Erectile Dysfunction In Patients Research Articles

Comparison of the efficacy of the early LI-SWT plus daily tadalafil with daily tadalafil only as penile rehabilitation for postprostatectomy erectile dysfunction

This study compares the efficacy of the early low-intensity shock wave therapy (LI-SWT) plus daily tadalafil with daily tadalafil only therapy as penile rehabilitation for postprostatectomy erectile dysfunction in patients with prostate cancer who underwent bilateral interfascial nerve-sparing radical prostatectomy (robotic or open). From April 2019 to March 2021, 165 patients were enrolled, and 80 of them successfully completed this prospective study. Daily tadalafil were administered to all the patients. LI-SWT consisted of a total of six sessions. Each session was performed on days 4, 5, 6, and 7, and on the second and fourth weeks after surgery. Each LI-SWT session consisted of 300 shocks at an energy density of 0.09 mJ/mm2 and a frequency of 120 shocks per minute that were delivered at each of the five treatment points for 15 min. Thirty-nine patients were treated with tadalafil-only (group A) while 41 were treated with tadalafil and LI-SWT simultaneously (group B). At postoperative 6 months, the proportion of patients with erection hardness scores (EHS) ≥ 3 (4/39 vs. 12/41) was significantly higher in group B (p = 0.034), and LI-SWT was the only independent factor for predicting EHS ≥ 3 (OR, 3.621; 95% CI, 1.054–12.437; p = 0.041). There were no serious side effects related to early LI-SWT. Early LI-SWT plus daily tadalafil therapy as penile rehabilitation for postprostatectomy erectile dysfunction is thought to be more efficacious than tadalafil only. Further large-scaled randomized controlled trials will be needed to validate these findings.

Adenoprosin in the complex treatment of lower urinary tract symptoms in combination with prostatitis of category III

Introduction.The problem of effective and safe therapy of patients with benign prostatic hyperplasia and prostatitis of category III remains relevant, despite the numerosity of the drugs used in different groups. Under these conditions, the search for new pharmacological agents continues.The study objectivewas to evaluate the efficacy of Adenoprosin in the treatment of lower urinary tract symptoms and erectile dysfunction in patients with chronic pelvic pain syndrome and prostate hyperplasia.Materials and methods.The 90-day study included 60 patients aged 40 to 60 years with chronic pelvic pain syndrome and erectile dysfunction on the background of benign prostatic hyperplasia. Patients of the main group received alfa-1-adrenoreceptor blocker tamsulosin for 30 days in combination with the nonsteroidal anti-inflammatory drug nimesulide for 5 days and Adenoprosin suppositories. The men of the control group took tamsulosin for 30 days and nimesulide for 5 days. Over the next 60 days, the dynamics was evaluated based on the data from the NIH-CPSI (National Institutes Health Chronic Prostatitis Symptom Index), IPSS (International Prostate Symptom Score), QoL (Quality of Life Scale), AMS (Aging Male Symptoms), IIEF-5 (International Index of Erectile Function); urination diary analysis; general urine analysis; blood test for the level of prostate specific antigen, glucose; prostate secretion analysis; transrectal ultrasound examination of the prostate gland with measurement of residual urine; uroflowmetry.Results.Urinary frequency decreased at day 30 in the treatment group from 12.7 ± 1.4 to 7.3 ± 1.8 micturitions per day, in the control group from 13.1 ± 1.8 to 9.6 ± 1.1; subsequently (on days 60 and 90) positive effect persisted in the treatment group, while in the control group urinary frequency increased. Per the NIH-CPSI questionnaire, symptoms decreased at day 30: in the treatment group from 25.4 ± 2.1 to 12.3 ± 1.9 points, in the control group from 24.3 ± 1.7 to 17.6 ± 0.4 points; in the treatment group the trend towards symptom decrease remained, while in the control group symptoms increased at day 90. IPSS score at day 30 decreased in the treatment group from 12.9 ± 0.5 to 5.2 ± 1.4, in the control group from 14.1 ± 0.7 to 8.2 ± 0.9; further decrease was observed in both groups at day 60, but at day 90 the score increased (higher in the control group). Quality of life (QoL) improved in both groups at day 30 (in the treatment group 1.4 ± 0.6 points, in the control group 3.1 ± 0.8). Erectile function improved per the IIEF-5 questionnaire: in the treatment group from 11.5 ± 1.1 to 18.9 ± 1.4 points at day 30 with further positive tendency, in the control group from 10.7 ± 1.4 to 15.3 ± 1.1 points with subsequent negative dynamics. Uroflowmetry showed positive dynamics of Qmaxat the end of treatment in the treatment (from 8.3 ± 1.5 to 14.7 ± 1.1 mL/s) and control (from 8.8 ± 1.3 to 13.1 ± 1.6 mL/s) groups, with its further decrease. Prostate volume in the treatment group was about 33.5 ± 3.1 cm3at day 90 (with baseline volume 42.6 ± 2.5 cm3), in the control group it was 41.6 ± 1.9 cm3(with baseline volume of 43.1±1.4 cm3). No significant changes in urine tests, prostatic fluid, prostate-specific antigen level, and blood glucose were observed during the treatment.Conclusions.The study shows that administration of tamsulosin with Adenoprosin in patients with BPH and category III prostatitis is advantageous compared to administration of only alfa-1-adrenoreceptor blockers.

Assessment of the intracavernosal injection platelet-rich plasma in addition to daily oral tadalafil intake in diabetic patients with erectile dysfunction non-responding to on-demand oral PDE5 inhibitors.

This study aimed to evaluate the effectiveness of ICI of platelet-rich plasma (PRP) in addition to daily oral tadalafil intake in diabetic erectile dysfunction (ED) patients non-responding to PDE5 inhibitors. Overall, 48 patients complaining of ED non-responding to on-demand PDE5 inhibitors were allocated into 2equal groups, diabetics and non-diabetics that were given a daily dose of 5mg tadalafil plus vardenafil 20mg on demand during the study besides being subjected to 3 doses of ICI of PRP, 4weeks apart. Responses to on-demand PDE5 inhibitors, International index of erectile function-5 (IIEF-5) score, erection hardness scores (EHS) and pharmaco-dynamic duplex studies were assessed. After PRP injections, 33% and 50% of cases were satisfied with on-demand PDE5 inhibitors, respectively, whereas 41% and 66% of them showed improved EHS response. Compared with baseline scores, the mean IIEF-5scores were significantly improved after PRP therapy in the diabetic ED group (12.1 vs. 8.04, p=0.003) as well as in the non-diabetic ED group (14.8 vs. 10.2, p=0.001) linked to pharmaco-penile duplex readings. Both good and fair diabetic control exhibited significant responses to ICI therapy of PRP compared with bad controlled cases. The significant improvement included; the IIEF-5score increase (86.7%, 126% vs. 16.1%), improved EHS as well as penile duplex readings. Baseline HbA1C demonstrated a significant negative correlation with IIEF-5score before (p=0.019) and after PRP therapy (p=0.002) respectively. It could be concluded that ICI of PRP could be an effective therapy for treating ED patients non-responding to on-demand oral PDE5 treatment.

Under-recognized factors affecting penile implant satisfaction in patients.

Surgical management via penile prosthesis is an option for patients who have failed medical management. There is a paucity of literature surrounding factors contributing to patient satisfaction after implant surgery. The objective of this study was to characterize patients' and surgeons' attitudes toward factors affecting satisfaction with this procedure. Two patient cohorts were identified and contacted via email: a medical management of erectile dysfunction (ED) cohort and a penile implant patient cohort. A third cohort, Canadian urologists who perform penile implant surgeries, was also contacted. The surveys consisted of 5-7 questions, including a rating question regarding the importance of various penile implant factors. Forty-six ED patients, 45 post-implant patients, and 12 urologists completed the survey. The mean overall satisfaction on a 10-point scale was 6.49 (standard deviation [SD] 2.92). Most (67%) urologists selected patient satisfaction as one of their least favorite aspects of penile implant surgery. Compared to postimplant patients, ED patients reported greater importance in the areas of appearance (p=0.035), soft glans (p=0.040), and concealment of implant (p=0.007). Urologists ranked natural feel (p=0.019) and generating a discrete erection (p=0.022) as less important than patients. This is the first study that examines which specific variables of penile implant surgery are associated with satisfaction while comparing surgeons' understanding of what patients desire from this surgery. This study identifies several factors deemed important by patients but under-recognized by urologists. This knowledge can aid urologists in optimizing preoperative counselling and improving patient satisfaction.

Effectiveness of Sildenafil in Erectile Sexual Dysfunction in Prostate Cancer Patients

Introduction: Prostate cancer is the first cause of death by cancer in Cuban men and affects the quality of their sexual life. Objective: To investigate the efficacy of sildenafil in the treatment of erectile dysfunction in patients with prostate cancer after hormone or radiotherapy. Method: An observational, double perspective and cross-sectional study was conducted in the Service of Urology of Hospital “Dr. Agostinho Neto” in Guantanamo from 2014 to 2018, which was approved by the medical ethics committee. The study consisted of 70 patients diagnosed with prostate cancer who received hormone therapy or radiotherapy with erectile dysfunction. In each patient, we studied age, cancer treatment, time of postoperative dysfunction, and the response of penile erectile function to the use of sildenafil. Results: 37.2% of the patients were between 70 and 79 years old, and 79.1% of the patients received hormone therapy; the highest proportion of erectile dysfunction occurred 1–2 years after treatment (48.8%); 81.4% responded adequately to sildenafil treatment, which was not related to hormone or radiotherapy for cancer. Conclusions: Prostate cancer patients treated with hormone and/or radiotherapy benefit from the efficacy of sildenafil.

Homocysteine levels correlate with velocimetric parameters in patients with erectile dysfunction undergoing penile duplex ultrasound.

IntroductionHyperhomocysteinemia may contribute to the development of endothelial dysfunction and, consequently, atherosclerosis, a systemic disease involving the vessels that may affect the cavernous arteries leading to vasculogenic erectile dysfunction. Our study aims therefore to explore the relationship between homocysteine levels and velocimetric parameters detected by basal penile duplex ultrasound such as peak systolic velocity and flaccid penile acceleration in patients with erectile dysfunction.MethodsA cross‐sectional study was conducted collecting clinical, metabolic, hormonal, and instrumental (basal penile duplex ultrasound) data in patients affected by vasculogenic erectile dysfunction.ResultsData of 126 subjects affected by erectile dysfunction were collected. Mean age was 52.1 ± 12.6 years, whereas mean body mass index was 25.6 ± 4.0 kg/m2. Basal penile duplex ultrasound showed peak systolic velocity values of 13.1 ± 2.9 cm/s and mean flaccid penile acceleration of 2.28 ± 0.70 m/s2, with a strong correlation among these two parameters (r = 0.690; p < 0.001). Frankly pathological values of peak systolic velocity and flaccid penile acceleration were detected in 39.7% and 4.8% of the subjects examined, respectively. Mean homocysteine levels were 14.9 ± 9.5 μmol/l. Homocysteine values >15 μmol/l were found in 26% of the subjects with erectile dysfunction. Peak systolic velocity values and homocysteine levels showed an inverse correlation (r = –0.213; p = 0.03). Similarly, flaccid penile acceleration values were inversely correlated to homocysteine levels (r = –0.199; p = 0.05). In addition, an inverse correlation was found between both peak systolic velocity and flaccid penile acceleration and body mass index, atherogenic lipid pattern, and age. Homocysteine and metabolic parameters showed no significant correlations.ConclusionHyperhomocysteinemia is highly prevalent in erectile dysfunction patients. The results of our study show that homocysteine levels correlate with velocimetric parameters assessed by basal penile duplex ultrasound, confirming the role of hyperhomocysteinemia in the genesis of erectile dysfunction of arterial origin.

Effect of Antioxidants Supplementation on Erectile Dysfunction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

In Erectile dysfunction (ED) patients, phosphodiesterase type 5 (PDE5) inhibitors are considered as the first-line therapy. However, 30-50% of ED patients fail to follow this therapeutic option because of adverse events, lack of efficacy, or drug costs. Antioxidant supplementation is widely applied in clinical practice and viewed as a potential therapeutic option for ED. Therefore, it is attractive to assess the effect of antioxidants supplementation on ED patients. To evaluate the effects of antioxidants supplementation on ED. Published randomized controlled trials of antioxidants in ED were searched in the PubMed, Embase, and Cochrane Library databases from inception to October 3, 2021. Meta-analyses were carried out using a random-effects model. The results were presented as standard mean differences (SMDs) with their 95% confidence intervals (CIs). Eighteen studies with 1,331 ED patients were included in the study. Compared with placebo, antioxidants alone treatment showed a statistical increase in International Index of Erectile Function (IIEF) score (SMD = 1.93; 95% CI: 0.15, 3.72; P = .034). Compared with placebo, antioxidants compound treatment elicited a significant increase in IIEF score (SMD = 2.74; 95% CI: 1.67, 3.81; P < .001) as well as sexual satisfaction score (SMD = 1.61; 95% CI: 0.63, 2.59; P = .001). Compared with the PDE5 inhibitors alone, combination of PDE5 inhibitors and antioxidants showed a significant increase in IIEF score (SMD = 1.1; 95% CI: 0.51, 1.68; P < .001) and sexual satisfaction score (SMD = 1.28; 95% CI: 0.06, 2.51; P = .04). This study found that the effect of antioxidant alone treatment on ED may be limited. However, antioxidant compound treatment, as well as combination of PDE5 inhibitors and antioxidants, were associated with improved ED, and can be considered as an accessary therapeutic option for ED.

Significance of hyperhomocysteinaemia as an effective marker for vasculogenic erectile dysfunction: a cross-sectional study.

BackgroundThe primary objective of this cross-sectional study aimed at evaluating serum levels of homocysteinemia (Hcy) in a cohort of erectile dysfunction (ED) patients, and at assessing the correlation between Hcy and vasculogenic ED.MethodsA total of 119 Chinese patients presenting with ED [International Index of Erectile Function (IIEF)-5≤21] were enrolled in this study. The whole cohort was asked to complete the IIEF-5 questionnaire and blood analysis. A detailed medical history, physical examination, nocturnal penile tumescence (NPT) tests and penile color Doppler ultrasonography (pDUS) were performed by a urologist. Based on the pDUS result, they were further categorized into 2 main groups: non-vasculogenic ED (n=79) and vasculogenic ED (n=40).ResultsAge and Hcy levels were significantly higher in the vasculogenic ED group compared to the non-vasculogenic ED group (38.45±8.51 vs. 32.29±7.57 and 22.91±5.85 vs. 16.31±5.23 µmol/L, respectively, P<0.01). Univariate and multivariable regression analyses showed that the incidence of vasculogenic ED raised significantly with the increase of Hcy level. After multivariable adjustment, ED patients with hyperhomocysteinaemia (HHcy) had 13.42 times the odds of vasculogenic ED compared with patients without HHcy (OR: 13.42, 95% CI: 3.78 to 47.64). Moreover, the risk of vasculogenic ED was 1.24 (95% CI: 1.04 to 1.48, P=0.01) per-unit increase in Hyc concentration for ED with HHcy. In addition, the smoothing curve revealed that Hcy levels were inversely correlated with peak-systolic velocity (PSV) (β: −0.48, 95% CI: −0.91 to −0.05, P=0.04) in vasculogenic ED patients by multivariate regression analysis. Furthermore, in the analysis of receiver operating characteristic curve, the area under curve for Hcy to predict vasculogenic ED was 0.81 (95% CI: 0.73 to 89) in patients with ED.ConclusionsThese findings suggest a dose-dependent association between Hcy and vasculogenic ED. HHcy was a risk factor for vasculogenic erectile dysfunction. Therefore, HHcy is likely to be a potential indicator to predict and diagnose vasculogenic ED when using pDUS.

Systematic Review and Meta-Analysis of 16 Randomized Controlled Trials of Clinical Outcomes of Low-Intensity Extracorporeal Shock Wave Therapy in Treating Erectile Dysfunction.

We conducted a meta-analysis to evaluate the efficacy of low-intensity extracorporeal shock wave therapy (LI-ESWT) in the treatment of erectile dysfunction (ED). From July 2011 to June 2021, we finally selected 16 randomized controlled trials (RCTs) including 1,064 participants to evaluate the efficacy of LI-ESWT in the treatment of ED from PubMed, EMBASE, and Cochrane databases. The data are analyzed by Review Manager Version 5.4. Fifteen articles mentioned International Index of Erectile Function (IIEF), in the follow-up of 1 month (mean difference [MD] = 3.18, 95% confidence interval [CI] = [1.38, 4.98], p = .0005), 3 months (MD = 3.01, 95% CI = [2.04, 3.98], p < .00001), and 6 months (MD = 3.20, 95% CI = [2.49, 3.92], p < .00001). After treatment, the improvement of IIEF in the LI-ESWT group was better than that in the control group. Besides, eight of the 16 trials provided data on the proportion of patients with baseline Erectile Hardness Score (EHS) ≤ 2 improved to EHS ≥ 3. The LI-ESWT group was also significantly better than the placebo group (odds ratio [OR] = 5.07, 95% CI = [1.78, 14.44], p = .002). The positive response rate of Questions 2 and 3 of the Sexual Encounter Profile (SEP) was not statistically significant (SEP2: OR = 1.27, 95% CI = [0.70, 2.30], p = .43; SEP3: OR = 4.24, 95% CI = [0.67, 26.83], p = .13). The results of this meta-analysis suggest that treatment plans with an energy density of 0.09 mJ/mm2 and pulses number of 1,500 to 2,000 are more beneficial to IIEF in ED patients. In addition, IIEF improvement was more pronounced in patients with moderate ED after extracorporeal shockwave therapy.

Erectile dysfunction in young patients and elderly patients by sexual encounter profile: A comparative study.

Demand for erectile dysfunction treatments has increased not only in elderly patients but also in young patients. Reports indicate that frequent causes of erectile dysfunction in Japan are organic disorders in elderly patients and psychogenetic disorders in young patients. We defined patients under the age of 40 as young erectile dysfunction patients, and those over 65 as elderly erectile dysfunction patients. We divided these two groups and conducted a retrospective comparative study based on medical questionnaires. We selected 215 cases of patients under the age of 40, and 176 cases of patients over the age of 65, and created a group of young patients and a group of elderly patients. We implemented the erectile hardness score, Sexual Health Inventory for Men, and sexual encounter profile questions 2 and 3 as the patient's daily clinical journal. The median age of young patients was 36 years, and that of elderly patients was 70 years. With respect to Sexual Health Inventory for Men, the average score was a significantly higher score in the young patients (9.26 vs 7.10, P < 0.001). Concerning erectile hardness score, young patients showed significantly higher scores in erectile hardness score (3.15 vs 2.06, P < 0.001). In terms of sexual encounter profile question 2, 50.9% of young patients responded "yes," but 24.3% of elderly patients responded, thus indicating a significantly higher score in young patients. In terms of sexual encounter profile question 3, 6.1% of young patients responded "yes," and 0.7% of elderly patients responded "yes," indicating a significantly higher in young patients. The results showed that many young patients with erectile dysfunction were able to perform insertion, but were unable to maintain erection.

Impact of atorvastatin on erectile dysfunction: A meta-analysis and systematic review.

Atorvastatin may be an effective treatment for erectile dysfunction (ED). The purpose of this meta-analysis was to determine whether atorvastatin therapy is effective in the treatment of ED. All published research on atorvastatin in the treatment of ED patients in EMBASE, PubMed, Web of Science and Cochrane were investigated till 30 October 2021. A meta-analysis of randomized controlled trials (RCTs) was done to investigate the efficacy of atorvastatin and placebo in the treatment of ED. Moreover, we also performed a meta-analysis based on single-arm trials (SATs) to explore the atorvastatin treatment on the efficacy of ED. In a meta-analysis based on RCTs, the weighted mean difference of the change of International Index for Erectile Function-5 (IIEF-5) score in the atorvastatin treatment group with or without treatment was 4.53 (95 per cent confidence interval [CI] of 3.28-5.79) higher than in the control group. In an SAT-based meta-analysis, the ES of the change in IIEF-5 score in the atorvastatin treatment group before and after treatment was 3.22 (95 per cent CI of 1.32-5.12). Atorvastatin is an effective therapeutic drug for patients with ED. However, we expect that more multicentre clinical trials will be conducted to support this assertion.

Evaluation of the sexual function of female partners of men with erectile dysfunction receiving different treatment modalities: An observational study.

To evaluate sexual functions of patients with erectile dysfunction (ED) and their female partners. A total of 90 consecutive ED patients who received different ED therapies and their partners and 90 consecutive controls and their partners were divided into four groups. All participants were evaluated by the 15-item international index of erectile function and the Arabic version of female sexual function index (Ar-FSFI). All ED patients who received sildenafil demonstrated significant improvements of their erectile function compared to baseline. Their partners did not demonstrate improvements in frequency of pain during vaginal penetration (3.86 ± 0.58, 3.93 ± 0.45, p = 0.477), confidence of becoming aroused (3.86 ± 0.58, 3.93 ± 0.45, p 0.477), frequency of satisfaction with arousal (3.07 ± 0.37, 3.03 ± 0.49, p 0.712), and maintenance of lubrication (4.37 ± 0.49, 4.23 ± 0.73, p 0.354). All ED patients who received quadmix demonstrated significant improvements of their erectile function compared to baseline. Their partners did not demonstrate improvements in desire level (2.6 ± 0.67, 2.63 ± 0.85, p = 0.869) and lubrication maintenance (3.53 ± 0.82, 3.47 ± 0.82, p = 0.423). Finally, All ED patients who underwent semi rigid penile implant demonstrated significant improvements of their erectile function compared to baseline. Their female partners demonstrated significant improvements in all items of FSFI-19 compared to baseline except the frequency of pain during vaginal penetration (3.86 ± 0.58, 3.93 ± 0.45, p = 0.477), confidence of becoming aroused (3.86 ± 0.58, 3.93 ± 0.45, p = 0.477), frequency of satisfaction with arousal (3.07 ± 0.37, 3.03 ± 0.49, p = 0.712), and maintenance of lubrication (4.37 ± 0.49, 4.23 ± 0.73, p = 0.354). Sexual functions of ED males significantly improved after ED therapies. Nevertheless, some sexual functions of their partners were not positively impacted.

Possible effects of Saffron (Crocus sativus) in the treatment of erectile dysfunction: A randomized, double-blind, placebo-controlled trial

Aim of the studyA significant portion of erectile dysfunction (ED) patients, receiving available treatments, fails to respond. This study aims to evaluate efficacy of saffron in improving erectile function compared with placebo in men with erectile dysfunction. Materials and methodsMen with ED of at least a mild severity participated in a 6-week, parallel-group, double-blind, placebo-controlled trial. Participants were randomized to receive 15 mg saffron or placebo capsules twice daily. The trial continued for six weeks, and participants were evaluated every two weeks. The primary outcome of interest was the change in the erectile function. The results were analyzed using t-test, linear regression, and repeated-measures ANOVA. ResultsSixty-two participants were equally randomized into two groups, and 29 participants in each group completed the trial. Participants had a mean age of 41years, and the majority suffered from mild erectile dysfunction. Positive changes in erectile function scores reached 6.14 (95% CI [4.97, 7.30]) points in the saffron group, which was superior to the placebo. The confidence interval excluded the minimal clinically important difference of the scale. The adverse events were similar between the two groups and saffron showed a clinically acceptable profile. ConclusionOur findings suggest saffron might be an effective and safe option to ameliorate erectile dysfunction among ED patients, especially those who decline or are unwilling to use phosphodiesterase type 5 inhibitors.

A Novel Method to Quantify Penile Arterial Blood Supply Using Shear Wave Elastography During Penile Duplex Ultrasound in Men with Erectile Dysfunction.

BackgroundPeak systolic volume (PSV), the essential parameter of penile Doppler ultrasonography (PDU), can reflect the penile artery blood supply. The present study was conducted to explore the correlations between PDU parameters and shear wave elastography (SWE), a feasible technology to measure penile stiffness.Material/MethodsA total of 78 erectile dysfunction (ED) patients and 32 healthy controls were enrolled in our study. The PDU and SWE were performed to each participant simultaneously by a blinded radiologist. The penoscrotal junction was used to measure the PDU parameters and the SWE values. The PDU and SWE measurements were conducted formally at flaccid state and 5, 10, 15, 20, and 25 min after intra-cavernous injection (ICI) of vasoactive agents.ResultsThe significant correlation between PSV and SWE value was found in both ED patients (r=−0.748, P<0.001) and healthy controls (r=−0.815, P<0.001). SWE values of corpus cavernosum penis (CCP) decreased significantly with the increase of PSV during penile erection in both the ED patients and healthy controls. When the SWE value of CCP was less than 11.57 kPa, it showed that the penile artery blood supply was sufficient to finish satisfactory sexual intercourse. The sensitivity and specificity were 0.838 and 0.872, respectively.ConclusionsQuantitative measurement of SWE values in CCP can reflect the penile arterial blood supply during PDU examination. The SWE technique could be used for evaluating the penile artery blood supply combined with the ICI test, with the advantages of noninvasiveness, simple operation, and excellent repeatability.

Mean platelet volume as a predictive marker of erectile dysfunction: a meta-analysis.

Erectile dysfunction (ED) is a global health problem that commonly occurs due to multiple factors, particularly by a vascular abnormality with the activation of platelet (PLT). Mean platelet volume (MPV), a PLT activity marker, has been hypothesized to be associated with ED. The present meta-analysis aims to evaluate the MPV and its contribution to ED diagnosis. A systematic searching to summarize the association of MPV as a predictive marker for ED was conducted on two databases, including MEDLINE (PubMed) and CINAHL (EBSCOhost). We included all English studies that measured MPV levels in ED and non-ED subjects. A total of 168 publications were initially retrieved and screened systematically. 12 studies with 1643 subjects were included for both qualitative and quantitative analysis. The MPV mean difference between ED patients and healthy subjects; vasculogenic and non-vasculogenic ED showed significant differences. Our findings show PLT is associated with the development of ED. Higher MPV level was found in the ED subjects compared to the healthy controls. Nevertheless, the evidence is still limited due to the small number of studies and further investigations are required to support the utilization of MPV for ED diagnosis.

Role of shear wave elastography (SWE) in erectile dysfunction patients for evaluation of daily tadalafil treatment outcome.

The purpose of this study was to evaluate and anticipate the outcome of daily use of tadalafil in patients with erectile dysfunction using elastography. 183 volunteers and 183 patients with erectile dysfunction were included. Pretreatment SWE readings for our patients were calculated with a linear probe. IIEF score Q was measured once at the start of the study for volunteers and twice for patients, one prior to the start of tadalafil administration and the other on one year of 5mg daily tadalafil after the second post-washout (one month post-treatment stopped). There was no significant difference between patients and volunteers in mean age or risk factors except in SWE values as mean SWE of volunteers was 14.03±1.54kpasc, while mean SWE of patients was 21.278±8.228kpasc. The presence of comorbid diabetes, severe disease and pre-SWE ≥23.635 was significantly associated with poor outcome. We conclude that penile SWE could be useful to select probable good responders for a continuous tadalafil use, thus avoiding the unnecessary cost and time in non-responders.

INFLUENCE OF THE DURATION OF DIABETES AND VIBRATION PERCEPTION THRESHOLD ON THE SEVERITY OF ERECTILE DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.

Erectile dysfunction(ED) in men is a frequent under-reported complication of diabetes mellitus, which is becoming significant health problem worldwide. The study aims to determine the prevalence and risk factors for development of ED in North Indian patients with type 2 diabetes mellitus. We used international index of erectile function (IIEF-5) for the assessment of ED in 796 patients with type 2 diabetes mellitus. We recorded the age, duration of diabetes, glycemic status, body mass index, diabetes medications, microvascular and macrovascular complications. The mean age of patients in the study was 49.38 ± 9.52 years. The prevalence of ED in patients with type 2 diabetes mellitus was 79.4%. Logistic regression analysis revealed that age, body mass index, glycemic control, insulin therapy, retinopathy and nephropathy was not significantly associated with erectile dysfunction in patients with type 2 diabetes mellitus. Duration of diabetes (OR = 1.054, 95% CI 1.007 to 1.102, P=0.023) and vibration perception threshold (OR = 1.071, 95% CI 1.042 to 1.102, P=0.000) were identified as key risk factors for development of ED. Duration of diabetes and peripheral neuropathy emerged as significant risk factors for development of severe erectile dysfunction.

Efficacy of Adjusted Dose Tadalafil for Treating Erectile Dysfunction in Patients on Chronic Hemodialysis.

Although erectile dysfunction is frequently seen in hemodialysis patients, little information is documented about the efficacy of phosphodiesterase type 5 (PDE5) inhibitors and almost all the articles evaluate sildenafil. We aimed to evaluate the efficacy of chronic low dose tadalafil in this group of patients. The International Index of Erectile Function (IIEF) questionairre was administered to patients under hemodialysis program. A total of 58 patients with ED (International Index of Erectile Function (IIEF) score < 26), each having a stable partner, between 18-60 years, receiving routine outpatient HD matched the inclusion criteria and divided into two equal groups; placebo and tadalafil 5 mg/3 days. Changes of the IIEF score was recorded after one month of treatment. The mean age of the patients was 50.0±9.93 years. Duration of dialysis was 57.5(12-108) months. Hemoglobin (g/dl) and creatinin clearence (ml/Min) values of placebo and tadalafil groups were not significantly different; 10.9(8.8-14) vs 10.7(8.9-13) and 5.7±1.3 vs 6.0±1.4 respectively. There was a statistically significant increase for all subgroups related erectile dysfunction 9.28±4.17 vs 21.07±5.99 (p=0.037), intercourse satisfaction 8(3-9) vs 10(5-15) (p<0.001), orgasmic function 4(1-10) vs 8(4-10) (p<0.001), sexual desire 4(2-10) vs 7(3-9) (p<0.001) and general satisfaction 5(2-9) vs 6(2-9) (p<0.001) with low dose of tadalafil at the end of four weeks without any major side effects. There was only a significant increase in sexual desire 4(3-9) vs 6(4-10) (p<0.001),in placebo group with an insignificant change in all other IIEF domains. Total IIEF score of the placebo group was insignificantly increased from 21.13±7.73 to 21.99±7.04 (p=0.771) while there was a statistically significant increase in tadalafil group; from 20.87±8.84 to 30.75±7.04 (p<0.001). Tadalafil 5 mg once in three days is appear to be efficacious and well tolerated for the treatment of ED in hemodialysis patients.

The role of penile elastography in the evaluation of erectile dysfunction in patients with chronic obstructive pulmonary disease

IntroductionIn this study, we aimed to measure the change in penile stiffness by evaluating corpus cavernosum (CC) with shear wave elastography (SWE) in patients with chronic obstructive pulmonary disease (COPD).Material and methodsSeventy outpatient patients aged 50–80 years who were diagnosed with COPD were evaluated using SWE. Patients were divided into 2 groups according to the International Index of Erectile Function-5 (IIEF-5) questionnaire (IIEF-5 >17: Group A, IIEF-5 <17: Group B). The measurements were made in both transverse and longitudinal sections.ResultsThe mean age of the patients was 60 ±7.9 years. The duration of COPD was significantly higher in Group B than in Group A (p = 0.003). The mean SWE values of right transverse mid-portion of corpus penis (RTM) and left transverse mid-portion of corpus penis (LTM) in Group B (21.1 ±5.6 kPa and 20.8 ±4.8 kPa, respectively) were significantly higher than in Group A (15.2 ±2.3 kPa and 15.8 ±2.7 kPa, respectively); (p <0.001 and p <0.001, respectively). There was a significant negative correlation between IIEF-5 scores and the duration of COPD (p <0.05). There was a significant negative correlation between IIEF values and RTM and LTM values of the patients (p <0.05 and p <0.05, respectively). There was a significant positive correlation between the duration of COPD and both RTM and LTM values (p <0.05 and p <0.05, respectively).ConclusionsIn our study, according to the SWE findings, we showed the effect of systemic changes created by COPD on penile tissue and the negative effect of this on erectile function in patients.

Anxiety, depression, and sexual dysfunction in patients with psoriasis

Background: There are few studies investigating the association between psoriasis and depression, anxiety, sexual dysfunction in the literature. Aims: We aimed to investigate depression, anxiety, and sexual dysfunction in patients with psoriasis and the association between the psychiatric comorbidity and the severity and involvement sites of psoriasis. Materials and Methods: A total of 200 participants, including 100 psoriasis patients and 100 healthy volunteers as a control group, were included in the study. All participants were questioned about sociodemographic characteristics, smoking, alcohol use, and comorbidities. All participants completed the Dermatology Life Quality Index, Beck Depression Scale, Beck Anxiety Scale, Arizona Sexual Experiences Scale, Female Sexual Function Scale/International Erectile Function Index. Results: In the psoriasis group, an increased risk for depression and anxiety was observed, regardless of the clinical features and severity of psoriasis, and a positive correlation was detected between the severity of the disease and impaired quality of life. An increased risk for sexual dysfunction regardless of clinical features and severity in male patients with psoriasis was detected compared with the control group. It was found that the risk for erectile dysfunction in patients with psoriasis increased regardless of the risk factors such as smoking, alcohol, diabetes, hypertension, and cardiovascular disease. Conclusion: Our study shows that psoriasis increases the risk for impaired quality of life, depression, anxiety, and sexual dysfunction in individuals. This increase is not always associated with the clinical characteristics of psoriasis such as severity, duration, and sites of involvement. Therefore, dermatologists should consider not only the skin findings of psoriasis but also the psychosocial status of the patient and refer the patient to psychiatry if necessary.