Assessment Of Erectile Dysfunction Research Articles

The role of Doppler ultrasound in the evaluation of penile haemodynamics—A sonographer's guide to the documentation of vasculogenic erectile dysfunction

AbstractVasculogenic erectile dysfunction (ED) is the most common form of ED affecting the male population. Once the first line investigation for erectile dysfunction, penile Doppler ultrasound examinations have reduced in number following the introduction of oral phosphodiesterase inhibitors as a treatment method. As such, skilled professionals versed in the performance of these examinations are dwindling. This skill deficit is compounded by the lack of standardisation that exists in the performance and interpretation of penile haemodynamics relative to impotence of vascular origin. Despite the success of pharmacological agents in the treatment of vasculogenic dysfunction, penile Doppler examinations are still relevant in the assessment of ED in non‐responders, and those patients in which pelvic surgery or trauma has altered the normal erectile mechanism. Growing evidence in the literature also suggests that vasculogenic ED may be an early indicator of systemic vascular disease and therefore prognostic of future cardiovascular events. Considering this, the relevance of Doppler assessment of penile haemodynamics with ultrasound should not be underestimated. This article will introduce the sonographer to advanced vascular anatomy of the penis, pathophysiology of erectile function and the principles of normal and pathological penile haemodynamic patterns. It also aims to suggest a standardised protocol for the performance of penile Doppler ultrasound relative to primary vasculogenic ED and reduce the amount of variability that exits between operators. As such the sonographer can make a significant contribution to patient management pathways.

The association between the severity of erectile dysfunction and left ventricular diastolic dysfunction in patients with and without cardiovascular disease.

Erectile dysfunction (ED) is considered a microvascular disorder and serves as an indicator for the potential development of cardiovascular disease (CVD). Although left ventricular diastolic dysfunction (LVDD) reflects early myocardial damage caused by microvascular disorders, the association between ED and LVDD remains poorly elucidated. A cross-sectional study was conducted on 123 patients with ED. They underwent RigiScan, and conventional echocardiography, and attempted International Index of Erectile Function (IIEF) questionnaire. ED severity was evaluated by measuring changes in the penile base circumference and duration of penile rigidity (≥70%) during erection. The early diastolic velocity of mitral inflow (E) and early diastolic velocity of the mitral annulus (e') were measured using echocardiography. The patients were grouped based on the presence of CVD. Among 123 patients, 29 had CVD and 94 did not. Patients with CVD exhibited more pronounced ED and more severe LVDD. Associations between increased penile circumference with echocardiographic parameters were more prominent in patients with CVD than in those without CVD (ΔTtop and e' wave, r=0.508 and r=0.282, respectively, p for interaction=0.033; ΔTbase and E/e' ratio, r=-0.338 and r=-0.293, respectively, p for interaction <0.001). In the multivariate linear regression, the increase of penile base circumference was an independent risk factor for LVDD (e', B=0.503; E/e' ratio, B=-1.416, respectively, p<0.001). ED severity correlated well with LV diastolic dysfunction, particularly in the presence of CVD. This study highlighted the potential role of ED assessment as early indicator of CVD development.

Prevalence and predictors of erectile dysfunction among men in the diabetes prevention program outcomes study

ObjectiveTo determine burden and identify correlates of erectile dysfunction (ED) among men with prediabetes (PreD) and type 2 diabetes (T2D) enrolled in the Diabetes Prevention Program (DPP) Outcomes Study (DPPOS). Research design and methodsThe 2017 DPPOS visit included administration of the International Index of Erectile Function. Of 648 male participants, 88 % (n = 568) completed the survey. Associations between sociodemographic, behavioral, clinical, and glycemic measures at time of ED assessment, and ED were examined using multivariable logistic regression models in men with PreD and T2D separately. ResultsOverall, 218 (38 %) men met ED criteria. Prevalence was similar in men with PreD (41 %) and T2D (37 %) (p = 0.4). In all men, age (p < 0.001) increased odds of ED. Among men with PreD, those assigned to intensive lifestyle intervention (ILS), but not metformin, had decreased odds of ED compared with the placebo group (OR = 0.35, 95 % CI = 0.13, 0.94). Non-Hispanic White race was associated with increased odds of ED compared with other races (OR = 4.3; 95 % CI = 1.92, 9.65). Among men with T2D, ED risk did not differ by DPP treatment assignment; however, individuals with metabolic syndrome defined by National Cholesterol Education Program criteria, had increased odds of ED (OR = 1.85, 95 % CI = 1.14, 3.01), as did individuals with depression (OR = 2.05; 95 % CI = 1.10, 3.79). ConclusionsED is prevalent in men with PreD and T2D. Our finding of reduced odds of ED in men randomized to ILS and with PreD suggests a potential opportunity for risk mitigation in the prediabetes interval. In men who have progressed to T2D, metabolic factors appear to be associated with ED.

Can atherogenic indices and the triglyceride-glucose index be used to predict erectile dysfunction?

Atherosclerosis and insulin resistance play an important role in the development of erectile dysfunction (ED), and few studies have comprehensively evaluated more specific indicators like atherogenic indices and the triglyceride-glucose (TyG) index in the assessment of ED. This study aimed to reveal the role of atherogenic indices (atherogenic index of plasma [AIP], Castelli risk index-1/2 [CRI-1/2], and atherogenic coefficient [AC]) based on plasma lipid ratios, which have been used as more sensitive indicators of atherosclerosis in recent years, and the TyG index, a practical indicator of insulin resistance, in predicting vasculogenic ED. The study included a total of 199 patients who met the inclusion criteria and a total of 51 control subjects without ED complaints according to the International Index of Erectile Function (IIEF-5) scores (>21) between May 2021 and October 2022. For all participants, the demographic and biochemical parameters were evaluated, and atherogenic indices, namely CRI-1 (total cholesterol/high-density lipoprotein [HDL]), CRI-2 (LDL/HDL) AIP [log10(triglycerides/HDL)], and AC (non-HDL/HDL), as well as the TyG index [Ln {fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2}] were calculated. The TyG index, which is an indicator of insulin resistance, and atherogenic indices such as CRI-1, AIP, and AC were significantly associated with ED, and especially AIP and the TyG index seem to be more important in the evaluation of ED. According to the univariate analysis, the patient group had significantly higher CRI-1 (5.3 ± 1.4 vs 4.7 ± 1.3; P = .005), AIP (0.31 ± 0.26 vs 0.13 ± 0.2; P < .001), AC (4.1 ± 1.4 vs 3.70 ± 1.2; P = .026), and TyG (9.16 ± 0.71 vs 8.77 ± 0.52; P < .001) values compared with the control group. In the correlation analysis, a significant negative correlation was found between the AIP and TyG index and the IIEF-5 scores (r2 = 0.120, P < .001 between AIP and IIEF-5; r2 = 0.091, P < .001 between TyG index and IIEF-5). The multivariate analysis revealed AIP and the TyG index as independent predictive factors for ED. The use of atherogenic indices and TyG index in daily urology practice can help physicians in the diagnosis and follow-up of ED. The lack of sex hormone-binding globulin and free testosterone levels represents a limitation of our study. Another limitation is that the severity of ED was determined using the IIEF-5 scores, rather than a more objective method, such as penile artery ultrasound. Atherogenic indices and the TyG index can be used as inexpensive and practical markers to predict the severity of arteriogenic ED.

(357) Nocturnal Penile Tumescence Test in Patients with Erectile Dysfunction Associates With Penile and Systemic Vascular Disease

Abstract Introduction Erectile dysfunction (ED) is the most frequent male sexual dysfunction along with premature ejaculation. Moreover, its prevalence is increasing worldwide due to ageing of the population and spreading of risk factors like obesity, diabetes, hypercholesterolemia, hypertension, etc. Also, it represents an important cardiovascular risk marker because of its demonstrated tight association with cardiovascular disease (CVD). We dispose of many diagnostic tools to assess ED and a proper workup includes the anamnesis, a physical exploration, blood tests for hormonal and metabolic evaluation, and ED grading through validated questionnaires such as the International Index of Erectile Function (IIEF). One of the instrumental tests we may indicate is the nocturnal penile tumescence (NPT) test or “Rigiscan”. This test measures the spontaneous erections overnight and helps discriminating between organic and psychological ED. However, this is a highly specific but low sensitive test since a positive (normal) result can roll out an organic ED and suggest a psychological etiology while a negative result cannot confirm or exclude an organic condition. Objectives In this context the aim of this study is to investigate the predictive role of Rigiscan in discriminating patients with an organic ED and the presence of vascular disease in patients with ED. Methods We conducted a prospective study in patient 25 patient who underwent a Rigiscan test as part of ED assessment. Each patient had blood tests for hormonal and metabolic analysis, a measurement of the carotid intima-media thickness (cIMT), a brachial flow-mediated vasodilation test (FMD), and a penile color doppler ultrasound (PCDU) to assess penile hemodynamics. Results Our patients had a mean age of 47.9 ± 13.7 years, with a mean IIEF score of 9.0 ± 6.5. Among them 13 (54.2%) were active smokers, 5 (20.8%) were diabetics, 8 (32%) had dyslipidemia, and 4 (16.7%) had hypertension. Eleven patients (44%) had a normal Rigiscan while 14(56%) had a pathological result. We found that patient with a pathological Rigiscan presented with a cluster of impaired vascular function at different levels. In particular, they had statistically lower peak systolic velocity (PSV) in the PCDU (52.5 vs 80.2 cm/s p=0.014) and a higher prevalence of arterial insufficiency (42.9% vs 0.0% p=0.020). Moreover, in patients with negative Rigiscan, there was a higher cIMT (0.9 vs 0.7 mm) and lower response to FMD (7.7% vs 9.6%) with a more frequent diagnose of impaired FMD (63.6% vs 46.2%) but without reaching a statistically significance. Conclusion We can conclude that a negative Rigiscan is indicative of altered penile hemodynamics and may suggests the presence of systemic vascular disease. Therefore, while a positive Rigiscan excludes organic ED, a negative Rigiscan should be considered a cardiovascular risk marker and induce the clinician to address the cardiovascular risk in that patient. More studies with larger population are warranted to confirm and further investigated these findings. Disclosure No

Influence of Bariatric Surgery on Erectile Dysfunction—a Systematic Review and Meta-Analysis

IntroductionObesity is associated with a higher prevalence of various comorbidities including erectile dysfunction (ED). Bariatric surgery leads to weight loss and remission of weight-related diseases. The exact influence of bariatric treatment on ED is yet to be established; however, the number of papers on the subject is growing.MethodologyA systematic review with meta-analysis comparing erectile dysfunction before and after surgery was conducted according to PRISMA guidelines with a literature search performed in June 2022. Inclusion criteria involved (1) ED assessment using the International International Index of Erectile Function (IIEF) and (2) longitudinal study design. Secondary endpoints involved hormonal changes and specific fields of IIEF.ResultsAn initial search yielded 878 records. Fourteen studies were included in the meta-analysis involving 508 patients. The quality of analyzed studies was moderate. Analysis showed significant differences in IIEF before and after surgery (Std. MD = 1.19, 95% CI 0.72 to 1.66, p<0.0001). Testosterone after surgery is higher by 156.32 pg/ml (95% CI 84.78 to 227.86, p<0.0001). There were differences in erectile function (MD:4.86, p < 0.0001), desire (MD: 1.21, p < 0.0001), intercourse satisfaction (MD: 2.16, p < 0.0001), and overall satisfaction (MD: 1.21, p = 0.003). There were no differences in terms of orgasms (MD: 0.65, p = 0.06).ConclusionThere are differences in ED before and after bariatric surgery. Patients achieve 19% more in the IIEF questionnaire showing improvement. Further studies, including multivariate regression models on large cohorts, are required to determine whether the surgery is an independent factor in alleviating ED.Graphical

The association between heavy metal exposure and erectile dysfunction in the United States.

Literature regarding the impacts of heavy metal exposure on erectile dysfunction (ED) is scarce. We aimed to evaluate the correlation between 10 urinary metals and ED in a large, nationally representative adult male sample. The dataset was extracted from the National Health and Nutrition Examination Survey (NHANES) during the period of 2001-2002 and 2003-2004. Weighted proportions and multivariable logistic regression analysis adjusted for confounding variables were utilized to determine the relationship between metal exposure and ED. Weighted quantile sum (WQS) regression was utilized to evaluate the impact of a mixture of urinary metals on ED. A total of 1328 participants were included in our study. In multivariable logistic regression analysis, cobalt (Co) and antimony (Sb) were positively associated with ED (odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.10-1.73, P = 0.020; and OR: 1.41, 95% CI: 1.12-1.77, P = 0.018, respectively) after full adjustment. Men in tertile 4 for Co (OR: 1.49, 95% CI: 1.02-2.41, P for trend = 0.012) and Sb (OR: 1.53, 95% CI: 1.08-2.40, P for trend = 0.041) had significantly higher odds of ED than those in tertile 1. Furthermore, the WQS index was significantly linked with increased odds of ED after full adjustment (OR: 1.31, 95% CI: 1.04-1.72, P < 0.05). Our study expanded on previous literature indicating the possible role of heavy metal exposure in the etiology of ED. The evaluation of heavy metal exposure should be included in the risk assessment of ED.

The association between urinary organophosphate insecticide metabolites and erectile dysfunction in the United States.

Organophosphate (OP) insecticides are the main chemicals used in agriculture for pest elimination, and they have been linked with many diseases. However, there is no literature regarding the impacts of organophosphate insecticide metabolite exposure on erectile dysfunction (ED). We aimed to evaluate the correlation between 4 urinary organophosphate insecticide metabolites and the presence of ED in a representative sample of men aged 20 and older. The dataset including a total of 555 subjects was obtained from the National Health and Nutrition Examination Survey (NHANES) 2003-2004. ED was assessed by a question from a self-report questionnaire. Weighted proportions and multivariable logistic regression analysis were utilized to examine the relationship between organophosphate insecticide metabolite exposure and ED. In multivariable logistic regression analysis, diethylphosphate (DEP) was positively correlated with ED (OR 1.07; 95% CI 1.01-1.14; P = 0.033) after full adjustment. Men in DEP tertile 4 had a significant 33% higher risk of ED than those in tertile 1. Furthermore, in a subgroup analysis, our results showed that higher DEP levels were significantly associated with ED in the young age group (20 ≤ age ≤ 39). Our study revealed a significant association between organophosphate insecticide metabolite exposure and an increased risk of ED. Moreover, the correlations were more evident in the young age group. The evaluation of urinary organophosphate insecticide metabolite exposure should be included in the risk assessment of ED. Further study to investigate the underlying mechanism, such as how long the urinary metabolite is present, whether ED is reversible in this population by lowering DEP concentrations, and how exposure to this metabolite affects erectile tissue, is warranted.

The flow index provides a comprehensive assessment of erectile dysfunction by combining blood flow velocity and vascular diameter

Dynamic duplex sonography (DUS) is not comprehensive in the evaluation of arteriogenic erectile dysfunction (ED). We introduced a new parameter, the flow index (FI), into the assessment of arteriogenic ED. A retrospective review of a prospective database was conducted. Patients undergoing DUS and pelvic computed tomography angiography for the evaluation of ED were included. The FI was calculated from peak systolic velocity (PSV) and the percentages of pelvic arterial (PLA) stenosis. Correlations between PSV, PLA stenosis, the FI, and erectile function were calculated. Eighty-three patients were included. Compared with PSV, the FI had better correlations with the erection hardness score (EHS) (rs = 0.405, P < 0.001 for FI; rs = 0.294, P = 0.007 for PSV). For EHS < 3, the areas under the ROC curve of FI and PSV were 0.759 and 0.700, respectively. In patients with normal DUS but EHS < 3, PLA stenosis was more severe (62.5% vs. 10.0%, P = 0.015), and the FI was lower (8.35 vs. 57.78, P = 0.006), while PSV was not different. The FI is better than PSV in the evaluation of arteriogenic ED. On the other hand, assessment of the pelvic arterial system should be included in the evaluation of ED.

Novel predictive risk factor for erectile dysfunction: Serum high-sensitivity C-reactive protein.

C-reactive protein (CRP), as a marker of inflammation, may be closely related to erectile dysfunction (ED), however, there is no meta-analysis exists for it. We aimed to verify the relationship between CRP and erectile dysfunction and to explore the changes of CRP levels in ED patients after first-line treatment. We searched databases including the Cochrane Library, PubMed, and MEDLINE to identify studies up to January 1, 2022. We performed a comprehensive analysis of the included studies by STATA software and calculated standardized mean differences (SMDs) and their corresponding 95% confidence intervals. A total of 12 studies were included and the analysis showed that CRP levels were higher significantly in patients with erectile dysfunction than the healthy controls (p<0.001) and decreased by a mean of 0.38mg/L after first-line PDE5i drug treatment (p=0.001). This novel meta-analysis suggests that CRP is statistically significantly associated with erectile dysfunction and may be a predictor or risk factor for the assessment of ED. However, further original studies with large sample sizes are needed to validate this.

INFLUENCE OF THE DURATION OF DIABETES AND VIBRATION PERCEPTION THRESHOLD ON THE SEVERITY OF ERECTILE DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.

Erectile dysfunction(ED) in men is a frequent under-reported complication of diabetes mellitus, which is becoming significant health problem worldwide. The study aims to determine the prevalence and risk factors for development of ED in North Indian patients with type 2 diabetes mellitus. We used international index of erectile function (IIEF-5) for the assessment of ED in 796 patients with type 2 diabetes mellitus. We recorded the age, duration of diabetes, glycemic status, body mass index, diabetes medications, microvascular and macrovascular complications. The mean age of patients in the study was 49.38 ± 9.52 years. The prevalence of ED in patients with type 2 diabetes mellitus was 79.4%. Logistic regression analysis revealed that age, body mass index, glycemic control, insulin therapy, retinopathy and nephropathy was not significantly associated with erectile dysfunction in patients with type 2 diabetes mellitus. Duration of diabetes (OR = 1.054, 95% CI 1.007 to 1.102, P=0.023) and vibration perception threshold (OR = 1.071, 95% CI 1.042 to 1.102, P=0.000) were identified as key risk factors for development of ED. Duration of diabetes and peripheral neuropathy emerged as significant risk factors for development of severe erectile dysfunction.

A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM).

IntroductionAlthough erectile dysfunction (ED) involves an interaction between physiological and psychological pathways, the psychosocial aspects of ED have received considerably less attention so far.AimTo review the available evidence on the psychosocial aspects of ED in order to develop a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine (ESSM).MethodA comprehensive, narrative review of the literature was performed.Main outcome measuresSpecific statements and recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria were provided.ResultsA multidisciplinary treatment, in which medical treatment is combined with a psychological approach, is preferred over unimodal treatment. There is increasing evidence that psychological treatments of ED can improve medical treatments, the patient's adherence to treatment, and the quality of the sexual relationship. The main components of psychological treatment of ED involve cognitive and behavioral techniques aimed at reducing anxiety, challenging dysfunctional beliefs, increasing sexual stimulation, disrupting sexual avoidance, and increasing intimacy and communication skills in a relational context. When applicable and possible, it is strongly recommended to include the partner in the assessment and treatment of ED and to actively work on interpartner agreement and shared decision-making regarding possible treatment options. To ensure a better integration of the biopsychosocial model into clinical practice, developing concrete treatment protocols and training programs are desirable.ConclusionBecause the psychosocial approach to ED has been underexposed so far, this position statement provides valuable information for clinicians treating ED. Psychological interventions on ED are based on existing theoretical models that are grounded in empirical evidence. However, the quality of available studies is low, which calls for further research. The sexual medicine field would benefit from pursuing more diversity, inclusivity, and integration when setting up treatments and evaluating their effect.Dewitte M, Bettocchi C, Carvalho J, et al. A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med 2021;9:100434.

PD48-08 PROSPECTIVE EVALUATION OF ERECTILE DYSFUNCTION WITH A VALIDATED PATIENT REPORTED OUTCOME MEASURE IN PATIENTS WITH PEYRONIE’S DISEASE REQUIRING NESBIT’S TYPE SURGERY

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie's Disease (PD48)1 Sep 2021PD48-08 PROSPECTIVE EVALUATION OF ERECTILE DYSFUNCTION WITH A VALIDATED PATIENT REPORTED OUTCOME MEASURE IN PATIENTS WITH PEYRONIE’S DISEASE REQUIRING NESBIT’S TYPE SURGERY Marta Skrodzka, Deji Akiboye, Jade Harrison, Sylvia Yan, Madhavi Natarajan, Eleni Anastasiadis, Pareeta Patel, Benjamin Ayres, and Nicholas Watkin Marta SkrodzkaMarta Skrodzka More articles by this author , Deji AkiboyeDeji Akiboye More articles by this author , Jade HarrisonJade Harrison More articles by this author , Sylvia YanSylvia Yan More articles by this author , Madhavi NatarajanMadhavi Natarajan More articles by this author , Eleni AnastasiadisEleni Anastasiadis More articles by this author , Pareeta PatelPareeta Patel More articles by this author , Benjamin AyresBenjamin Ayres More articles by this author , and Nicholas WatkinNicholas Watkin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002070.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are very few prospective studies of the outcome of surgical intervention for Peyronie’s disease. In studies specifically reporting erectile dysfunction (ED), established tools used (including SHIM and IIEF) are not validated for Peyronie’s disease patients and can lead to erroneous results. We have previously published development of a validated PROM for Nesbit’s surgery measuring subjective outcomes. In this study we determined the rate and severity of ED pre and post-operatively. METHODS: 5 year prospective study of all patients recruited into a Peyronie’s PROM development. After a RAND consensus group of Peyronie’s patients and pilot PROM, a 4 question, 5 point (0-4) domain for erectile dysfunction was validated. Scores from 0 (no ED) to 16 (very severe ED) were recorded and stratified (mild ED – 5-8, moderate ED – 9-12, severe ED – 13-16) pre and post operatively. Exclusions: surgery for congenital curvature and grafts. Patients completed the PROM in clinic at time of decision for surgery, within a week pre-operatively, and 12 weeks post-Nesbit’s type surgery. RESULTS: 130 men underwent Nesbit surgery. Median age 57 years (25-73). 12 patients were excluded from the analysis for starting ED treatment in the preoperative period after the decision for surgery. Rates for no-, mild-, moderate- and severe ED were 47 (39.8%), 45 (38.1%), 23 (19.5%) and 3 (2.5%) out of 118 men. Post operatively, rates were 56 (47.5%), 43 (36.4%), 19 (16.1%) and 0 men. 93 men (78.8%) were on no treatment pre operatively and 79 men (66.9%) took no treatment for ED post operatively. 24 men (20.3%) were already on PDE5 treatment prior to presentation, with 38 men (32.2%) on tablet treatment post operatively. One patient who was on alprostadil injections pre-operatively remained on the same treatment post operatively. CONCLUSIONS: We report the first prospective assessment of ED in Peyronie’s surgery using validated PROM. Surgery did not result in deterioration of erectile function. High rates of pre-existing ED should be managed alongside surgery for a satisfactory patient outcome. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e841-e841 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marta Skrodzka More articles by this author Deji Akiboye More articles by this author Jade Harrison More articles by this author Sylvia Yan More articles by this author Madhavi Natarajan More articles by this author Eleni Anastasiadis More articles by this author Pareeta Patel More articles by this author Benjamin Ayres More articles by this author Nicholas Watkin More articles by this author Expand All Advertisement Loading ...

Canadian Urological Association guideline: Erectile dysfunction.

Erectile dysfunction (ED) impacts the wellness and quality of life of millions of Canadians. An evaluation focused on the identification of reversible and irreversible underlying factors is recommended for patients presenting with ED. Through a shared decision-making model framework, the goal of ED treatment is to improve functional outcomes and enhance sexual satisfaction while minimizing adverse effects associated with treatment. Given that ED is assessed and treated by multiple different types of health practitioners, the purpose of this guideline is to provide the best available evidence to facilitate care delivery through a Canadian lens. After a narrative review of ED assessment and treatment for general readership, five key clinical questions relating to priority areas of ED are assessed using the GRADE and evidence-to-decision-making frameworks.

The Relationship Between Hematologic Parameters and Erectile Dysfunction.

IntroductionCertain hematologic parameters related to blood cells, known as the biomarkers that predict cardiovascular disease, might be potential predictors of erectile dysfunction (ED) due to the shared pathophysiology between ED and cardiovascular disease .AimTo investigate the relationship between ED and these hematologic parameters and the clinical significance of hematologic parameters for the diagnosis of ED.MethodsA total of 113 male patients diagnosed with ED were included in this study. Blood samples were collected before 10:00 AM for blood cells examination, biochemical tests, and sex hormone analysis. Another 212 healthy controls without ED from the health management center was included as the control group. The relationship between hematologic parameters and ED was assessed by comparing differences in body mass index (BMI), biochemical indexes and hematologic parameters between the 2 groups, and the diagnostic value of hematologic parameters for ED was also examined and compared.Main outcome measuresInternational Index of Erectile Function, hematologic parametersResultsThe neutrophil count (NC), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in ED patients were significantly higher than those in healthy controls, whereas the lymphocyte count (LC) was significantly lower than that in healthy controls. After adjusting for age, BMI, uric acid (UA), fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL), increases in the NC, NLR, and PLR and a decrease in the LC were shown to be independent risk factors for ED. Receiver operating characteristic (ROC) curve analysis showed that the NLR exhibited better diagnostic performance for ED than the other parameters.ConclusionIncreases in the NC, NLR, and PLR and a decrease in the LC significantly increased the risk of ED. The NC, LC, NLR and PLR could contribute to the diagnosis and assessment of ED. Zhangcheng L, Yuxin T, Xiucheng L and Dongjie L, et al. The Relationship Between Hematologic Parameters and Erectile Dysfunction. Sex Med 2021;9:100401.

D-(+)-Galactose-induced aging: A novel experimental model of erectile dysfunction.

Erectile dysfunction (ED) is defined as the inability to achieve and/or maintain penile erection sufficient for satisfactory sexual relations, and aging is one of the main risk factors involved. The D-(+)-Galactose aging model is a consolidated methodology for studies of cardiovascular aging; however, its potential for use with ED remain unexplored. The present study proposed to characterize a new experimental model for ED, using the D-(+)-Galactose aging model. For the experiments, the animals were randomly divided into three groups receiving: vehicle (CTL), D-galactose 150 mg/kg (DGAL), and D-(+)-galactose 150 mg/Kg + sildenafil 1.5 mg/Kg (DGAL+SD1.5) being administered daily for a period of eight weeks. All of the experimental protocols were previously approved by the Ethics Committee on the Use of Animals at the Federal University of Paraíba n° 9706070319. During the treatment, we analyzed physical, molecular, and physiological aspects related to the aging process and implicated in the development of ED. Our findings demonstrate for the first time that D-(+)-Galactose-induced aging represents a suitable experimental model for ED assessment. This was evidenced by an observed hyper-contractility in corpora cavernosa, significant endothelial dysfunction, increased ROS levels, an increase in cavernous tissue senescence, and the loss of essential penile erectile components.

Prevalence of erectile dysfunction and its associated factors among patients with diabetes in Ethiopia: a systematic review and meta-analysis.

ObjectivesWe aimed to estimate the pooled prevalence of erectile dysfunction (ED) among patients with diabetes mellitus (DM) in Ethiopia and to identify its associated factors.MethodsWe performed a systematic search of scientific databases (PubMed, ScienceDirect); the grey literature was also searched (Google, Google Scholar). Data were extracted from primary studies using a data extraction format and exported for statistical analysis. I2 tests were used to assess the heterogeneity of studies. Owing to heterogeneity among the included studies, we used a random-effects model to determine pooled estimates of ED. Publication bias was assessed using Egger’s and Begg’s tests.ResultsThe pooled prevalence of ED among patients with DM in Ethiopia was 54.3% (95% confidence interval [CI]: 28.2–80.5). Older age (OR: 4.42, 95% CI: 2.83–6.00) and duration of DM (OR: 3.2, 95% CI: 1.74–4.66) had statistically significant associations with ED.ConclusionOne in two individuals with DM in Ethiopia also had ED. This finding highlights the need to integrate assessment and management of ED into routine medical care in diabetes follow-up visits. Special attention is recommended for patients with older age and a longer duration of DM.

Reliability and Validity of Malayalam Version of 5-Item International Index of Erectile Function

Introduction: Erectile Dysfunction (ED) is a common problem affecting men and it also negatively impacts mental health. A self administered questionnaire which is validated in local language will help in better detection of ED. Aim: To assess the reliability and validity of Malayalam version of 5 item International Index of Erectile Function (IIEF-5) in the Malayali population of India. Materials and Methods: This prospective observational study was done in Government Medical College, Thiruvananthapuram, India. A total of 136 subjects were recruited into the study after taking written informed consent. Subjects were divided into two groups. Group I included 68 subjects who had complaints of ED and group II included 68 subjects who had no complaints of ED. The subjects were administered Malayalam translated IIEF-5 at baseline and after four weeks. Results: Internal consistency of the Malayalam IIEF-5 was assessed using Cronbach’s alpha and the whole scale had an excellent internal consistency of 0.90. The 5 items had an overall Intraclass Correlation Coefficient (ICC) of 0.91 showing a good test retest reliability. The Malayalam version was also highly sensitive and specific to the change in ED after four weeks. Conclusion: This study shows that the Malayalam version of IIEF-5 is a reliable and valid tool for assessment of ED, making it useful as an initial screening tool in a clinical setting. The ease of administering and favourable diagnostic properties of Malayalam IIEF-5 can help in the reducing the number of undiagnosed cases of ED.

Prognostic Indicators for Successful Low-intensity Extracorporeal Shock Wave Therapy Treatment of Erectile Dysfunction

ObjectiveTo assess prognostic factors affecting successful low-intensity extracorporeal shockwave therapy (Li-ESWT) treatment of erectile dysfunction (ED) in patients with vasculogenic ED and to report 30-month follow-up. MethodsThis study was conducted upon 425 patients with vasculogenic ED. Assessment of ED was done using Sexual Health Inventory for Men (SHIM) score. Patients were treated by Li-ESWT using PiezoWave2 (Richard Wolf) device. Successful Li-ESWT was defined as 6-month SHIM score of 22-25. Patients with successful treatment were followed for 30 months. ResultsMean Baseline SHIM scores for the total population studied was 11.8 with a range from 5 to 20. After 6 months from treatment, 220 (51.8%) patients reported satisfactory sexual intercourse. Age, diabetes, hypertension, smoking, obesity, hyperlipidemia, pretreatment SHIM score, and the duration of ED were all found to be significant factors affecting the success of Li-ESWT. At 30-month follow-up, 168 (76.3%) patients from those who responded to Li-ESWT still reported satisfactory sexual intercourse with a SHIM score of 22-25 without using PDE5i. ConclusionLi-ESWT is safe and effective treatment of ED with 30 months success in 39.5% of patients treated. Li-ESWT should be offered to patients with mild-to-moderate ED and not to those with severe ED.

Erectile dysfunction in Egyptian patients with chronic obstructive pulmonary disease

Background Chronic obstructive pulmonary disease (COPD) is a life-long disease affecting the airways. It occurs owing to long-term exposure to hazardous smokes and particles and leads to increased inflammatory response in the airway. Multiple well-recognized comorbidities are associated with COPD presence. Sexual affection is considered one of them through incompletely understood mechanism. Studies demonstrating erectile dysfunction (ED) prevalence among Egyptian patients with COPD are limited.Aim This study aimed to assess ED prevalence in male patients with a confirmed diagnosis of COPD and also to assess their serum testosterone level.Patients and Methods One hundred male patients with COPD and 40 age-matched healthy male controls were included in the study. Each participant was subjected to detailed medical history and full clinical examination, pulmonary assessment (pulmonary function tests by spirometry and arterial blood gas analysis), and measurement of total testosterone level. Also, each participant completed the Arabic version of the IIEF-5 questionnaire for assessment of erectile function and ED severity.Results The scores of the IIEF-5 questionnaire revealed that 71% of patients had ED of varying severity: 16% mild, 4% mild to moderate, 18% moderate, and 33% severe.Conclusion The results showed that patients with COPD also have ED of variable degrees. IIEF-5 scores negatively correlated with the age of the patients and the duration of COPD.