Erectile Dysfunction In Patients Research Articles

Frequency of Erectile Dysfunction in Patients with Type 2 Diabetes Mellitus Presenting with Peripheral Neuropathy at a Tertiary Care Hospital

Background: Erectile dysfunction (ED) is notably prevalent among patients with type 2 diabetes mellitus (T2DM), especially those suffering from peripheral neuropathy. The condition significantly impacts the quality of life and is often exacerbated by diabetes-related complications. Objective: This study aims to ascertain the frequency and severity of ED among patients with T2DM and peripheral neuropathy, and to examine the association between ED and variables such as age, duration of diabetes, and glycemic control. Methods: A prospective cohort study was conducted at the Baqai Institute of Diabetology and Endocrinology, Karachi, from July 2021 to September 2022. We included 115 male patients aged 35-65 years with T2DM and diagnosed peripheral neuropathy. ED was assessed using the Urdu version of the International Index of Erectile Function-5 (IIEF-5) questionnaire. Demographic details, medical history, and laboratory results were collected and analyzed using SPSS version 25. Statistical tests included chi-squared and one-way ANOVA, with a significance level set at p<0.05. Results: The mean age of the participants was 50.97 ± 7.21 years, and the average duration of diabetes was 9.37 ± 6.56 years. The mean IIEF-5 score was 14.33 ± 6.0, indicating moderate ED. Severe ED was observed in 20% of the participants, moderate ED in 19.1%, and mild to moderate ED in 28.7%. The study found a significant association between the duration of diabetes and ED severity (p < 0.001), while age and HbA1c levels did not show a significant correlation with ED status. Conclusion: ED is highly prevalent and severe among patients with T2DM and peripheral neuropathy, with disease duration being a significant predictor of ED severity. These findings underscore the need for early screening and targeted interventions in this population.

Treatment of erectile dysfunction by intracavernosal administration of mesenchymal stem cells in patients with diabetes mellitus.

The purpose of study is to assess and analyse the effectiveness of their use in the treatment of erectile dysfunction in patients with diabetes mellitus. The literature search was conducted using systematic methods and analysis in databases such as Web of Science, Scopus, PubMed, Elsevier, and Springer, with 41 sources included for further review. The study highlights microangiopathic and neuropathic links as key factors in erectile dysfunction development in diabetic patients, stemming from endothelial dysfunction and conductivity disturbances. Mesenchymal stem cell therapy from bone marrow, adipose tissue, and umbilical cord mitigates pathogenic impact through regenerative and anti-apoptotic effects. Due to this, most studies indicate high efficacy of the treatment and rapid therapeutic action through intracavernosal administration. Some studies suggest an increase in the body's receptor sensitivity to other drugs, such as sildenafil. From the perspective of further research on this issue, standardising the preparation of stem cells and the treatment method using a large sample size is essential to introduce such a method as an extremely promising therapy for this delicate issue in men into practical medicine. The practical value of the study lies in the systematisation of information on different sources of mesenchymal stem cells for treating erectile dysfunction.

Correlation between Serum Levels of Nitric Oxide and Adropin and Erectile Dysfunction in Males with Nonalcoholic Fatty Liver Disease: An Observational Study.

The current study aimed to evaluate the serum levels of nitric oxide (NO) and adropin in males with non-alcoholic fatty liver disease (NAFLD) induced erectile dysfunction (ED) and NAFLD patients without ED and controls. The current study selected 165 participants from the hepatology department from November 2021 to November 2022. The patients were either suffering from NAFLD with normal liver functions or non-alcoholic steatohepatitis with abnormal liver functions. They were diagnosed by abdominal ultrasonography. Participants were evaluated using the validated Arabic version of the International Index of Erectile Function (ArIIEF-5), the Arabic form of the Generalized Anxiety Disorder-7 (GAD-7) questionnaire and the Patient Health Questionnaire-9 (PHQ-9). Noteworthy, there were significant positive correlations between ArIIEF-5 score, NO, adropin and total testosterone (r = 0.380, p = 0.001; r = 0.507, p =  < 0.001; r = 0.246, p = 0.038, respectively). Meanwhile, there were significant negative correlations between ArIIEF-5 score, creatinine, duration of the disease and scores of GAD-7 and PHQ-9 (r = -0.656, p =  < 0.001; r = -0.368, p = 0.002; r = -0.663, p =  < 0.001; r = -0.248, p = 0.037, respectively). Finally, a linear regression analysis revealed that GAD-7, creatinine, and adropin were the only strong independent predictors of ArIIEF-5, as the 95% confidence interval in the form of upper and lower bounds was -0.349, -0.843, p < 0.001, -6.507, -18.402, p < 0.001, 0.476, 0.117, and p 0.002, respectively. Impaired NO and adropin levels play a potential role in the development of ED in patients with NAFLD.

Prevalence and Correlates of Self-Reported Erectile Dysfunction among Adult Male Patients Receiving Cardiovascular Care in Southern Nigeria

Abstract Background: The global incidence of erectile dysfunction (ED) is on the rise, with an estimated 152 million men currently affected. Cardiovascular risk factors are strongly linked to the occurrence of ED, particularly in men with cardiovascular disease (CVD). In countries like Nigeria, where it is not typically viewed as life-threatening, ED often receives less attention. Consequently, there is limited data on selfreported ED among patients seeking cardiovascular care in cardiac clinics. Therefore, this study aims to determine the prevalence of self-reported ED among adult patients with CVD visiting a cardiac center. Materials and Method: A retrospective hospital-based study of self-reported ED patients carried out in a cardiac center among males (31-82 years) in Port Harcourt, Southern Nigeria, over a one-year period (October 2022 to January 2024). Participants’ demographic data and medical history were retrieved and analyzed. Results: The study had a total of 23 male subjects. Majority of the participants were between 50-69 years old (47.8%), 65.2% took alcohol and 21.7% smokes cigarette. 82.6% had a history of hypertension and (73.9%) were on antihypertensive, (34.8%) had diabetes mellitus, (17.4%) were on antidiabetic while (60.9%) were on other forms of medication. Overweight and obesity account for 34.8% and 52.2% of the subjects respectively. Beta-blocker (23.5%) was the frequently used medication and angiotensinconverting enzyme (ACE) inhibitors was the least accounting for (5.9%). Conclusions: The increasing incidence of ED among patients with CVD risk factors and an aging population suggest that patients should be screened. ED may become a significant public health problem and closer attention needs to be paid to control these patients to reduce further complications. Keyword: Erectile dysfunction, cardiovascular risk factor, cardiac Centre, self-reported, Good Heart medical consultants’ Hospital.

Endovascular penile revascularization improves erectile dysfunction in patients with penile arterial insufficiency

In most institutions, patients with erectile dysfunction due to penile arterial insufficiency are offered palliative treatments like vacuum constrictor devices, intraurethral alprostadil, intracavernosal injection of prostaglandins, and/or implantation of penile prosthesis when these patients can be treated by endovascular penile revascularization. 50% of patients with erectile dysfunction are non-responders to phosphodiesterase-5 inhibitors. 70% of non-responders to phosphodiesterase-5 inhibitors have penile arterial insufficiency that can be treated with endovascular penile revascularization. Patients who are non-responders to phosphodiesterase-5 inhibitors should be screened for penile arterial insufficiency using penile duplex scan. If penile artery peak systolic velocity is &lt;35 cm/s, then arterial insufficiency is suspected, and computed tomography (CT) angiogram is obtained to confirm presence of significant stenosis in iliac-pedundle-penile arterial system. Patients with penile arterial insufficiency should be offered endovascular penile revascularization. This minimally invasive procedure has minimal perioperative complications (&lt;1%) and has significant clinical improvement in erectile function in &gt;60% of patients at 12 months. Endovascular penile revascularization is safe and has long term clinical improvement in erectile function. This minimally invasive procedure can result in improved erectile function and preserves penile size and shape in most non-responders to phosphodiesterase-5 inhibitors.

Inflammatory cytokine profiles in erectile dysfunction: a bidirectional Mendelian randomization.

Inflammatory cytokines (ICs) play an important role in erectile dysfunction (ED). Previous studies have demonstrated that most ED patients have high levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8). The causality between 41 ICs and ED is investigated using the Mendelian randomization (MR) approach. Single nucleotide polymorphisms (SNPs) exposure data of 41 ICs came from a genome-wide association study (GWAS) of 8293 subjects. At the same time, the FINNGEN R9 database provided the ED outcome data containing 2205 ED patients and 164104 controls. MR-Egger (ME), inverse variance weighting (IVW), and weighted median (WM) were applied to conduct the MR study and IVW was taken as the main criterion. From a genetic perspective, the increase of interferon-inducible protein-10 (IP-10) level significantly increased the risk of ED (P=0.043, odds ratio (OR)=1.269, 95% confidence interval (95%CI): 1.007-1.600), while the increase of interleukin-1 receptor antagonist (IL-1RA) markedly decreased the risk of ED (P=0.037, OR=0.768, 95%CI: 0.600-0.984). Meanwhile, IP-10 (p=0.099) and IL-1RA (p=0.135) failed to demonstrate causality in reverse MR analysis. Changes in ICs levels will significantly affect the risk of ED, especially IP-10 as a risk component for ED and IL-1RA as a protective component for ED. In the future, we can achieve targeted treatment and prevention of ED by intervening with specific inflammatory factors.

Acupuncture for erectile dysfunction: a randomized controlled trial.

To observe the clinical efficacy of acupuncture in treating erectile dysfunction (ED). A total of 64 ED patients were randomly divided into an acupuncture group (32 cases, 2 case dropped out) and a western medication group (32 cases, 2 cases dropped out). In the acupuncture group, acupuncture treatment was applied at Baihui (GV 20), Qihai (CV 6), Guanyuan (CV 4), Zhongji (CV 3), Dahe (KI 12), Qugu (CV 2), Zusanli (ST 36), and etc., two groups of acupoints were used alternately, 30 min each time, once every other day. In the western medication group, 50 mg of sildenafil tablet was took orally 1 h before sexual activity. Both groups were treated for 30 d. The international index of erectile function citrate (IIEF-5) score, self rating anxiety scale (SAS) score, self rating depression scale (SDS) score, TCM syndrome score were observed before and after treatment, and in follow-up of 2 weeks after treatment completion, the serum testosterone (T) level was detected before and after treatment, and the clinical efficacy was evaluated in the two groups. After treatment and in follow-up, the IIEF-5 scores were increased compared with those before treatment in the two groups (P<0.01). In follow-up, the IIEF-5 score in the acupuncture group was ascended compared with that in the western medication group (P<0.05). Except for the SDS and TCM syndrome scores in the western medication group of follow-up, the SAS scores, SDS scores, and the TCM syndrome scores were decreased after treatment and in follow-up compared with those before treatment in the two groups (P<0.01, P<0.05); in the acupuncture group, the SAS scores, SDS scores and the TCM syndrome scores after treatment and in follow-up were lower than those in the western medication group (P<0.01). After treatment, the serum T levels were increased compared with those before treatment in the two groups (P<0.01). The total effective rate of the acupuncture group was 83.3% (25/30), and it was 86.7% (26/30) in the western medication group, there was no significant difference in total effective rate between the two groups (P>0.05). Acupuncture can effectively improve erectile function, anxiety and depression state, and TCM syndrome in ED patients, and has a advantage of posterior effect compared with western medication treatment.

Association between severe headache or migraine and erectile dysfunction in American adults: a cross-sectional of data study from the NHANES.

Currently, few studies have explored the relationship between severe headache or migraine and erectile dysfunction (ED). The aim of our study was to assess the association between severe headache or migraine and ED in adult men in the US from the National Health and Nutrition Examination Survey (NHANES). We used data from two separate NHANES datasets for the analysis: 2001-2002 and 2003-2004. We used multiple logistic regression, subgroup analysis, and sensitivity analyses to assess the relationship between severe headache or migraine and ED. From 2001 to 2004, 3117 adult male participants (582 ED patients, 2535 non-ED patients) were identified. Categorical and continuous variables are described using counts and frequencies and means and standard errors, respectively. For continuous variables, the two groups were compared using survey-weighted linear regression, while for categorical variables, survey-weighted chi-square tests were performed. Multiple logistic regression analysis showed that in the fully adjusted Model 3, severe headache or migraine was statistically significantly associated with ED (OR 1.51; 95% CI 1.14-1.99; P = 0.0036). In the fully adjusted Model 3, the results of the subgroup analysis showed that an age of 40-60 years (OR = 1.55, 95% CI: 1.05, 2.31, P = 0.029), a body mass index (BMI) < 25 kg/m2 (OR = 1.68, 95% CI: 1.02, 2.75, P = 0.0406) or ≥30 kg/m2 (OR = 1.65, 95% CI: 1.07, 2.54, P = 0.022), hypertension (OR = 1.78, 95% CI: 1.22, 2.60, P = 0.0029), diabetes mellitus (OR = 1.71, 95% CI: 1.26, 2.31, P < 0.001), CVD (OR = 1.54, 95% CI: 1.12, 2.10, P = 0.011) and hyperlipidemia (OR = 1.83, 95% CI: 1.07, 3.13, P = 0.028) were associated with ED with severe headache or migraine. This study demonstrated a statistically significant association between severe headache or migraine and ED among adult men in the US. However, the results of the study should be interpreted with caution due to the failure to assess the effects of depression and anxiety on the outcomes.

Association between bowel movement frequency and erectile dysfunction in patients with ulcerative colitis: a cross-sectional study.

The association between ulcerative colitis (UC) and erectile dysfunction (ED) has been previously reported. Numerous previous studies have also reported an association between gastrointestinal symptoms and ED. Constipation and diarrhea are common in patients with UC. However, the specific association between bowel movement frequency and ED remains unclear. The aim of this study is to investigate the association between bowel movement frequency and ED in 164 patients with UC. The definition of ED, moderate to severe ED, and severe ED was the Sexual Health Inventory for Men score <22, <12, and <8, respectively. Bowel movement frequency was divided into three categories: (1) high (More than once a day), (2) normal (once a day, reference), and low (less than one time/day). The definition of constipation was based on the Rome I criteria and/or medication for constipation. The prevalence of constipation and ED was 10.4% and 86.0%, respectively. The rate of high, normal, and low bowel movement frequency was 56.1%, 25.0%, and 18.9%, respectively. High bowel movement frequency was independently and positively associated with ED and moderate to severe ED (ED: adjusted odds ratio [OR] 4.42, 95% confidence interval [CI] 1.35-15.98; moderate to severe: adjusted OR 2.98, 95% CI 1.22-7.61). Low bowel movement frequency was independently and positively associated with moderate to severe ED and severe ED (moderate to severe: adjusted OR 3.96, 95% CI 1.27-13.08; severe: adjusted OR 3.20, 95% CI 1.08-9.86). No association between constipation and ED was found. In conclusion, in Japanese patients with UC, both high and low bowel movement frequency were independently and positively associated with ED.

Evaluating the efficacy and safety of platelet-rich plasma injection for erectile dysfunction: a systematic review and meta-analysis of randomized controlled trials.

Platelet-rich plasma (PRP) is rich in factors that play a role in stem cell recruitment, inflammation modulation, and angiogenesis. With numerous preclinical and clinical studies exploring PRP as a potential treatment for erectile dysfunction (ED), this study focused on assessing the effectiveness of intracorporeal PRP injection for ED patients based on randomized controlled trials (RCTs). The study sought to evaluate the efficacy and safety of intracorporeal injection of PRP in treating ED through a systematic review and meta-analysis of RCTs. This study adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search was conducted on online databases (PubMed, Scopus, and ScienceDirect) to identify RCTs comparing PRP with a placebo for ED treatment. The primary outcomes assessed were the proportion of patients achieving the minimal clinically important difference in the International Index of Erectile Function (IIEF) domain and the change in the IIEF domain from baseline. The results were combined as a standardized mean difference between the PRP and placebo groups. Three RCTs comprising 230 patients were included. The overall effect favored PRP over placebo: total patients attaining minimal clinically important difference in the IIEF domain (odds ratio [OR], 5.64; 95% confidence interval [CI], 2.05 to 15.55; P = .0008), IIEF change from baseline (mean difference [MD], 2.99; 95% CI, 1.74 to 4.24; P = .00001), PSV (MD, 9.34; 95% CI, 0.84 to 17.84; P = .03), end-diastolic volume (standardized MD, 0.50; 95% CI, 0.17 to 0.83; P = .003), Sexual Encounter Profile question 3 (standardized MD, 0.78; 95% CI, 0.45 to 1.12; P = .00001), and visual analog scale score (MD, -0.30; 95% CI, -0.53 to -0.08; P = .008). PRP appears to be a safe and effective treatment for mild-to-moderate ED. However, further support from high-quality RCTs is needed to strengthen these findings.

Monocyte-to-high-density lipoprotein cholesterol ratio and the risk of erectile dysfunction: a study from NHANES 2001-2004.

The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) has become a novel inflammation marker with a possible association with erectile dysfunction (ED); however, there are fewer studies exploring the association between MHR and ED. This study sought to explore the association between MHR and ED. This study population was drawn from participants in two 2-year cycles of the National Health and Nutrition Examination Survey (2001-2002 and 2003-2004). MHR was calculated as the ratio of monocyte count (103 cells/μL) to high-density lipoprotein cholesterol (mg/dL). The relationship between MHR and ED was explored using survey-weighted logistic regression models with MHR as a continuous variable and divided into tertiles (tertile 1 [T1]: <0.01; T2: 0.01-0.014; T3: >0.014). We also used a smooth curve fit (penalized spline method) to characterize the dose-response relationship between MHR and ED. In addition, subgroup analyses based on age, body mass index, smoking, hypertension, diabetes mellitus, and cardiovascular disease were performed to further analyze the data. Sensitivity analyses were also conducted to further assess the stability of the results. The main outcome measure was the difference in ED prevalence between MHR levels. A total of 1361 participants were enrolled, with 513 (T1), 438 (T2), and 410 (T3) participants in the 3 MHR groups. After adjusting for all potential covariates, survey-weighted logistic regression analyses showed a significant association between MHR and ED (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.26-3.05). When MHR was used as a categorical variable, the adjusted OR for ED prevalence increased significantly with increasing MHR after adjusting for all potential covariates (T3 vs T1: OR, 2.14; 95% CI, 1.29-3.55). The dose-response curves showed that the prevalence of ED increased with increasing MHR. Easy to access and low cost, MHR is a convenient clinical tool that helps clinicians in the prevention and treatment of ED. The present study is the first to examine the association between MHR and ED nationally representative data. However, the study population was derived from a U.S. database, so the findings are limited to the U.S. population. Our study demonstrated that MHR levels were independently associated with ED and that ED patients had higher MHR levels, suggesting that MHR may be a valuable predictor for identifying people at higher risk for ED.

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

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

Accurate diagnosis and effective treatment of abnormal meridians in erectile dysfunction patients based on infrared thermography: an electrophysiological technique study.

An increasing body of research has demonstrated that appropriate stimulation of the meridians and acupoints in the human body can play a preventative and therapeutic role in diseases. This study combines the use of infrared thermography with intelligent electrophysiological diagnostic system (iEDS) to accurately diagnose and apply transdermal low-frequency electrical stimulation to treat abnormal meridians in patients with erectile dysfunction (ED). The treatment protocol included 6 treatments (each lasting 30 min and performed twice a week). The International Index of Erectile Function-5 (IIEF-5), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Erection Hardness Scale were used to assess treatment results. A total of 62 patients were included in this study, with 31 patients in the treatment group and 31 patients in the sham therapy group. After six treatments, the treatment group improved significantly in IIEF-5 (15.52 ± 2.06 vs. 18.84 ± 2.67, p < 0.001), PHQ-9 (8.32 ± 6.33 vs. 4.87 ± 4.41, p < 0.001), GAD-7 (5.32 ± 5.08 vs. 2.94 ± 3.31, p = 0.003), and EHS (2.48 (2.00, 3.00) vs. 2.90 (2.00, 3.00), p = 0.007). After six sham treatment sessions, no improvements in any of the scores were reported in the sham therapy group. Following that, this group had an additional six treatments of regular therapy, which resulted in statistically significant improvements in IIEF-5 (16.65 ± 1.96 VS. 19.16 ± 2.40, p < 0.001), PHQ-9 (8.81 ± 6.25 VS. 4.97 ± 4.36, p < 0.001), GAD-7 (5.74 ± 5.18 VS. 3.68 ± 3.42, p < 0.001), and EHS (2.61 (2.00, 3.00) VS. 3.03 (2.00, 4.00), p = 0.003). No adverse events were reported regarding penile discomfort, pain, injury, or deformity. CLINICAL TRIALS: The study protocol is registered in the Clinical Trials Registry with the identification number ChiCTR2300070262.

Psychological Impact of Sexual Disorders Related to Benign Prostatic Hypertrophy

Objectives: Lower urinary tract disorders related to BPH are today among the most frequent symptoms in urology. The aim of our study is to determine the prevalence of erectile dysfunction in patients with BPH-related lower urinary tract symptoms and the related psychological impact. Methods: We conducted a study to assess the psychological impact of BPH-related sexual dysfunction. We used two scores to assess anxiety-depressive symptoms. The Patient Health Questionnaire-9 (PHQ-9), which gives an indication of the severity of depression, and the Generalized Anxiety Disorder - 7 (GAD-7) 1 for screening patients for generalized anxiety disorder. The severity of erectile dysfunction was specified using the SHIM score (Sexual Health Inventory for Men). Results: A total of 290 participants. The mean age was 58 years, 175 (60%) patients had erectile dysfunction, 120 (60%) of these patients with ED were treated with alpha blockers (OR=2.38, RR = 1.43, p = 0.04). The most represented age group was 60-69 years, 50 (28%) patients were treated with alpha blockers (OR=1.67, RR = 1.15, p = 0.01) while only 10 (5.7%) patients were treated with herbal extracts (phytotherapy). 65% of participants with erectile dysfunction showed varying degrees of depression and 53% of participants with erectile dysfunction showed varying degrees of anxiety. Conclusion: Micturition disorders caused by benign prostatic hyperplasia (BPH) and erectile dysfunction are frequent and often coexist. BPH-related erectile dysfunction has a significant psychological impact.

PKC Inhibition Improves Human Penile Vascular Function and the NO/cGMP Pathway in Diabetic Erectile Dysfunction: The Role of NADPH Oxidase.

Erectile dysfunction (ED) is a frequent and difficult-to-treat condition in diabetic men. Protein kinase C (PKC) is involved in diabetes-related vascular and cavernosal alterations. We aimed to evaluate the role of PKC in endothelial dysfunction and NO/cGMP impairment associated with diabetic ED in the human corpus cavernosum (CC) and penile resistance arteries (PRAs) and the potential mechanisms involved. Functional responses were determined in the CC and PRAs in patients with non-diabetic ED and diabetic ED undergoing penile prosthesis insertion. PKC activator 12,13-phorbol-dibutyrate (PDBu) impaired endothelial relaxations and cGMP generation in response to acetylcholine in the CC from non-diabetic ED. PDBu also impaired responses to a PDE5 inhibitor, sildenafil, in non-diabetic ED patients. Conversely, a PKC inhibitor, GF109203X, improved endothelial, neurogenic, and PDE5-inhibitor-induced relaxations and cGMP generation only in the CC in diabetic ED patients. Endothelial and PDE5-inhibitor-induced vasodilations of PRAs were potentiated only in diabetes. Improvements in endothelial function in diabetes were also achieved with a specific inhibitor of the PKCβ2 isoform or an NADPH-oxidase inhibitor, apocynin, which prevented PDBu-induced impairment in non-diabetic patients. PKC inhibition counteracted NO/cGMP impairment and endothelial dysfunction in diabetes-related ED, potentially improving response to PDE5 inhibition.

BMP4 and GREM1 are targets of SHH signaling and downstream regulators of collagen in the penis.

Cavernous nerve (CN) injury, caused by prostatectomy and diabetes, initiates a remodeling process (smooth muscle apoptosis and increased collagen) in the corpora cavernosa of the penis of patients and animal models that is an underlying cause of erectile dysfunction (ED), and the Sonic hedgehog (SHH) pathway plays an essential role in the response of the penis to denervation, as collagen increases with SHH inhibition and decreases with SHH treatment. We examined if part of the mechanism of how SHH prevents penile remodeling and increased collagen with CN injury involves bone morphogenetic protein 4 (BMP4) and gremlin1 (GREM1) and examined the relationship between SHH, BMP4, GREM1, and collagen in penis of ED patients and rat models of CN injury, SHH inhibition, and SHH, BMP4, and GREM1 treatment. Corpora cavernosa of Peyronie's disease (control), prostatectomy, and diabetic ED patients were obtained (N= 30). Adult Sprague Dawley rats (n = 90) underwent (1) CN crush (1-7days) or sham surgery; (2) CN injury and BMP4, GREM1, or mouse serum albumin (control) treatment via Affi-Gel beads or peptide amphiphile (PA) for 14days; (3) 5E1 SHH inhibitor, IgG, or phosphate-buffered saline (control) treatment for 2 to 4days; or (4) CN crush with mouse serum albumin or SHH for 9days. Immunohistochemical and Western analysis for BMP4 and GREM1, and collagen analysis by hydroxyproline and trichrome stain were performed. BMP4 and GREM1 proteins were identified in corpora cavernosa smooth muscle of prostatectomy, diabetic, and Peyronie's patients, and in rat smooth muscle, sympathetic nerve fibers, perineurium, blood vessels, and urethra. Collagen decreased 25.4% in rats with CN injury and BMP4 treatment (P = .02) and increased 61.3% with CN injury and GREM1 treatment (P = .005). Trichrome stain showed increased collagen in rats treated with GREM1. Western analysis identified increased BMP4 and GREM1 in corpora cavernosa of prostatectomy and diabetic patients, and after CN injury (1-2days) in our rat model. Localization of BMP4 and GREM1 changed with SHH inhibition. SHH treatment increased the monomer form of BMP4 and GREM1, altering their range of signaling. A better understanding of penile remodeling and how fibrosis occurs with loss of innervation is essential for development of novel ED therapies. The relationship between SHH, BMP4, GREM1, and collagen is complex in the penis. BMP4 and GREM1 are downstream targets of SHH that impact collagen and may be useful in collaboration with SHH to prevent penile remodeling and ED.

(268) Intracavernous Prostaglandin Injection as a Predictor and Effectiveness Measure for LISWT Sessions in ED Patients: A Single Urologist's Experience

Abstract Introduction In recent years, therapeutic approaches for treating vasculogenic Erectile Dysfunction (ED) have evolved, with Low Intensity Shock Wave Therapy (LISWT) emerging as a promising modality. Objective To objectively evaluate the efficacy of LISWT for ED patients and to predict the required number of sessions, we examined the effects of administering up to 10 mcg of intracavernous alprostadil injections both before and after treatment Methods 85 vasculogenic ED patients (Average age: 57); 33 with mild to moderate ED and 52 with moderate or severe ED. Intracavernous injection (ICI) of ≤10 mcg of alprostadil was given before LISWT and one month post-treatment. Depending on ICI response, patients underwent either six (Erection Hardness Score (EHS) ≤3) or four (EHS=4) weekly LISWT sessions using PiezoWave2 from Richard WOLF. LISWT Parameters: 0.16mj/mm2 energy flux density, 8 Hz frequency, 10mm wave focus penetration depth, and 6000 shocks per session distributed among the two crura of the penis (2000 shocks), dorsum penis (2000 shocks), and lateral penis (2000 shocks). Results 33 patients showed a robust response to the 10mcg ICI and were treated with four LISWT sessions. 52 patients exhibited a partial response to the 10mcg ICI, necessitating six LISWT sessions. 78.6% (26 out of 33) of the patients who initially responded well to 10 mcg ICI had a consistent response to 8 mcg ICI; 63.6% (33 out of 52) of those with a partial initial response to 10 mcg ICI demonstrated an improved reaction to the same dosage post-treatment (table 1) (fig. 1). No complications were reported from the ICI. Conclusions Intracavernous prostaglandin injection can serve as a predictor for the required number of LISWT sessions and can objectively gauge the treatment's effectiveness in ED patients. Further randomized studies, incorporating parameters such as EHS, IIEF, and the ICI dosage, are recommended to validate this method's feasibility Disclosure No.

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

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

(112) Penile Rehabilitation by Daily Intake of 5 mg Tadalafil for Erectile Dysfunction After Penile Fracture

Abstract Introduction Penile fracture is a rare complication to penile trauma, characterized by a sudden injury of the tunica albuginea of one or both corpora cavernosa of the penis. This commonly occurs during the erect state, when the tunica is thinner and under tension of fully engorged corpora cavernosa. Erectile dysfunction (ED) may occur in up to 12% of these patients due to organic and psychosexual factors including penile fibrosis. Objective This study aimed to assess the potential predictors of erectile dysfunction in patients who had penile fracture repair and the role of rehabilitation course of daily tadalafil 5 mg in management of ED following penile fracture. Methods From January 2022 to February 2023, 25 patients were included. Patients' baseline data as well as history including the time of presentation, the pattern and length of the tunical tear, and the presence of urethral injury, were obtained. After a week, all patients were followed up on and told to resume intercourse after at least two weeks if their wound had epithelialized. Only patients with a complaint of a weak erection, as determined by the Arabic validated version of the international index of erectile function (ArIIEF-5), were started on daily tadalafil 5 mg as a penile rehabilitation for at least one month, or until they regained their normal erection. The Hospital Anxiety and Depression Scale (HADS) was used for assessing patients. Patients with confounding disease as metabolic syndrome or mental illness were eliminated. Results Significant indicators predicting erectile dysfunction, according to the multiple logistic regression model, are the patients' age and the length of the tunical tear. A 1% increase in age was linked with a 73.6% rise in the probability of erectile dysfunction (p = 0.046), and a 1 cm increase in tunical tear length was associated with a 20.04 times increased risk of erectile dysfunction (p = 0.04). With a mean score of 20 on the Arabic-approved version of the internal index of erectile function, 5 of 9 patients with erectile dysfunction (55%) had improved erections after one month of penile rehabilitation, while only 4 of 9 patients (44%) required an additional month of treatment. Conclusions We propose that patients with penile fractur be counselled about erectile dysfunction and begin penile rehabilitation as soon as possible following repair to regain a normal erection. Disclosure No.

(113) Investigating the Prevalence of Erectile Dysfunction in Patients with Non-Alcoholic Fatty Liver and Its Relationship with the Severity of Fatty Liver

Abstract Introduction Today, the relationship between erectile dysfunction in men and the pathogenesis process in the field of metabolic syndrome is of interest. Non-alcoholic fatty liver disease is one of the diseases related to metabolic syndrome, which has a high prevalence. This study was conducted with the aim of evaluating the prevalence of erectile dysfunction in men with non-alcoholic fatty liver disease and investigating the relationship between its severity and the grading of liver complications. Objective In this research, the frequency of erectile dysfunction and decreased libido and sexual satisfaction in patients with non-alcoholic fatty liver disease have been investigated and compared with the control group. Also, the relationship between the severity of sexual dysfunction and fatty liver grading has been investigated. Methods In this study, 1200 patients with non-alcoholic fatty liver disease were randomly selected and participated in this study between 2019 and 2022. In order to investigate sexual disorders, the standard male sexual performance questionnaire was used along with the demographic questionnaire. Results The results of this study showed that the indicators of male sexual dysfunction in patients with non-alcoholic fatty liver have a high prevalence (44.5%). Also, the severity of erectile dysfunction has a significant relationship with the severity of non-alcoholic fatty liver disease (pv=0.002). Conclusions A holistic view of the health category requires that in the treatment of medical disorders, the effective factors and consequences of the disorder should be considered. Paying attention to the diagnosis and treatment of sexual disorders in the treatment process will be one of the most important aspects of the patient's health; Because erectile dysfunction in men, apart from the effect on sexual relations, will have destructive consequences on their psychological indicators and quality of life. On the other hand, it is possible to improve the quality of patients' health by modifying the lifestyle and interdisciplinary cooperation. Disclosure No.