Chronic Erectile Dysfunction Research Articles

Актуальні питання ведення пацієнта з хронічним простатитом і еректильною дисфункцією в амбулаторній практиці: клінічний випадок, проблеми та їх вирішення

Актуальні питання ведення пацієнта з хронічним простатитом і еректильною дисфункцією в амбулаторній практиці: клінічний випадок, проблеми та їх вирішення

Rehabilitation complex in treatment of chronic pelvic pain syndrome and erectile dysfunction in men

The study objective is to evaluate the effectiveness of rehabilitation complex in treatment of chronic pelvic pain syndrome in men.Materials and methods. At the Kyrgyz Scientific Research Institute of Balneology and Rehabilitation, Ministry of Health of the Kyrgyz Republic, 86 patients aged between 18 and 55 years with chronic prostatitis, chronic pelvic pain syndrome in remission and erectile dysfunction (ED) were examined. In the treatment group (n = 56), rehabilitation complex (balneotherapy, physiotherapy, ultraviolet irradiation of autologous blood, psychotherapy) was used; in the comparison group (n = 30), only standard therapy was used. Blood and urine were tested; total testosterone, luteinizing, follicle-stimulating hormones were measured; ultrasound and rheography of the prostate and penis, color Doppler ultrasonography of the penile vessels, prostatic fluid cultures, spermogram analysis were performed.Results. In the treatment group, pain syndrome was diagnosed in 52 % of patients, severe ED – in 55 %; in the comparison group, pain syndrome was diagnosed in 33 % of patients, ED – in 23 %. Ultrasound of the prostate in both groups showed diffuse changes of moderate severity. After the rehabilitation complex, all patients of the treatment group showed improvement in general condition and microscopic content of the prostatic fluid, decreased pain syndrome, dysuria, sperm viscosity, increased sperm count, number of sperm with normal morphology and motility. Rheography showed increased volume of pulse blood filling of the lower pelvic organs, venous outflow to the prostate. Frequency of severe ED decreased in the treatment group from 55 to 26 %, in the comparison group – from 23 to 16 %.Conclusion. The results show the positive effect of rehabilitation complex on chronic nonbacterial prostatitis, especially in case of improvement of erectile function.

IMPULSE BAROTHERAPY IN A COMPLEX TREATMENT OF PATIENT WITH CHRONIC ABACTERIAL PROSTATITIS AND ERECTILE DYSFUNCTION USING THE MKV-01 “IVAVITA” SYSTEM (CLINICAL CASE)

In this article clinical case of treatment of chronic abacterial prostatitis and erectile dysfunction using the local baroimpulse therapy with the urogynecological device “Ivavitа” is presented. This method is included in complex therapy along with standard methods. Clinical and instrumental parameters were corrected by this treatment regimen in this patient.

PD070: Relationship between chronic periodontitis and erectile dysfunction: an observational study on Spanish population

PD070: Relationship between chronic periodontitis and erectile dysfunction: an observational study on Spanish population

Re: Does any Association Exist between Chronic Obstructive Pulmonary Disease and Erectile Dysfunction? The DECODED Study.

Re: Does any Association Exist between Chronic Obstructive Pulmonary Disease and Erectile Dysfunction? The DECODED Study.

Characteristics of patients with erectile dysfunction in a family physician-led erectile dysfunction clinic: Retrospective case series

Objective To examine the characteristics of patients with erectile dysfunction in a family physician led erectile dysfunction clinic; To review association of chronic disease spectrum and erectile dysfunction; To review initial treatment pattern and outcome. Design Retrospective case series review. Subjects All consecutive patients seen in a regional hospital family physician led erectile dysfunction clinic from April 2014 to March 2015. Main outcome measures The severity of erectile dysfunction, based on International Index of Erectile Function (IIEF-5). The associated chronic comorbidities of patients. Treatment patterns and patient outcomes. Results One hundred and eighty three patients presented with erectile dysfunction (ED) with mean age 58.7 (range 23 to 82) years old were seen during the study period. One hundred and twenty seven patients (69.4%) had comorbidity of chronic diseases, including 50.8% had hypertension, 38.8% had diabetes mellitus and 33.9% had hyperlipidaemia. Their mean body mass index was 25.2 kg/m2, the mean blood pressure was 137.3/79.5 mm Hg (1 mm Hg = 0.133 kPa). According to IIEF-5 score, 50.3%, 30.6% and 18.6% had severe, moderate and mild erectile dysfunction respectively. The average duration of ED before seeking medical help was 3.9 years. Phosphodiesterase 5 (PDE5) inhibitors were prescribed to 119 patients (65%), and 57.1% of them achieved good response. Twenty nine patients (15.8%) were referred to other specialty for further management, including 27.6% had contraindication for PDE5 inhibitor. Conclusion High proportion of erectile dysfunction patients had comorbitiy of chronic diseases. 57.1% of those patients receiving PDE5 inhibitors showed good response.

Relationship between Chronic Periodontitis and Erectile Dysfunction: A Narrative Review

Objective. To conduct a descriptive literature review on research studies investigating the association between chronic periodontitis (CP) and erectile dysfunction (ED). Methods. Cohort studies, case-control studies, cross-sectional studies, randomized control trials, and animal studies up to July 2015 that studied the relationship between CP and ED were reviewed and reported. Data sources included PubMed, EMBASE, Cochrane Library, and Clinicaltrials.gov. The themes “periodontal disease” and “erectile dysfunction” and the role of periodontal therapy were identified and discussed throughout the narrative review. Results. After reviewing the literature, it was found that an association between CP and vasculogenic ED likely exists. Inflammation resulting from CP promotes endothelial dysfunction by increasing the systemic levels of inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α). Periodontal therapy attempts to decrease the release of TNF-α and could act to restore endothelial function, particularly in the penile vasculature. Conclusion. Although the literature reported a positive association between CP and ED, the studies were few and possess several methodological limitations. Large-scale cohort studies and confounder analysis are recommended. Dentists and physicians should collaborate to manage patients with either CP or ED because of their potential association not only with each other but also with other serious systemic comorbidities.

Forensic Biomechanics/Functional Anatomy/Physiology Analysis of Erectile Dysfunction: A Defense Perspective in a Product Liability Case

In forensic biomechanics, most of us who provide expertise in this discipline have a large percentage of vehicle accident cases [1]. Certainly, as experts we appreciate unusual cases and new challenges outside the box of auto accidents. This specific case involved the defense of a bicycle seat manufacturer in a claim involving a middle aged man who reported that after an approximate 30 mile ride, the nose of his bicycle seat saddle had deformed during the last few miles of his ride resulting in his chronic erectile dysfunction (i.e. ED).

Correlation between chronic prostatitis and erectile dysfunction

Objective To discuss the clinical correlation between chronic prostatitis (CP) and erectile dysfunction (ED). Methods A retrospective analysis was made on the clinical data from patients who were diagnosed as CP in urology department of the First People′s Hospital of Yunnan Province and the First Affiliated Hospital of Sun Yat-sen University. Patients′ data were collected from July 2005 to July 2012. All the patients were diagnosed as CP based on their clinical manifestation, the NIH Chronic Prostatitis Symptom Index, prostatic fluid examination, routine urine examination and ultrasonography. The condition of erectile function was inquired on every patient and recorded. Results There were 4 315 patients diagnosed as CP in present study, while their age ranged from 17 to 64 years (average, 31 years). Sixty-one (1.41%) patients were identified as moderate and severe types of ED (International Index of Erectile Function 5 ≤11), while 42 (0.97%) patients were confirmed as ED after they got CP. 435/4 315 patients (10.08%) felt obviously sexuality descent after they got CP, and the sexuality was reported improved in 426/435 patients after prostatitis symptomatic relief. Conclusions The incidence rate of ED in CP patients is not obviously higher than that in common community. And sexuality descent in patients might be caused by local indisposition and anxiety after CP. Key words: Chronic prostatitis; Erectile dysfunction; Prevalence

Periodontitis may Increase Likelihood of Erectile Dysfunction in Taiwanese Men

Article Title and Bibliographic Information A nationwide population-based study on the association between chronic periodontitis and erectile dysfunction. Keller JJ, Chung S-D, Lin H-C. J Clin Periodontol 2012;39:507-12. Reviewer Raul I. Garcia, DMD, MMedSc Purpose/Question To explore the association between chronic periodontitis and erectile dysfunction Source of Funding Authors received no external funding Type of Study/Design Case–control study Level of Evidence Level 2: Limited-quality, patient-oriented evidence Strength of Recommendation Grade N/A: Not applicable

Long-term results of corpus cavernosum autoinjection therapy for chronic erectile dysfunction.

Between May 1985 and March 1992, 172 patients suffering from chronic erectile dysfunction (21-70 years old) underwent constant corpus cavernosum autoinjection therapy (CAT) with a standardized papaverine phentolamine mixture (16385 injections). Thereafter 41 patients continued CAT with the single agent papaverine (1257 injections). On the basis of both these 17642 protocol auto-injections, and over 6 years of experience with intracavernosal autoinjection therapy we conclude that, especially with the papaverine-phentolamine mixture, CAT constitutes an effective therapy (full rigidity in 95.8%) with tolerable side-effects for chronic erectile dysfunction when preceded by careful patient selection and thorough multi-disciplinary evaluation. This is especially so in the case of arterial and/or neurogenic aetiology of the erectile dysfunction. In addition, the contraindications must be strictly observed, the treatment and technique fully explained, and a regular follow-up instituted. CAT is generally well accepted by the patients and their partners (98.8%/97.6%) and has distinct positive effects on self-esteem (77.8%), performance anxiety (84.4%), and partnership (79.5%). The most serious side-effect was prolonged erection (25 out of 17642 injections). In 6 patients reversible fibrotic changes near the tunica albuginea were observed.

Urologic complications of radiotherapy

Radiation therapy is commonly used to treat pelvic or retroperitoneal cancers but has some impact on genito-urinary system: short-term side effects are frequent with usually a completed regression. However, the incidence of major complications is about 12% and is probably underestimated due to a long delay between radiation therapy and diagnosis of some adverse events such as ureteral strictures or fistula. Clinical follow-up must absolutely include an early diagnosis and treatment of radiation therapy complications such as renal dysfunction, ureteral stricture, ureteral fistula, chronic bladder injury, bladder fistula, urethral stricture, infertility or erectile dysfunction.

EFFICACY, SAFETY AND PATIENT ACCEPTANCE OF SILDENAFIL CITRATE AS TREATMENT FOR ERECTILE DYSFUNCTION

We assessed the efficacy and safety of sildenafil citrate as treatment for erectile dysfunction. A total of 433 completely evaluated men with chronic erectile dysfunction were treated with sildenafil citrate. Response was assessed prospectively by baseline and followup physician interviews, and by a patient self-administered 15-item questionnaire on the domains of patient treatment response and satisfaction, partner treatment satisfaction, comparative previous treatment satisfaction, adverse effects, and patient and partner quality of life. Of the 304 men (70.2%) who completed the questionnaire 278 received sildenafil, including 186 who previously had undergone treatment for erectile dysfunction, principally involving intracavernous injection therapy. A response was elicited by a median dose of 100 mg. in 188 patients (67.6%) who achieved erection suitable for sexual intercourse. Those with psychogenic erectile dysfunction responded significantly better than those with organic dysfunction (p <0.001). Erection suitable for intercourse was attained by 30.8% of patients with erectile dysfunction after radical prostatectomy and 80% with cavernous veno-occlusive dysfunction. Of previous intracavernous injection responders 29.9% were refractory to sildenafil, while 33. 3% of previous intracavernous injection nonresponders responded to sildenafil. The sildenafil response was considered inferior to the intracavernous injection response by 43.6% of the men who previously responded to intracavernous injection, of whom 51.5% continued to receive intracavernous injection as the only treatment (19.5%) or as an alternative to sildenafil (32%). Adverse effects in 53.6% of cases were assessed as mild in 56.4%, moderate in 38.3% and severe in 5.3%. Multiple adverse effects were reported by 62.4% of patients, while 17 (6.1%) discontinued sildenafil as a direct result of intolerable adverse effects. The most common adverse effects were facial flushing in 33.5% of cases, headaches in 23.4%, nasal congestion in 12.6%, dyspepsia in 10.1% and dizziness in 10.8%. Baseline patient and partner quality of life scores significantly improved after sildenafil treatment (p <0.001), while significantly improved quality of life was noticed by 51.5% and 43.1%, respectively. Sildenafil citrate is effective oral first line treatment for erectile dysfunction. Although more than 50% of men reported adverse effects, most were considered mild and rarely resulted in treatment cessation. There was a trend in those on intracavernous injection who responded to sildenafil to continue intracavernous injection as the only therapy or as an alternative to sildenafil. Also, we noted that some cases refractory to sildenafil responded to intracavernous injection. These findings imply that intracavernous injection remains an effective erectile dysfunction treatment option.

Multicenter study of the treatment of erectile dysfunction with transurethral alprostadil (MUSE) in Korea

A Korean multicenter study was conducted to assess the effectiveness of transurethral alprostadil with MUSE in 334 subjects with chronic erectile dysfunction (ED) who were enrolled in 21 clinical centers. Patients with psychogenic impotence comprised about 30% of subjects. Intraurethral alprostadil was titrated in a stepwise fashion in the clinics from 250 to 500 or 1000 mcg based on erectile response and tolerability. The erectile responses were evaluated using an erection assessment scale (score of 1-5). The dose that produced a maximal penile response of score 5 (full rigid erection) or 4 (full tumescence, partial rigidity) was selected for home treatment. Patients who showed partial erection (score of 3) with 1000 mcg were also included in the home-treatment group. In-clinic phase: 198 men (59.3%) had maximal penile responses of score 4 or 5. The rate of maximal responses was not related to patient age, etiology or duration of the ED. A total of 228 (68.3%) men progressed to home treatment. The overall level of comfort of the transurethral alprostadil was rated as uncomfortable or very uncomfortable in 12%. Home phase: During the two-month period of home treatment, 178 (78.1%) men had successful sexual intercourse at least once, and 78.2% of administrations (1976) resulted in successful intercourse. The main causes of drop-out were insufficient erectile response in 27 men (11.8%), adverse reactions (mostly penile or urethral pain) in 7 (3.1%) or both in 7 (3.1%). In conclusion, transurethral alprostadil could be a suitable treatment option for patients with ED regardless of age and etiology of ED. Efficacy in an Asian population (Korea) is comparable to that reported previously in Caucasians.

TREATMENT OF INTRACORPOREAL INJECTION NONRESPONSE WITH SILDENAFIL ALONE OR IN COMBINATION WITH TRIPLE AGENT INTRACORPOREAL INJECTION THERAPY

We assess the efficacy of sildenafil as salvage therapy for intracorporeal injection therapy nonresponse. The study group comprised 93 patients with a mean age of 53.6 years (range 24 to 77) with chronic erectile dysfunction. In all cases a home trial of intracavernosal injection of high dose alprostadil and triple agent intracavernosal injection therapy had failed. Patients were treated with sildenafil citrate alone or in combination with intracavernosal injection therapy. The etiology of erectile dysfunction was arteriogenic in 29 cases, cavernosal venous leakage in 36, mixed vasculogenic in 24, psychogenic in 3 and post-priapism intracavernous fibrosis in 1. Of the 32 sildenafil responders (34% of the study group) 30 required 100 and 2 required 50 mg. The 29 sildenafil intracavernosal injection (combined therapy) responders (31% of the study group) required 100 mg. sildenafil. There were 32 nonresponders (34% of the study group). Mean International Index of Erectile Function questions 3 and 4 scores were 1.7 and 1.5 at baseline, 2.3 and 1.9 with intracavernosal injection, 4.6 and 42.2 with sildenafil, and 4.1 and 4.10 with combined therapy, respectively. Of the 93 patients 29 (31%) treated with intracavernosal injection reported adverse effects, including penile pain in 27, dizziness in 5 and headache in 2. Of the patients treated with sildenafil 34 (37%) reported side effects, including headache in 30, facial flushing in 25, dyspepsia in 12, nasal congestion in 9, dizziness in 5 and visual disturbances in 1. Of the 41 patients given combined therapy 20 (49%) reported adverse effects, including penile pain in 15, headache in 15, facial flushing in 12, dyspepsia in 7, nasal congestion in 3, dizziness in 12 and syncope in 1. Sildenafil alone or sildenafil plus intracavernosal injection is effective salvage therapy for intracavernosal injection nonresponse. Sildenafil in combination with intracavernosal injection is associated with a 33% incidence of adverse effects, including a 20% incidence of dizziness.

A double-blind, placebo-controlled evaluation of the erectile response to transurethral alprostadil

Objectives Previous studies have indicated that the urethra may provide an effective route for administering vasoactive medication for the treatment of erectile dysfunction. We evaluated the safety and efficacy of alprostadil administered intraurethrally at home for the treatment of this disorder. Methods This prospective, multicenter, double-blind, placebo-controlled study evaluated the erectile response to randomly assigned doses of transurethral alprostadil at home in 68 men with long-standing (mean 41 months) erectile dysfunction of primarily organic etiology. Patients completing the study each administered a random sequence of four different doses ( 125, 250, 500, and 1000 μg) and placebo over a 2 to 4 week period. Assessments included the couples' ability to have intercourse, patient ratings of erectile response by both categorical and visual analogue scales, penile volume measurements, and overall assessments of comfort and ease of administration. Results Overall, 75.4% (49 of 65) of study patients achieved full enlargement of the penis and 49.2% (32 of 65) achieved an erection judged by the patient to be sufficient for intercourse. In addition, 63.6% (42 of 66) of patients reported intercourse. Efficacy was similar across etiologies. The most common side effect was penile pain, which occurred in association with 9.1 % to 18.3% of alprostadil administrations, depending on dose. Mean comfort ratings ranged from 79 to 87, depending on dose, where 0 = severe discomfort and 100 = comfortable; ease of administration scores were above 90 for each dose, where 0 = difficult and 100 = easy. There were no episodes of priapism in this study. Conclusions Short-term treatment with transurethral alprostadil produced erections resulting in sexual intercourse in most patients with chronic erectile dysfunction. This therapy may be a useful treatment option for patients with erectile dysfunction.

Functional electromyostimulation of the corpus cavernosum penis--preliminary results of a novel therapeutic option for erectile dysfunction.

Transcutaneous application of low-frequency electric current in the treatment of partially or temporarily denervated striated muscles is widely used to prevent or treat muscular atrophy. Due to the high regenerative capacity of smooth-muscle cells, this approach should be beneficial in the treatment of diseases with smooth-muscle degeneration due to partial denervation. Our study was done to evaluate the possible beneficial effect of transcutaneously applied low-frequency electric current on the corpus cavernosum penis in the treatment of erectile dysfunction. After a comprehensive workup, 21 patients with chronic erectile dysfunction (20/21 vasoactive nonresponders) received daily (3-5 x 20 min) transcutaneous functional electromyostimulation of the corpus cavernosum smooth muscles [FEMCC; zero-line symmetric impulses of trapezoid shape, 2-channel device with alternating stimulations; frequency (f), 10-20 Hz for channel I and 20-35 Hz for channel II; impulse duration (ti), 100-150 microseconds; approx. 12 mA; rise time, 0.5 s; stimulation time, 5 s/channel; pause between stimulations, 0.5 s. In all, 4/21 patients (19%) regained full spontaneous erections and another 3/21 (14%) responded to vasoactive drugs after FEMCC. Overall, 14/21 were FEMCC failures, including 2 who subjectively "improved." In a similar group of patients who were evaluated during the same period but received no therapy, no spontaneous improvement in erectile function was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment options for men with sexual dysfunction.

Erectile dysfunction can occur in men of any age, but it is more common in older men. It is one of the most devastating problems a man can face. An estimated 10 to 12 million American men experience impotence. Increased sexual expectations for an aging population have resulted in an increased interest in the treatment of impotence. Treatment options range from a simple adjustment in medication to surgical implantation of a penile prosthesis. The good news is that sexual function can almost always be restored. The bad news is that many men with chronic erectile dysfunction never seek help. A sensitive nurse who has an understanding of sexual health and functioning and the conditions that interfere with them can steer those who need help in the direction of treatment.

Effects of intracavernosal pharmacotherapy on self-esteem, performance anxiety and partnership in patients with chronic erectile dysfunction.

156 patients undergoing intracavernosal autoinjection pharmacotherapy for periods of 2-36 months were studied for the effect of treatment on self-esteem, performance anxiety, partnership and acceptance using a semi-structured questionnaire. Replies were received from 86.3% of the patients. 93% gave a very good, good or satisfactory rating of intracavernosal pharmacotherapy. 78.2% indicated that their self-esteem had grown. 79.4% said that performance anxiety diminished in the course of therapy (25.6%) or disappeared entirely (53.8%). 71.8% of the replies confirm the positive effect of treatment on marital relations or partnership. 61.9% of the patients used intracavernosal pharmacotherapy permanently. 28.3% needed therapy intermittently or at large intervals only, and 4.5% (7 patients) were cured of their chronic sexual dysfunction. When preceded by thorough multidisciplinary diagnostics and careful patient selection, intracavernosal pharmacotherapy constitutes an efficient mode of treatment for chronic erectile dysfunction.

Arterial anatomy and arteriographic diagnosis of arteriogenic impotence.

One hundred twenty-six bilateral selective arteriographic examinations of the iliopudendal vascular tree were performed after comprehensive multidisciplinary evaluation in patients with chronic erectile dysfunction. Best imaging results were obtained by performing the arteriography under epidural anesthesia after intracavernous injection of a vasoactive drug combination. The arteriography is mandatory prior to revascularization procedures. It is further indicated in primary erectile dysfunction and posttraumatic erectile failure. The importance of cavernosography and selective arteriography in primary erectile dysfunction is stressed. Increasing knowledge about the influence of vasoactive drugs on penile hemodynamics has led to its application in diagnosis and therapy of erectile dysfunction. Pharmacocavernosography, Doppler-ultrasound of penile arteries after intracavernous injection of a vasoactive drug combination, and pharmacoarteriography are refined techniques to prove a vascular etiology of erectile dysfunction. The results of the morphologic studies of the vascular system are correlated with functional testing of erectile capacity by intracavernous application of a papaverine-phentolamine drug combination.