domain score only for sexual desire. In all study groups, domain score for erectile function correlated with the BDI-II score, while scores for erectile function and sexual desire correlated with a degree of insulin resistance. The obtained results suggest that prediabetes may impair sexual functioning in young men. The risk is particularly high in individuals with the presence of both IFG and IGT.

Cost-effectiveness of a New Opportunistic Screening Strategy for Walk-in Fingertip HbA1c Testing at Community Pharmacies in Japan

OBJECTIVE

A new opportunistic community-based strategy was launched in Japan in April 2014 to detect lifestyle-related diseases, including diabetes, by creating Specimen Measurement Offices (SMOs). SMOs offer walk-in fingertip HbA_1c testing. This article aimed to assess the value-for-money of HbA_1c testing services at SMOs by conducting a cost-effectiveness analysis.

RESEARCH DESIGN AND METHODS

We compared two scenarios: 1) status quo, defined as HbA_1c testing that is available only through conventional screening, and 2) HbA_1c testing available at SMOs as a complement to the status quo scenario. The model consisted of a screening module with a decision tree and a disease progression module with a Markov model. We calculated incremental cost-effectiveness ratios (i.e., cost per quality-adjusted life-years [QALYs]) over the lifetime analytic horizon as the primary end point of the cost-effectiveness analysis. In this model, we assumed the participant cohort to be people 40-74 years of age who sought walk-in fingertip HbA_1c testing at SMOs on the premises of community pharmacies. Costs and outcomes were discounted at a rate of 3%. The cost-effectiveness was analyzed from a societal perspective.

RESULTS

The incremental cost per individual for those 40-74 years of age was estimated to be -527 U.S. dollars (USD) (-52,722 Japanese yen [JPY]) for HbA_1c testing at SMOs compared with the status quo. Incremental effectiveness was estimated to be 0.0203 QALYs for HbA_1c testing at SMOs compared with the status quo. Therefore, this cost-effectiveness analysis showed that compared with the status quo, HbA_1c testing at SMOs was more effective and had lower cost for the population studied.

CONCLUSIONS

We consider our results to be robust because most simulations were under the threshold of USD 50,000 (JPY 5,000,000) per QALYs gained, by sensitivity analysis. These results will be useful to managers of pharmacies or other health institutions and/or policy makers in local government.

Frequency of Hypogonadism and Erectile Dysfunction in Type-II Diabetic Patients

Introduction: The persistent state of hyperglycemia in diabetes mellitus predisposes diabetic patients to suffer from neuropathy, vasculopathy, and endocrinological changes. Hypogonadism and erectile dysfunction are commonly observed in diabetic patients secondary to androgen deficiency. In the developing world, patients usually under-report their sexual dysfunction. We conducted this study to determine the frequency of hypogonadism and erectile dysfunction and the associated risk factors in type-II diabetic male patients presenting in the outpatient department of a tertiary care hospital in Pakistan.

Methods: This was an observational, cross-sectional hospital-based study conducted at Jinnah Allama Iqbal Institute of Diabetes and Endocrinology (JAIDE), Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan from April 2017 to October 2017. One hundred and sixty type-II diabetic patients meeting the inclusion criteria were enrolled in the study after informed consent. All patients were given the International Index of Erectile Function (IIEF) questionnaire to determine the severity of erectile dysfunction. Patients were tested for serum total testosterone levels and hypogonadism labeled if the serum testosterone level came out to be less than 8 nmol/L with or without symptoms of hypogonadism or with a testosterone level of 8-12 nmol/L and symptoms of hypogonadism.

Results: The mean age of the patients was 51.2 ± 11.5 years (range: 31 – 60 years). The mean duration of type-II diabetes mellitus was 8.3 ± 5.1 years. The frequency of erectile dysfunction was found to be 62.5%. Mild erectile dysfunction was seen in 19 patients (11.9%), mild to moderate in 15 patients (9.4%), moderate in 42 patients (26.2%), and severe in 24 patients (15.0%) with an IIEF score of 17-21, 12-16, 8-11, and 1-7, respectively. More severe erectile dysfunction was seen in patients with a prolonged history of diabetes (p-value <0.0001). The mean testosterone level was 18.1 + 8.4 (range: 0.31-38.1) nmol/L. Based on our criteria, hypogonadism was seen in 61 patients (38.1%) with 29 (18.1%) and 32 (20.0%) suffering from severe and mild forms of hypogonadism, respectively. Forty percent of the patients with erectile dysfunction suffered from some form of hypogonadism with subnormal testosterone levels. The difference in the testosterone level of patients with and without erectile dysfunction was statistically significant (p-value: 0.0001).

Conclusion: Patients suffering from type-II diabetes mellitus had a significantly greater frequency of erectile dysfunction and hypogonadism. Diabetic patients should be counseled and treated for these issues to improve their quality of life, especially in under-developed countries where sexual health problems are seldom reported.

Erectile dysfunction therapy in countries where implant is economically not feasible

Erectile dysfunction (ED), a frequent complaint in the primary care setting, is strongly associated with obesity, cigarette smoking and other common cardiovascular risk factors like hypertension, diabetes mellitus (DM), lipid disorders and the metabolic syndrome. The prevalence of these cardiovascular disorders is rising at staggering rates in most Latin American countries. ED is a symptom that mainly affects economically productive men (40–70 years of age) potentially causing major psychosocial repercussions and reduced quality of life. The management of ED in these developing countries is increasingly challenging due to poor patient education and non-adherence to the medical treatment of theses concomitant comorbidities. The financial implications of commonly prescribed medications and surgical procedures limit their use to a minority of patients. For this reason, the clinician must adopt a holistic approach in the management of this disease focusing on preventive measures based on patient education and non-surgical interventions. This review summarizes common associated risk factors of ED and outlines non-pharmacological interventions for the management of this disease.

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

Erectile dysfunction (ED) is the most common male sexual dysfunction, and shares many risk factors with systemic conditions including cardiovascular disease (CVD) and the metabolic syndrome (MetS). ED is considered to be an independent risk factor for CVD and can be a harbinger of future cardiovascular events. Given this relationship, each encounter for ED should be viewed by healthcare providers as an opportunity to screen for CVD and other comorbid conditions, including the MetS, that can significantly affect a man's overall health. While universally accepted screening guidelines are lacking, expert panels do recommend an approach to risk stratification in men with ED. In this review, we discuss the current state of understanding of the relationship between ED, the MetS, and CV risk, and how this impacts the approach to the patient presenting with ED.

Diabetic peripheral neuropathy and prevalence of erectile dysfunction in Japanese patients aged <65 years with type 2 diabetes mellitus: The Dogo Study

Only limited epidemiological evidence exists regarding the relationship between diabetic neuropathy and erectile dysfunction (ED) among Japanese patients with type 2 diabetes mellitus. To investigate the relationship between diabetic neuropathy and ED among Japanese patients with type 2 diabetes mellitus, a multicenter cross-sectional study was conducted in 287 male Japanese patients with type 2 diabetes mellitus, age (19-65 years). Diabetic neuropathy was diagnosed if the patients showed two or more of the following three characteristics: neuropathic symptoms, decreased or disappeared Achilles tendon reflex and/or abnormal vibration perception. ED, moderate to severe ED, and severe ED were defined as present when a subject had a Sexual Health Inventory for Men score <22, <12 and <8, respectively. The prevalence values of diabetic neuropathy and severe ED were 47.0 and 39.0%, respectively. Diabetic neuropathy was independently positively associated with severe ED, but not ED and moderate ED: the adjusted odds ratio was 1.90 (95% confidence interval: 1.08-3.38). No relationships were found between diabetic retinopathy or diabetic nephropathy and ED. Diabetic neuropathy is positively associated with severe erectile dysfunction among Japanese type 2 diabetes mellitus patients aged <65 years.

Effects of the start time of glycemic control on erectile function in streptozotocin-induced diabetic rats

Diabetes-induced ED correlates with diabetes duration and glycemic control. This study evaluated the effect of glycemic control start time on erectile function in streptozotocin-induced diabetic rats. Rats were divided into normal controls (C); untreated diabetic rats (DM); and rats treated after 7 weeks (7W), and 10 weeks (10W) from DM. Treated diabetic rats received a timed daily injection of insulin. After 14 weeks of lab-controlled diabetes, experiments were performed. Group DM showed the ratio of intracavernosal pressure, significantly lower than other groups (10W vs DM; P<0.001). Groups 7W and 10W responded similarly, but did not recover to normal level (group C vs 7W; P<0.001). The percentage of α-smooth muscle actin increased more with earlier start times, and group DM's percentages decreased significantly (group 10W vs DM; P<0.001). Apoptosis recovered significantly only in group 7W, comparable to group C. As start times became earlier, for all molecules (eNOS, Akt, MYPT1 and PECAM-1), treatment groups' results neared those of group C. In conclusion, erectile function of diabetic rats recovered closer to normal controls if diabetic treatment started earlier. And the level of glycemic control was expected to be more important than the start time of diabetic treatment.