Changes In Erectile Function Research Articles

The Effect of Phosphodiesterase-type 5 Inhibitors on Erectile Function: An Overview of Systematic Reviews.

Background: Multiple systematic reviews explore the effect of phosphodiesterase type 5 (PDE5) inhibitors on erectile dysfunction (ED), with each study addressing specific outcomes. However, physicians and policymakers require a holistic approach of this topic.Objective: To summarize the current evidence regarding the efficacy and safety of PDE5 inhibitors for the management of ED through an overview of systematic reviews.Methods: Studies were identified by searching PubMed, Web of Science, Cochrane Library and Scopus databases, as well as sources of grey literature until June 12, 2021 (PROSPERO: CRD42020216754). We considered systematic reviews, meta-analyses or network meta-analyses of randomized trials that provided outcomes about the efficacy and safety of any approved PDE5 inhibitor (avanafil, sildenafil, tadalafil and vardenafil). We constructed forest plots for meta-analytic effects regarding the change in erectile function, adverse events and dropouts after administration of PDE5 inhibitors in the general population and in specific patient groups.Results: We included 23 studies with 154,796 participants and a total of 258 meta-analytic effects. Sildenafil 25 mg [Weighted Mean Difference (WMD): 13.08, 95% Confidence Interval (CI): 10.1-16.06] seemed to be statistically superior to all interventions in improving erectile function compared to placebo, but studies with low-dose sildenafil are lacking. Moreover, comparing among different PDE5 inhibitors, sildenafil 50 mg or sildenafil 100 mg were considered the most effective compounds in the general population. The latter derived, however, predominantly from indirect comparisons among different PDE5 inhibitors. Still, sildenafil 100 mg was associated with more treatment-related adverse events and dropouts. Interestingly, low-dose daily tadalafil may be more effective than high-dose on-demand tadalafil (WMD: 1.24, 95% CI: 0.03-2.44). Furthermore, testosterone and PDE5 inhibitors in patients with ED and hypogonadism seem to further improve symptoms, while the addition of a-blockers in patients with urinary symptoms treated with PDE5 inhibitors does not provide additional benefits (WMD: −0.8, 95% CI: −1.65-0.06).Conclusion: Although the efficacy and safety of PDE5 inhibitors, compared to placebo, is well-documented, the existing evidence comparing different PDE5 inhibitors is low. Therefore, high-quality, head-to-head, trials comparing different PDE5 inhibitors are necessary to determine their ideal dosage and formulation based on their safety and efficacy profile.Systematic Review Registration: PROSPERO, identifier [CRD42020216754].

MP46-19 DETAILING SEXUAL OUTCOMES AFTER FOCAL THERAPY FOR LOCALISED PROSTATE CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy (MP46)1 Sep 2021MP46-19 DETAILING SEXUAL OUTCOMES AFTER FOCAL THERAPY FOR LOCALISED PROSTATE CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS Gaelle Fiard, Aminah Chowdhury, Aneirin Potter, Celina Pook, Daniel Kelly, Mark Emberton, and Tet Yap Gaelle FiardGaelle Fiard More articles by this author , Aminah ChowdhuryAminah Chowdhury More articles by this author , Aneirin PotterAneirin Potter More articles by this author , Celina PookCelina Pook More articles by this author , Daniel KellyDaniel Kelly More articles by this author , Mark EmbertonMark Emberton More articles by this author , and Tet YapTet Yap More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002067.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal therapy has emerged as a promising option to treat well-selected men with localised prostate cancer while preserving healthy prostate tissue and key structures, such as the urethral sphincter and neurovascular bundles. However, how this tissue preservation may translate into improved outcomes, particularly into improved sexual outcomes, is still an active research field. We conducted a systematic review and meta-analysis of the literature to summarise the existing evidence in order to provide patients with updated data on what to expect after treatment, and help identify gaps in current knowledge that may warrant future research. METHODS: A systematic literature search was conducted on Medline, EMBASE, Scopus and Web of Science. The search strategy was defined using the ‘litsearchr’ function in R based on a preliminary “naïve” search using the following terms on Medline: ((“focal therapy” OR “focal treatment”) AND (“prostate cancer”) AND (“sexual function” OR “erectile function”)). A total of 37 studies, comprising 2573 patients treated and 1992 with available sexual outcomes were included in the data synthesis. RESULTS: HIFU (n=856, 43%) and cryotherapy (n=404, 20%) accounted for the highest number of patients analysed, while irreversible electroporation (n=137, 7%) was the least studied technique. The 5 item International Index of Erectile Function (IIEF-5) was the most frequently used questionnaire (26/37 studies), with completion rates ranging from 24-100% at 18-24 months. A significant decrease in IIEF-5 scores was noted at 3 months with an improvement at 6 and 12 months (Figure). Patients with an altered baseline sexual function were more likely to experience a significant postoperative decrease in erectile function scores. Continence rates (no pad use) ranged from 87.5 to 100%. Radical treatment rates ranged from 1.7% to 20.8%. The patient-reported outcomes (PRO) questionnaires used were not designed for a diverse population. CONCLUSIONS: Focal therapy led to changes in erectile function in most cases under the significance threshold of the patient-reported outcomes questionnaires used. Patients should be counseled according to their baseline erectile function. More research is warranted to detail aspects other than erectile function. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e821-e821 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gaelle Fiard More articles by this author Aminah Chowdhury More articles by this author Aneirin Potter More articles by this author Celina Pook More articles by this author Daniel Kelly More articles by this author Mark Emberton More articles by this author Tet Yap More articles by this author Expand All Advertisement Loading ...

Уровни витамина D, половых гормонов и состояние эректильной функции у мужчин молодого и среднего возраста

Актуальность. Эректильная дисфункция (ЭД) при D-гиповитаминозе у мужчин ассоциирована со снижением уровня тестостерона (Т) в крови. При этом в современных исследованиях отсутствуют данные относительно состояния эректильной функции (ЭФ) в зависимости от изменений показателя относительной андрогенизации — величины соотношения Т к эстрадиолу (Е2) (Т/Е2) при условии констатации дефицита и недостаточности витамина D. Нет сравнительных данных состояния ЭД у мужчин молодого и среднего возраста, особенно при наличии и отсутствии сахарного диабета 2-го типа (СД2). Цель: установить особенности изменений ЭФ в зависимости от уровней 25-гидроксихолекальциферола (25(ОН)D) в крови и андрогенного состояния у мужчин молодого и среднего возраста. Материалы и методы. 47 человек мужского пола в возрасте 23–59 лет были распределены на три группы: первая группа (n = 20) — мужчины молодого возраста (32,3 ± 1,1 года); вторая группа (n = 15) — мужчины среднего возраста (53,0 ± 1,0 года) без СД2; третья группа (n = 12) — мужчины, больные СД2, среднего возраста (54,0 ± 1,1 года). В крови иммуноферментным методом с использованием стандартных наборов определяли содержание 25(ОН)D (ELISA, Германия), общего Т («Алкор-Био») и Е2 (DRG). Состояние ЭФ определяли с помощью опросника «Международный индекс эректильной функции-5». Исследования проведены в осенне-зимний период 2019–2020 г. Результаты. Содержание 25(ОН)D в крови у мужчин среднего возраста независимо от наличия или отсутствия у них СД2 было существенно меньше по сравнению с мужчинами первой группы. Доказано, что формирование ЭД у мужчин как молодого, так и среднего возраста обусловлено уменьшением уровней Т в крови и снижением величин соотношения Т/Е2. Выводы. Установлено, что предиктором развития гипотестостеронемии и нарушений андроген-эстрогенового баланса у мужчин независимо от возраста, в том числе больных СД2, может быть снижение содержания в крови 25(ОН)D.

Efficacy and Safety of Avanafil in Chinese Subjects With Erectile Dysfunction: A Multi-Center, Randomized, Double-Blinded, Placebo-Controlled Phase III Clinical Trial.

IntroductionThe incidence of erectile dysfunction (ED) increases with age in mainland China and phosphodiesterase 5 inhibitors (PDE5i) are the major drugs used for its treatment.AimTo determine the efficacy and safety of Chinese developed avanafil as therapy for ED in China.MethodsThis phase III trial was carried out in 7 medical centers in China. Eligible subjects suffering from ED were allocated randomly into 3 groups (ratio 1:1:1) and orally received a placebo, 100 or 200 mg avanafil for a total of 12 weeks.Main outcome measuresThe primary endpoint was changes in erectile function (EF) domain scores according to the International Index of EF (IIEF) questionnaire from baseline to week 12 of therapy. Secondary endpoints assessments were changes in the response rates of SEP, Q2 and Q3; changes in IIEF other domain scores. Safety evaluation monitored treatment-emergent adverse events (TEAEs), serious TEAEs, laboratory test results, vital signs and electrocardiographs.ResultsOf 218 randomized ED subjects, 182 (83.5%) completed the study. After 12-week therapy, alterations from baseline of the mean IIEF-EF domain scores in the 100 mg and 200 mg groups were greater than for the placebo (all P < .05) group. The changes in mean SEP Q2 response rates from baseline to week 12 in the placebo, 100 mg and 200 mg groups were 5.4%, 22.3% and 22.1%, and SEP Q3 response rate were 22.7%, 42.6% and 38.1%, respectively. Avanafil treatment (regardless of dose) improved EF vs placebo for most of other secondary efficacy endpoints studied (all P < .05). No differences were detected in efficacy endpoints between the 100 and 200 mg dosage groups (all P > .05) or in the incidence of TEAEs and drug-related TEAEs among the 3 groups (all P > .05).ConclusionAvanafil (100 or 200 mg) was effective and generally well tolerated in Chinese subjects with ED.Jiang H, Lin H, Li F, et al. Efficacy and Safety of Avanafil in Chinese Subjects With Erectile Dysfunction: A Multi-Center, Randomized, Double-Blinded, Placebo-Controlled Phase III Clinical Trial. Sex Med 2021;9:100337.

Study on the relationship between sex hormone changes and erectile dysfunction in patients with chronic prostatitis/chronic pelvic pain syndrome.

To investigate the relationship between serum sex hormones and erectile dysfunction (ED), changes in erectile function and sex hormones were studied in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). A total of 171 patients with CP/CPPS who met the inclusion criteria from January 2016 to June 2019 were retrospectively analyzed. The level of patient's testosterone (TT), estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), premature ejaculation diagnostic tool (PEDT) score and international index of erectile function (IIEF-5) score were separately observed and compared. Among 171 eligible patients, 131 (76.61%) cases were diagnosed as ED and 40 (23.39%) cases were normal. Between the ED and No-ED groups, the PRL and PEDT score were statistically significant (P<0.01) based on the test results. ED-dependent and PEDT-dependent receiver operating characteristic (ROC) analysis and decision curve analysis (DCA) were performed on different degrees of ED to determine the predictive performance and clinical applicability. The results showed that PRL can better predict the possibility of ED in CP/CPPS patients than PEDT. For CP/CPPS patients, the Prolactin level decreases as the degree of ED increases. Prolactin can be used as a predictor to better predict the possibility of ED in CP/CPPS patients.

Glans Preservation in Surgical Treatment of Distal Urethral Strictures With Dorsal Buccal Mucosa Graft Onlay by Subcoronal Approach

To describe dorsal onlay buccal mucosa graft urethroplasty technique by subcoronal approach and glans preservation in distal penile urethral strictures with fossa navicularis involvement and to report safety, effectiveness, and cosmetic outcomes. Retrospective review of a prospective database of patients treated at Hospital Italiano de Buenos Aires between January 2011 and December 2019. Main surgical steps: ventral subcoronal incision, dorsal dissection of glandelar urethra until piercing the tip of the glans, dorsal urethrotomy, and graft transposition. Low urinary tract symptoms, uroflowmetry, and urinalysis were assessed at follow-up. Simplified International Index Erectile Function and Hypospadias Objective Scoring Evaluation were applied 1 year after surgery. Sixteen patients with a median age of 56.5 years (IQR 35.7-66.7) were included. Median stricture length was 5.5 cm (IQR 4-8.7). In 3 patients, Clavien-Dindo grade I-II complications were reported. At 1 year, median peak flow was 18 mL/seg (IQR 12.7-27.4) and median mean flow 7.8 mL/seg (IQR 6.1-9.9). At 41.5 months follow-up (IQR 13.2-74), all patients were stricture free and had no changes in erectile function. Hypospadias Objective Scoring Evaluation score ≥14 points was achieved by 14 patients (87.5%). For treatment of distal penile urethral strictures with fossa navicularis involvement, dorsal onlay buccal mucosa graft by subcoronal approach and glans preservation is a feasible technique with excellent functional outcomes, minimal complications, and substantial cosmetic results.

Sexual and ejaculatory function after holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate: a single-center experience.

Currently available surgical treatments for Lower Urinary Tract Symptoms (LUTS) due to Benign Prostatic Obstruction (BPO) are associated with an increased risk of sexual dysfunction. The aim of our study is to compare sexual and ejaculatory function after Holmium Laser Enucleation of the Prostate (HoLEP) and Bipolar Transurethral Enucleation of the Prostate (B-TUEP). We performed a retrospective analysis of data prospectively collected from 62 (44.9%) and 76 (55.1%) patients who underwent HoLEP and B-TUEP, respectively. Erectile function and ejaculation characteristics were assessed with the International Index of Erectile Function-Erectile Function (IIEF-EF) domain and the Male Sexual Health Questionnaire-Ejaculatory function (MSHQ-EJ) questionnaires. Our study recorded no change in erectile function and no significant difference in rates of preserved antegrade ejaculation after both surgeries. One month after surgery, rates of physical pain/discomfort and perceived decreased physical pleasure during ejaculation were higher in HoLEP than B-TUEP patients (all p < 0.03). Moreover, HoLEP patients were more bothered by their ejaculatory difficulties than B-TUEP men (p = 0.03). At 3- and 12-months follow-up, all ejaculation-related differences disappeared. In conclusion, both procedures are valid alternatives for BPO treatment as they offer comparable urinary and sexual outcomes in the long term. However, in the first month after surgery, HoLEP patients present with more ejaculatory difficulties.

Evaluation of penile erectile function changes by assessing the nitrate oxidase expression in rat corpus cavernosum with neck bladder obstruction and given alpha blocker

Evaluation of penile erectile function changes by assessing the nitrate oxidase expression in rat corpus cavernosum with neck bladder obstruction and given alpha blocker

Effect of surgical repair of acquired buried penis on sexual function in adults.

This study was performed to investigate the effect of surgical repair of acquired buried penis on sexual function in adults and provide a reference for clinical treatment. Thirty-two adult patients who underwent surgical treatment of buried penis from August 2010 to August 2017 were selected as the study group. The basic operative method was penile lengthening. Suprapubic liposuction, suspensory ligament release, and preputial plasty were performed according to the clinical manifestations. The changes in erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction sexual function were evaluated according to the International Index of Erectile Function (IIEF) before and after treatment. All 32 patients were analyzed by the IIEF before and after the operation. The results showed statistically significant differences in sexual function before and after the operation (P < 0.05). Surgical repair of acquired buried penis in adults can significantly improve patients' sexual function.

Dynamic Changes in Erectile Function and Histological Architecture After Intracorporal Injection of Human Placental Stem Cells in a Pelvic Neurovascular Injury Rat Model

IntroductionThe human placenta provides a bountiful and noncontroversial source of stem cells which have the potential for regeneration of injured tissue. These cells may restore erectile function after neurovascular tissue injury such as that seen in radical pelvic surgeries and pelvic trauma. AimTo determine the effect of human placenta–derived stem cells on erectile function recovery and histological changes at various time points in a cavernous nerve injury rat model and to study the fate of injected stem cells throughout the regenerative process. MethodsHuman placental stem cells (PSCs) were dual labeled with monomeric Katushka far red fluorescent protein (mKATE)-renLUC using a lentivirus vector. A pelvic neurovascular injury–induced erectile dysfunction model was established in male, athymic rats by crushing the cavernous nerves and ligating the internal pudendal neurovascular bundles, bilaterally. At the time of defect creation, nonlabeled PSCs were injected into the corpus cavernosum at a concentration of 2.5 × 106 cells/0.2 mL. The phosphate-buffered saline–treated group served as the negative control group, and age-matched rats (age-matched controls) were used as the control group. Erectile function, histomorphological analyses, and Western blot were assessed at 1, 6, and 12 weeks after model creation. The distribution of implanted, dual-labeled PSCs was monitored using an in vivo imaging system (IVIS). Implanted cells were further tracked by detection of mKATE fluorescence in histological sections. Main Outcome MeasureThe main outcome measure includes intracavernous pressure/mean arterial pressure ratio, neural, endothelial, smooth muscle cell regeneration, mKATE fluorescence, and IVIS imaging. ResultsThe ratio of intracavernous pressure to mean arterial pressure significantly increased in PSC-injected rats compared with phosphate-buffered saline controls (P < 0.05) at the 6- and 12-week time points, reaching 72% and 68% of the age-matched control group, respectively. Immunofluorescence staining and Western blot analysis showed significant increases in markers of neurons (84.3%), endothelial cells (70.2%), and smooth muscle cells (70.3%) by 6 weeks in treatment groups compared with negative controls. These results were maintained through 12 weeks. IVIS analysis showed luminescence of implanted PSCs in the injected corpora immediately after injection and migration of cells to the sites of injury, including the incision site and periprostatic vasculature by day 1. mKATE fluorescence data revealed the presence of PSCs in the penile corpora and major pelvic ganglion at 1 and 3 days postoperatively. At 7 days, immunofluorescence of penile PSCs had disappeared and was diminished in the major pelvic ganglion. Clinical ImplicationsPlacenta-derived stem cells may represent a future “off-the-shelf” treatment to mitigate against development of erectile dysfunction after radical prostatectomy or other forms of pelvic injury. Strength & LimitationsSingle dose injection of PSCs after injury resulted in maximal functional recovery and tissue regeneration at 6 weeks, and the results were maintained through 12 weeks. Strategies to optimize adult stem cell therapy might achieve more effective outcomes for human clinical trials. ConclusionHuman PSC therapy effectively restores the erectile tissue and function in this animal model. Thus, PSC therapy may provide an attractive modality to lessen the incidence of erectile dysfunction after pelvic neurovascular injury. Further improvement in tissue regeneration and functional recovery may be possible using multiple injections or systemic introduction of stem cells.Gu X, Thakker PU, Matz EL, et al. Dynamic Changes in Erectile Function and Histological Architecture After Intracorporal Injection of Human Placental Stem Cells in a Pelvic Neurovascular Injury Rat Model. J Sex Med 2020;17:400–411.

Noninvasive Treatment Options for Peyronie's Disease.

Evidence for noninvasive management of Peyronie's disease contains many options with varying levels of evidence for each. Many first-line treatments recommended by urologists lack strong evidence for their use. We summarize the noninvasive (oral medications, topical medications, traction, vacuum erection devices, extracorporeal shock wave therapy, intracavernosal injections and electromotive therapy) treatment options for Peyronie's disease and provide the levels of evidence for each. A literature search of PubMed, EMBASE, Cochrane Library, and ClinicalKey databases was conducted, current up to April2019. For each treatment modality, we measured level of evidence, change in penile curvature, change in erectile function, the percentage of patients with improved angulation, and pain scores. There is weak evidence to support the use of oral or topical medications. Higher levels of evidence exist for intracavernosal injections and extracorporeal shock wave therapy and may be helpful in certain patient populations. The mechanisms behind Peyronie's disease are not fully understood. Penile injections provide the highest quality of evidence for noninvasive treatment. Ory J, MacDonald L, Langille G. Noninvasive Treatment Options for Peyronie's Disease. Sex Med Rev 2020;8:603-614.

381 Conservative Management of Suspected Fractures in Men Undergoing Collagenase Clostridium Histolyticum for Peyronie's Disease Is not Associated with Worsening of Erectile Function

Collagenase clostridium histolyticum (CCH) for Peyronie's Disease (PD) causes penile fractures in a small percentage of men. The appropriate management of fractures remains debatable, with no studies evaluating the impact of observation on erectile function. To assess whether conservative management of penile fractures with CCH leads to worsened erectile function. An 18-item follow-up survey was administered to 158 PD men who completed 4 series of CCH injections. The survey included International Index of Erectile Function Erectile Function Domain (IIEF-EFD) questions and specific items querying potential symptoms of a corporal rupture. Patients who reported a popping sensation or rapid detumescence of the penis were defined as (+) Suspected Fracture. Statistical comparisons were subsequently performed to identify baseline characteristics associated with suspected fracture and changes in erectile function. The primary outcome was changes in erectile function between Suspected Fracture (+) and (-) patients; secondary outcomes included frequency and temporality of suspected fractures, correlational baseline characteristics, and treatment outcomes.

349 Penile Duplex Ultrasonography Supplements Goniometry in Formal Assessment of Efficacy of Intralesional Collagenase Clostridium Histolyticum for Peyronie's Disease

The evaluation of effectiveness of Collagenase Clostridium histolyticum (CCh) in treating men with Peyronie’s disease is largely limited to goniometry, symptoms assessment, and standardized questionnaires. These assessments do not determine objective changes in erectile function or vascular flow. Additionally, goniometry typically does not capture improvement in hourglass deformities or hinge defects. Doppler ultrasound measurement of peak systolic velocities has been investigated as a possible adjunctive assessment tool. While initial studies did not demonstrate improvement in velocities, these studies did not take into consideration velocities both proximal and distal to the penile plaque. This study evaluated the changes in peak systolic velocities of the cavernosal arteries of men with PD before and after 8 injections of CCh. An institutional review board approved database of 152 patients treated with CCh at an academic men’s health practice from January 2016 through April 2019 was reviewed. Doppler ultrasonography was performed after a chemically induced erection by a single examiner both before and after 8 CCh injections. Peak systolic velocities (PSV) were measured both proximal and distal to the palpable plaque bilaterally. Patient demographic information and goniometry data were also extracted. Univariate statistical analysis compared PSV data before and after CCh therapy.

Erectile function after WST11 vascular-targeted photodynamic therapy for low-risk prostate cancer treatment.

Vascular-targeted photodynamic therapy (VTP) using padeliporfin is currently assessed as a low-risk prostate cancer (LRPCa) treatment. The aim of this study was to assess erectile function outcomes of VTP for LRPCa treatment. We prospectively included all patients treated with VTP for LRPCa. The primary endpoint was the post-treatment International Index of Erectile Function score (IIEF5 score) evolution (at 6 months, 12 months, and then every year for 5 years). Secondary endpoints were the need of erectile dysfunction (ED) treatment and its efficacy. Eighty-two men were included. The median follow-up was 68 (range: 6–89) months. There was a 3-point significant decrease in the median IIEF5 score between baseline and at 6 months post-VTP (23 [range: 1–25] vs 20 [range: 1–25], P = 0.005). There was a 1-point decrease at 1 year and 2 years post-VTP compared to baseline (22 [range: 2–25] and 22 [range: 0–25], P < 0.005). There was no significant difference at 3, 4, and 5 years compared to baseline. Twenty-seven (32.9%) patients received ED treatment: phosphodiesterase type-5 inhibitors (PDEI5; n = 18), intracavernous injections (ICI; n = 9), and intra-urethral gel (n = 1). The median IIEF5 score statistically significantly increased after ED treatment (7 [range: 0–24] vs 21 [range: 1–25], P < 0.001). ED treatment was efficient for 75% of the patients. There was no statistically significant difference between IIEF5 score at baseline and after ED treatment (P = 0.443). Forty-six patients were totally potent before VTP and among them, 13 needed ED treatment post-VTP with a success rate of 69.2%. VTP induced minimal changes in erectile function with a 3-point and a 1-point reduction in the IIEF5 score at 6 months and at 1 year, respectively. When required, ED treatment was efficient.

A Prospective Clinical Study of a Prosexual Nutrient: Nano Leo for Evaluation of Libido, Erection, and Orgasm in Indian Men with Erectile Dysfunction.

Aim The present study aimed to assess the effects of Nano Leo, a prosexual nutrient formulation, on libido, erection, and orgasm in patients with erectile dysfunction (ED). Methods This was a prospective, single-center, phase IV efficacy study. Patients received two capsules for 7 days and thereafter one capsule through 90 days. Main outcome measures: primary endpoint was change in erectile function assessed using the International Index of Erectile Function (IIEF) questionnaire. Secondary endpoints included improvement in testosterone levels, FSH, LH, and prolactin levels; seminal parameters; and overall quality of life (QoL). Results Our study included 99 men (mean age 32.2 ± 4.71 years). Mean erectile function domain score increased from 18.9 ± 5.67 at baseline to 23.7 ± 4.01 on day 90 (P < 0.001). Similar improvements were observed in orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction domains of IIEF score which was seen as early as day 30. Improved IIEF corroborated with improvement in all QoL domains. From baseline to day 90, treatment with Nano Leo increased testosterone levels (5.04 ± 2.22 vs. 5.57 ± 1.53 ng/mL, P < 0.001). Similar improvements were observed in orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction domains of IIEF score which was seen as early as day 30. Improved IIEF corroborated with improvement in all QoL domains. From baseline to day 90, treatment with Nano Leo increased testosterone levels (5.04 ± 2.22 vs. 5.57 ± 1.53 ng/mL, Conclusion Nano Leo showed improved libido, erection, and orgasm as evaluated by IIEF and QoL and was well tolerated. Therefore, Nano Leo could be an effective and safe pronutrient supplement in managing ED.

Effect of mirabegron on erectile function in sexually active men with bothersome overactive bladder symptoms.

To evaluate the change of erectile function (EF) in sexually active male overactive bladder (OAB) patients treated with Mirabegron. Mirabegron, a selective β3 adrenoceptor agonist, approved for the treatment of OAB, has been reported to relax human and rat corpus cavernosum and might have beneficial effect on EF. A total of 128 consecutive men with lower urinary tract symptoms attended urology outpatient clinic were evaluated for OAB and EF. Thirty-four sexually active OAB patients were prospectively enrolled in this study and received mirabegron 50 mg oral once a day. The evaluation of EF and OAB was based on a self-administered questionnaire containing International Index of Erectile Function (IIEF-5) and OAB symptom score (OABSS), respectively. Men with an OABSS urgency score of ≥2 and sum score of ≥3 were considered to have OAB. The therapeutic outcomes were assessed at baseline, 4, and 12 weeks. Mirabegron usage was associated with a statistically significant improvement of OAB symptoms (OABSS 32.1% decrease) at 4-week follow-up and the therapeutic effects were maintained at 12-week follow-up. Mirabegron usage did not improve EF (IIEF-5 4.9% decrease at 4-week; p = 0.106, and 9.1% decrease at 12-week follow-up; p = 0.077). However, the IIEF-5 was significantly decreased in the higher baseline IIEF-5 (≥17) group (11.7% decrease; p = 0.044), noncoronary artery disease (13.2%; p = 0.007), or non-DM group (13.9% decrease; p = 0.021) at 12-week follow-up. This preliminary study demonstrates that mirabegron treatment of men with OAB improved OAB symptoms, but has no beneficial effect on EF.

Effect of Intensive vs Standard Blood Pressure Treatment Upon Erectile Function in Hypertensive Men: Findings From the Systolic Blood Pressure Intervention Trial

IntroductionThe effect of intensive blood pressure control upon erectile function in men with hypertension, but without diabetes, is largely unknown. AimTo examine the effects of intensive systolic blood pressure (SBP) lowering on erectile function in a multiethnic clinical trial of men with hypertension. MethodsWe performed subgroup analyses from the Systolic Blood Pressure Intervention Trial ([SPRINT]; ClinicalTrials.gov: NCT120602, in a sample of 1255 men aged 50 years or older with hypertension and increased cardiovascular disease risk. Participants were randomly assigned to an intensive treatment group (SBP goal of <120 mmHg) or a standard treatment group (SBP goal of <140 mmHg). Main Outcome MeasureThe main outcome measure was change in erectile function from baseline, using the 5-item International Index of Erectile Function (IIEF-5) total score, and erectile dysfunction ([ED]; defined as IIEF-5 score ≤21) after a median follow-up of 3 years. ResultsAt baseline, roughly two-thirds (66.1%) of the sample had self-reported ED. At 48 months after randomization, we determined that the effects of more intensive blood pressure lowering were significantly moderated by race-ethnicity (p for interaction = 0.0016), prompting separate analyses stratified by race-ethnicity. In non-Hispanic whites, participants in the intensive treatment group reported slightly, but significantly better change in the IIEF-5 score than those in the standard treatment group (mean difference = 0.67; 95% CI = 0.03, 1.32; P = 0.041). In non-Hispanic blacks, participants in the intensive group reported slightly worse change in the IIEF-5 score than those in the standard group (mean difference = −1.17; 95% CI = −1.92, −0.41; P = 0.0025). However, in non-Hispanic whites and non-Hispanic blacks, further adjustment for the baseline IIEF-5 score resulted in nonsignificant differences (P > 0.05) according to the treatment group. In Hispanic/other participants, there were no significant differences in change in the IIEF-5 score between the two treatment groups (P = 0.40). In a subgroup of 280 participants who did not report ED at baseline, the incidence of ED did not differ in the two treatment groups (P = 0.53) and was without interaction by race-ethnicity. Clinical ImplicationsThe effect of intensive treatment of blood pressure on erectile function was very small overall and likely not of great clinical magnitude. Strength & LimitationsAlthough this study included a validated measure of erectile function, testosterone, other androgen, and estrogen levels were not assessed. ConclusionIn a sample of male patients at high risk for cardiovascular events but without diabetes, targeting a SBP of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in statistically significant effects on erectile function that differed in accordance with race-ethnicity, although the clinical importance of the differences may be of small magnitude.Foy CG, Newman JC, Russell GB, et al. Effect of Intensive vs Standard Blood Pressure Treatment Upon Erectile Function in Hypertensive Men: Findings From the Systolic Blood Pressure Intervention Trial. J Sex Med 2020;17:238–248.

Progression of erectile function in men with chronic obstructive pulmonary disease: a cohort study

BackgroundAlthough sexual function is a quality of life aspect that is markedly affected in males with chronic obstructive pulmonary disease (COPD), this topic has not attracted much attention and research on this matter is lacking. In this study, we investigated longitudinal changes in the erectile function of men with COPD in order to identify latent groups and influencing factors.MethodsA total of 185 men with COPD from the Korean Obstructive Lung Disease study, which was conducted from 2005 to 2013, were analyzed in this study. Data on their erectile function, based on the International Index of Erectile Function-5, were collected over a period of 4 years. Growth mixture modeling and logistic regression analysis were used to determine the factors predicting distinct erectile function changes over time.ResultsOverall, subjects’ erectile function slightly improved in the first year and then gradually worsened over time. Using growth mixture modeling, we identified four distinct latent groups, which we labeled as follows: “consistently maintained normal erectile function” (9.7%), “rapidly worsened and then rapidly improved” (9.2%), “gradually improved in the early stage and then gradually worsened” (36.8%), and “consistently maintained poor erectile function” (44.3%). Progression of erectile function was significantly associated with age, economic status, and self-rated health status.ConclusionsThis suggests that comprehensive patient care involving the management of COPD as well as erectile dysfunction in patients with chronic respiratory disease is important from a prophylactic perspective and should be developed in accordance with the characteristics of the disease process.

Oncological and Quality-of-life Outcomes Following Focal Irreversible Electroporation as Primary Treatment for Localised Prostate Cancer: A Biopsy-monitored Prospective Cohort

BackgroundFocal irreversible electroporation (IRE) can be used to treat men with localised prostate cancer (PCa) with reduced impact on quality of life (QoL). ObjectiveTo assess oncological and functional outcomes. Design, setting, and participantsTo report on a prospective database of patients undergoing primary IRE between February 2013 and August 2018. A minimum of 12-mo follow-up was available for 123 patients. Median follow-up was 36 mo (interquartile range [IQR] 24–52 mo). A total of 112 (91%) patients had National Comprehensive Cancer Network intermediate risk and 11 (9%) had low risk. A total of 12 (9.8%) had International Society of Urological Pathology (ISUP) grade 1, 88 (71.5%) had ISUP 2, and 23 (18.7%) had ISUP 3. InterventionFocal IRE ablation of PCa lesions. Outcome measurements and statistical analysisFollow-up involved serial prostate-specific antigen (PSA), multiparametric magnetic resonance imaging (mpMRI), and transperineal template mapping biopsy (TTMB) at 12 mo. Failure-free survival (FFS) was defined as progression to whole-gland or systemic treatment or metastasis/death. Functional outcomes were assessed. Results and limitationsMedian age was 68yr (IQR 62–73yr). Median preoperative PSA was 5.7ng/ml (IQR 3.8–8.0ng/ml). On post-treatment TTMB, in-field recurrence was present in 2.7–9.8% of patients. FFS at 3yr was 96.75%, metastasis-free survival 99%, and overall survival 100%. A total of 18 patients required salvage treatment (12 had repeat IRE; six had whole-gland treatment). The negative predictive value of mpMRI was 94% and sensitivity 40% for detecting in-field residual disease 6 mo after treatment. Among patients who returned questionnaires, 80/81 (98.8%) remained pad free and 40/53 (76%) had no change in erectile function. ConclusionsFocal IRE in select patients with localised clinically significant PCa has satisfactory short-term oncological outcomes with a minimal impact on patient QoL. Patient summaryIn this study, 123 patients underwent focal therapy using irreversible electroporation. Follow-up biopsy was clear of residual disease in 90.2–97.3% of patients. Of patients, 96.75% avoided whole gland treatment at 3yr.

SUN-230 Association of Estrogens and Androgens with Sexual Function after Hematopoietic Stem Cell Transplant

Background: Hematopoietic stem cell transplantation (HCT) is a potentially curative treatment for hematologic malignancies, but is associated with negative side effects, including reduced sexual function. It was recently reported that estradiol may exert an effect on sexual desire & erectile function, independent to that of testosterone, in healthy men. We hypothesized that changes in estrogen would be directly associated with changes in sexual function in men undergoing HCT. Methods: Nineteen men planning autologous HCT completed the International Index of Erectile Function (IIEF) & provided a morning, fasted blood sample at Baseline (before initiating preparatory chemotherapy) & 30±10 days post-HCT (FU). IIEF contains sub-categories of Erectile Function (EF), Orgasmic Function (OF), Sexual Desire (SD), Intercourse Satisfaction (IS), & Overall Satisfaction (OS). Plasma samples were analyzed for total testosterone (TT), dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), sex-hormone binding globulin (SHBG), 17-OHprogesterone, 17-OHpregnenelone, androstenedione, androsterone, pregnenolone, progesterone, estrone (E1), & estradiol (E2) via LCMS; bioavailable (BT) & free T (FT) were calculated using local laboratory-derived albumin levels. Follicle-stimulating hormone (FSH) was analyzed via ELISA. Non-parametric, paired t-tests compared Baseline to FU & multiple regression identified significant predictors of sexual function changes using forced variables (age, HCT-comorbidity index (CI), cumulative steroid exposure, post-HCT testing day, diagnosis) & conditional variables (change scores for each hormone & relative fat mass change). Data are median ± SEM. Results: Men were 68±3 years of age (multiple myeloma, N=15; leukemia, N=6). Significant changes were observed at FU for E2 (-5.2±1.9 pg/mL, p=0.048), E1 (-6.6±2.2 pg/mL, p=0.002), FSH (4.6±0.9 IUL, p=0.002), TT (1.3±0.4 ng/mL, p=0.02), SHBG (41.2±5.5 nmol/L, p=0.001), DHT (0.06±0.03 ng/mL, p=0.03), androsterone (0.02±0.02 ng/mL, p=0.045), androstenedione (0.54±0.16 ng/mL, p=0.001), progesterone (0.02±0.01 ng/mL, p=0.01), & 17-OHprogesterone (0.27±0.08 ng/mL, p=0.001). Sexual function significantly decreased at FU for EF (p=0.003), OF (p=0.01), SD (p=0.009), IS (p=0.03), & IIEF Total (p=0.004). There were no significant predictors of OF, SD, or OS change scores. Diagnosis, HCT-CI, & change scores for E2 & 17-OHpregnenolone were significant predictors of EF change (F=13.3, p=0.005). Age, diagnosis, HCT-CI, & change scores for E2 androstenedione were significant predictors of IS change (F=14.5, p=0.004). Age, diagnosis, HCT-CI, & change scores for E2 & DHEA were significant predictors of Total IIEF changes (F=20.1, p=0.002). Conclusion: Acute changes in sexual function after HCT are likely influenced by HCT-induced reductions in estradiol, independent of changes in testosterone.