Cases Of Erectile Dysfunction Research Articles

Serum 25-hydroxyvitamin D level and erectile dysfunction: a causal relationship? Findings from a two-sample Mendelian randomization study.

Serum 25-hydroxyvitamin D level is associated with erectile dysfunction (ED) in observational studies. However, whether there is a causal association between them remains uncertain. Conduct a two-sample Mendelian randomization (MR) analysis to investigate the causal effect between serum 25-hydroxyvitamin D level and ED risk. Genome-wide association study (GWAS) data of serum 25-hydroxyvitamin D levels comprising 6,896,093 single nucleotide polymorphisms (SNP) from 496,949 people of European ancestry were regarded as exposure for the MR analysis. Additional GWAS data involving 9,310,196 SNPs of 6,175 European ED cases and 217,630 controls were used as outcome data. The MR-Egger, inverse variance weighted (IVW) method, weighted median, simple mode, and weighted mode were employed to evaluate causal effects, among which IVW was the primary MR analysis method. The stability of the MR analysis results was confirmed by a heterogeneity test, a horizontal pleiotropy test, and the leave-one-out method. There were 103 SNPs utilized as instrumental variables (p < 5 × 10-8). The results of MR analysis showed no causal effects of serum 25(OH) D concentration on ED risks (IVW; OR = 0.9516, 95% CI = 0.7994 to 1.1328, p = 0.5772). There was no heterogeneity and pleiotropy in the statistical models. The present MR study did not support a causal association for genetically predicted serum 25-hydroxyvitamin D concentration in the risk of ED in individuals of European descent.

Circulating miRNA-21 is an innovative biomarker for cardiovascular events in erectile dysfunction patients.

It is well-known that circulating microRNAs (miRNAs) play a relevant role in many kinds of diseases by regulating the expression of genes involved in various pathophysiologic processes, including erectile dysfunction (ED) and cardiovascular diseases (CVD). This study aimed to identify the miRNA-21 profile in the blood samples of patients with ED, CVD, and the combination of both pathologies to elucidate the potential function of miRNA-21. A total of 45 patients with CVD and/or who underwent the erectile function test were included and divided into the following categories: CVD with ED (cases, n = 29) and controls (n = 16) with either ED or CVD. Real-time polymerase chain reaction analysis verified the results. miRNA-21 expression was quantified, and informatics analysis was applied to predict the functions of this differentially expressed miRNA-21. A total of 64% of cases (63 ± 9 years, 66% with severe ED, 56% with CV ejection fraction) first presented ED as the sentinel clinical manifestation. Serum miRNA-21 levels in the control ED were significant, up to 10-fold higher than in the CVD controls and cases. A significant inverse (p = 0.0368, β = -2.046) correlation was found between erectile function and miRNA-21 levels. Our study provides comprehensive insights into the functional interaction between miRNA-21 and ED in CVD patients. Its relevance lies in the potential of miRNA as a biomarker to be applied in the cardiovascular predictive medicine field.

(082) Erectile Dysfunction: Tool to Break Men's Sexual Stigma

Abstract Introduction Statistics reveal that a significant number of men, particularly those over the age of 30 and 50, experience some form of erectile dysfunction (ED). Shockingly, 8 out of 10 men suffering from ED do not take any proactive measures to treat or prevent it. This rise in ED cases has been closely linked to the increasing rates of obesity, diabetes, and cardiovascular diseases, with hypertension also being a contributing factor. As of 2017, nearly half of all adults in the US (47%, or 116 million) had hypertension. Unfortunately, many men choose to conceal or remain silent about their struggles with ED, primarily due to the social stigma that surrounds this issue. Objective Our goal is to break the stigma surrounding men’s sexual health, transform men's attitudes towards their intimate well-being, and encourage them to proactively prioritize it. We aim to encourage men to pay more attention to their sexual health and empower them to lead long, fulfilling intimate lives while also seeking timely medical assistance when needed. Methods We have developed a mobile application for iOS that allows men anonymously to discreetly monitor, maintain, and enhance their sexual health. The application offers the following features: 1. Physical and relaxation exercises, alongside a sexual activity tracker, enabling users to record details about sexual encounters, masturbation, and erection quality. For instance, the tracker revealed that men reported engaging in masturbation 40% more frequently than participating in sexual activities. Additionally, 17.8% of users experienced incomplete erections during intercourse, while a significant 71% of men were affected by varying degrees of erectile dysfunction (ED). 2. Educational content: Articles categorized into topics such as sexual education, diseases, sexual education for children and teenagers, gender identity, and more. 3. Regular "Check-up" feature helps users keep track of recommended tests based on their age, providing reminders for scheduled doctor's visits. It is important to note that the application doesn't replace a visit to a doctor. In June 2023, a user survey was conducted to assess the impact of the application on men's health, and 57 male participants were recruited from the app's user base, voluntarily participating in the study. Results The findings revealed that the majority of participants reported positive changes in their sexual health after using the application. 1. 75% reported a general improvement in their sexual health. These positive changes encompassed various aspects of sexual well-being, such as erectile function, libido, orgasm intensity, and overall satisfaction. 2. 42% reported an improvement in the quality of their erections. 3. 23% experienced more intense orgasms. 4. 25% reported an increase in their libido. 5. 42% became more aware of their sexual health. Conclusions The survey findings suggest that the app may have contributed to improvements in various aspects of sexual well-being, including erection quality, orgasm intensity, libido, and sexual health awareness. The results highlight the potential value of the application as a tool for men seeking to monitor, enhance, and unlock the full potential of their sexual health. Disclosure No.

(281) Low-Intensity Shockwave Therapy Combined with Tadalafil 5mg Daily has Better Efficacy for Mild and Moderate Erectile Dysfunction: The Preliminary Results of a Multicenter Clinical Study in China

Abstract Introduction Most clinical studies have demonstrated that low-intensity extracorporeal shockwave therapy (Li-ESWT) can improved erectile function in patients with erectile dysfunction (ED). The EAU guideline recommended to use Li-ESWT for mild vasculogenic ED patients. However, the therapeutic advantages of Li-ESWT combined with phosphodiesterase type 5 inhibitors (PDE5i) have not been explored clearly in clinical practice for mild and moderate ED patients. Objective To compare the therapeutic effects of Li-ESWT and Li-ESWT combined with PDE5i in mild and moderate ED patients with 8≤IIEF-5≤16 from a multicenter clinical study in China. Methods Patients with ED which IIEF-5 score is less than 22 and aged 18–60 years old were enrolled from three clinical centers from Jun. 2019 to Mar. 2023. The demographic data, International Index of Erectile Function-5 (IIEF-5), erectile hardness score (EHS) and self-reported symptom questions were collected. Patients were treated by a linear low-energy shock waves generator (Renova). Low-intensity shock wave (energy density of 0.09mJ/mm2) treatments were applied (once a week, 4 weeks in total, 5000 shocks each time). Patients in Li-ESWT combined with PDE5i group took 5mg of tadalafil once a day for one continuous month during ESWT. Comparative analyses of pre- and post-treatment and intergroup were used for statistics. Results In total, 42 ED cases (37.43±11.86 years) in Li-ESWT group and 116 cases (37.41±10.14 years) in combined group were enrolled for analysis. The IIEF-5 score and EHS in both groups were significantly improved after 1 month treatment (p&amp;lt;0.01). Compared with Li-ESWT group, patients in combined group significantly had higher self-reported efficiency (61.2% vs. 47.6%, p=0.013), IIEF-5 scores (15.34±7.15 vs. 13.96±7.71, p=0.039) and EHS (2.85±0.82 vs. 2.69±0.89, p=0.050). In the mild and moderate ED (with 8≤IIEF-5≤16) sub-group, 30 ED cases (36.81±10.99 years) in Li-ESWT group and 96 cases (36.80±10.69 years) in combined group were enrolled for analysis. The combined regimen showed better therapeutic advantages, including effective parameters IIEF-5(14.50±6.74 vs. 12.87±8.54, p=0.040), EHS (2.85±0.75 vs. 2.81±0.67, p=0.046) and self-reported efficiency (64.2% vs. 54.1%, p=0.001). Conclusions Li-ESWT can effectively improve erectile function in this multicenter clinical study in China, and the combination of Li-ESWT with daily use PDE5i had a better therapeutic effect on Chinese ED patients, especially on mild and moderate ED. Long-term follow-up with large sample study need to be developed for exploring the optimal therapeutic regimen. Disclosure No.

The value of audiovisual sexual stimulation with virtual reality in diagnosing erectile dysfunction.

The traditional audiovisual sexual stimulation (AVSS) test may experience limitations including low erectile response rate and lack of unified diagnostic criteria. We aimed to explore the clinical value of AVSS with virtual reality (VR-AVSS) test in assessing erectile function and diagnosing erectile dysfunction (ED). Participants 18 to 60years of age were screened for analysis in 3 clinical centers from June 2020 to March 2022. Demographic data, 5-item International Index of Erectile Function (IIEF-5), erectile hardness score (EHS), and self-reported symptom questions were collected. The ED patients and control patients were confirmed according to the IIEF-5 and EHS. All subjects watched a 60-minute erotic video by VR device during RigiScan recording. The parameters including tip average rigidity, tip effective erectile duration (duration of rigidity ≥60%, tip effective erectile duration), base average rigidity, and base effective erectile duration were evaluated. The main outcome of interest was the application of VR immersion technology to improve the traditional AVSS test. A total of 301 ED cases and 100 eligible control patients were included for final analysis. Compared with control patients, ED cases had significantly lower IIEF-5 scores, EHS, positive response rate, and erectile rigidity and duration. The positive response rate of ED and control patients were 75.5% and 90.9%, respectively. The cutoff points of tip average rigidity, tip effective erectile duration, base average rigidity, and base effective erectile duration were 40.5% (sensitivity: 77.6%, specificity: 70.2%; P < .001), 4.75minutes (sensitivity: 75.9%, specificity: 75.4%; P < .001), 48.5% (sensitivity: 77.6%, specificity: 75.1%; P < .001), and 7.75minutes (sensitivity: 79.3%, specificity: 75.7%; P < .001). The technological superiority of VR will enable the VR-AVSS immersion test to be a more accurate detection than traditional AVSS modes. Our study applied VR immersion technology to establish the standard operation procedure for the AVSS test, which could effectively reduce the interference of adverse factors and minimize the detecting errors. However, the test data only included positive response subjects, so the true erectile status of men with a negative response to the AVSS test cannot be obtained. The VR-AVSS test can effectively improve the diagnostic accuracy of ED. The average rigidity and effective erectile duration were the optimal diagnostic parameters for excluding ED.

Long-term tadalafil once daily in Chinese men with erectile dysfunction: a 2-year final analysis of a post-marketing, multicenter, randomized, open-label trial.

The long-term safety and effectiveness of once-daily tadalafil is crucial, but limited data are available in Chinese patients with erectile dysfunction (ED). In this post-marketing, multicenter, randomized, open-label trial with 2-year follow-up, 635 ED cases were randomized to receive daily oral tadalafil 2.5 mg or 5 mg for 3 months, of whom 580 continued once-daily tadalafil 5 mg for 21 months. Treatment-emergent adverse events in the 12-month and 24-month period were similar, with the most common being viral upper respiratory tract infection, upper respiratory tract infection, and headache. Significant improvement from baseline in the International Index of Erectile Function-Erectile Function (IIEF-EF) score was detected at month 12 (least squares mean [LSM] change: 7.9, 95% confidence interval [CI]: 7.5-8.4, P < 0.001) and was maintained to month 24 (LSM change: 8.6, 95% CI: 8.1-9.0, P < 0.001). The proportions of patients regaining normal erectile function (IIEF-EF score ≥26) were 43.7% and 48.0% at months 12 and 24, respectively. Global Assessment Questionnaire results showed improved erection function in 97.5% of patients and improved ability to engage in sexual activity in 95.9% of patients at month 12; these values were 96.1% and 95.0% at month 24, respectively. The quality of sexual life score based on the Sexual Life Quality Questionnaire (SLQQ) was increased by 52.2% at month 12 and by 55.3% at month 24 (both P < 0.001). The treatment satisfaction score determined by SLQQ (mean ± standard deviation) was 62.4 ± 21.0 at month 12 versus 65.9 ± 20.2 at month 24. Two-year daily application of tadalafil 5 mg in Chinese men with ED showed a favorable safety profile and durable improvement in sexual performance and satisfaction.

More Efficient Approach: Independent Diagnostic Value of Audiovisual Sexual Stimulation for Psychogenic Erectile Dysfunction

The diagnostic value of audiovisual sexual stimulation (AVSS) for psychogenic erectile dysfunction (ED) is still unclear. We investigated the independent diagnostic value and optimal cut-off parameter of AVSS for psychogenic ED. All participants had received the AVSS test and nocturnal penile tumescence and rigidity (NPTR) monitoring at least twice. ED patients were divided into psychogenic ED and organic ED according to NPTR examination. The diagnostic accuracy of AVSS parameters was evaluated with the receiver operating characteristic (ROC) curve, and the Youden index was employed to determine the optimal diagnostic cut-off values. A total of 346 patients with ED and 60 healthy men were included in this study, among which 162 and 184 cases of psychogenic and organic ED were identified based on NPTR, respectively. When comparing the two ED groups, the area under the curve (AUC) of AVSS parameters was 0.85–0.89. Six-selected AVSS parameters could precisely diagnose psychogenic ED, exhibiting increased diagnostic specificity compared with corresponding sensitivity. When comparing psychogenic ED with the control group, the AUC of the tumescence of the tip was superior to the AUC other parameters (0.81 vs. 0.58, 0.66, 0.59, 0.53, 0.68), and the best determined diagnostic cut-off value was the tumescence of the tip < 29.87%. Independent AVSS could diagnose psychogenic ED objectively and effectively, and its diagnostic value was highest when 1.50% ≤ tumescence of the tip < 29.87%.

Efficacy of Chinese Herbal Medicine Formula in the Treatment of Mild to Moderate Erectile Dysfunction: Study Protocol for a Multi-Center, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial.

Erectile dysfunction (ED) is a prevalent condition in urology, primarily managed with PDE5 inhibitors (PDE5Is). However, approximately 20% of patients do not experience improvement in overall sexual satisfaction (OS) after taking PDE5Is. Among these, traditional Chinese medicine (TCM) has emerged as a complementary approach, with formulas like Hongjing I granules (HJIG) showing promise in preliminary studies. This study aims to rigorously evaluate the effectiveness and safety of HJIG in mild to moderate ED cases, assessing improvement in both sexual function and TCM pattern alignment. This study is a randomized, double-blind, placebo-controlled multicentre trial. Recruitment will be conducted from patients who have a strong willingness to try using only traditional Chinese medicine treatment (This is very common in traditional Chinese medicine hospitals.). A total of 100 patients diagnosed with mild to moderate ED caused by qi deficiency and blood stasis will be recruited and randomly assigned to receive one of two treatments: HJIG (N = 50) or placebo (N = 50). Patients will receive 8 weeks of treatment and a 16-week follow-up starting from the fourth week of treatment. Outcome measures, including the International Index of Erectile Function-Erectile Function domain (IIEF-EF) score, Sexual Encounter Profile (SEP), and Traditional Chinese Medicine symptom score, will be evaluated. The expected outcome of this trial is that the use of the herbal formula HIJG alone can improve overall sexual satisfaction (OS) in patients with mild to moderate ED, while also improving their traditional Chinese medicine symptom scores. This will provide evidence-based support for the use of Chinese medicine in the treatment of ED in China. Chinese Clinical Trial Registry, ChiCTR2000041127, Registered on 19 December 2020, https://www.chictr.org.cn/showproj.html?proj=46469. Recruitment began in March 2021, therefore 80 patients have been recruited. It is expected to finish recruiting in December 2023.

Causal effects of gut microbiota on erectile dysfunction: a two-sample Mendelian randomization study.

Several observational studies have reported the correlation between gut microbiota and the risk of erectile dysfunction (ED). However, the causal association between them remained unestablished owing to intrinsic limitations, confounding factors, and reverse causality. Therefore, the two-sample Mendelian randomization (MR) study was performed to determine the causal effect of gut microbiota on the risk of ED. The MR analysis utilized the publicly available genome-wide association study (GWAS) summary-level data to explore the causal associations between gut microbiota and ED. The gut microbiota data were extracted from the MiBioGen study (N = 18,340), and the ED data were extracted from the IEU Open GWAS (6,175 ED cases and 217,630 controls). The single nucleotide polymorphisms (SNPs) served as instrumental variables (IVs) by two thresholds of P-values, the first P-value setting as <1e-05 (locus-wide significance level) and the second P-value setting as <5e-08 (genome-wide significance level). The inverse variance weighted approach was used as the primary approach for MR analysis, supplemented with the other methods. In addition, sensitivity analyses were performed to evaluate the robustness of the MR results, including Cochran's Q test for heterogeneity, the MR-Egger intercept test for horizontal pleiotropy, the Mendelian randomization pleiotropy residual sum, and outlier (MR-PRESSO) global test for outliers, and the forest test and leave-one-out test for strong influence SNPs. Our results presented that the increased abundance of Lachnospiraceae at family level (OR: 1.265, 95% CI: 1.054-1.519), Senegalimassilia (OR: 1.320, 95% CI: 1.064-1.638), Lachnospiraceae NC2004 group (OR: 1.197, 95% CI: 1.018-1.407), Tyzzerella3 (OR: 1.138, 95% CI: 1.017-1.273), and Oscillibacter (OR: 1.201, 95% CI: 1.035-1.393) at genus level may be risk factors for ED, while the increased abundance of Ruminococcaceae UCG013 (OR: 0.770, 95% CI: 0.615-0.965) at genus level may have a protective effect on ED. No heterogeneity or pleiotropy was found based on the previously described set of sensitivity analyses. Our MR analysis demonstrated that the gut microbiota had inducing and protective effects on the risk of ED. The results provide clinicians with novel insights into the treatment and prevention of ED in the future. Furthermore, our study also displays novel insights into the pathogenesis of microbiota-mediated ED.

An atypical erectile dysfunction patient with infertility treated with penile prosthesis implantation and testicular epididymal sperm aspiration (TESA)-intracytoplasmic sperm injection (ICSI): A case report.

Erectile dysfunction (ED) is common in middle-aged and elderly men, affecting more than 100 million males worldwide. Most ED cases can be attributed to organic and/or psychological factors. Here we report an atypical ED case with no clear manifestation fitting the diagnosis for recognized types of ED. The 35-year-old male is unable to have normal erection since puberty, and unable to complete intercourse with his wife. He had no history of trauma, surgery or psychiatric/psychological disease. The patient has a normal male karyotype. There is no significant finding in physical examination, nocturnal penile tumescence test, and ultrasound measurement of penis vascular functions. The serum levels of major hormones are all in normal ranges. Atypical ED, psychogenic ED not excluded; infertility. Oral phosphodiesterase inhibitors Tadalafil (20 mg, BIW) or Sildenafil (50 mg, BIW) had no effect in this patient. Penile prosthesis implantation helped the patient to acquire normal sexual life, but did solve the ejaculation failure and infertility. Motile sperms were obtained by testicular epididymal sperm aspiration under the guidance of ultrasound, and intracytoplasmic sperm injection was performed with occytes retrieved from his wife. The patient sexual life was significantly improved after penile prosthesis implantation; the patient wife is currently in the first trimester of pregnancy as the result of in vitro fertilization. The no response to phosphodiesterase type 5 inhibitors (PDE5) treatment may suggest an impediment of PDE5-related pharmacological pathways or the presence of defect/injury in the neural system. This special case raises a question if some patients with persistent ED may have similar manifestations and can be treated with the same procedures.

#3118 ERECTILE DYSFUNCTION IS A HARBINGER OF CHRONIC KIDNEY DISEASE

Abstract Background and Aims Chronic kidney disease (CKD) shares similar cardiovascular risk factors with erectile dysfunction (ED). ED is an early warning sign for future cardiovascular events, however it is not yet known whether it also behaves as a harbinger of future CKD. Method We identified cases of ED and CKD using diagnostic codes from primary care records, hospital episode statistics, Death Register records, and self-reported diagnoses in a prospective cohort of 94,955 male participants of UK Biobank who had linkage to primary care records, from 01/01/2000 until 01/09/2017. We excluded participants with CKD diagnosed prior to this period as well as before the age of 35. We compared risk of CKD using cause-specific Cox proportional hazards models with competing risk of death, using age as time scale and adjusted for time-fixed covariates (birth cohort, ethnicity, body mass index [BMI], Townsend deprivation index [TDI], and smoking status) and time-dependent covariates (hypertension, diabetes mellitus, ischaemic heart disease, and ischaemic stroke/transient ischaemic attack). We imputed missing values for BMI, TDI, and smoking status (percentage missing ranging between 0.16-0.71%) using multiple imputation with predictive mean matching. As a sensitivity analysis, we repeated the analyses in a propensity score-matched cohort. Results Among 15,848 men diagnosed with ED, 830 developed CKD (71.9/10,000 person-years) median 5.9 years later (IQR 2.8-10.4), compared with 3,452 among 79,107 men without ED (39.6/10,000 person-years). Men with a diagnosis of ED had higher BMIs than men without (28.7 vs 27.7 kg/m2) and were more likely to have other diagnoses such as hypertension (38% at time of diagnosis of ED/56% at any time vs 40% at any time) and diabetes mellitus (21% at time of diagnosis of ED/30% at any time vs 12% at any time). A diagnosis of ED (without hypertension or diabetes mellitus) carried an increased risk of subsequent CKD (Figure 1), with an adjusted cause-specific hazard ratio of 1.53 (95% CI 1.33-1.77). There was significant interaction with hypertension (p&amp;lt;0.001), i.e. the increase in hazard of CKD by ED was smaller (adjusted hazard ratio 1.10, 95% CI 1.00-1.20), whereas there was no significant interaction with diabetes mellitus; i.e. men with a diagnosis of ED had a similar hazard ratio for CKD regardless of presence of diabetes mellitus (p = 0.33 for interaction). These results were numerically similar in a propensity score matched analysis. Conclusion Men who are diagnosed with ED are at a higher risk of developing CKD, independent of comorbidities such as diabetes mellitus. A diagnosis of ED should therefore prompt screening for CKD and its risk factors.

Genes Predisposing to Erectile Dysfunction and Management: A Review

Abstract Background: The burden of erectile dysfunction (ED) is rising worldwide due to unresponsiveness of some affected individuals to existing drugs and treatment strategies. Fortunately, improvement in biological techniques has led to the understanding that some cases of the disorder may have a genetic etiology, which, when fully understood, may lead to improved treatment. Objective: This review articulated established ED candidate genes and pathophysiology to assist researchers and medical practitioners to formulate effective drugs and treatment procedures. Methods: The Google search engine was used to retrieve relevant information on the topic from reputable academic databases, including PubMed, Medline, Google Scholar, Scopus, and SpringerLink. Results: The search discovered 10 ED candidate genes, which are SIM1, SLC6A4, 5-HTTLPR, TGFB1, DAT1, MC4R, NOS3, GNB3, AR, and MTHFR. Polymorphisms or mutations in these genes may disrupt erectile activities of the hypothalamus, neurotransmitters such as dopamine, serotonin, and nitric oxide as well as relaxation of penile tissues. Clinical presentations of ED include loss of erection, weak vaginal penetration, premature ejaculation, and anejaculation. Each gene has a distinct mechanism, which, if targeted in the affected may reverse the disorder or reduce the effects. Conclusion: Some cases of ED are genetic, which, when fully understood, may give an insight into new treatment procedures or improve on the current ones. Medical practitioners are advised to formulate treatment procedures that target the affected gene (s) in individuals.

The Race to Replace PDE5i: Recent Advances and Interventions to Treat or Manage Erectile Dysfunction: Evidence from Patent Landscape (2016-2021).

For a few decades, globally, erectile dysfunction (ED) has become more prominent even in young adults and represents a mounting health concern causing a significant effect on men’s quality of life. There is an expectation that by the end of 2025, the number of ED cases can rise to 322 million. We aimed to comprehensively analyze the scientific output of scholarly articles and studies in the field of ED (2016–2021). Data from scholarly articles were collected using Pubmed, and clinical trials-related information was accessed from the clinical trials website. An extensive patent search was conducted using databases such as USPTO (United States patent and trademark office) and EPO (European patent office), WIPO (World Intellectual Property Organization), etc. Owing to the high market value of ED drugs, considerable interest was attained to grab the opportunities. The race to replace the phosphodiesterase type 5 inhibitor (PDE5 inhibitor-PDE5i) can be identified as evident from the significant number of patents filed and the inventions cleared with clinical trials. Some other intriguing interventions are identified for ED treatment but have yet to gain public acceptance. The current analysis confirms the overall evolution and unexplored corners of research on ED treatment strategies with a current global projection.

MP36-14 THE EFFECT OF RENAL TRANSPLANTATION ON ERECTILE FUNCTIONS IN PATIENTS WITH END-STAGE RENAL DISEASE

You have accessJournal of UrologyCME1 May 2022MP36-14 THE EFFECT OF RENAL TRANSPLANTATION ON ERECTILE FUNCTIONS IN PATIENTS WITH END-STAGE RENAL DISEASE Serdar Karadag Serdar KaradagSerdar Karadag More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002590.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile dysfunction (ED) is defined as the inability to achieve and maintain an erection sufficient to allow satisfactory sexual performance. In end-stage renal disease (ESRD), ED is an important problem that impairs quality of life. The incidence of ED may increase up to 84%, especially in ESRD patients receiving hemodialysis. Our aim is to determine the effect of renal transplantation on erectile functions in ESRD patients and patient-related factors affecting this change. METHODS: Data of patients with ESRD who had a renal transplant at our center from January 2015 to August 2020 were reviewed retrospectively. All male patients who had a kidney transplant for any reason and whose data were not missing were included. The patients were screened for erectile functions before kidney transplantation and at the 1st, 3rd and 12th months after transplantation. The International Index of Erectile Function (IIEF-5) evaluation questionnaire was used as a measure of erectile functions. The total scores were calculated, with normal erectile function defined as a score of 22 to 25; cases of ED were classified as mild (12–21), moderate (8–11), or severe (5–7). RESULTS: The mean age of 55 patients included in the study was 39.7±10.9 years. Mild ED was detected in 21 patients (38.2%), moderate ED in 19 patients (34.5%), and severe ED in 10 patients (18.2%). Preoperative mean IEFF-5 score was calculated as 13.8±5.5, 14.3±5.7 at 1st month, 16.9±6.8 at 3rd months, and 18.4±6.9 at 12th months. In the evaluation of erectile function, no significant improvement was observed in erectile functions at post-transplant 1st month (p>0.05), while significant improvements were noted at postoperative 3rd and 12th months (p=0.03, p=0.02, respectively). When the change in IEFF-5 score was evaluated between 3rd and 12th months, there was a statistically significant difference (p=0.04). Age, diabetes, hypertension, coronary artery disease, transplantation time and preoperative IEFF-5 score were found to be significantly associated with postoperative IEFF-5 score changes at the 3rd and 12th months. (p<0.05). CONCLUSIONS: Our data show that kidney transplantation improves erectile function in ESRD patients. Age, diabetes, hypertension, coronary artery disease, transplantation time and pre-transplant erectile function status were found to be significantly associated with postoperative erectile function changes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e602 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Serdar Karadag More articles by this author Expand All Advertisement PDF DownloadLoading ...

Assessment of combination therapies versus phosphodiesterase type 5 inhibitor monotherapy for erectile dysfunction: A systematic review and meta-analysis

ABSTRACT Introduction Combining two first-line treatments for erectile dysfunction (ED) or initiating other effective modalities on top of phosphodiesterase type 5 inhibitors (PDE5i) may produce beneficial outcomes. Objective To assess the efficacy and safety of different combination therapies with PDE5i compared to PDE5i monotherapy in various subgroups of patients with ED through a systematic review and meta-analysis. Methods We considered randomized trials on males with ED that assessed the effect of combination therapy versus PDE5i monotherapy with validated questionnaires. Studies were identified by searching Medline, Cochrane Library and Scopus databases We undertook a meta-analysis for the mean international index of erectile function (IIEF) change, and for the number of adverse events (AEs) based on different treatment modalities and subgroups of patients. Results We included 3,853 individuals (44 trials). Combination therapy with PDE5i, compared to PDE5i monotherapy, was associated with a mean IIEF improvement of 1.92 points (95% CI: 1.41 to 2.44, I2=82%). Adding to PDE5i: daily tadalafil, low-intensity shockwave therapy, vacuum erectile device or antioxidants resulted in a significant IIEF improvement. The latter was not observed with a-blockers. Compared to monotherapy, combination treatment improved IIEF in patients with hypogonadism, monotherapy-resistant or prostatectomy-induced ED. The treatment-related AEs did not differ between combination treatment with PDE5i and PDE5i monotherapy (OR:1.10, 95% CI: 0.66 to 1.85, I2=78%). Still, despite multiple subgroup and sensitivity analyses, the levels of heterogeneity for all outcomes remained high. Conclusions Combination therapy with PDE5i and antioxidants improves ED without increasing the AEs, while treatment with PDE5i and daily tadalafil, shockwaves or vacuum device seems effective, but data are scarce. Combination treatment should be initially preferred in patients with hypogonadism or prostatectomy-induced ED. Conversely, the addition of a-blockers to PDE5i does not provide additional efficacy in patients with urinary symptoms. Overall, combination therapy with PDE5i is safe and effective and should be considered as first-line treatment for refractory or difficult-to-treat cases of ED. Disclosure Work supported by industry: no.

Safety and Efficacy of Inflatable Penile Prostheses for the Treatment of Erectile Dysfunction: Evidence to Date.

Erectile dysfunction (ED) is a common problem, and prevalence rates are expected to rise as life expectancy increases worldwide. In more severe cases of ED, penile prosthesis implantation has been an excellent option for patients. Over the past few decades, significant design improvements have been made to the penile prosthesis and modifications to surgical technique to improve clinical outcomes. The purpose of this review is to summarize the safety and efficacy of FDA-approved penile implants in the US market. Design modifications have greatly improved the safety and reliability of the implant. Development of improved surgical techniques has decreased intraoperative injuries and reservoir-related complications. With its high overall satisfaction rates and low risk of complications, the inflatable penile prosthesis remains an excellent option for patients with erectile dysfunction.

Erectile dysfunction among patients and health care providers during COVID-19 pandemic: A systematic review.

COVID-19 pandemic is associated with devastating effects on social, psychological, and economical aspects of survivors. We assume that erectile function (EF) is affected as well. We performed a systematic review of the published articles about the change in EF among patients and health care providers during the COVID-19 pandemic. We searched PubMed and Cochrane databases for English literature using a combination of medical subject headings (MeSH) terms and keywords. We extracted data of erectile dysfunction (ED) rate, international index of erectile function (IIEF), changes related to exposure to the pandemic (Primary objectives), and factors affecting these differences (Secondary objectives). Twenty articles were included in the screening phase. Only 3 articles were eligible for primary objectives, and 2 articles were included for the secondary objective. Three articles revealed an increase in ED cases and a reduction in IIEF-5 scores during the pandemic. Rates of ED have ranged from 32% to 87% of the study populations. Anxiety, depression, and post-traumatic stress disorder (PTSD) were associated with increased ED rates. We conclude that the COVID-19 pandemic is associated with increased rates of ED. Anxiety and depression augment this increase. Health care providers are at higher risk for PTSD, which increases the risk of ED.

An update in improving erectile dysfunction therapy in Indonesia by using Li-ESWT and tadalafil combination — vascular endothelial growth factor and peak systolic velocity comparison: a randomized clinical trial

Background: Erectile dysfunction (ED) affects men’s life desperately and the incidence increases continuously. There are a few lines of ED therapy, but there are still many ED cases that have not treated utterly. Therefore, research is needed to obtain the most appropriate line of ED therapy, based on the underlying mechanism of ED. The aim of this study is to analyze the effect of oral daily 2.5 mg of tadalafil administration and twice weekly Low Intensity Extracorporeal Shockwave Therapy (Li-ESWT) for 4 weeks in erectile dysfunction patients, based on Peak Systolic Velocity (PSV) and Vascular Endothelial Growth Factor (VEGF). Methods: A 26-sample clinical trial was conducted with pre and post-test control group design. Random allocation was done to divide the samples into two groups. Control group was given 2.5 mg oral daily tadalafil, while the experimental group, additional twice weekly Li-ESWT was given. Therapies were given for 4 weeks. All subjects were assessed using Erection Hardness Score (EHS) score, International Index of Erectile Function (IIEF-5) score, and Color Doppler Ultrasonography (CDUS) penis for PSV, and plasma level of VEGF twice, prior to and after therapy. Results: The experimental group showed significant improvement compared to the control group in EHS (delta) 2 (1–2) vs 1 (0–2); IIEF-5 (delta) 7 (3–15) vs 4 (0–11); PSV (delta) 2.60 ± 1.34 vs 1.28 ± 1.86; and VEGF (delta) 26.69 ± 24.23 vs 6.32 ± 25.43. Conclusions: Li-ESWT and tadalafil combination therapy improved erectile dysfunction, specifically based on PSV and VEGF parameters.

Serum Homocysteine Level as A Marker of Erectile Dysfunction

Background: The Fourth International Consultation on Sexual Medicine defined erectile dysfunction (ED) as a consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction homocysteine (Hcy) is a toxic, nonproteogenic sulfur-containing amino acid synthesized from dietary methionine in the liver and is metabolized either via trans-sulfuration or remethylation pathway. Objective: To investigate serum Hcy levels in ED patients as compared to those in healthy controls, and to explore its correlation with severity of ED. Patients and methods: This study consisted of 30 ED-affected men and 50 age-matched controls who were free from ED. All participants were recruited from the Andrology Outpatient Clinic of Mansoura University Hospital, between October 2019 and September 2020. Results: Serum Hcy was significantly higher in ED cases compared to controls (P 15 μmol/L). On the other hand, 6 out of 50 controls (12 %) had elevated level of Hcy. Elevation of Hcy levels was associated with an increased risk of ED, and that a cut-off value of 8.28 µmol/L was able to detect ED patients with a corresponding sensitivity and specificity of 90.0% and 78% respectively. Conclusion: Elevated Hcy is associated with ED and may represent an important risk factor and play a pathophysiologic role in ED. Hence, Hcy-lowering agents, such as folic acid and vitamin B12, seem reasonable choices for the prevention and management of this condition.

Significant Increase of Erectile Dysfunction in Men With Post-stroke: A Comprehensive Review

Men with erectile dysfunction (ED) are considered to be at risk from stroke events. Conversely, post-stroke patients are also at high risk of ED, whereas a quantitative result from all the relevant studies has not been previously addressed. Therefore, we have performed a comprehensive review and meta-analysis on this issue. This study was registered on PROSPERO (ID No. CRD42021226618). Twenty studies with a total of 3,382 stroke events were included, of which six studies were included for quantitative analysis, and the remaining 14 studies were calculated for the ratio of ED. Synthetic results from four eligible studies providing the ED cases showed that stroke patients were associated with a significantly higher risk of ED than the general population [pooled relative risk (RR) = 3.32, 95% confidence interval (CI): 1.25–8.82, P = 0.016]. Men with stroke were also found to be associated with a significant decline in International Index of Erectile Function −5 (IIEF-5) score as compared with the healthy controls [three studies, standard mean differences (SMD) = −1.8, 95% CI: −2.94 to −0.67, P = 0.002]. The prevalence of ED in post-stroke patients among 14 studies ranged from 32.1 to 77.8%, which was dramatically higher than that of the general population. The result of the GRADE-pro revealed that the quality of the evidence in this study was moderate. The present study has confirmed the high prevalence of ED in men with stroke. ED in stroke patients is a result of both neurological and psychological factors. Rehabilitative interventions rather than phosphodiesterase-5 (PDE-5) inhibitors are recommended to improve the erectile function for those survivors with ED.