Влияние предоперационных факторов риска на изменение эректильной функции после уретропластики

Introduction. At present, the progress in reconstructive urology demonstrates high efficiency rates in treating urethral strictures (US), ensuring satisfactory urination parameters. Meanwhile, there is a need to maintain a high quality of life associated with male sexual function.Objective. To evaluate the erectile function in males suffering from US considering the presence of risk factors for erectile dysfunction (ED), characteristics of US and surgical techniques employed.Materials & methods. The study involved 153 sexually active patients with US who underwent surgical treatment. The assessment of erectile function was carried out using the IIEF-5 questionnaire, while considering the presence of risk factors for ED in patients (age, smoking, coronary heart disease, arterial hypertension, type 2 diabetes mellitus), stricture parameters (primary/recurrent, length) and surgical technique (transecting and non-transecting techniques). Evaluation time points: baseline (before surgery), 3, 6, and 12 months after urethroplasty.Results. The mean age of the patients was 53.0 years, and their baseline erectile function scores were 19.0 points. Regardless of the parameters under study, a decline in erectile function was observed in all study groups by the 3-month follow-up, which regressed over the one-year follow-up period. The duration of recovery and severity of erectile dysfunction were associated with age, smoking, the presence of coronary heart disease and arterial hypertension, US length, and recurrent nature of strictures. No significant differences were found in erectile function indicators after surgery, depending on the grade of transection of the spongy body. According to multivariate analysis, predictors of ED development after surgery include age (adjusted odds ratio [AOR] 1.082; 95% confidence interval [CI] 1.038–1.127; p < 0.001), arterial hypertension (AOR 4.608; 95% CI 1.089–19.511; p = 0.038), and baseline erectile function status (AOR 0.046; 95% CI 0.013–0.160; p < 0.001). Conclusion. ED following surgical treatment of urethral strictures is predominantly transient, with regression observed by the 12-month follow-up period. The recovery of erectile function is adversely affected by advanced age, smoking, cardiovascular diseases, the length and recurrent nature of US.

Longitudinal Changes in U.S. Parameters of Neurovascular Bundles Suggest Mechanism for Radiation-Induced Erectile Dysfunction

The aim of this work was to investigate the risk factors associated with the incidence of sexual dysfunction in patients who underwent robot-assisted surgery with several treatment options, such as neoadjuvant chemoradiotherapy and lateral lymph node dissection, and clarify the longitudinal course of erectile function in risk groups. A total of 203 male patients who underwent robot-assisted total mesorectal excision for rectal cancer between 2013 and 2019 were included. The risk factors for erectile and ejaculatory dysfunction as well as the longitudinal course of erectile function were retrospectively investigated in all cohorts and several risk groups, including those who underwent neoadjuvant chemoradiotherapy, lateral lymph node dissection and adjuvant chemotherapy. Erectile dysfunction was assessed using the International Index of Erectile Function and ejaculatory dysfunction was assessed using original questions. The survey was performed preoperatively and at 3, 6 and 12 months postoperatively. Erectile and ejaculatory dysfunction occurred in 46.8% and 15.7% of the patients, respectively. Multivariate analysis showed that neoadjuvant chemoradiotherapy was an independent risk factor for erectile dysfunction. Erectile function recovered longitudinally to the preoperative level overall, as well as in lateral lymph node dissection and postoperative adjuvant chemotherapy subgroups; however, recovery was poor in the neoadjuvant chemoradiotherapy group, even at 12 months postoperatively. Neoadjuvant chemoradiotherapy was found to be a risk factor for erectile dysfunction after robot-assisted surgery for rectal cancer. Erectile function recovered postoperatively in patients undergoing lateral lymph node dissection; however, those receiving neoadjuvant chemoradiotherapy showed poor recovery, even at 12 months postoperatively.

Sleep Apnea is an Independent Correlate of Erectile and Sexual Dysfunction

Preface Currently, there are many wellestablished therapeutic options for early prostate cancer, and therefore, it is difficult for both urologists and patients to choose the optimal treatment. It is essential for urologists to counsel their patients according to reliable information about the advantages and disadvantages of each therapeutic option. We picked the topic for this issue, “Characteristics and management of erectile dysfunction after various treatments for prostate cancer,” because erectile dysfunction (ED) is one of the most frequent adverse events encountered in the management of prostate cancer. We invited six specialists to review each therapeutic option: radical prostatectomy, laparoscopic radical prostatectomy, robot-assisted laparoscopic radical prostatectomy, external beam radiotherapy, brachytherapy, and androgen deprivation therapy (ADT). Among these modalities, surgical interventions tend to induce a quick drop in erectile function with slow postoperative recovery. Early postoperative rehabilitation has been introduced, aiming at the early recovery of ED. On the contrary, radiation therapy tends to maintain the patient’s erectile function for a while after treatment but it gradually decreases. ADT may compromise not only the erectile function but also the libido level, and may result in significant deterioration of the patient’s quality of life. We hope these reviews will help urologists to counsel their patients with regards to decision-making in the management of early prostate cancer.

This study evaluated the effect of correction of serum cholesterol levels on erectile function and sildenafil treatment in patients with erectile dysfunction who have only hypercholesterolaemia as a risk factor for erectile dysfunction. Twenty-five patients with a single risk factor (hypercholesterolaemia, serum cholesterol > 200 mg/dl) for erectile dysfunction were included in the study. The patients were recommended to take sildenafil (minimum two 100 mg tablets/week) 1 h before sexual intercourse for 4 weeks. After 1 month washout period, the patients received a single dose of atorvastatin 10 mg/day for 1 month. Similarly, after a 1 month washout period, atorvastatin 10 mg/day and sildenafil (minimum two 100 mg tablets/week) were administered for 1 month as combination therapy. Erectile function was evaluated before and after all treatment regimens using the International Index of Erectile Function (IIEF). Following each treatment modality mean IIEF scores were significantly higher than baseline IIEF scores (p < 0.01). The IIEF score after sildenafil treatment was significantly higher than in the atorvastatin treatment group (p < 0.01); and the IIEF score after combined treatment was significantly higher than in the sildenafil and atorvastatin treatment groups. Correction of serum cholesterol levels with atorvastatin could improve erectile function in patients who have only hypercholesterolaemia as a risk factor for erectile dysfunction. Furthermore, atorvastatin could improve sildenafil's effects on erectile function in hypercholesterolaemic patients with erectile dysfunction.

Risk Factors for Erectile Dysfunction in Patients with Urethral Strictures Secondary to Blunt Trauma

Patients' Knowledge about Risk Factors for Erectile Dysfunction is Poor

89 Background: Preservation of EF is a goal of care for many men with newly diagnosed prostate cancer. In order to accurately counsel patients regarding their likely treatment outcome, an assessment of baseline EF, and screening for known risk factors, should form part of the assessment of all prostate cancer patients. Methods: We performed a retrospective review of prospectively-collected data regarding baseline EF in men with prostate cancer referred for a radiotherapy opinion. 1173 consecutive patients referred over a 5.5 year period from 2011-16 were included. All patients were offered the opportunity to complete the International Index of Erectile Function (IIEF-5) questionnaire in privacy. Information on known risk factors such as age, vascular comorbidity, smoking and alcohol history, and cardiovascular risk factors was recorded. Results: Of the 1173 patients, 233 were excluded due to metastatic disease at referral. Of the remaining 940 with localised disease, 812 (86%) completed the questionnaire. 561 (69%) successfully filled the questionnaire yielding a score. A further 251 (31%) commented on the questionnaire without completing the score (see table). Median age was 66years (IQR 62-71). 574(61%) had known risk factors for erectile dysfunction such as hypertension or diabetes. 173 (18.5%) had a history of peripheral, cardiovascular, or cerebrovascular disease. Smoking and alcohol history was available for 645 patients, 353(60%) had a smoking history, and 450(70%) had a history of alcohol use. Conclusions: In this population, there is a high prevalence of baseline erectile dysfunction (IIEF-5 ≤16), 242/561 (43%). Additionally, significant numbers of patients were sexually inactive or unconcerned regarding ED. Known risk factors for erectile dysfunction were common in this population, many of which are modifiable. [Table: see text]

What's known on the subject? and What does the study add? Penile colour Doppler ultrasonography (CDU) can be an invaluable investigative tool to characterize penile abnormalities to complement clinical history and physical examination in the evaluation of men with Peyronie's disease (PD) and/or erectile dysfunction (ED). Although CDU findings between men with PD and those with ED were not markedly different, subtle differences were observed. The classic penile CDU findings in men with PD comprise tunical thickening, intracavernosal fibrosis, septal fibrosis and intracavernosal calcification, while, in men with ED, low peak systolic velocity and high end-diastolic velocity are found on penile haemodynamics. Previously published studies have focused predominantly on either ED or PD exclusively, or examine the risk of progression to ED in the PD population. To our knowledge, this is the largest and most comprehensive analysis of penile CDU and clinical findings in men with PD and/or ED. The large sample size and multivariable analysis allow meaningful interpretation of the results. This study has found some substantial differences in the penile CDU findings of men with PD and/or ED that have not previously been reported. Although the risk factors of ED may be greater than those for PD, there is crossover in age, cardiovascular risk factors, trauma and penile CDU findings in men with PD and/or ED. To explore the differences in penile colour Doppler ultrasonography (CDU) findings between men with Peyronie's disease (PD) and those with erectile dysfunction (ED). Patients presenting with PD and/or ED who underwent penile CDU were recruited to the study. Patient demographics, comorbidities, International Index of Erectile Function-5 scores, previous therapies and physical findings were documented. Penile curvature, presence of tunical thickening, septal fibrosis, intracavernosal fibrosis and calcification, and cavernosal vascular status were recorded. A total of 1500 men underwent penile CDU during the 10-year period. Of these men, 891 men presented with PD and 609 men had ED only. Men with ED had higher rates of diabetes and coronary artery disease (P < 0.05). Isolated tunical thickening was more common in older men and in the PD cohort. The presence of intracavernosal fibrosis correlated strongly with difficulty maintaining erection (P < 0.05). Impaired cavernosal arterial flow was observed in men with decrease penile rigidity and penile pain, while higher end-diastolic velocities were found in men with difficulty maintaining erection and tunical thickening on penile CDU. Men with PD and ED had many similarities and differences on penile CDU. Penile CDU continues to be an invaluable clinical tool in the management of men with male sexual dysfunction.

Erectile dysfunction (ED) was established to be linked to the risk factors of coronary artery disease such as metabolic syndrome, hypertension, diabetes, smoking, obesity and dyslipidemia. To study the influence of smoking and obesity on penile hemodynamics in patients with erectile dysfunction. This prospective study was carried out on 130 patients above 40years and suffering from ED for more than 6months. Selected patients were divided into four groups: group 1 (nonsmokers/non-obese) N = 36, group 2 (nonsmokers/obese) N = 30, group 3 (smokers/non-obese) N = 34, group 4 (smokers and obese) N = 30. Other risk factors for ED were excluded except dyslipidemia. All patients were subjected to personal history, sexual history, history of medical disorders or operations, evaluation of erectile function using an abridged IIEF-5. Measuring of BMI, fasting lipid profile, blood sugar, TT, prolactin, and PSA was performed. Penile hemodynamics was evaluated using intracavernosal injection of 1cc Bimix (papaverin + phentolamine) and penile duplex ultrasound measuring the peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI), and cavernosal artery diameter before and after injection. The mean ages of group 1, group 2, group 3 and group 4 were 50.92 ± 6.52, 55.20 ± 7.18, 50.88 ± 7.66 and 52.30 ± 7.61, respectively, with no statistically significant (p = 0.341). A statistically significant difference observed between mean value of PSV between group 1 and all other groups on both sides and between group 3 and 4. Also, our results recorded a statistically significant difference between mean value of EDV and RI between group 1 and all other groups on both sides. Concerning the change in the cavernosal artery diameter after ICI, there was a significant difference was seen between the following groups 1 and 4, 3 and 4 on both sides and between groups 1 and 2 at right side only. There was a statistically significant difference between the study groups concerning patient's response to ICI (p value 0.000). A significant negative correlation between BMI and total testosterone was recorded (p = 0.001). Regarding the mean value of testosterone, a significant difference was observed between the different four groups (p = 0.002). And a statistically significant difference was reported between group 1 and group 2 (p = 0.004) and group 2 and group 3 (p = 0.007). Both smoking and BMI are strong risk factors for ED and affect response to ICI and penile duplex parameters (PSV, EDV, RI). Smoking and BMI together cause more deterioration of penile duplex parameters and response to ICI. The effect of smoking on EDV and RI was more than BMI. The effect of BMI on PSV, response to ICI and testosterone levels was more than smoking.

SUMMARYThere are insufficient data on the effects of alpha‐blockers and finasteride on erectile function in men who have other risk factors for erectile dysfunction (ED). This study was conducted to compare the relative effects of these medications on ED in men who may be on other medications or have other risk factors for ED. Patients attending urology and primary care clinics were asked to complete an IRB‐approved questionnaire that combined the validated Sexual Health Inventory for Men (SHIM) and a detailed medical history. A total of 123 patients completed the questionnaire. The age range was 28–88 years (mean: 68 years). Eighty‐one per cent of patients had SHIM scores &lt;21, indicating some degree of ED. The average SHIM scores in a population of patients with similar age and risk factors who had been on finasteride or alpha‐blockers indicated the presence of ED but did not reveal a significant difference between the two groups. The scores were no different from an age‐matched group of patients who were not on either medication, demonstrating the relatively greater importance of various other risk factors for ED. There was an inverse linear relationship between the number of ED risk factors and SHIM scores. There does not appear to be a significant difference between alpha‐blockers and finasteride as independent risk factors for ED. Age and other risk factors (heart disease, diabetes, hypertension, smoking, and hypercholesterolaemia) tend to have a much stronger influence on the severity of ED as assessed by SHIM scores.

The Link Between Cigarette Smoking and Erectile Dysfunction: A Systematic Review

Targeted therapy for erectile dysfunction (ED) involves fewer screening tests and provides a variety of treatment choices for patients. Although the advantage of targeted therapy in diagnosis and therapy for ED has been recognized, the rational mode for oriented ED therapy has not been established. This study aimed to investigate targeted diagnosis and therapy for ED. A total of 198 patients with ED were included in the study. After intracavernosal vasoactive agent injection was given, color Doppler flow imaging was performed and penile rigidity was classified as Schramek grade 5 (10 minutes duration), grade 4 (10 minutes duration), grade 3 and grade 2, defining four patient groups as group V (143 cases), group IV (23 cases), group III (18 cases), and group II (14 cases). Appropriate and acceptable treatment was recommended to patients according to erection grade. In 198 patients with ED, the peak systolic velocity, end diastolic velocity, and resistance index in the cavernosal artery and dorsal artery and the flow velocity in the deep dorsal vein were not significantly different before injection (P > 0.05). After injection, peak systolic velocity, end diastolic velocity, and resistance index in the cavernosal artery were different among the four groups (P < 0.05). Between each two groups, the difference in resistance index was significant (P < 0.05). The statistical differences in other indexes were not significant (P > 0.05). Selective targeted therapy based on erection grade by color Doppler flow imaging improved the clinical satisfaction rate to 91.91% (182/198). Based on the routine diagnosis of ED, blood flow indexes in the cavernosal artery are measured by color Doppler flow imaging following minimally invasive intercavernosal injection, which is combined with the Schramek grade of erection. The most appropriate and acceptable treatment is recommended according to the different groups, which improves the clinical satisfaction of treatment for ED and is an ideal model of targeted diagnosis and treatment.

Erectile Dysfunction Risk Factors in Noninsulin Dependent Diabetic Saudi Patients