Diagnosis Of Erectile Dysfunction Research Articles

Erectile dysfunction and retinal microvascular network: an optical coherence tomography angiography study.

The aims of this study were to examine the microvascular network of the retina using the optical coherence tomography angiography (OCT-A) device in patients with erectile dysfunction (ED) and to determine whether the OCT-A values could assist in the differential diagnosis of ED. The study design was prospective, observational, and cross-sectional. The vessel densities (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP), and retinal peripapillary capillary plexus (RPCP) were assessed using OCT-A in patients with ED and healthy subjects. All the participants were evaluated and scanned for systemic and hormonal disorders and those with ED also underwent penile Doppler ultrasonography (PDU). After recording the data, the participants were divided into three groups: organic ED, psychogenic ED, and healthy control. The relationships between the OCT-A parameters and other clinical findings were analyzed. The right eyes of 80 patients with ED and 40 healthy volunteers were evaluated in this study. Of the ED patients, 46 were included in the organic ED group according to the results of PDU. The VDs of DCP, SCP, and the temporal sector of RPCP were significantly lower in the organic ED group than the psychogenic ED and healthy control groups. The VDs of SCP and DCP were correlated with the peak systolic velocity of both left and right penile cavernous arteries. The VDs of DCP were also correlated with the left and right resistive indexes. In conclusion, the OCT-A data of SCP and especially DCP could be helpful in evaluating ED, and provide reliable information about the origin of the disease along with the other laboratory testing and penile vascular evaluation.

Current approaches to the diagnosis of vascular erectile dysfunction.

Vascular erectile dysfunction (ED) is closely related to cardiovascular events, and early diagnosis of vascular ED may be helpful to predict the occurrence of cardiovascular events and improve prognosis. At present, there are many approaches to diagnose ED, but each method has its advantages and limitations. This study retrospectively reviewed all available literature focusing on the diagnosis of vascular ED through a systematic PubMed and EMBASE search. According to the different application scenarios, the main methods for the diagnosis of vascular ED are divided into four categories. Intra-cavernous injection of vasoactive drugs is the earliest method used in the diagnosis of vascular ED and is a basic test. For the diagnosis of arterial ED, color duplex Doppler ultrasound, selective penile angiography, magnetic resonance imaging, and computed tomography are more commonly used. While for the diagnosis of venous ED, shear wave elastography, dynamic infusion cavernosometry and cavernosography are more accurate. Endo-peripheral arterial tonometry (PAT) has also been used to detect vascular endothelial function. Although various existing examinations are widely used for the evaluation of vascular ED, they still have some shortcomings, such as invasiveness, contingency, high false positive (negative) rate. New methods of long-term dynamic detection are needed.

PD28-01 PROCESS OF CARE OF ED 3.0 FOR THE UROLOGIC PROVIDER

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation I (PD28)1 Apr 2020PD28-01 PROCESS OF CARE OF ED 3.0 FOR THE UROLOGIC PROVIDER Michael Rosenheck*, John Sobieski, Hailu Yang, MD Miner Martin, MD Joel Heidelbaugh, MD Michael DiSanto, andPhD Allen SeftelMD Michael Rosenheck*Michael Rosenheck* More articles by this author , John SobieskiJohn Sobieski More articles by this author , Hailu YangHailu Yang More articles by this author , Miner MartinMiner Martin More articles by this author , Joel HeidelbaughJoel Heidelbaugh More articles by this author , Michael DiSantoMichael DiSanto More articles by this author , and Allen SeftelAllen Seftel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000892.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile Dysfunction (ED) is defined as the inability to achieve or maintain an erection for satisfactory sexual performance. A Process of Care (PoC) Model was established in 1999 wherein a clinical algorithm with broad appeal was developed to evaluate and treat male patients with erectile dysfunction (ED). The PoC model was updated in 2018 (Mulhall et al.), just as the AUA updated its ED management guidelines (Burnett et al.). To integrate the updated 2018 AUA guideline with the PoC model, we present PoC 3.0. PoC 3.0 provides a simplified suite of ED evaluation and management tools for the urologic provider. METHODS: The 1999 and 2018 PoC models, along with the 2018 AUA guidelines, were used as the template for PoC 3.0. PoC 3.0 removes the previously suggested tiered or hierarchal ED treatment approach (consistent with the 2018 AUA guidelines). PoC 3.0 has been endorsed by the American Society of Men’s Health (ASMH). RESULTS: PoC 3.0 has been tailored to the urologic provider, as ED evaluation, management and treatment has become expansive. As an example, we have incorporated penile duplex doppler with intravcavernous injection of a pharmacologic agent (PDUS) into the diagnostic pathway. By utilizing our updated “provider’s toolkit” that condenses the previous tiered treatment process into a more streamlined treatment pathway, this evolved process of care model broadens patients’ freedom to choose by offering all of the currently available treatment options at the outset under the guidance of the experienced urologic provider. This PoC model addresses the pitfalls of patient self-treatment of ED and suggests that patients can be educated in lifestyle modification, shared decision-making, and CV risk assessment along with treatment options (see graphic). CONCLUSIONS: Our updated PoC model, PoC 3.0, is the first PoC model that is specific to the urologic provider. This redesigned PoC model incorporates PDUS in the diagnosis of ED and removes the tiered approach to ED treatment. Through this updated model, patients will feel more involved in their ED care, better understand their clinical options, and leverage the knowledge of their provider to treat their ED in a personalized manner. Source of Funding: na © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e612-e612 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Rosenheck* More articles by this author John Sobieski More articles by this author Hailu Yang More articles by this author Miner Martin More articles by this author Joel Heidelbaugh More articles by this author Michael DiSanto More articles by this author Allen Seftel More articles by this author Expand All Advertisement PDF downloadLoading ...

Time-effect of penile color duplex Doppler ultrasound for diagnosing vascular erectile dysfunction.

This study aimed to explore the time-effect of color duplex Doppler ultrasound (CDDU) in the diagnosis of vascular erectile dysfunction (ED). Using a self-control study, we included patients who underwent penile CDDU and cavernosography in our hospital. We compared the arterial peak systolic velocity (PSV) of CDDU among different intervals for the diagnosis of arterial ED. We included 357 patients who were under consideration for vascular ED. We found significant differences in all the pairwise comparison of PSV in the 1st (0-5 min), 2nd (6-10 min), 3rd (11-15 min), and 4th (16-20 min) 4 intervals after the injection of prostaglandin E1 (p<0.001), except the 11-15 min vs. the 16-20 min interval (p=0.387). Using cavernosography, 294 patients were diagnosed with venous ED. Compared with other intervals, the diagnosis of CDDU 11-15 min after the intracavernous injection of 20 ug prostaglandin E1 (PGE1) had the best consistency with cavernosography (Kappa=0.761; p<0.001). Compared with other intervals, CDDU at 11-15 min had the highest specificity (93.65%), the highest Youden index (0.85), positive likelihood ratio of 14.46, positive predictive value of 98.54%, negative predictive value of 71.08% and a coincidence rate of 92.16%. Our findings support the increased utilization of CDDU for the diagnosis of both arterial and venous ED. The diagnosis at 11-15 min after intracavernous injection of PGE1 is accurate and stable, which would help to simplify the process and shorten the time of CDDU.

Diagnostic categorization of erectile dysfunction using duplex color doppler ultrasonography and significance of phentolamine redosing in abolishing false diagnosis of venous leak impotence: A single center experience.

Background and Aims:Erectile dysfunction (ED) is an inability to achieve and maintain erectile rigidity sufficient for satisfactory sexual performance. It is either organic or psychogenic in origin. This study was aimed at establishing vasculogenic causes among patients being evaluated for ED using Penile Doppler Ultrasound.Methods:Fifty-two consecutive patients with the clinical diagnosis of ED were evaluated with color Doppler ultrasound scan using a 7.5 MHz high-frequency linear transducer between July 2016 and June 2019. The examination was commenced 3 min after an intracavernosal injection with 10-20 μg of PGE1 and continued for 30 min. The measurements were obtained alternately from both deep penile arteries. The variables analyzed were the peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI), calculated as (PSV-EDV)/PSV. Erection Hardness was evaluated subjectively using the EH Score (EHS), a 5-point response score denoting how the patient would rate his erection. ED was subjectively assessed using the International Index of Erectile Function (IIEF-5) questionnaire. In patients with a diagnosis of vasculogenic ED, intracavernosal PGE1 injection was started with a 5 μg dose and then increased in 5 μg increments until the final dose of 20 μg was reached.Results:PSV of cavernosal arteries (CA) varied between 19.2 and 106.2 cm/s (mean: 43.8 ± 18.2) among the entire patients and between 19.7 and 80.2 cm/s (mean: 42.6 ± 11.3) among patients with arteriogenic ED. Arteriogenic ED was found in 8 patients (15.3%), while venogenic ED was observed in 12 patients, which constituted 23% of the entire study population and mixed arteriogenic-venogenic ED was found in 6 patients (11.5%) of the study population. DICC performed on patients diagnosed with venogenic ED on color Doppler ultrasonography revealed venous leakage and no statistically significant differences between results of DICC and color Doppler ultrasonography were found in EDV, RI, and PI measurements (P< 0.005). Among patients with venogenic ED and mixed arteriogenic-venogenic ED,2 patients had a normal erectile response and the remaining 16 received 2 mg phentolamine. A significant increase in PSV between baseline and 20 mg PGE1 (P < 0.001) was observed in all cases. Following phentolamine, there was a significant increase in grade of erection (P = 0.0001) and a significant reduction in the EDV (P = 0.0001). A reduction of the EDV to below 0.0 cm/s was observed in 12 patients. In patients with arteriogenic erectile dysfunction, mean (±standard deviation) duration of erection for consecutive doses of PGE15 μg, 10 μg, 15 μg, and 20 μg were 42.2±18.4, 55.4±24.1, 66.1 ± 31.1, and 83.3±36.7 minutes, respectively, with significant increase for each dose. In patients with veno-occlusive dysfunction, mean durations of erection significantly increased from 9.1±8.0 minutes at 10 μg to 19.2±9.8 minutes at 20 μg.Conclusion:In the current study, 50% of patients had vasculogenic ED and “false-positive’’ diagnosis of venous leakage was unmasked by phentolamine re-dosing. It is therefore imperative that patients with ED benefit from duplex color Doppler ultrasonography which is safe, cheap and non-ionizing diagnostic modality before initiating therapy as ED treatment is cause specific.

109 Predictors of Rapid Disease Progression from Initial Diagnosis of Erectile Dysfunction to Surgical Intervention

The prevalence of erectile dysfunction (ED) increases with age. Its association with metabolic syndrome, which poses a growing threat in the United States, has been well described. Urologists commonly follow a treatment algorithm involving phosphodiesterase type 5 inhibitors as first-line therapy, with escalation to other therapies and ultimately to penile prosthesis placement. While many are aware of risk factors for the development of ED, less is known about the comorbidities which may contribute to earlier surgical intervention. We aimed to look at trends in the treatment of men with ED from diagnosis to surgery, and clinical data associated with this progression. We used medical coding to query our database and identify men who underwent penile prosthesis implantation for ED from 2002 to 2017 within our regional health care system, excluding men with post-prostatectomy ED. We determined the date of initial ED diagnosis, and analyzed patient clinical data and associations with shorter time interval from diagnosis to surgical intervention using accelerated failure time models.

COMBINATION OF PLATELET RICH PLASMA, LOWINTENSITY PULSED ULTRASOUND AND SILDENAFIL ORAL SPRAY IN TREATMENT OF ERECTILE DYSFUNCTION

Relevance. Some non-pharmacological methods, such as low-intensity pulsed ultrasound (LIPUS) proved to be effective in ED treatment due to stimulation of penile tissue regeneration and penile hemodynamics increase. The biological methods that utilize cellular growth factors such as platelet-rich plasma (PRP) therapy proved to be effective in stimulation of neovascularization processes and correction of endothelial dysfunction while ED treatment.Local negative pressure (LNP) therapy shall be considered as an auxiliary method to PRP and LIPUS due to its ability to slow down PRP outflow from injection zones. Sildenafil («Strondex») is perspective pharmacological addition to ED treatment protocol. Aim. Evaluation of the efficacy and safety of therapeutic model of combined application of PRP intracavernous injections, LNP, LIPUS and Sildenafil («Strondex») for vasculogenic (arterial and corporal veno-occlusive) ED treatment.Materials and methods. Prospective study was conducted in a group of 64 outpatients with diagnosis of erectile dysfunction of vascular genesis (ICD-10: N48.4) in Men’s Health Clinic (Kyiv, Ukraine). “International Index of Erectile Function-5” (IIEF-5), “Erectile Hardness Score” (EHS) were used as the tools for clinical assessment. Ultrasonic cavernous bodies scanning and pharmacodopplersonography were used for the data validation.Study results. Main group patients underwent treatment consisting of 6 sessions of PRP intracavernous injections and 12 sessions of local penile LIPUS combined with LNP and Sildenafil («Strondex») pharmacotherapy. Control group underwent 12 sessions of local penile LIPUS combined with LNP and the same pharmacotherapy. According to the IIEF-5 data obtained 12 weeks after the study the erectile function improvement was found in 27 patients of the main group and 20 patients of the control group. EHS improved by 1 point or more in 29 and 20 patients correspondingly.Conclusions. Treatment protocol specifying combination of PRP, LIPUS, LNP and Sildenafil («Strondex») is promising due to PRP-therapy augmentation by intracavernous ultrasonic activation of platelet growth factors, but the data obtained require further physiological validation and clinical placebo-controlled studies with involvement of larger groups of population.

Current therapeutic strategies for erectile function recovery after radical prostatectomy – literature review and meta-analysis

Current therapeutic strategies for erectile function recovery after radical prostatectomy – literature review and meta-analysis

Is topical alprostadil an usable and reliable alternative to intracavernous injection for penile dynamic duplex ultrasonography?

No study has yet been done to evaluate topical alprostadil as a less invasive alternative vasoactive agent for Penile Dynamic Duplex Ultrasonography (PDDU) in the diagnosis of erectile dysfunction. The main aim of our study was to evaluate the usability and reliability of topical alprostadil for PDDU compared with standard intracavernous injection. A further objective was to determine the patients' preference between these two different approaches. During session A, patients received injection while during session B, they received topical alprostadil. Each patient underwent both sessions, 1week apart from the other. A total of 80 patients were enrolled. After 20min from drug administration, no significant difference was found between the two procedures in terms of peak systolic velocity and end-diastolic velocity, while Erection Hardness Score was significantly higher with injection. Patients reported less pain/discomfort during the procedure in case of topical alprostadil use and an overall preference towards this examination modality. Topical alprostadil could represent a usable and reliable alternative to intracavernous injection for PDDU, with less discomfort and greater preference by patients.

Cavernous smooth muscles: innovative potential therapies are promising for an unrevealed clinical diagnosis.

While erectile dysfunction (ED) is highly prevalent worldwide, unrevealed cavernous smooth muscles (CSM) defects can confound the diagnosis of vascular ED and lead to failure of treatments. Currently, the first-line oral treatment for ED is phosphodiesterase type 5 inhibitors (PDE5Is). Patients with diabetes mellitus (DM), those who have undergone a radical prostatectomy (RP), and the elderly population are difficult to treat by the PDE5Is; unrevealed CSM defects can result in corporo veno-occlusive dysfunction (CVOD); and penile veno-ligation surgeries are currently abandoned due to high failure rates. It has been found that gene and stem cell therapies, among others, reduce cavernous tissue apoptosis and fibrosis and can specifically target CSM defects such as the nitric oxide (NO)-mediated signaling pathway, Rho-ROCK system, and transformation growth factor (TGF)-β1/angiotensin II (Ang II) pathway, in several laboratory animals. Current data clarify the need of diagnostic techniques that can provide an initial assessment of CSM. This assessment should be essential before giving a diagnosis of vascular ED and before applying several tests searching for a specific CSM defect to guide the specific therapy. Moreover, while patients with corporal fibrosis would fail the current medical therapies, these patients can benefit from the stem cell-based therapies that induce the internal mechanisms of tissue repair. However, penile elastography can determine the stiffness of tissues and corpus cavernosum electromyography (CC-EMG) can assess the integrated activity of CSM bulk, further refinements are required for these techniques before being considered in the evaluation of patients with ED. In conclusion, on the basis of the current scientific research, it may be possible to formulate new therapies and achieve the appropriate selection of patients who can benefit from these therapies.

Современные технологии мониторинга эффективности диагностики и лечения эректильной дисфункции

Современные технологии мониторинга эффективности диагностики и лечения эректильной дисфункции

Is It Compulsory to Investigate for Erectile Dysfunction in Patients Presenting for Low Urinary Tract Symptoms?

BackgroundCurrent European Association of Urology guidelines suggest investigation of erectile dysfunction (ED) among patients with lower urinary tract symptoms (LUTS) whenever there is a clinical suspicion. ObjectiveTo assess factors predictive of ED, which may drive the need for a clinical assessment in men only presenting for LUTS. Design, setting, and participantsData from 914 men presenting for LUTS at a single-center outpatient clinic and without a previous diagnosis of ED were analyzed. InterventionAll patients completed the International Prostatic Symptom Score (IPSS) and the International Index of Erectile Function—erectile function (IIEF-EF) questionnaires. Outcome measurements and statistical analysisLogistic regression analyses tested potential predictors of ED and severe ED. The accuracy of the predictive models was assessed, and decision curve analyses (DCAs) tested their clinical benefit. Results and limitationsThe median baseline IPSS score was 12 (7–19). IIEF-EF scores suggestive of unreported ED were observed in 503 (55%) patients; of all, 251 (27%) men showed severe ED. At logistic regression analysis, age (odds ratio [OR]: 1.04; p<0.001), IPSS score (OR: 1.04; p<0.001), diabetes mellitus (OR: 2.37; p=0.02), and smoking history (OR 1.36; p=0.03) were associated with unreported ED, after accounting for body mass index, hypertension, other cardiovascular diseases, and dyslipidemia. The same factors were associated with severe ED (all p≤0.03). The predictive model including these variables showed good accuracy for predicting ED (areas under the curve 0.69 and 0.72, respectively). However, DCAs showed no greater clinical benefit regarding identifying which patients should actually be screened for ED using these variables versus screening all patients with LUTS. Conversely, the net clinical benefit of the tested model was higher when predicting severe ED. As a limitation, we could not check prospectively the clinical impact of detecting ED in LUTS patients. ConclusionsGiven the importance of ED in terms of overall men’s health, segregating patients to be investigated or not for ED according to the traditional risk factors did not emerge more clinically useful than screening all patients presenting for LUTS. Patient summaryLower urinary tract symptoms (LUTS) are frequently associated with erectile dysfunction (ED). Patients presenting for LUTS only in the everyday clinical practice should always be screened for ED and managed accordingly.

Associations between erectile dysfunction and psychological disorders (depression and anxiety): A cross-sectional study in a Chinese population.

The present cross-sectional survey was performed to evaluate the prevalences and correlations of depression and anxiety among Chinese erectile dysfunction (ED) men. Between February 2017 and January 2019, male patients with or without ED treated in andrology clinic and urology clinic were enrolled in the investigation. All enrolled patients were required to fill in the International Index of Erectile Function Questionnaire (IIEF-5), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder 7-item scale (GAD-7) which intended to evaluate the diagnosis and severity of ED, depression and anxiety respectively. Of the 958 included participants, 79.82% (613/768) and 79.56% (611/768) ED patients appeared to have anxiety and depression; 13.68% (26/190) of men without ED had anxiety and depression. In addition, young ED patients (age ≤35years) and long ED duration patients (duration >12months) had higher incidences and severities of anxiety and depression (p<.05). After adjusting the age, IIEF-5 was negatively correlated with PHQ-9 (adjusted r=-.653, p<.001) and GAD-7 scores (adjusted r=-.607, p<.001). The prevalences of anxiety and depression were 79.82% and 79.56% in Chinese ED patients. The prevalences and severities of anxiety and depression increased as the ED severity increased. Based on the high incidences of anxiety and depression among Chinese ED patients, clinicians are supposed to pay more attention to early diagnosis and therapy of psychiatric symptoms for ED patients, especially among young patients and patients with long ED duration.

An Evaluation of a Clinical Care Pathway for the Management of Men With Nonorganic Erectile Dysfunction

IntroductionThere exists little literature on the outcomes of the medical management of men with erectile dysfunction (ED) with no overt organic etiology. AimThis study was conducted to assess the outcomes of men with nonorganic ED treated medically. MethodsAll patients had normal hormone profiles and vascular assessment. All were given a trial of a phosphodiesterase type 5 inhibitor (PDE5i). If no improvement was experienced, intracavernosal injection (ICI) therapy was administered. All patients were encouraged to seek a consultation with a mental health professional. Main Outcome MeasurePatient demographics, medical comorbidities, hormone and hemodynamics assessments, and change in International Index of Erectile Function scores of patients were recorded. Results116 men with a mean age or 38 ± 19 (range 16−57) years were studied. 21% had mild ED, 47% had moderate ED, and 32% had severe ED. 21% had seen a psychiatrist. 81% of patients responded to PDE5i with a penetration hardness erection on follow-up (mean duration of 7 ± 3 months postcommencement of PDE5i). However, only 68% of these were capable of a consistently good response. The mean Erectile Function domain score on PDE5i for the entire group improved from 18 ± 11 to 22 ± 6 (P = .01), and for PDE5i responders it was 27 ± 4 (P < .001). 28% of men (22 PDE5i failures and 10 with a mixed response to PDE5i) attempted ICI, all obtaining consistently functional erections. At a mean time point of 11 ± 5 months, 83% of those responding to PDE5i had ceased using PDE5i due to a lack of need. 11% of those using ICI continued to use them 6 months after starting ICI; the remainder had been transitioned back to PDE5i. Of the 29 patients in the latter subgroup, 66% were no longer using PDE5i consistently due to a lack of need. Clinical ImplicationsNot all men with nonorganic ED respond to PDE5i initially and many of those who respond do so only intermittently; such patients are potentially curable, using erectogenic pharmacotherapy for erectile confidence restoration, most men are capable of being weaned from drug therapy. Strengths & LimitationsThe strengths of the study are the large number of patients and the use of serial validated instruments to assess erectile function outcomes. As a weakness, despite normal hormone and vascular assessments, the diagnosis of nonorganic ED is still a presumptive one. ConclusionMedical management of nonorganic ED utilizing the process of care model results in cure in a large proportion of such patients. The transient use of ICI in some patients permits successful PDE5i rechallenge.Jenkins LC, Hall M, Deveci S, et al. An Evaluation of a Clinical Care Pathway for the Management of Men With Nonorganic Erectile Dysfunction. J Sex Med 2019;16:1541–1546.

Low-Intensity Shockwave Therapy (LiST) for Erectile Dysfunction: Is It Safe for Patients on Anticoagulant Medication?

IntroductionA significant percentage of men with vasculogenic erectile dysfunction (ED) use antiplatelet therapy because they have a history of cardiovascular disease. However, the safety of this novel treatment modality in patients under antiplatelet treatment has been based on anecdotal cases, and published data are lacking. The aim of this study is to examine the safety of low-intensity shockwave therapy (LiST) on a group of patients under antiplatelet therapy who were treated with LiST. MethodsA pulled data analysis, conducted from November–December 2018, including 2 randomized clinical trials conducted at an Andrology outpatient clinic is presented. The 2 trials used the same design, the same shockwaves generator, as well as the same method of delivering the energy. The LiST protocol differed between the patients regarding LiST sessions number (6, 12, or 18), sessions frequency (1, 2, or 3 sessions/wk) and energy flux density used, which was either 0.05 or 0.1 mJ/mm2. The number of 5,000 pulses/session remained unchanged. For the purpose of the current study, patients receiving anticoagulant medication at the time of treatment and follow-up period were included in this analysis. All patients had a diagnosis of vasculogenic ED. According to the study protocol, after every treatment visit, as well as at 1 and 3 months after treatment, all patients reported any side effects or complications of the treatment; physical examination of the penis was performed before and after each treatment session, as well as at follow-up visits at 1 and 3 months. Penile ultrasonography was performed at baseline, as well as at 3 months’ follow-up, at the same time with triplex ultrasonography by the same investigator. Results138 patients were included in the 2 trials, whereas 135 (98%) of them finished the 3 months follow-up. 35 (25.3%) of them were under anticoagulant/antiplatelet medication during LiST. No bleeding events or any other side effects were reported. Strengths & LimitationsThe main strength of this article is that it is the first report on the safety of LiST on the specific group of cardiovascular patients with ED under anticoagulant/antiplatelet therapy. However, it is a pulled data analysis, based on 2 randomized studies, which did not have safety of LiST as a primary outcome. ConclusionLiST seems to be a safe and well-tolerated treatment option for vasculogenic ED in patients on antiplatelet medication.Kalyvianakis D, Memmos D, Mykoniatis I, et al. Low-Intensity Shockwave Therapy (LiST) for Erectile Dysfunction: Is It Safe for Patients on Anticoagulant Medication? J Sex Med 2019;16:1478–1480.

Диагностика эректильной дисфункции. Современное состояние проблемы

Диагностика эректильной дисфункции. Современное состояние проблемы

Prevalence of erectile dysfunction in Spanish primary care setting and its association with cardiovascular risk factors and cardiovascular diseases. SIMETAP-ED study

IntroductionFew studies conducted in primary care setting report about age-adjusted prevalence rates of erectile dysfunction (ED). Aims of SIMETAP-ED study were to determine crude and age-adjusted prevalence rates of ED diagnosis, to compare these rates with other similar studies, and to compare prevalence rates of cardiovascular risk factors (CVRF), cardiovascular diseases (CVD), metabolic diseases and chronic kidney disease (CKD) between populations with and without ED. MethodsCross-sectional observational study conducted in primary care setting. Population-based random sample: 2934 adult men. Response rate: 66%. A clinical interview was conducted to diagnose ED using a question derived from ED definition. The medical records of patients were reviewed to identify their CVRF and diseases associated with ED. The age-adjustments were standardized to Spanish population. ResultsThe prevalence rates of metabolic diseases, CVD, CVRF, and CKD in population with ED were higher than population without ED, highlighting the CVD.The crude prevalence of ED was 17.2% (95% confidence interval: 15.8•18.6). The age-adjusted prevalence rates of ED were 0.71% in men under 40 years, 12.4% in men over 18 years, 10.8% in men aged 40•69 years, 18.9% in men over 40 years, and 48.6% in men over 70 years. ConclusionsSIMETAP-ED study showed association of ED with metabolic diseases, CKD, CVRF, and highlighting CVD.The age-adjusted prevalence of ED was 12.4% in adult men, 19% in men over 40 years, and almost 50% in men over 70 years.

Prevalence of erectile dysfunction in Spanish primary care setting and its association with cardiovascular risk factors and cardiovascular diseases. SIMETAP-ED study

IntroductionFew studies conducted in primary care setting report about age-adjusted prevalence rates of erectile dysfunction (ED). Aims of SIMETAP-ED study were to determine crude and age-adjusted prevalence rates of ED diagnosis, to compare these rates with other similar studies, and to compare prevalence rates of cardiovascular risk factors (CVRF), cardiovascular diseases (CVD), metabolic diseases and chronic kidney disease (CKD) between populations with and without ED. MethodsCross-sectional observational study conducted in primary care setting. Population-based random sample: 2934 adult men. Response rate: 66%. A clinical interview was conducted to diagnose ED using a question derived from ED definition. The medical records of patients were reviewed to identify their CVRF and diseases associated with ED. The age-adjustments were standardized to Spanish population. ResultsThe prevalence rates of metabolic diseases, CVD, CVRF, and CKD in population with ED were higher than population without ED, highlighting the CVD.The crude prevalence of ED was 17.2% (95% confidence interval: 15.8–18.6). The age-adjusted prevalence rates of ED were 0.71% in men under 40 years, 12.4% in men over 18 years, 10.8% in men aged 40–69 years, 18.9% in men over 40 years, and 48.6% in men over 70 years. ConclusionsSIMETAP-ED study showed association of ED with metabolic diseases, CKD, CVRF, and highlighting CVD.The age-adjusted prevalence of ED was 12.4% in adult men, 19% in men over 40 years, and almost 50% in men over 70 years.

Diagnostic Accuracy of Different Criteria of Pharmaco‐penile Duplex Sonography for Venous Erectile Dysfunction

ObjectivesThe aim of this study was to analyze the diagnostic accuracy of different criteria of pharmaco‐penile duplex sonography in venous erectile dysfunction (ED).MethodsThe following parameters were measured after an intracavernous injection test in patients with ED from May 2016 to February 2017 at our hospital: diameter, peak systolic velocity, end‐diastolic velocity, and resistance index of the cavernous artery; diameter and peak velocity (if leak occurred) of the deep dorsal vein. Three ultrasonographic diagnostic criteria of venous ED were applied. Criterion A: continuous blood flow signals in the deep dorsal vein, peak velocity greater than 3 cm/s, peak systolic velocity greater than 30 cm/s, end‐diastolic velocity greater than 5 cm/s; Criterion B: resistance index less than 0.89 and other parameters corresponding with Criterion A; Criterion C: resistance index less than 0.80 and other parameters corresponding with Criterion A. The diagnostic results of each criterion were compared with the cavernosographic results.ResultsThirty‐six patients were diagnosed as venous ED by cavernosography in 54 ED cases. The diagnostic specificity, sensitivity, and accuracy of Criterion A were 70.6%, 91.7%, and 84.9%, respectively. Those of Criterion B were 82.4%, 69.4%, and 73.6%, while the results for Criterion C were 94.1%, 33.3%, and 52.8%, respectively. Criterion A had the highest diagnostic accuracy, the largest area under the receiver operating characteristic curve (area = 0.811), and the highest consistency (kappa = 0.642) with the cavernosographic results in the 3 criteria. The difference was statistically significant (P < .05).ConclusionsAmong the 3 commonly used ultrasonographic criteria, Criterion A is most appropriate in the diagnosis of venous ED.

Tighter Blood Pressure Control Is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men

IntroductionTighter blood pressure control is widely thought to be associated with better erectile function, although the preponderance of data is limited to dichotomous representations of hypertension without an attempt to look at degree of blood pressure control. AimTo determine the association between optimal blood pressure control over time and the development of erectile dysfunction (ED) in a cohort of potent men. MethodsWe performed a retrospective cohort study of newly diagnosed hypertensive men without major medical comorbidities in an integrated healthcare system. Patients were stratified by exposure to hypertension, with varying levels of blood pressure control, as measured by ordinal categories of systolic blood pressure and deviation from the mean systolic pressure. Main Outcome MeasuresIncidence of ED was defined by at least 2 primary care or urology diagnoses of ED in our electronic health records within 2 years, at least 2 filled prescriptions for ED medications within 2 years, or 1 diagnosis of ED and 2 filled prescriptions for ED medications. ResultsWe identified 39,320 newly diagnosed hypertensive men. The overall incidence for ED was 13.9%, with a mean follow-up of 55.1 ± 28.7 months. Higher average systolic blood pressure was associated with a higher risk of ED in a dose-dependent manner (trend test, P < .001). Wide variation in blood pressure control was associated with a higher incidence of ED (OR [95% CI]; 1.359 [1.258–1.469]) and a shorter time to the development of ED (log rank, P < .0001). Clinical ImplicationsWe believe these data may serve as a motivator for hypertensive men to better adhere to their hypertension treatment regimen. Strength & LimitationsThe retrospective nature of our study precludes us from drawing more than an association between tighter blood pressure control and ED. Strengths of our study include the large sample size, community cohort, and completeness of follow-up. ConclusionAmong adults diagnosed with hypertension, tighter blood pressure control, as measured by average systolic blood pressure and deviation from the average, is associated with a lower incidence and a longer time to the development of ED.Hsiao W, Bertsch RA, Hung Y-Y, et al. Tighter Blood Pressure Control Is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men. J Sex Med 2019;16:410–417.