Diagnosis Of Erectile Dysfunction Research Articles

Comparing risk of post infection erectile dysfunction following SARS Coronavirus 2 stratified by acute and long COVID, hospitalization status, and vasopressor administration: a U.S. large claims database analysis.

No study has yet assessed the risk of developing erectile dysfunction (ED) after a diagnosis of long COVID, defined by the Centers for Disease Control and Prevention as the persistence or presence of new symptoms at least 4 weeks after initial SARS-CoV-2 infection, when compared to those diagnosed with acute COVID or cases in which more severe treatment is required. To assess these risks, we queried the TriNetX COVID-19 Research Network from December 1st 2020 through June 2023. Men aged ≥ 18 diagnosed with long COVID were compared to those diagnosed with acute COVID and analyses were performed to compare men who were/were not hospitalized within 1 month of acute COVID diagnosis and men who did/did not need vasopressors. Cohorts were propensity score matched and compared for differences in new ED diagnosis and/or prescription of phosphodiesterase-5 inhibitors (PDE5i). After propensity score matching, the long and acute COVID cohorts included 2839 men with an average age of 54.5±16.7 and 55.1±17.1 years respectively (p = 0.21). Men with long COVID were more likely to develop ED or be prescribed PDE5i (3.63%) when compared to men with only acute COVID infections (2.61%) [RR 1.39; 95% CI 1.04, 1.87]. There was no statistically significant risk of developing ED or being prescribed PDE5i for individuals who received vasopressors [RR 0.92; 95% CI 0.77,1.10] or were hospitalized [RR 0.93; 95% CI 0.82,1.06].

Prescribing semaglutide for weight loss in non-diabetic, obese patients is associated with an increased risk of erectile dysfunction: a TriNetX database study.

Semaglutide was approved in June 2021 for weight loss in non-diabetic, obese patients. While package inserts include sexual dysfunction as a side effect, no study has assessed the degree of this risk. The objective of our study is to assess the risk of developing erectile dysfunction after semaglutide is prescribed for weight loss in obese, non-diabetic men. The TriNetX Research database was used to identify men without a diagnosis of diabetes ages 18 to 50 with BMI > 30 who were prescribed semaglutide after June 1st, 2021. Men were excluded if they had a prior erectile dysfunction diagnosis, any phosphodiesterase-5 inhibitors prescription, intracavernosal injections, penile prosthesis placement, history of testosterone deficiency, testosterone prescription, pelvic radiation, radical prostatectomy, pulmonary hypertension, or were deceased. We further restricted our cohort to non-diabetic, obese men by excluding men with a prior diabetes mellitus diagnosis, a hemoglobin A1c > 6.5%, or having ever received insulin or metformin. Men were then stratified into cohorts of those that did and did not receive a semaglutide prescription. The primary outcome was the risk of new ED diagnosis and/or new prescription of phosphodiesterase type 5 inhibitors at least one month after prescription of semaglutide. The secondary outcome was risk of testosterone deficiency diagnosis. Risk was reported using risk ratios with 95% confidence intervals (95% CI). 3,094 non-diabetic, obese men ages 18-50 who received a prescription of semaglutide were identified and subsequently matched to an equal number cohort of non-diabetic, obese men who never received a prescription of semaglutide. After matching, average age at index prescription for non-diabetic, obese men was 37.8 ± 7.8 and average BMI at index prescription was 38.6 ± 5.6. Non-diabetic men prescribed semaglutide were significantly more likely to develop erectile dysfunction and/or were prescribed phosphodiesterase type 5 inhibitors (1.47% vs 0.32%; RR: 4.5; 95% CI [2.3, 9.0]) and testosterone deficiency (1.53% vs 0.80%; RR: 1.9; 95% CI [1.2, 3.1]) when compared to the control cohort of non-diabetic men who never received a semaglutide prescription.

A comprehensive review of monitoring methods for erectile dysfunction diagnosis

AbstractBackgroundErectile dysfunction (ED) is commonly associated with cardiovascular diseases and age. However, it is important to note that it can also affect younger males, potentially serving as an early indicator of compromised overall health. Despite the high prevalence, ED remains underdiagnosed due to factors such as reluctance to testing, concerns about privacy, and the persistent social stigma surrounding the condition.ObjectiveThis review offers an overview of diagnostic and monitoring devices employed in the assessment of nocturnal ED and aims to assess both historical and recent developments in this field. It considers the emerging technological trends in digital innovation, particularly in the context of home‐based decentralized healthcare settings.MethodsA comprehensive literature search was performed via PubMed using keywords ‘nocturnal penile tumescence’, ‘NPT’, ‘sleep‐related erection’, ‘SRE’, ‘rigidity monitoring’, ‘NPTR’, ‘tumescence monitoring’, ‘erectile dysfunction’ and ‘smart wearable’. All relevant literature was retrieved and reviewed. Web‐based Google and manual searches of references were also performed to identify relevant articles and solutions missed by online indexes.FindingsAn increasing number of methods and solutions are integrating digital technologies, harnessing sensors, and utilizing data analytics for continuous monitoring and AI‐assisted prediction of ED.ConclusionThe future of ED monitoring is expected to leverage digital technologies to enhance evaluation, monitoring, and accurate diagnosis in decentralized healthcare environments maintaining patient privacy and driving early detection and intervention.

The combination of electrotherapy with pelvic floor muscle training in the treatment of a patient with postcovid erectile dysfunction. Clinical case

The combination of electrotherapy with pelvic floor muscle training in the treatment of a patient with postcovid erectile dysfunction. Clinical case

Phosphodiesterase Type 5 Inhibitors in Men With Erectile Dysfunction and the Risk of Alzheimer Disease: A Cohort Study.

Repurposing phosphodiesterase type 5 inhibitors (PDE5Is) as drugs for Alzheimer disease (AD) risk reduction has shown promise based on animal studies. However, evidence in humans remains inconclusive. Therefore, we conducted a cohort study to evaluate the association between PDE5I initiation compared with nonuse and the risk of developing AD in men with erectile dysfunction (ED). Using electronic health records from IQVIA Medical Research Data UK (formerly known as the THIN database), we identified men aged ≥40 years with a new diagnosis of ED between 2000 and 2017. Individuals with a previous diagnosis of dementia, cognitive impairment, confusion, or prescription for dementia symptoms were excluded. The occurrence of incident AD was identified using diagnostic read codes. To minimize immortal-time bias, PDE5I initiation was treated as a time-varying exposure variable. Potential confounders were adjusted using inverse probability of treatment weighting based on propensity scores. Cox proportional hazard models were used to estimate the adjusted hazard ratio (HR) with 95% CIs. A secondary analysis explored the association between AD and the cumulative number of PDE5I prescriptions. Sensitivity analyses included lag (delay) periods of 1 and 3 years after cohort entry to address the prodromal stage of AD. The study included 269,725 men, with 1,119 newly diagnosed with AD during a median follow-up of 5.1 (interquartile range 2.9-8.9) years. The adjusted HR in PDE5I initiators compared with nonuse was 0.82 (95% CI 0.72-0.93). The associated risk of AD decreased in individuals issued >20 prescriptions: HR 0.56 (95% CI 0.43-0.73) for 21-50 prescriptions and HR 0.65 (95% CI 0.49-0.87) for >50 prescriptions. Sensitivity analysis with a 1-year lag period supported the primary findings (HR 0.82, 95% CI 0.72-0.94), but the results differed with the inclusion of a 3-year lag period (HR 0.93, 95% CI 0.80-1.08). PDE5I initiation in men with ED was associated with a lower risk of AD, particularly in those most frequently issued prescriptions. The differences between primary and sensitivity analyses highlight the need to explore the optimal lag period. To enhance the generalizability of our findings, a randomized controlled trial including both sexes and exploring various PDE5I doses would be beneficial to confirm the association between PDE5I and AD.

Evaluation of Lower Urinary Tract Symptoms in Males and Urinary Incontinence in Females in Primary Health Care in Greece.

Background and Objectives: The significant prevalence of Lower Urinary Tract Symptoms (LUTS), erectile dysfunction (ED), and associated adverse effects calls for increased attention in primary care settings. In Greece, there is a lack of sufficient data for LUTS and ED screening in primary care. Therefore, the aim of our study was to estimate the prevalence of LUTS and ED, identify associated risk factors, and evaluate their impact on quality of life among adult primary healthcare users aged 40 years and older in Crete, Greece. Materials and Methods: A cross-sectional study was conducted to explore the prevalence of LUTS and ED in 1746 primary health care users visiting rural primary health care practices in Crete, Greece. Participants underwent a comprehensive evaluation including demographic parameters, screening for LUTS utilizing the validated International Prostate Symptoms Score (IPSS) questionnaire and for ED using the International Index of Erectile Function (IIEF-5), in males, and for urinary incontinence in women with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Participants with a prior diagnosis of LUTS or ED were excluded (n = 183). Results: Out of 536 participants finally included (n = 1746 screened), 32% of males and 36% of females exhibited moderate to severe LUTS. Following adjustments, we identified advanced age, retirement, and the presence of diabetes type 2 as factors associated with the occurrence of LUTS in men. Patients with LUTS also had a substantially increased likelihood of experiencing ED. Moreover, it was observed that women with hypertension or diabetes type 2 and lower education levels face an increased likelihood of developing LUTS, which adversely affects their quality of life. Conclusions: In conclusion, the findings of this study reveal a high occurrence of LUTS and ED in adults aged 40 years and older who utilize primary healthcare services, with a negative impact on their quality of life.

(073) Post-Infection Erectile Dysfunction Risk - Comparing COVID-19 with Other Common Acute Viral Infections: A Large National Claims Database Analysis

Abstract Introduction It is unknown if erectile dysfunction (ED) risk following Coronavirus-19 (COVID-19) infection is virus-specific. Objective To assess the risk of ED in COVID-19 patients as compared to patients with other common viral infections. Methods A US claims database (TriNetX Diamond Network) was queried from January 2020 to April 2023. Cohorts included men aged ≥18 with ≥1 outpatient visit (CPT 1013627, 1013638) within 1-18 months of infection (Figure 1). Cohorts were generated for men positive for (1) SARS Coronavirus 2 (TNX Curated 9088), (2) influenza (ICD-10 J9-11), (3) RSV (CPT 87280, 87634; ICD-10 J12.1, 21.0, B97.4; LOINC 31950-9, 33390-6, 33045-6, 5876-8, 5877-6, 68966), (4) enterovirus (ICD-10 A08.39, B34.1; LOINC 5843-8, 82194-2, 29558-4, 29591-5, 97151-5, 49847-7, 93856-3), (5) acute viral hepatitis (ICD-10 B15-16, 17.0-2, 17.9), (6) mononucleosis (ICD-10 B27), (7) herpes zoster (CPT B02), and (8) no acute viral illness. Men with multiple viral infection types were excluded. Men with ED diagnosis (ICD10 N52), phosphodiesterase-5 inhibitors (PDE5i) (RxNorm 1231301, 598, 358263, 306674, 136411), intracavernosal injections (CPT 54235, J0270, J2760, J2440), and penile prosthesis (CPT 54405-11, 54415-7; ICD-10 N48.6) prior to infection were excluded. Those with prostatectomy (SNOMED 9047006), pelvis radiation (ICD-10 DWY6-7, DW06-7), pulmonary hypertension (ICD-10 I27.0, I27.2, I27.20), or chronic viral hepatitis (ICD-10 B18) before or after infection were excluded. All sildenafil, vardenafil, and avanafil doses and 10 or 20 mg tadalafil were included. Outcomes were rates of new ED diagnosis (ICD-10 N52), PDE5i prescription (RxNorm 1231301, 598, 358263, 306674, 136411), and new ED diagnosis or PDE5i prescription 1-18 months following infection diagnosis. ED diagnosis and/or PDE5i prescription rates were compared between men with COVID-19 to all other cohorts. Propensity score matching was performed with age at index, race, ethnicity, type 2 diabetes mellitus (ICD-10 E11), overweight and obesity (E66), hypertension (I10), ischemic heart disease (I20-I25), pure hypercholesterolemia (E78.0), alcohol dependence (F10), nicotine dependence (F17), mood disorders (F34), atherosclerosis (I70), obstructive sleep apnea (G47.33), testicular hypofunction (E29.1), inpatient hospital services (CPT 1013659), and outpatient services (CPT 1013626). Results The COVID-19 cohort was matched to: 35,226 in the influenza cohort, 1,565 in the RSV cohort, 16,317 in the enterovirus cohort, 2,461 in the viral hepatitis cohort, 2,797 in the mononucleosis cohort, 2,171 in the herpes zoster cohort, and 87,064 in the no acute viral illness cohort. After matching, men with COVID-19 were not more or less likely to receive an ED diagnosis or PDE5i prescription when compared to influenza (risk ratio (RR) [95% Confidence Interval] RR 1.098 [0.999-1.206]), RSV (RR 1.318 [0.761-2.284]) or enterovirus (RR 1.039 [0.909-1.187]) (Table 1). Men with COVID-19 were less likely to develop ED diagnosis or PDE5i prescription than men with viral hepatitis (RR 0.711 [0.512-0.988]) and herpes zoster (RR 0.37 [0.72-0.490]) and more likely to receive an ED diagnosis or PDE5i prescription than men without any viral illness diagnosis (RR 1.329 [1.247-1.416]) (Figure 2). Conclusions COVID-19 infection was associated with lower risk for ED diagnoses or PDE5i prescriptions than infection with herpes zoster. This may indicate post-viral ED may be more related to the general febrile response than the virus itself. Disclosure No.

(159) Characteristics and Hypertension Management Trends in Hypertensive Men With and Without Erectile Dysfunction

Abstract Introduction Hypertension, defined as a blood pressure (BP) ≥ 130/80 mmHg and/or use of BP lowering medications, affects 47% of the U.S. population and is the most important modifiable risk factor for cardiovascular disease (CVD) prevention. Prevalence of BP control appears to be decreasing in the U.S. and currently only 1 in 4 adults with hypertension have controlled BP. Erectile dysfunction (ED), an early marker of subclinical CVD, often accompanies hypertension. Most BP lowering medications have been shown to not affect sexual function, but the drug class of angiotensin receptor blockers (ARBs) have generally been found to have favorable effects on erectile function through their inhibition of angiotensin II. Therefore, exploring the relationship between hypertension management and ED is advantageous for the ultimate control and treatment of these two common and highly prevalent diseases. Objective Assess the demographics of hypertensive men with and without ED and examine associations of ED with hypertension management and BP control outcomes Methods All men presenting for an initial visit for hypertension (ICD-10 codes I10, I11.0, and I11.9) between January 2017-December 2022 at an academic medical center were included for analysis. The electronic health record was queried for patient demographics, the diagnosis of ED, cardiovascular comorbidities, major drug classes of antihypertensives, and major PDE5-inhibitors. Descriptive statistics was used to describe patient characteristics by ED status. Chi-squared, t-test, and Mann-Whitney U tests was used to compare characteristics of patients by presence of ED. Results Of 24,723 hypertensive men in our health system during the study period, only 1,119 men (4.5%) were noted to have ED (Table 1). Hypertensive men with ED were younger (56 ± 11), than those without ED (61±15). There was no statistically significant difference in the use of ARBs amongst hypertensive men with and without ED. Initial systolic and diastolic BP was significantly higher amongst men with ED. After pooling all outpatient clinic visits prior to and after the diagnosis of ED, BP control did improve mildly over the study period, but this was coupled with a decrease in BP medication use across all drug classes. Finally, there was a significant increase in hypertensive males who were on a either sildenafil or tadalafil after their ED diagnosis (Table 2). Conclusions This study elucidates several key points in conceptualizing the ED and hypertension problem and lays a foundation for the next phase in addressing critical gaps in care. This research further validates the underdiagnoses and thus undertreatment of ED overall, with a significantly lower than expected number of men with ED. Despite the well-established benefits of ARBs in hypertensive men with ED, we observed a trend of underutilization of this beneficial BP medication option. Improvements in BP control over time for hypertensive men with ED emphasize the role ED could play in hypertension management. Leveraging ARBs and education on the interplay of ED and hypertension could lead to improved rates and control of both diseases. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals, ForHims.

(072) Comparing Risk of Post-Infection Erectile Dysfunction Following SARS Coronavirus 2 Stratified by Acute and Long COVID, Vasopressor Administration, and Hospitalization Status

Abstract Introduction While multiple studies have shown an association between acute COVID-19 infection and subsequent development of erectile dysfunction (ED), no study has yet assessed the risk of developing ED after a diagnosis of long COVID. It is unclear if there is an increased risk of ED in those with long COVID compared to only those diagnosed with acute COVID. In addition, the impact of vasopressor use and hospitalization for an acute COVID infection on ED development is uncertain. Objective This study sought to assess the risk of ED in individuals with acute COVID-19 when compared to individuals with long COVID-19, as well as risk of ED following more severe cases requiring vasopressors and hospitalization. Methods The TriNetX COVID-19 Research Network was queried from December 1st 2020 through June 2023. We included men aged ≥ 18-years old and analyzed cohorts comparing the following 1) men diagnosed with long COVID-19 (ICD-10: U09) were compared to those that were diagnosed with or had positive test for acute COVID-19 but no diagnosis of long COVID. Men were included if they had at least one outpatient follow-up visit 2 weeks after the initial positive test result and excluded if they received a prior ED diagnosis or treatment, prostatectomy, pelvis radiation, or pulmonary hypertension diagnosis at any time. Additional analyses were performed with the same above criteria including men that were and were not hospitalized within 1 month of acute COVID diagnosis and whether men needed vasopressors or not. Cohorts were propensity score matched and compared for differences in new ED diagnosis and/or prescription of phosphodiesterase-5 inhibitors (PDE5i). Variables on which propensity scores were matched are detailed in Table 1. Results A total of 2839 men were included in each cohort after propensity score matching with an average age of 54.5 +/- 16.7 years and 55.1 +/- 17.1 years in the long and acute COVID cohorts, respectively. Men diagnosed with long COVID-19 were more likely to develop ED or be prescribed PDE5i (3.63%) when compared to men with only acute COVID-19 infections (2.61%) [RR 1.39; 95% CI 1.04, 1.87]. There was no statistically significant increased or decreased risk of developing ED or being prescribed PDE5i for individuals who received vasopressors [RR 0.922; 95% CI 0.774,1.098] or were hospitalized [RR 0.933; 95% CI 0.824,1.056]. Conclusions We found that long COVID-19 infection was associated with greater risk for ED diagnosis or PDE5i prescriptions when compared with men diagnosed with only an acute COVID-19 infection, while there was no significantly increased risk for individuals requiring vasopressors or hospitalization. Disclosure No.

(150) Erectile Dysfunction and Peyronie’s Disease Diagnosis Rates After Penile Fracture – A Retrospective Claims Database Cohort Analysis

Abstract Introduction Penile fracture (PF) is a rare urologic emergency, with an estimated incidence of 500-600 PFs per year in the United States. Delays in surgical repair increase the risk of developing erectile dysfunction (ED) and Peyronie’s disease (PD). Objective Our objective was to analyze the rates of ED and PD following a PF using a large, multi-institutional claims database. Methods We conducted a cohort analysis utilizing the TriNetX Research database. The inclusion criteria included men ages 15 or older with a diagnosis of PF and any office visit within 5 years of the PF. Our exclusion criteria included any prior ED diagnosis, prescription of erectile aids, or penile prosthesis placement. Our primary outcome was the diagnosis of ED or prescription of erectile-aid dosing of phosphodiesterase-5 inhibitors (PDE5i) within five years. A secondary analysis was used to assess rates of PD following a PF. Subgroup analyses were performed for age and the impact of initial repair. Propensity-matching was performed to compare men with and without PF by calculating risk ratios (RR). Results 1,242 men were identified with a diagnosis of PF and subsequently matched to men without a PF, resulting in equal cohorts of 1,227 men. Men with a history of PF were more likely to receive a diagnosis of ED or require PDE5i (RR 3.18, 95% CI 2.30-4.40). Men over the age of 45 years who had a PF were more likely to develop ED or require ED treatment compared to men under 45 years (RR: 1.65, 95% CI 1.14-2.39). Men who did not undergo immediate repair had higher rates of ED diagnoses or treatment (RR: 1.84, 95% CI 1.22-2.78). Rates of PD diagnoses were significantly higher in men with a history of PF (5.8% vs 0%, p-value<0.0001). Rates of PD were significantly lower if immediate repair of the fracture was performed (RR: 0.20, 95% CI 0.10-0.41). Men over the age of 45 years with a history of a penile fracture were more likely to develop Peyronie’s Disease within 5 years compared to men under the age of 45 years with a history of penile fracture (RR: 3.73, 95% CI 1.94-7.16). Conclusions We found that a PF increases the risk of both ED and PD, especially for those treated with conservative measures or over the age of 45 years. Consequently, it is essential to follow up with these patients in the long term and survey potential adverse side effects relating to sexual function that may arise. Disclosure No.

(234) How Age and Obesity Influence Erectile Dysfunction: Evaluation Based Upon Penile Color Duplex Doppler Ultrasound

Abstract Introduction Color duplex Doppler ultrasound (CDDU) is an objective and reliable diagnostic tool for documenting penile hemodynamics. Objective vascular testing provides a physiologic diagnosis of erectile dysfunction (ED) and helps direct appropriate therapy even in this age of ED management including oral drugs. Although age and diabetes are known to be the major etiological factors in development of ED, it is not clear whether obesity as such also plays any role or not. Objective The main objective of this study is to retrospectively assess the penile CDDU hemodynamic parameters of obese men with ED in comparison to non-obese ED men in relation to age. Methods A total of 271 men including obese and non-obese who were diagnosed with ED visiting our Andrology clinic were included in this study. Initial ED was determined by using the International Index of Erectile Function (IIEF) score. Penile CDDU data was retrospectively collected from these ED patients, and parameters mainly peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were used for analysis. RI (=PSV-EDV/PSV) was calculated, and different types of penile vascular status were established based on our previously published SOP guidelines for standardization of penile CDDU parameters. Statistical analysis was performed using MedCalc statistical software version 22.009 (MedCalc Software bv, Ostend, Belgium). Results Our study results revealed that with advancement of age the occurrence of vascular changes in obese men were higher in comparison to non-obese men with ED. Table 1 summarizes the influence of obesity on the prevalence of penile vascular status in different age groups of obese and non-obese men with ED. Surprisingly, higher number of obese men showed non-vascular, venous and mixed vascular components compared to non-obese ED patients. Among these obese groups of all ages, the venous leakage was prevalent than arterial or mixed components. Conclusions Our current analysis indicates that besides age, obesity is also one of the major risk factors in altering the penile hemodynamics with increased incidence of veno-occlusive dysfunction (VOD) in ED patients. In addition, this demonstrates the utility of performing CDDU and diagnosing the presence of VOD in further understanding the pathophysiology of obesity associated ED, and an important determining factor in such patient care. Disclosure No.

Access to inflatable penile prosthesis surgery as indicated by distances traveled among US men with Medicare.

The significance of geographic barriers to receiving inflatable penile prosthesis (IPP) treatment is uncertain according to the existing medical literature. To describe the travel patterns of men with erectile dysfunction (ED) in the United States who underwent IPP surgery. This retrospective cohort study utilized data from the 100% Medicare Standard Analytical Files. Men aged ≥65 years with an ED diagnosis who underwent IPP surgery between January 2016 and December 2021 were identified from the database. Federal Information Processing Series codes from the National Bureau of Economic Research's County Distance Database were used to determine geographic distances from patients' homes to the facilities at which surgery was performed. Evaluations included the proportions of men who traveled outside their county of residence or state for IPP treatment and the average distances in miles traveled. Among 15 954 men with ED undergoing IPP treatment, 56.4% received care out of their county for IPP, at a mean distance of 125.6miles (range, 3.8-4935.0). Although patients aged ≥80 years were less likely to travel outside their county as compared with men aged 65 to 69 years (48.1% vs 57.1%, P < .001), if they traveled, they were likely to travel farther (mean, 171.8 vs 117.7miles; P < .001). South Dakota had the highest proportion of men traveling outside their county for IPP treatment (91.3%; mean, 514.2miles), while Vermont had the highest proportion traveling outside their home state (73.7%). By unveiling disparities in access, this study will potentially lead to tailored interventions that enhance patient care and health outcomes. Strengths include the uniqueness in (1) evaluating the proportions of patients who travel out of their county of residence or home state for IPP treatment and (2) quantifying the average distances that patients traveled. An additional strength is the large sample size due to the retrospective design and database used. The analysis did not capture all Medicare enrollees; however, it did encompass all traditional Medicare enrollees, representing approximately half of all men in the US aged ≥65years. Limitations include not being generalizable to entire population of the US, as the study examined only Medicare enrollees. In addition, the study period includes the pandemic, which could have affected travel patterns. Furthermore, the coding and accuracy of the data are limitations of using administrative claims data for research. Study findings showed that many men with Medicare and ED traveled from their home geographic location for IPP treatment.

Identification and validation of new fatty acid metabolism-related mechanisms and biomarkers for erectile dysfunction.

Erectile dysfunction (ED) is a common condition affecting middle-aged and elderly men. The study sought to investigate differentially expressed fatty acid metabolism-related genes and the molecular mechanisms of ED. The expression profiles of GSE2457 and GSE31247 were downloaded from the Gene Expression Omnibus database and merged. Differentially expressed genes (DEGs) between ED and normal samples were obtained using the R package limma. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses of DEGs were conducted using the R package clusterProfiler. Fatty acid metabolism-related DEGs (FAMDEGs) were further identified and analyzed. Machine learning algorithms, including Lasso (least absolute shrinkage and selection operator), support vector machine, and random forest algorithms, were utilized to identify hub FAMDEGs with the ability to predict ED occurrence. Coexpression analysis and gene set enrichment analysis of hub FAMDEGs were performed. Fatty acid metabolism-related functions (such as fatty acid metabolism and degradation) may play a vital role in ED. In total, 5 hub FAMDEGs (Aldh2, Eci2, Acat1, Acadl, and Hadha) were identified and found to be differentially expressed between ED and normal samples. Gene set enrichment analysis identified key pathways associated with these genes. The area under the curve values of the 5 hub FAMDEGs for predicting ED occurrence were all >0.8. Our results suggest that these 5 key FAMDEGs may serve as biomarkers for the diagnosis and treatment of ED. The strengths of our study include the use of multiple datasets and machine learning algorithms to identify key FAMDEGs. However, limitations include the lack of validation in animal models and human tissues, as well as research on the mechanisms of these FAMDEGs. Five hub FAMDEGs were identified as potential biomarkers for ED progression. Our work may prove that fatty acid metabolism-related genes are worth further investigation in ED.

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

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

Post-infection erectile dysfunction risk - comparing COVID-19 with other common acute viral infections: a large national claims database analysis.

It is unknown if the risk of erectile dysfunction (ED) following Coronavirus-19 (COVID-19) infection is virus-specific. Our study assessed the risk of ED in COVID-19 patients as compared to patients with other common viral infections. The TriNetX COVID-19 Research Network was queried. We examined cohorts of men aged ≥18 years infected with: COVID-19, influenza, respiratory syncytial virus, enterovirus, acute viral hepatitis, mononucleosis, and herpes zoster. Men were included if they had at least one outpatient follow-up visit within 18 months and excluded if they had one of the other viruses of interest or a prior ED diagnosis or treatment, prostatectomy, pelvis radiation, or chronic hepatitis infection. Cohorts were propensity score matched and compared for differences in new ED diagnosis and/or prescription of phosphodiesterase-5 inhibitors (PDE5i). COVID-19 positive men were less likely to develop ED or have a PDE5i prescription than men with infected with herpes zoster [Relative Risk(RR): 0.37, 95% Confidence Interval (CI) 0.27-0.49] and more likely to develop ED or have a PDE5i prescription than men with no acute viral illness (RR: 1.33, 95% CI 1.25-1.42). In this national propensity-matched cohort study comparing post-infection ED risk and PDE5i prescriptions, we found that COVID-19 was no more likely to result in a diagnosis of ED or prescription of PDE5i when compared to all acute viral illnesses except herpes zoster, which was more likely to result in a diagnosis of ED or prescription of PDE5i when compared to COVID-19. These findings suggest an inflammatory etiology (perhaps due to cytokine release, endothelial dysfunction, or blunted hormone signaling) behind any acute infection can result in a heightened ED risk; however, further studies are required to investigate the connection between other viral infections and ED.

Changes in frequency of urology clinic visits and diagnosis of erectile dysfunction in Germany before and during COVID-19

To explore and analyze [1] the differences in the total number of patients visiting urology practices in Germany, [2] explore and analyze any differences in the number of newly diagnosed erectile dysfunction (ED) patients as well as [3] the number of new drug prescription, before and during the COVID-19 pandemic in Germany (April 2019-March 2020 and April 2020-March 2021). This retrospective cross-sectional study used data from the Disease Analyzer database (IQVIA) and included all patients aged ≥18 years with at least one visit to one of 85 urology practices across Germany. Outcomes were the mean number of patients with [1] new diagnosis of ED and [2] new prescription of drugs for erectile dysfunction per practice, in pandemic (April 2020-March 2021) versus non-pandemic (April 2019-March 2020) time periods. Differences between the periods were assessed using Wilcoxon tests. In the non-pandemic period, there were 195,895 men, and in the pandemic period, 192,659 men visiting urology practices in Germany. A total of 10,977 men were initially diagnosed with ED in non-pandemic and 12,213 (+11.26%) men in pandemic time periods. Although the differences of new ED diagnoses were not statistically significant, a non-significant increase of new ED diagnoses was observed across all age groups. Also, a non-significant increase in new ED prescription drugs was detected across all age groups. Even though less urology practice-visits of men with ED were recorded during the COVID-19 pandemic, an increase of new ED diagnosis was observed across all age groups between April 2020 and March 2021.

Use of phosphodiesterase 5 inhibitors is not associated with ocular adverse events.

Phosphodiesterase 5 inhibitor (PDE5i) use has been linked to a number of ocular side effects, such as serous retinal detachment (SRD), retinal vascular occlusion (RVO), and ischemic optic neuropathy (ION). We investigated the risk for SRD, RVO, and ION in patients using PDE5is. We utilized the IBM MarketScan (2007-2021) Commercial and Medicare Supplemental Databases (version 2.0) for this analysis. To estimate overall events risk, Cox proportional hazard models were applied to calculate the hazard ratios (HRs) for erectile dysfunction (ED) diagnosis and the different treatments, adjusting for region, median age, obesity, diabetes mellitus, hyperlipidemia, smoking, hypertension, coronary artery disease, and sleep apnea. Additionally, the same analyses were performed to calculate the HRs for benign prostatic hyperplasia (BPH) diagnosis and the different treatments. HRs for SRD, RVO, and ION. In total, 1 938 262 men with an ED diagnosis were observed during the study period. Among them, 615 838 (31.8%) were treated with PDE5is. In total, 2 175 439 men with a BPH diagnosis were observed during the study period. Among them, 175 725 (8.1%) were treated with PDE5is. On adjusted Cox regression analysis, PDE5i use was not associated with SRD, RVO, ION, and any ocular event when compared with ED diagnosis and other ED treatments. Importantly, as the intensity of ED treatment increased, so did the risk of ocular events. In addition, PDE5i use was not associated with SRD and ION when compared with BPH diagnosis and other BPH treatments. In contrast, in patients with BPH, PDE5i use was associated with RVO (HR, 1.14; 95% CI, 1.06-1.23). Importantly, patients with BPH receiving other medical treatment (ie, 5a reductase/alpha blocker; HR, 1.11; 95% CI, 1.06-1.16) or surgical treatment (HR, 1.10; 95% CI, 1.02-1.19) had a higher risk of RVO. We did not observe any consistent association between PDE5i use and any ocular adverse events (SRD, RVO, and ION). Because we did not have access to the patients' medical records, we recorded outcome definitions using ICD-9 and ICD-10 coding. Patients using PDE5is for ED or BPH indications did not have an increased risk of ocular events, even when compared with other treatments for ED or BPH.

Erection Hardness Score in Masturbation Can Serve as a Preliminary Screening Tool for Organic Erectile Dysfunction

To explore the efficacy, in terms of sensitivity and specificity, of Erection Hardness Score (EHS) applied to masturbation in diagnosing predominantly organic erectile dysfunction (ED), compared to the actual standard, which is nocturnal penile tumescence and rigidity (NPTR). A total of 189 consecutive patients who came to our outpatient clinic from October 2019 to October 2020, reporting ED and an abridged International Index of Erectile Function (IIEF-6) score <26 were enrolled. Patients filled out two psychometric questionnaires: the IIEF-6 applied to partnered intercourse and the EHS applied to masturbation, then they underwent the NPTR test with Rigiscan for 2 consecutive nights in good sleep condition. Sensitivity, specificity, positive predictive value, and negative predictive value of EHS and IIEF-6 scales with NPTR as the standard, as well as the correlation between EHS, IIEF-6, and NPTR results were calculated. Results show that the sensitivity of the EHS scale for the diagnosis of ED was 60.0%, the specificity was 95.7%, the positive predictive value was 83.3%, the negative predictive value was 86.9%, and the coincidence rate was 86.2%. The correlation coefficient was 0.572 and the area under the ROC curve was 0.78, which means the strength of erection in masturbation as evaluated by the EHS can effectively help in discriminating between predominantly organic and apparently nonorganic ED. An EHS score of 3-4, meaning good-optimal erectile function during masturbation, decreases the likelihood of predominantly organic ED and reduces the need for further NPTR testing.

The Association Between Insomnia, Insomnia Medications, and Erectile Dysfunction

BackgroundSleep quality and duration have been investigated for their association with health. Insomnia affects up to one-third of adults and may impact male erectile function. In addition, medical treatments for insomnia (many of which are sedatives) may also affect erectile quality. ObjectiveTo investigate the association of erectile dysfunction (ED) in patients diagnosed with and treated for insomnia. Design, setting, and participantsWe utilized the IBM MarketScan (2007–2016) Commercial and Medicare Supplemental Databases (v 2.0). Age- and enrollment-matched controls were selected among patients without insomnia diagnosis or treatment. Outcome measurements and statistical analysisCox proportional hazard models were used to estimate the risk of incident ED (ie, diagnosis alone, or diagnosis and treatment with phosphodiesterase-5 inhibitors [PDE5i], intracavernous injection (ICI)/urethral suppositories, and penile prosthesis) after the diagnosis or treatment of insomnia while adjusting for relevant comorbidities. Results and limitationsIn total, 539 109 men with an insomnia diagnosis were identified. Of these men, 356 575 were also medically treated for insomnia. The mean (±standard deviation) follow-up times for patients diagnosed with insomnia and those diagnosed with and treated for insomnia were 2.8 ± 1.6 and 3.1 ± 1.8 yr, respectively. Men with insomnia were more commonly smokers and had a higher number of office visits and comorbidities than controls (p < 0.001). On an adjusted analysis, both untreated and treated insomnia were associated with increased risks of ED diagnosis (hazard ratio or HR [95% confidence interval {CI}]: 1.58 [1.54–1.62] and 1.66 [1.64–1.69], respectively; p < 0.001). Similarly, men with treated insomnia had a higher risk of having ED treated with PDE5i (HR [95% CI]: 1.52 [1.49–1.55]; p < 0.001) and ICI (HR [95% CI]: 1.32 [1.14–1.54]; p < 0.001) when compared with controls. A limitation of this study was that a lack of granularity regarding patient clinical characteristics (eg, severity of disease, laboratory data, etc.) is inherent to insurance claims data. In addition, the follow-up was limited and may affect associations at longer time points. ConclusionsIn the current report, a consistent association between insomnia and ED diagnosis was identified. Men diagnosed with insomnia only were found to have a higher risk of developing ED. Moreover, men with pharmacological insomnia treatments were more often prescribed treatments for ED. Given the prevalence of insomnia, future studies are warranted to delineate the association of insomnia and its treatment with erectile function. Patient summaryInsomnia affects up to one-third of adults and impact male erectile function. Men only diagnosed with insomnia were found to have a higher risk of developing erectile dysfunction (ED). Moreover, men with pharmacological insomnia treatments were more often prescribed treatments for ED.

Erectile dysfunction and Peyronie's disease diagnosis rates after penile fracture-a retrospective claims database cohort analysis.

Our objective was to analyze the rates of erectile dysfunction and Peyronie's disease following a penile fracture using a large, multi-institutional claims database. Inclusion criteria included men ages 15 or older with a diagnosis of penile fracture and any office visit within 5 years of the penile fracture. Exclusion criteria included prior erectile dysfunction, prescription of erectile aids, or penile prosthesis placement. Our primary outcome was the diagnosis of erectile dysfunction or prescription of phosphodiesterase-5 inhibitors within 5 years. A secondary analysis assessed rates of Peyronie's disease following penile fracture. 1242 men were identified with penile fracture and subsequently matched to men without penile fracture, resulting in equal cohorts of 1227 men. Men with a history of penile fracture were more likely to receive a diagnosis of erectile dysfunction or require phosphodiesterase-5 inhibitors (RR 3.18, 95% CI: 2.30-4.40). Men who did not undergo immediate repair had higher rates of erectile dysfunction or treatment (RR: 1.84, 95% CI: 1.22-2.78). Men over the age of 45 years who had a penile fracture were more likely to develop erectile dysfunction or treatment compared to men under 45 years (RR: 1.65, 95% CI: 1.14-2.39). Rates of Peyronie's disease were higher in men with a history of penile fracture (5.8% vs 0%, p < 0.0001). Rates of Peyronie's disease were lower if immediate repair of the fracture was performed (RR: 0.20, 95% CI: 0.10-0.41). Men over the age of 45 years with penile fracture were more likely to develop Peyronie's Disease within 5 years compared to men under the age of 45 years penile fracture (RR: 3.72, 95% CI: 1.94-7.16). Penile fracture increases the risk of both erectile dysfunction and Peyronie's disease, especially those treated with conservative measures or over the age of 45 years compared to patients under 45 years with a penile fracture.