Erectile Dysfunction In Patients Research Articles

P35-1 Erectile dysfunction in patients with metastatic prostate cancer treated with androgen-deprivation therapy

Sexual function is affected by treatment for both localized and advanced prostate cancer (PC). Erectile dysfunction (ED) has been studied in localized PC but rarely in advanced or metastatic disease. This study aimed to establish the prevalence of ED in patients with metastatic PC treated with androgen-deprivation therapy (ADT), and to determine the differences in the severity of ED in patients who have received different ADT: bilateral orchiectomy, hormonal therapy, androgen inhibitor, or their combination.

Early outcomes of short-course low intensity shockwave therapy (LiSWT) for erectile dysfunction: A prospective, randomized, double-blinded, sham-controlled study in Malaysia.

Low‐intensity shockwave therapy (LiSWT) has emerged as a promising non‐invasive treatment modality for erectile dysfunction (ED) yet the well‐designed randomized clinical trials are still lacking to prove its claimed benefits. A randomized, prospective, double‐blinded sham‐controlled study was conducted to evaluate the effectiveness and safety profile of short course LiSWT on vasculogenic ED patients. The International Index of Erectile Function‐5 (IIEF‐5) and Erection Hardness Score (EHS) questionnaires were used for evaluation. Patients underwent weekly sessions for 4 weeks and were re‐assessed at 1, 3 and 6 months post therapy. Fifty one patients were recruited and randomized into sham and treatment arms. The mean IIEF‐5 scores were significantly improved in the treatment arm compared to worsening of scores in the sham arm after 1 month (14.1 vs. 9.3 p < 0.001), 3 months (14.9 vs. 8.6, p < 0.001) and 6 months (14.2 vs. 7.9, p < 0.001) post treatment. A significant improvement of EHS was demonstrated at 1 month (2.4 vs. 1.8, p = 0.001, 3 months 2.7 vs. 1.7, p < 0.001) and 6 months (2.7 vs. 1.6, p < 0.001) in the treatment arm compared to sham arm. The success rate based on IIEF score increment more than five points was 26% in treatment arm and 0% in sham arm. Improvement in EHS score ≥3 in the treatment versus sham arm was 63% and 4%, respectively. There was no adverse effect reported. This 4‐week LiSWT protocol reflects better treatment compliance, and it prevents further deterioration of erectile function among this cohort of patients. This study proves that LiSWT is a well‐tolerated treatment with modest improvements in erectile function and hardness, among patients with vasculogenic ED.

Primary organic versus primary psychogenic erectile dysfunction: Findings from a real-life cross-sectional study.

Erectile dysfunction aetiology has been historically identified as organic, psychogenic and mixed. To stratify and compare a cohort of patients seeking medical help for erectile dysfunction for the first time according to the newly proposed binary classification of the European Association of Urology guidelines: 'primary organic' versus 'primary psychogenic'. Complete data from 2009 consecutive patients presenting for erectile dysfunction were analysed. All patients completed the International Index of Erectile Function at baseline. According to the presence of erectile dysfunction-related risk factors indexed by the European Association of Urology Guidelines on Sexual and Reproductive Health, patients were categorised as having primary organic (≥1 risk factor) or primary psychogenic (0 risk factor) erectile dysfunction. Descriptive statistics compared the two groups. Linear regression analysis tested the association between the number of risk factors and erectile dysfunction severity. Locally estimated scatterplot smoothing method graphically explored the relationship between the number of risk factors for erectile dysfunction and the International Index of Erectile Function domain scores. Median (interquartile range) age at first presentation was 50 (39-61) years. Of all, 1632 (86.2%) and 377 (13.8%) were identified as having primary organic and primary psychogenic erectile dysfunction, respectively. Overall, 1488 (74.1%) patients were >40 years of age; in this subgroup, the most frequent risk factors were age, hypertension (29%), active smoking (42%) and alcohol intake (25.1%). Median (interquartile range) International Index of Erectile Function-erectile function score was 15 (7-22). Primary organic erectile dysfunction patients depicted lower International Index of Erectile Function-sexual desire and International Index of Erectile Function-orgasmic function scores (all p≤0.02), whilst groups did not differ in terms of International Index of Erectile Function-erectile function, International Index of Erectile Function-intercourse satisfaction and International Index of Erectile Function-overall satisfaction scores. One out of nine patients complaining of erectile dysfunction depict criteria for primary psychogenic erectile dysfunction. Erectile function severity could be as severe as patients with organic erectile dysfunction. The single-centre-based cross-sectional nature of the study, raising the possibility of selection biases, is our main limitation. One out of nine patients presenting for erectile dysfunction depict criteria suggestive for primary psychogenic erectile dysfunction in the real-life setting. Patients with primary psychogenic and primary organic erectile dysfunction have comparable erectile dysfunction severity, thus outlining the importance of a comprehensive and tailored management work-up in every patient seeking medical help for the first time.

Erectile Dysfunction in Patients with Substance Abuse: A Preliminary Report in Bandung, West Java, Indonesia

Substance abuse (psychoactive) has multiple adverse effects, i.e., biological, psychological, economic, social or legal. Among the biological effects, little is known about its impact on sexual function, especially erectile dysfunction (ED) in men. The study’s objective was to determine the patient’s risk factors of ED comorbid with substance abuse at the Methadone Maintenance Therapy Program Clinic (MMTPC), Hospital Dr. Hasan Sadikin Clinic, Bandung, Indonesia. This was a crosssectional study among patients at the MMTPC, Hospital Dr. Hasan Sadikin Clinic, Bandung, Indonesia. We obtained the ED data using the self-reporting International Index of Erectile Function (IIEF-5) questionnaire. Based on 30 respondents who attended the clinic, the age of the subjects ranged from 24-52 years, with a mean age of 40 years. The respondents with substance abused included those misusing opioids (N= 27, 90%), cannabis (N = 18, 60%), amphetamines (methamphetamines and ecstasy) (N= 10, 33.3%), benzodiazepine drugs (N= 7, 23.3%), alcohol (N= 2, 6.7%) and others (antidepressants and suboxone) (N= 2, 6.7%). ED occured in 90% of the respondents (n=27) where 64% (n=19) had mild, 23% (n=7) mild-moderate, 3% (N=1) moderate ED, and 10% (n=3) without an ED. There was no severe ED in the subjects of this study. Respondents without multiple drug abuse had a lower degree of ED with a median IIEF-5 score of 17.0 (IQR: 15.0-20.0) compared to those taking multiple substances (Median score = 20.0, IQR: 18.5-21.0). Respondents who reported cannabis use had a lower median IIEF-5 score of 17.0 (IQR: 15.0- 20.3), i.e., lesser ED than those with multiple drug substances (Median score = 19.5, IQR: 19.0-21.0). We performed additional analyses to identify variables, i.e., age, total type of drugs used, and duration of use in years associated with lower IIEF-5 scores and none of thosee variables showed a significant correlation with the IIEF-5 score (Spearman’s correlation coefficients &gt;0.05). In conclusion, a high incidence of ED in substance abuse patients undergoing methadone maintenance therapy programmes requires special attention from healthcare workers during the consultation in MMTPC.

Novel predictive risk factor for erectile dysfunction: Serum high-sensitivity C-reactive protein.

C-reactive protein (CRP), as a marker of inflammation, may be closely related to erectile dysfunction (ED), however, there is no meta-analysis exists for it. We aimed to verify the relationship between CRP and erectile dysfunction and to explore the changes of CRP levels in ED patients after first-line treatment. We searched databases including the Cochrane Library, PubMed, and MEDLINE to identify studies up to January 1, 2022. We performed a comprehensive analysis of the included studies by STATA software and calculated standardized mean differences (SMDs) and their corresponding 95% confidence intervals. A total of 12 studies were included and the analysis showed that CRP levels were higher significantly in patients with erectile dysfunction than the healthy controls (p<0.001) and decreased by a mean of 0.38mg/L after first-line PDE5i drug treatment (p=0.001). This novel meta-analysis suggests that CRP is statistically significantly associated with erectile dysfunction and may be a predictor or risk factor for the assessment of ED. However, further original studies with large sample sizes are needed to validate this.

Efficacy and safety of low-intensity extracorporeal shock wave therapy versus on-demand tadalafil for erectile dysfunction

ABSTRACT Objective To compare outcomes of low-intensity extracorporeal shock wave therapy (LIESWT) versus 20 mg of Tadalafil in Erectile dysfunction (ED) patients. Materials and Methods We performed a prospective study of 51 men with ED. Twenty-five were in the LIESWT group and 26 in the Tadalafil group. Patients in the LIESWT group received 6 sessions (2 per week) with an average of 6,000 shocks per session with the PiezoWave2 unit. Other patients self-administered Tadalafil on demand. The outcomes were assessed using the International Index of Erectile Function (IIEF-5) score, Erection Hardness Score (EHS) and Self-Esteem And Relationship (SEAR) questionnaire before, at 6 and 12 weeks after treatment. Treatment-related side effects and costs were recorded too. Results The mean age in the LIESWT group was 43.7 years old, and in the Tadalafil group was 47 years old. After the 6 and 12-week follow-ups, both groups showed significant improvement when comparing the baseline values to the follow-up variables for all IIEF-5, EHS, and SEAR (P < 0.05). There was a notable statistical difference between the two groups regarding the side effects, as the shockwave group was with mild side effects (8%), while the Tadalafil group (44%) of patients had side effects (p < 0.05). This cost difference is statistically significant (p < 0.001). LIESWT is more costly compared to Tadalafil. Conclusion LIESWT has a comparable short-term therapeutic efficacy with higher safety outcomes than on-demand 20 mg of Tadalafil for ED patients.

Sonic Hedgehog Signaling in Primary Culture of Human Corpora Cavernosal Tissue From Prostatectomy, Diabetic, and Peyronie's Patients

BackgroundCavernous nerve (CN) injury causes penile remodeling, including smooth muscle apoptosis and increased collagen, which results in erectile dysfunction (ED), and prevention of this remodeling is critical for novel ED therapy development. AimWe developed 2 peptide amphiphile (PA) hydrogel delivery vehicles for Sonic hedgehog (SHH) protein to the penis and CN, which effectively suppress penile distrophic remodeling (apoptosis and fibrosis), in vivo in a rat CN injury model, and the aim of this study is to determine if SHH PA can be used to regenerate human corpora cavernosal smooth muscle deriving from multiple ED origins. MethodsCorpora cavernosal tissue was obtained from prostatectomy, diabetic, hypertension, cardiovascular disease and Peyronie's (control) patients (n = 21). Primary cultures (n = 21) were established, and corpora cavernosal cells were treated with SHH protein, MSA (control), 5E1 SHH inhibitor, and PBS (control). Growth was quantified by counting the number of cells at 3–4 days. Statistics were performed by ANOVA with Scheffe's post hoc test. Concentration of SHH protein for maximal growth was optimized, and a more active SHH protein examined. OutcomesCultures were characterized by immunohistochemical analysis with ACTA2, CD31, nNOS and P4HB, and smooth muscle was quantified in comparison to DAPI. ResultsCultures established were >97% smooth muscle. SHH protein increased growth of smooth muscle cells from prostatectomy, diabetic, and Peyronie's patients in a similar manner (49%–51%), and SHH inhibition decreased growth (20%–33%). There was no difference in growth using 25 ug and 10 ug SHH protein, suggesting a threshold concentration of SHH protein above which smooth muscle growth is enhanced. A more active lipid modified SHH peptide further enhanced growth (15%), indicating a more robust growth response. SHH increased growth in smooth muscle cells from hypertension (37%) and cardiovascular disease (32%) patients. SHH protein increased growth under normal and high glucose conditions, suggesting that high glucose conditions that may be present in under controlled diabetic patients would not detract from SHH regenerative capacity. Clinical ImplicationsSHH PA would be beneficial to enhance smooth muscle regeneration in patients with ED of multiple etiologies. Strengths and LimitationsUnderstanding how human corpora cavernosal tissue responds to SHH treatment is critical for clinical translation of SHH PA to ED patients. ConclusionCorpora cavernosal smooth muscle from all ED patients responded to SHH treatment with increased growth.Stupp, SI. Sonic Hedgehog Signaling in Primary Culture of Human Corpora Cavernosal Tissue From Prostatectomy, Diabetic, and Peyronie's Patients. J Sex Med 2022;19:1228–1242.

A Prospectively Validated Nomogram for Predicting the Risk of PHQ-9 Score ≥15 in Patients With Erectile Dysfunction: A Multi-Center Study.

BackgroundAlthough erectile dysfunction (ED) often occurs simultaneously with depression, not all patients with ED suffer major depression (MD), with a PHQ-9 score ≥15 indicating MD. Because the PHQ-9 questionnaire includes phrases such as “I think I am a loser” and “I want to commit suicide,” the psychological burdens of ED patients are likely to increase inevitably after using the PHQ-9, which, in turn, may affect ED therapeutic effects. Accordingly, we endeavored to develop a nomogram to predict individual risk of PHQ-9 score ≥15 in these patients.MethodsThe data of 1,142 patients with ED diagnosed in Xijing Hospital and Northwest Women and Children's Hospital from January 2017 to May 2020 were analyzed. While the Least Absolute Shrinkage and Selection Operator regression was employed to screen PHQ-9 score ≥15 related risk factors, multivariate logistic regression analysis was performed to verify these factors and construct the nomogram. The training cohort and an independent cohort that comprised 877 prospectively enrolled patients were used to demonstrate the efficacy of the nomogram.ResultsThe IIEF-5 score, PEDT score, physical pain score, frequent urination, and feeling of endless urination were found to be independent factors of PHQ-9 score ≥15 in patients with ED. The nomogram developed by these five factors showed good calibration and discrimination in internal and external validation, with a predictive accuracy of 0.757 and 0.722, respectively. The sensitivity and specificity of the nomogram in the training cohort were 0.86 and 0.52, respectively. Besides, the sensitivity and specificity of the nomogram in the validation cohort were 0.73 and 0.62, respectively. Moreover, based on the nomogram, the sample was divided into low-risk and high-risk groups.ConclusionThis study established a nomogram to predict individual risk of PHQ-9 score ≥15 in patients with ED. It is deemed that the nomogram may be employed initially to avoid those with a low risk of MD completing questionnaires unnecessarily.

Efficacy Comparison of Intralesional inj.Interferon Alpha 2B (2 MU) against Intralesional Inj.Interferon Alpha 2B (3 MU) in Treatment of Peyronie’s Disease

Introduction: In Peyronie’s Disease, fibrous plaque is formed which has an excessive amount of collagen, fibroblastic proliferation and elastin framework alteration. Objective: To compare the effect of Intralesional Inj.Interferon alpha 2b (2 MU) against Intralesional Inj. Interferon alpha 2b (3 MU) on plaque size, penile deviation, erectile function and pain during erection in patients having Peyronie's disease Methods: It was comparative interventional/longitudinal study, conducted at Department of Urology, Kot Khawaja Saeed hospital, Lahore and Department of Urology, DHQ hospital Sheikhupura. Total 30 Patients of Peyronie's disease in Urology OPD were enrolled. Patients were randomized into two groups by online random number generator. Results: In Group-A, after therapy, mean plaque length was decreased from 9.9±2.4 to 8.8±2.1 mm and mean plaque width was decreased from 4.2±0.9 mm to 3.8±0.4 mm, mean penile curvature was decreased from 34.1°±8.4° to 26.2°±7.2°, mean IIEF score was improved from 35.1±11.4 to 46.2±10.6, and mean pain score was decreased from 4.2±1.1 to 3.4±0.7. In Group-B, after therapy, mean plaque length was decreased from 10.7±2.6 to 7.3±1.8 mm and mean plaque width was decreased from 4.3±0.7 mm to 3.0±0.3 mm, mean penile curvature was decreased from 35.4°±7.9° to 20.1°±6.3°, mean IIEF score was improved from 36.3±12.4 to 59.8±12.6, and mean pain score was decreased from 4.1±1.0 to 1.9±0.6. Conclusion: Intralesional inj. Interferon alpha-2b (3MU) is more effective than Intralesional inj. Interferon alpha-2b (2MU) for reducing plaque size, pain, and penile deviation, and for improvement in erectile dysfunction in patients with Peyronie's disease. Keywords: Peyronie’s disease, Interferon alpha 2b, Fibrous plaque

Study of erectile dysfunction in patients of type 2 diabetes mellitus and its association with cardiovascular risk

Background: Diabetes is a chronic metabolic disorder that is characterized by high level of blood glucose levels, which over a period of time can lead to micro-vascular or macro-vascular complications. Erectile dysfunction (ED) is common not much discussed and distressing complication of diabetes. ED in type 2 may be independent marker of coronary artery disease (CAD). Aim and objectives were to assess the ED in subject of type 2 diabetes mellitus (DM). Assessment of correlation of ED with CAD. Methods: The present cross-sectional study consisted total 180 diabetic patients. On basis of international index of erectile function (IIEF) questionnaire ED patients were assessed.Result: Out of 180 diabetic patients 36.11% had varying degree of ED. Out of 65 ED patients, maximum frequency of moderate ED (47.69%) was found then severe ED (32.30%), mild to moderate ED (12.30%) and mild ED (7.69%). Most of the patients were in the age group of 40-50 years 35 (53.84%), 50-60 years 22 (33.4%), &lt;40 years (9.23%) and 60-70 years 2 (3.07%) showed ED. Fasting blood sugar and postprandial blood sugar showed significant (p&lt;0.05) relation with ED. HbA1c show an insignificant correlation (p&gt;0.05) with ED. In patient with ED was having more value of atherosclerotic cardiovascular disease (ASCVD) (9.11±4.84) than patient without ED (8.82±5.72). There was no significant (p&gt;0.05) difference in term of ASCVD risk score in ED patient’s ED and without ED patients.Conclusions: Poor glycemic control was a strongest risk factor for ED.

Shockwave Therapy for Erectile Dysfunction: Which Gives the Best Results? A Retrospective National, Multi-Institutional Comparative Study of Different Shockwave Technologies.

Low-intensity shockwave therapy (Li-SWT) is a promising option for the treatment of erectile dysfunction (ED). Many devices with different characteristics in terms of generators, shockwaves, set-up parameters and procedure protocols are commercially available. In this report, we present our experience with the main shockwave technologies currently in use in clinical practice for ED treatment. A retrospective national, multi-institutional study was performed to compare the effects of different shockwave technologies in ED patients. All of the subjects underwent 8 consecutive weekly physical treatments with SWT under either a focused or non-focused regimen: 3,000 shocks per session at 0.09 mJ/mm2 and 10,000 shocks per session at 15 Hz and 90 mJ, respectively. Efficacy was evaluated by comparing pre- and post-treatment Sexual Health Inventory in Men (SHIM) scores, International Index of Erectile Function (IIEF-5) and Erection Hardness Score (EHS). Possible relationships between type of shockwave generator, source, morphology and type of ED were investigated. A total of 94 men were included in the analysis. There were no significant differences in the baseline clinical characteristics or demographics. The mean (SD) increase in the scores from questionnaires evaluated at 8 weeks was clinically and statistically significant, with overall improvements of +5.49, +5.47 and +1.18 (p<0.0001) in the IIEF-5, SHIM, and EHS scores, respectively. The increases in these scores were evaluated by a multiple regression analysis, in relation to the shockwave generator, type of ED, shockwave source and morphology, but none of the factors examined predicted improvement. No side effects were reported with any device. SWT is a clinically effective and safe treatment for ED that is independent of the generator type, source, shockwave morphology emitted, type of ED and perhaps treatment protocol.

Cardiovascular/Stroke Risk Assessment in Patients with Erectile Dysfunction-A Role of Carotid Wall Arterial Imaging and Plaque Tissue Characterization Using Artificial Intelligence Paradigm: A Narrative Review.

Purpose: The role of erectile dysfunction (ED) has recently shown an association with the risk of stroke and coronary heart disease (CHD) via the atherosclerotic pathway. Cardiovascular disease (CVD)/stroke risk has been widely understood with the help of carotid artery disease (CTAD), a surrogate biomarker for CHD. The proposed study emphasizes artificial intelligence-based frameworks such as machine learning (ML) and deep learning (DL) that can accurately predict the severity of CVD/stroke risk using carotid wall arterial imaging in ED patients. Methods: Using the PRISMA model, 231 of the best studies were selected. The proposed study mainly consists of two components: (i) the pathophysiology of ED and its link with coronary artery disease (COAD) and CHD in the ED framework and (ii) the ultrasonic-image morphological changes in the carotid arterial walls by quantifying the wall parameters and the characterization of the wall tissue by adapting the ML/DL-based methods, both for the prediction of the severity of CVD risk. The proposed study analyzes the hypothesis that ML/DL can lead to an accurate and early diagnosis of the CVD/stroke risk in ED patients. Our finding suggests that the routine ED patient practice can be amended for ML/DL-based CVD/stroke risk assessment using carotid wall arterial imaging leading to fast, reliable, and accurate CVD/stroke risk stratification. Summary: We conclude that ML and DL methods are very powerful tools for the characterization of CVD/stroke in patients with varying ED conditions. We anticipate a rapid growth of these tools for early and better CVD/stroke risk management in ED patients.

The brachial-ankle pulse wave velocity is a predictive factor for erectile dysfunction in patients with benign prostate hyperplasia

ABSTRACT Introduction Phosphodiesterase (PDE) 5 inhibitors induce relaxation of endothelial cells. Tadalafil, one of PDE 5 inhibitors, has been applied for the treatments of erectile dysfunction (ED) and benign prostate hyperplasia (BPH). Under continuous treatments with PDE 5 inhibitor for BPH, it is significant to investigate the relationship between endothelial and sexual functions by comparing the brachial-ankle pulse wave velocity (baPWV).and the sexual health inventory for men (SHIM) score. Objectives Total 89 BPH patients who consulted our clinic with a complaint of urinary symptoms were enrolled in this prospective study. They were treated with a daily dose of 5mg tadalafil. Methods The Institutional Review Board (IRB) approved this clinical study and informed consents had been obtained from 89 BPH patients. Their vessels endothelial function was assessed by baPWV and erectile function was evaluated by SHIM score. International prostate symptom score (IPSS) was obtained as male lower urinary symptoms (LUTS) parameters. However, we focused on the relationship between vessels endothelial and erectile function in this sub-analysis report. Therefore, the SHIM scores were compared with baPWV and IPSS at 0, 3, 6, 12, 24, 36, 48, 60, 72 and 84 months after PDE5 inhibitor treatment. Results The mean age of 89 patients was 66.7 +/- 11.1 years old. Their prostate size was 29.8 +/- 21.2 ml. Initial SHIM, baPWV and IPSS score were 7.4 +/- 5.6, 1742.5 +/- 393.0 cm/sec and 17.5+/- 7.5, respectively. Before tadalafil treatment, baPWV and SHIM were significantly correlated (p=0.0025) which indicated patients with low vessels endothelial function vessels endothelial function suffered from erectile dysfunction. F4rthere06re, all the data of baPWV and SHIM including after tadalafil treatment from 3 to 84 months (n=472) were significantly co-related each other (p&amp;lt;0.0001). On the other hand, baPWV were significantly improved from 3 to12 months after tadalafil administration, however baPWV levels returned to the baseline levels after 24 to 84 months. SHIM score was significantly improved from 3 to24 months after tadalafil administration, however SHIM levels returned to the baseline levels after 36 to 84 months. Conclusions Our previous paper (Aging Male 21, 2018) reported that PDE5 inhibitors improved ED, male LUTS and baPWV from 3 to 12 months. The present data also suggested that endothelial function and male LUTS strongly related to ED in BPH patients. However, baPWV and SHM score levels returned to the baseline levels after 24 and 36 months, respectively. Thus, tadalafil can delay vessels endothelial and erectile dysfunction in BPH patients. In addition, erectile dysfunction seems to be occurred after vessels endothelial dysfunction. Hence, baPWV might be a predictive factor for ED in BPH patients with tadalafil treatments. Disclosure Work supported by industry: no.

Increased risk of subsequent cardiovascular disease among men aged 31-60 years with erectile dysfunction

ABSTRACT Background Men presenting with erectile dysfunction (ED) or coronary artery disease (CAD) can be regarded as two different manifestation of vascular occlusion incident. ED has been proven to be an independent predictor of CAD, especially young men aged 40-49 years. Although psychogenic ED is more prevalent in younger patients less than 40 years of age, but the ED presentation can also be related to vasculogenic etiology. The purpose of this study is to evaluate the subsequent CAD risk in young ED patients and also determine the relative CAD risk in ED men stratified by age. Methods A total of 3091 ED patients and 9273 randomly-selected controls without ED were selected from the National research database and studied retrospectively from January 1,1997 to December 31, 2007. The comparison cohort without ED was matched for age and comorbidities (diabetes, hypertension, hyperlipidemia and ischemic stroke). All subjects were followed up by the end of 2009. Cox proportional hazards regression models were used to explore the connection between ED and the development of CAD. Results The ED patients have a greater chance of developing cardiovascular disease compared to controls (460/3091, 14.9% vs. 1021/9273, 11.0%, p-values &amp;lt; 0.0001). Cox proportional hazards regression suggested ED increases the risk of CAD development (HR 1.37, 95% CI [1.22-1.53], p&amp;lt;0.0001). Results stratified by 10-year age decades demonstrate ED men aged 31-40 years, 41-50 years, and 51-60 years pose greater risk of developing CAD comparing to the controls (HR 1.61, 95% CI [1.04-2.52], p=0.03; HR 1.79, 95% CI [1.38-2.32], p&amp;lt; 0.0001; HR 1.68, 95% CI [1.35-2.09], p&amp;lt; 0.0001, respectively). On the contrary, the incident cardiac events were not increased in ED men aged 21-30 years, 61-70 years and 71-80 years comparing to the controls (HR 1.77, 95% CI [0.50-6.29], p=0.38; HR 1.17, 95% CI [0.95-1.44], p=0.15; HR 0.88, 95% CI [0.65-1.19], p=0.40, respectively). Conclusion Erectile dysfunction is a harbinger of cardiovascular clinical events in men aged 31-60 years. Erectile dysfunction should prompt investigation and close follow up for further cardiac events. Disclosure Work supported by industry: no.

MP38-06 SONIC HEDGEHOG SIGNALING IN CORPORA CAVERNOSAL CELLS FROM PROSTATECTOMY, DIABETIC, HYPERTENSION AND PEYRONIE’S PATIENTS WITH ERECTILE DYSFUNCTION

You have accessJournal of UrologyCME1 May 2022MP38-06 SONIC HEDGEHOG SIGNALING IN CORPORA CAVERNOSAL CELLS FROM PROSTATECTOMY, DIABETIC, HYPERTENSION AND PEYRONIE’S PATIENTS WITH ERECTILE DYSFUNCTION Sarah Martin, Timothy Searl, Samuel Ohlander, Kevin McVary, and Carol Podlasek Sarah MartinSarah Martin More articles by this author , Timothy SearlTimothy Searl More articles by this author , Samuel OhlanderSamuel Ohlander More articles by this author , Kevin McVaryKevin McVary More articles by this author , and Carol PodlasekCarol Podlasek More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002592.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile dysfunction (ED) treatments are minimally effective in prostatectomy and diabetic patients due to injury to the cavernous nerve. With denervation the critical smooth muscle undergoes apoptosis and the penis becomes fibrotic, thus altering corpora cavernosal architecture. In order to devise novel ED therapies, prevention of corpora cavernosal remodeling is critical. Sonic hedgehog (SHH) treatment by peptide amphiphile (PA) nanofiber hydrogel, suppresses smooth muscle apoptosis and improves erectile function in a rat CN injury ED model. We examine if human corpora cavernosal smooth muscle responds in a similar manner to SHH treatment.In this study we: 1.) Examine if human corpora cavernosal smooth muscle cells from primary culture of ED patient tissues, respond to Sonic hedgehog (SHH) treatment by increasing growth rate, as in our in vivo animal model. 2.) Determine if human corpora cavernosal cells from patients with differing underlying mechanisms of ED development (prostatectomy, diabetes, hypertension, cardiovascular disease), respond similarly to SHH treatment. 3.) Identify if organ culture conditions (glucose) affect growth of corpora cavernosal smooth muscle and the response to SHH signaling. 4.) Examine the vascular component of ED (hypertension and cardiovascular disease). METHODS: Human corpora cavernosal tissue was obtained from prostatectomy, diabetic, hypertension, cardiovascular disease and Peyronie’s (control) patients (n=40) that were under going prosthesis implant to treat ED. Primary cultures (n=17) were established, and corpora cavernosal cells from passage 3-4 were treated with SHH protein, MSA (control), 5E1 SHH inhibitor, and PBS (control). Growth was quantified by counting the number of cells using a hemocytometer at 3-4 days. The concentration of SHH protein for maximal growth was examined, in addition to a lipid modified more active SHH peptide. RESULTS: SHH treatment increased smooth muscle growth in human corpora cavernosal cells from prostatectomy, diabetic, and Peyronie’s patients in a similar manner (43-53%). SHH inhibition decreased smooth muscle growth (24-32%). There was no difference in growth using 25ug and 10ug SHH peptide. A more active (150X) SHH peptide further enhanced growth (20%). SHH protein increased growth more in diabetic smooth muscle under high glucose conditions. SHH inhibition was less effective under high glucose conditions. SHH treatment increased growth less in cells from hypertension and cardiovascular disease patients. CONCLUSIONS: Corpora cavernosa smooth muscle from prostatectomy, diabetic, and Peyronie’s patients increased in response to SHH treatment in a similar manner, suggesting that SHH treatment would be beneficial to enhance smooth muscle regeneration in patients with ED of multiple origins. There is a threshold concentration of SHH protein above which smooth muscle growth is enhanced. Lipid modified SHH engendered a more robust growth response. High glucose conditions that may be present in under controlled diabetic patients would not detract from SHH usefulness as a protectant for corpora cavernosal morphology. Understanding how human corpora cavernosal tissue responds to SHH treatment is critical for clinical translation to ED patients. Source of Funding: NIH/NIDDK DK101536 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e620 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Martin More articles by this author Timothy Searl More articles by this author Samuel Ohlander More articles by this author Kevin McVary More articles by this author Carol Podlasek More articles by this author Expand All Advertisement PDF DownloadLoading ...

Characteristics and frequency of fibrosis in men with erectile dysfunction treated with intracavernous drugs

ABSTRACT Introduction Fibrosis of the corpora cavernosa is a complication related to the use of intracavernous medication (FIC) for erectile dysfunction (ED), which can produce sequelae that affect the quality of sexual intercourse. Objective The objective of this study is to determine the frequency of fibrosis in a group of ED patients treated with intracavernous medication with a magisterial combination of papaverine, phentolamine, atropine, and alprostadil and to characterize this event. Methods The clinical records of men with ED and use of FIC treated in an institution in the city of Monterrey in Mexico during 2018 were reviewed. Those with reports of complications after the use of treatment were identified and the search was complemented with the report of adverse events of the same year. The sociodemographic and clinical data of the patients were extracted, and a descriptive analysis of the information was made. Results 252 patients were treated with FIC in the period of interest. Five of them (0.019%) had fibrosis in the penis. Age ranged from 47 to 74 years, none had diabetes or other fibrosis-associated comorbidities, and no previous episodes of priapism were reported. The dose of the FIC varied with application between 2 and 3 times a week. The time from treatment to plaque formation varied between 3 and 10 months, the largest size of the lesion was 0.6 × 0.4 cm. Three patients reported failures with the technique of application of the intracavernous medication; four reported curvature between 10 and 40 degrees. Regarding the consequences of fibrosis, two patients reported pain, one patient informed inability to penetrate during intercourse, and another patient reported shortening of his penis. Conclusions The frequency of fibrosis in patients with ED after the use of intracavernous medication is low, however, those affected may present pain and inability to penetrate and have satisfactory sexual relations. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Boston Medical Group).

MP21-12 STILL ONE OUT OF FIVE MEN PRESENTING FOR ERECTILE DYSFUNCTION ARE YOUNG THAN 40 YEARS OF AGE: FINDINGS OF A REAL-LIFE CROSS-SECTIONAL STUDY OVER LAST DECADE

You have accessJournal of UrologyCME1 May 2022MP21-12 STILL ONE OUT OF FIVE MEN PRESENTING FOR ERECTILE DYSFUNCTION ARE YOUNG THAN 40 YEARS OF AGE: FINDINGS OF A REAL-LIFE CROSS-SECTIONAL STUDY OVER LAST DECADE Edoardo Pozzi, Paolo Capogrosso, Giuseppe Fallara, Luca Boeri, Christian Corsini, Daniele Cignoli, Massimiliano Raffo, Luigi Candela, Nicolò Schifano, Alessia d'Arma, Rayan Matloob, Federico Dehò, Vincenzo Mirone, Francesco Montorsi, and Andrea Salonia Edoardo PozziEdoardo Pozzi More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Luca BoeriLuca Boeri More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Nicolò SchifanoNicolò Schifano More articles by this author , Alessia d'Arma Alessia d'Arma More articles by this author , Rayan MatloobRayan Matloob More articles by this author , Federico DehòFederico Dehò More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002554.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile dysfunction (ED) has been demonstrated to be reasonably prevalent among young men (≤40 yr). We aimed to i) assess changes in patterns of reported ED in men ≤40 yr, and ii) compare the sociodemographic and clinical characteristics of ED men ≤40 yr vs. >40 yr of age over a 8-yr period at a single academic centre. METHODS: Data of 1179 patients seeking first medical help for ED and assessed by a single Sexual Medicine expert between 2013 and 2021 were analysed. All patients completed the IIEF at baseline. Descriptive statistics tested the sociodemographic and clinical characteristics of ED men ≤ 40 yr vs. > 40 yr of age. Within the two groups, multivariable linear regression models tested the association between advancing age and IIEF scores. Local polynomial regression models were applied to explore and graphically display ≤ 40 yr patients’ likelihood to report ED over the analysed time frame and to display changes of the IIEF-EF scores over increasing age between the two groups. RESULTS: Overall, median (IQR) age was 52 (41-62) yr. Median (IQR) IIEF-EF was 18 (15-22) at baseline. Of all, 268 (22.7%) were ≤40 yr whereas 911 (77.3%) were >40 yr at baseline. Rates of severe ED according to IIEF-EF did not differ between men ≤40 yr and >40yr (60 (22.4%) vs. 155 (17%)). No significant differences were found for the IIEF domains (-IS, -OS, -SD) but IIEF-OF domains, which scored higher in younger men (9 () vs. 8 (), p=0.002). At baseline, younger patients reported less comorbidities, less active smoking, lower BMI, higher total testosterone (tT) levels than older patients (all p<0.005). At linear regression models, within the ≤ 40 yr group, increasing age was not associated with changes across all IIEF domains. In contrast, in men > 40 yr, increasing age was linearly correlated with decreasing IIE-EF (all p<0.001), after adjusting for tT, BMI, CCI, smoking and arterial hypertension. Figure 1 graphically displays a stable 8-yr temporal trend of ≤40 yr ED patients. CONCLUSIONS: One out of five men seeking first medical help for ED at a single academic centre were younger than 40 yr. This trend has remained stable over the last 8-years. Increasing age among younger patients is not associated with worse erectile function as oppositely occurs among patients > 40 yr. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e331 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Edoardo Pozzi More articles by this author Paolo Capogrosso More articles by this author Giuseppe Fallara More articles by this author Luca Boeri More articles by this author Christian Corsini More articles by this author Daniele Cignoli More articles by this author Massimiliano Raffo More articles by this author Luigi Candela More articles by this author Nicolò Schifano More articles by this author Alessia d'Arma More articles by this author Rayan Matloob More articles by this author Federico Dehò More articles by this author Vincenzo Mirone More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Prevalence and Associated Risk Factors of Erectile Dysfunction in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Erectile dysfunction (ED) may be common in patients with inflammatory bowel disease (IBD), but its prevalence and risk factors still remain debatable. To evaluate the prevalence of ED in the IBD population and the potential role of risk factors in the development of ED. An extensive search in the PubMed, Cochrane Library, and Web of Science was performed to identify relevant English-language articles published up to December 2021 that evaluated the prevalence of ED on IBD patients. The included studies were evaluated by 2 independent reviewers for eligibility. We used an adapted Assessment Tool for Prevalence Studies to evaluate the quality of enrolled studies. Data were analyzed and graphed using the STATA software (version 16.0; Stata Corporation, College Station, TX, USA). The ORs with 95% CIs were pooled using a fixed or random-effects model according to heterogeneity. Subgroup analysis was performed to explore the source of heterogeneity. Sensitivity analysis was conducted to evaluate the stability of the results. The pooled prevalence of ED in IBD patients was calculated, and the OR value and 95% CIs were used to assess the strength of the association between IBD-related risk factors and ED. Fourteen studies included 32,858 individuals totally were enrolled for this meta-analysis. The overall pooled prevalence estimate of ED in IBD patients was 27% (95% CI: 20-34%). Operation (OR 1.28; 95% CI: 1.17-1.39; P < .00001; I2 = 0.0%), disease activity (OR 2.06; 95% CI: 1.07-3.05; P < .00001), and depression (crude OR 3.31; 95% CI: 1.08-5.54; P = .004; I2 = 0.0%) significantly increase the risk of ED in people with IBD. The association of depression and ED was further confirmed by calculating the pooled estimates of adjusted OR (1.58; 95% CI: 0.05-3.12; P < .05; I2 = 0.0%). The pooled prevalence estimates of ED were 30, 33, and 17% in the age <40, IIEF diagnostic tool, and IPAA surgery subgroups, respectively. IBD patients had a significantly increased prevalence of ED, indicating that erectile function in men with IBD should be concerned by clinicians. The strength of this study is that this is the first meta-analysis to assess the global prevalence and risk factors of ED in IBD patients. A limitation is that the results after pooling the included articles showed significant heterogeneity. The results of our meta-analysis and systematic review provide evidence of the high prevalence and risk factors of ED in IBD patients.

High estradiol level is associated with erectile dysfunction: A systematic review and meta-analysis.

Numerous studies conducted to study the role of testosterone in erectile dysfunction (ED) extensively, but less is known of the association between estradiol level and ED. To assess the strong association between estradiol and ED by quantitatively synthesizing all studies evaluating the relationship between estradiol and ED. An extensive literature search was conducted by two authors independently in three electronic databases, including PubMed, Web of Science and Cochrane Library, up to January 10, 2021. The Patient Population or Problem, Intervention, Comparison, Outcomes and Setting (PICOS) were used for inclusion criteria to identify studies. The Newcastle-Ottawa Scale was applied to assess the quality of studies. The standardized mean difference (SMD) and their corresponding 95% confidence intervals (95% CIs) were used to compare the estradiol level between ED patients and healthy subjects, and the pooled OR and 95%CI were used to evaluate the strong association between estradiol level and ED. Finally, six studies were included in this meta-analysis, satisfying predefined inclusion criteria. Five studies were considered to be high quality, and only one was judged of moderate quality. The estradiol level of ED patients was statistically higher than that in healthy subjects (SMD 0.45, 95%CI 0.28-0.63, p <0.0001). The pooled OR demonstrated that the estradiol was correlated to the ED significantly (OR 1.08, 95%CI 1.05-1.12, p <0.0001). Subgroup analyses were conducted based on age, diagnosis way, country, sample size, detection method and estradiol level. There was no substantial change in the result of SMD ranging from 0.41 (95% CI 0.31-0.51) to 0.53 (95% CI 0.44-0.62) when performing sensitivity analysis. No publication bias was detected by the Begg test or Egger test. This meta-analysis demonstrated that the estradiol level is correlated to ED significantly.

Nowoczesna terapia skojarzona tadalafilem i tamsulozyną jako schemat leczenia u mężczyzn z objawami ze strony dolnych dróg moczowych

Based on the available scientific research, tadalafil administered daily at a dose of 5 mg is safe and effective in the treatment of men with lower urinary tract symptoms and erectile dysfunction, compared to placebo or tamsulosin alone. The combination of 5 mg tadalafil and 0.4 mg tamsulosin daily allows for a better lower urinary tract symptoms improvement compared to monotherapy drugs, even with an increased, but acceptable and tolerable side effects. When tamsulosin or tadalafil is discontinued, lower urinary tract symptoms are significantly worsened compared to baseline in patients previously treated with combination therapy. Tadalafil 5 mg should be considered as one of the primary treatment options in lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction patients as it has an excellent tolerability, safety, and efficacy profile, both as monotherapy and in combination with 0.4 mg tamsulosin. Better effectiveness in alleviating lower urinary tract symptoms was observed with combination therapy while maintaining sexual function. Continuing to switch to monotherapy maintains lower urinary tract symptoms relief, but only tadalafil is able to maintain erectile dysfunction improvement. Our results support evidence of an increasingly tailored and modular lower urinary tract symptoms treatment.