Erectile Dysfunction Subjects Research Articles

Study of Association of Erectile Dysfunction in male subjects with the severity of Alcohol Dependence

Background: Alcohol dependence syndrome is a major public health problem, and it impacts the social, psychological, medical, economic, and religious spheres of our existence. Persistent alcohol abuse impacts sexual functioning negatively and leads to the onset of sexual dysfunction. Aim: This study was conducted to determine erectile dysfunction in males diagnosed with alcohol dependence syndrome and its association with the severity of alcohol dependence. Materials and Methods: The descriptive, non-interventional, cross-sectional study was conducted at the Department of Psychiatry in a tertiary care hospital where 78 subjects diagnosed with alcohol dependence syndrome were assessed for severity of dependence with the Severity of Alcohol Dependence Questionnaire (SADQ-C). Erectile dysfunction in these subjects was assessed with the International Index of Erectile Function scale (IIEF) and the severity of the same was correlated with the severity of alcohol dependence. Results: The results of our study indicated that erectile dysfunction was common in individuals having alcohol dependence syndrome and its severity was positively correlated with the severity of alcohol dependence. Unidentified sexual dysfunction may perpetuate alcohol dependence with poor response to deaddiction therapy. This information about sexual dysfunction due to alcohol dependence can also be used in motivational counseling of heavy drinkers to provide an impetus for change. Conclusions: The prevalence of erectile dysfunction was significantly higher than that of the general population. The same was significantly elevated in patients with severe alcohol dependence as compared to those with mild/moderate alcohol dependence.

The retinal neurovascular coupling is impaired in men with vasculogenic erectile dysfunction

The aim of this study was to study the retinal vessels in patients affected by vasculogenic erectile dysfunction (ED), using dynamic vessel analyzer (DVA). Patients with vasculogenic ED and control subjects were prospectively enrolled to undergo a complete urological and ophthalmologic evaluation, including DVA and structural optical coherence tomography (OCT). The main outcome measures were: (1) arterial dilation; (2) arterial constriction; (3) reaction amplitude (the difference between arterial dilation and constriction); and, (4) venous dilation. Thirty-five patients with ED and 30 male controls were included in the analysis. Mean ± SD age was 52.0 ± 10.8 years in the ED group and 48.1 ± 16.3 years in the control group (p = 0.317). In the dynamic analysis, the arterial dilation was lower in the ED group (1.88 ± 1.50%), as compared with the control group (3.70 ± 1.56%, p < 0.0001). Neither arterial constriction nor venous dilation differed between groups. The reaction amplitude was decreased in ED patients (2.40 ± 2.02%, p = 0.023), compared to controls (4.25 ± 2.20%). In the Pearson correlation analysis, the ED severity, was directly correlated with both reaction amplitude (R = .701, p = 0.004) and arterial dilation (R = .529, p = 0.042). In conclusion, subjects with vasculogenic ED are featured by a significant dysfunction of the retinal neurovascular coupling, which is inversely correlated with ED severity.

Education degree predicts cardiovascular outcomes in men suffering from erectile dysfunction.

The level of education has been recognized as a cardiovascular risk factor; nevertheless, it is often neglected in cardiovascular risk prediction. To evaluate the psychobiological correlates of the level of education and if it could predict incident major adverse cardiovascular events in men consulting for erectile dysfunction. Total 3733 men (49.8±13.7years old) attending an andrology outpatient clinic for erectile dysfunction were studied. Sexual and psychological symptoms, hormonal and metabolic, as well as instrumental (penile color Doppler ultrasound) parameters were evaluated according to the education level (university, upper secondary, lower secondary, and primary degree). For a subset of 956 patients, data on incident major adverse cardiovascular events were retrospectively collected for 3.9±2.4years. As compared with men with university degree, those with a lower education had an increased frequency of moderate-severe erectile dysfunction (odds ratio=1.21 [0.99;1.48], 1.41 [1.14;1.73], 1.70 [1.26;2.30] for upper secondary, lower secondary, and primary school, respectively) and reduced flaccid peak systolic velocity at penile color Doppler ultrasound. Men with a lower level of education tend to suffer from metabolic syndrome (odds ratio=1.38 [1.06;1.79], 1.73 [1.34;2.24], 1.72 [1.24;2.37] for upper secondary, lower secondary, and primary school, respectively) and were more likely to have history of previous cardiovascular events. In the longitudinal study, men with a higher level of education had a significantly lower incidence of major adverse cardiovascular events. The role of higher education as an independent predictor of major adverse cardiovascular events was established by multivariable Cox regressions (hazard ratio=2.14 [1.24-3.69]). In erectile dysfunction subjects, lower level of education is associated with a more severely impaired erectile function with atherogenic pathogenesis and with a worse cardio-metabolic profile. In addition, a lower level of education predicts forthcoming major adverse cardiovascular events. Therefore, education level should be considered as a costless but valuable information in the assessment of cardiovascular risk in patients with erectile dysfunction.

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.

Efficacy and Safety of Avanafil in Chinese Subjects With Erectile Dysfunction: A Multi-Center, Randomized, Double-Blinded, Placebo-Controlled Phase III Clinical Trial.

IntroductionThe incidence of erectile dysfunction (ED) increases with age in mainland China and phosphodiesterase 5 inhibitors (PDE5i) are the major drugs used for its treatment.AimTo determine the efficacy and safety of Chinese developed avanafil as therapy for ED in China.MethodsThis phase III trial was carried out in 7 medical centers in China. Eligible subjects suffering from ED were allocated randomly into 3 groups (ratio 1:1:1) and orally received a placebo, 100 or 200 mg avanafil for a total of 12 weeks.Main outcome measuresThe primary endpoint was changes in erectile function (EF) domain scores according to the International Index of EF (IIEF) questionnaire from baseline to week 12 of therapy. Secondary endpoints assessments were changes in the response rates of SEP, Q2 and Q3; changes in IIEF other domain scores. Safety evaluation monitored treatment-emergent adverse events (TEAEs), serious TEAEs, laboratory test results, vital signs and electrocardiographs.ResultsOf 218 randomized ED subjects, 182 (83.5%) completed the study. After 12-week therapy, alterations from baseline of the mean IIEF-EF domain scores in the 100 mg and 200 mg groups were greater than for the placebo (all P < .05) group. The changes in mean SEP Q2 response rates from baseline to week 12 in the placebo, 100 mg and 200 mg groups were 5.4%, 22.3% and 22.1%, and SEP Q3 response rate were 22.7%, 42.6% and 38.1%, respectively. Avanafil treatment (regardless of dose) improved EF vs placebo for most of other secondary efficacy endpoints studied (all P < .05). No differences were detected in efficacy endpoints between the 100 and 200 mg dosage groups (all P > .05) or in the incidence of TEAEs and drug-related TEAEs among the 3 groups (all P > .05).ConclusionAvanafil (100 or 200 mg) was effective and generally well tolerated in Chinese subjects with ED.Jiang H, Lin H, Li F, et al. Efficacy and Safety of Avanafil in Chinese Subjects With Erectile Dysfunction: A Multi-Center, Randomized, Double-Blinded, Placebo-Controlled Phase III Clinical Trial. Sex Med 2021;9:100337.

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

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

Enhanced Contribution of Orai Channels to Contractility of Human Penile Smooth Muscle in Erectile Dysfunction

BackgroundStore-operated calcium entry and its key players, stromal interaction molecule (STIM) and Orai calcium channels, have been proposed as emergent therapeutic targets in cardiovascular pathophysiology. We hypothesize alteration of STIM/Orai signaling in erectile dysfunction (ED). AimTo evaluate the contribution of STIM/Orai to human penile tissue contraction and to analyze the influence of ED on STIM/Orai signaling at functional and expression levels in human penile vascular tissues. MethodsHuman penile resistance arteries (HPRA) and human corpus cavernosum (HCC) were dissected from cavernosal specimens from 30 organ donors without history of ED (No ED) and from 48 patients with ED undergoing penile prosthesis insertion and functionally evaluated in wire myographs and organ chambers, respectively. Expression of STIM-1, Orai1, and Orai3 in HCC was localized and quantified by immunofluorescence. Main Outcome MeasuresThe main outcome measures are functional responses in HCC and HPRA and STIM/Orai channel protein expression in human cavernosal tissue. ResultsInhibition of Orai channels with YM-58483 (20 μM) significantly reduced norepinephrine–induced contractions in both HCC and HPRA from either No ED or ED subjects, but the effects were more marked in ED (−20.1 ± 5.9% vs −45.5 ± 13.2% and −15.9 ± 4.0% vs −31.4 ± 6.9% reduction in Emax to norepinephrine in HCC and HPRA, respectively). Thromboxane-induced contractions were reduced and neurogenic contractile and relaxant responses modulated by Orai inhibition in penile tissues from patients with ED. In fact, addition of YM-58483 concentration dependently relaxed precontracted HPRA and HCC. These relaxations were significantly more pronounced in tissues from patients with ED (EC50 7.5 vs 1.3 μM and 10.5 vs 1.3 μM, for HCC and HPRA, respectively). All HCC specimens displayed expression of STIM-1, Orai1, and Orai3. Significantly increased expression of Orai1 and Orai3 but not STIM-1 was observed in patients with ED. Clinical TranslationInhibition of enhanced Orai activity in human penile vascular tissue could facilitate erectile responses, alleviating ED. Strengths and LimitationsEnhanced STIM/Orai activity contribution to penile smooth muscle tone in ED is demonstrated at functional and structural levels in human tissues from a representative sample of patients with ED and in comparison with healthy tissue. We cannot differentiate the specific contribution of risk factors associated with ED to hyperactivity of the Orai system. ConclusionsOrai channels significantly contribute to human penile smooth muscle contraction. Orai contribution to penile smooth muscle tone is functionally enhanced in ED accompanied by increased expression of Orai channels in cavernosal tissue. Orai inhibition could be a potential therapeutic strategy to reduce penile smooth muscle contraction in ED.Sevilleja-Ortiz A, El Assar M, García-Rojo E, et al. Enhanced Contribution of Orai Channels to Contractility of Human Penile Smooth Muscle in Erectile Dysfunction. J Sex Med 2020;17:881–891.

AGE-RELATED CORRELATION BETWEEN ERECTILE DYSFUNCTION AND PREMATURE EJACULATION

Background and objectiveTo evaluate the relationship between erectile dysfunction (ED) and premature ejaculation (PE) among men aged 40–79 years and to compare age-related differences between men aged 40–59 years and 60–79 years. Materials and methodsFrom January 2014 to January 2019, records of 892 men aged 40–79 years were analyzed. We performed correlation analysis using the self-reported intravaginal ejaculation latency time (IELT), premature ejaculatory diagnostic tool (PEDT), Male Sexual Health Questionnaire-ejaculation (MSHQ-EjD), and International Index of Erectile Function5 (IIEF5) questionnaires. ResultsThe mean age of the 892 males was 52.8 ± 7.3 years (40–76). All subjects were divided into group 1 (40–59 years old) and group 2 (60–79 years old). The IIEF5 score of group 1 was significantly higher than that of group 2 (18.7 ± 5.5 vs. 17.7 ± 5.7, p = 0.049). Of the total subjects, 71 (8%) had IELT value of less than 1 min. A total of 51 (6.9%) and 20 (13.5%) were in groups 1 and 2, respectively (p = 0.02). The PEDT total score was higher and more subjects were identified as suffering from PE (PEDT ≥ 9) from amongst the ED subjects (IIEF-5 ≤ 21). In both groups 1 and 2, more PE subjects were identified in ED subjects (IIEF-5 ≤ 21) than normal subjects (IIEF-5 &gt; 21) (all p &lt; 0.01). In the total subjects, group 1 and 2, the IIEF-5 and PEDT score showed a weak negative correlation (r = −0.302, r = −0.361, r = −0.248, all p &lt; 0.01). In group 2, the IELT and MSHQ-EjD score also showed a weak positive correlation between the IIEF-5 score (r = 0.166, p = 0.044 and r = 0.164, p = 0.047, respectively). ConclusionMore subjects defined PE value as less than 1 min on the self-reported IELT in the elderly group ≥60 years than those among the 40–59 years age group; moreover, the lower the IIEF5 total score among subjects ≥ 60 years, the higher the PEDT score and the lower the IELT and MSHQ-EjD scores.

The association of Intron 4 VNTR and Glu298Asp polymorphisms of the nitric oxide synthetase 3 gene and vasculogenic erectile dysfunction in Turkish men

ABSTRACTSeveral studies have focused on the impaired role of endothelial nitric oxide synthase (NOS3) gene polymorphism and its association to erectile dysfunction (ED). However, currently controversial results have been reported due to their significant heterogeneity. The present study aimed to assess the genotypic distribution and the allelic frequency of Intron 4 VNTR and Glu298Asp gene polymorphisms in vasculogenic ED patients compared to healthy controls of a specific region of Turkey. A total of 75 patients with ED (median age: 56, IQR:10.5) and 75 healthy controls (median age: 56, IQR:10.5) were prospectively analyzed. All subjects were equally evaluated by the same physician with detailed history-taking, physical examination, International Index of Erectile Function (IIEF) questionnaire, and blood tests (incl. glucose, testosterone, triglyceride and total cholesterol level). Those with an IIEF score under 26 were considered to have ED, by classifying them according to their scores as mild (22–25), moderate (11–21) and severe (1–10) ED. Color doppler ultrasonography was carried out in patients with an IIEF score <22. Hypertension, diabetes mellitus, coronary artery disease, and smoking status were significantly associated with the ED group compared to control subjects with p values of <0.001, <0.001, 0.002 and <0.001, respectively. Overall genotype frequencies was 47 (31%) a/a, 22 (15%) a/b, 82 (55%) b/b for Intron 4 VNTR and 56 (37%) GG, 78 (52%) GT, 16 (11%) TT for the Glu298Asp polymorphism. The frequencies of Intron 4 VNTR a/a allele and Glu298Asp GT allele were associated with severe ED, while a/b and TT were associated with moderate or mild, and b/b and GG were associated with no ED. In contrast to Glu298Asp, statistically significant differences in genotypic frequencies of Intron 4 VNTR gene polymorphism between ED and control subjects was established.Abbreviations: NO: nitric oxide, NOS: nitric oxide synthase, NOS3: endothelial nitric oxide synthase, NOS2: inducible nitric oxide synthase, NOS1: neuronal nitric oxide synthase, HT: hypertension, DM: diabetes mellitus, CAD: coronary artery disease, ED: erectile dysfunction, IIEF: international index of erectile function, VNTR: variable number of tandem repeats, CDU: color doppler ultrasonography, PCR: polymerase chain reaction.

Osteoporosis risk-assessment related lifestyle and metabolic factors: A population-based study

Background: Several studies have investigated the risk factors for osteoporosis in China, but little is known about the situation of osteoporosis in Southern China in recent years. Our present study investigates the osteoporosis risk factors of total population, male population and female population in Southern Chinese community-based population, aiming to suggest more effects for prevention and control of osteoporosis. Materials: A multistage stratified random cluster sampling design was used in this cross-sectional study conducted in 2015. Osteoporosis was defined as T scores ≤ -2.5 at root bone. Unconditional and multivariate logistic regression analysis was used to calculate Odds Ratios (ORs) and 95% Confidence Intervals (CIs). Propensity Score (PS) matching analysis and Receiver Operating Characteristic (ROC) curve were used to control potential confounding and evaluate the predictive value of prediction model, respectively. Results: The estimated prevalence of osteoporosis in Southern China of Guangzhou was 16.69%. Osteoporosis was positively associated with age, education level, vitamin D intake, physical activity, weight, neck circumference, waistline and total cholesterol level in total population. Increased weight level was association with low risk of osteoporosis. Besides, erectile dysfunction subjects with low bone mineral density in male population and menopause was independent risk factor for development of osteoporosis in female population. What’s more, occasional and moderate drinking was protective factor for osteoporosis only in female population. Our study suggests that the roles of fat distribution but not only for fat quantity should be taken seriously to explore the association with osteoporosis. Conclusion: We observed a high prevalence of osteoporosis among the Southern China in Guangzhou City. Meanwhile, our study lends support that some related lifestyle and metabolic factors may be the association factors for the development of osteoporosis. Government and health department should take measures to improve people’s awareness of osteoporosis and reduce the prevalence of osteoporosis in Southern China. Our results will provide latest scientific evidence for health policy formulating.

018 Antagonizing penile smooth muscle contraction by inhibition of orai calcium channels. A potential therapeutic target in erectile dysfunction

Initially considered as irrelevant for vascular smooth muscle contraction, recent evidences propose store operated calcium entry (SOCE) and its key players, stromal interaction molecule (STIM) and Orai calcium channels as emergent therapeutic targets in cardiovascular pathophysiology. The aim was to evaluate the contribution of STIM/Orai in human penile tissue contraction and to analyze the influence of erectile dysfunction (ED) at functional and expression levels. Human penile resistance arteries (HPRA) and corpus cavernosum (HCC) were dissected from cavernosal specimens from 15 organ donors (OD) without history of ED and from 20 ED patients undergoing penile prosthesis insertion and functionally evaluated in wire myographs and organ chambers, respectively. All ED patients presented cardiovascular risk factors. Expression of STIM-1, Orai1 and Orai3 in HCC was localized and quantified by immunofluorescence. Inhibition of Orai channels with YM-58483 (20 μM) significantly reduced norepinephrine (NE)-induced contractions in both HCC and HPRA from either OD or ED subjects but the effects were more marked in ED (19.1±9.1% vs.47.3±13.1% and 11.5±2.8% vs.28.7±2.7% reduction in Emax to NE in HCC and HPRA, respectively). Thromboxane- and KCl-induced contractions were also reduced by Orai inhibition. In fact, addition of YM-58483 concentration-dependently relaxed precontracted HPRA and HCC. These relaxations were significantly more pronounced in tissues from ED patients (EC50 7.5 vs. 1.3 μM and 10.5 vs. 1.3 μM, for HCC and HPRA, respectively). All analyzed HCC specimens displayed expression of STIM-1, Orai1 and Orai3. Increased expression of Orai1 (+47.5±10.1%) and Orai3 (+82.2±14.4%, p<0.05) but not STIM-1 was observed in ED patients.

Elevated serum homocysteine level as an independent risk factor for erectile dysfunction: a prospective pilot case-control study.

Homocysteine is an amino acid that is produced from the metabolic demethylation of dietary methionine. It has gained arising attention for its association with increased risk of myocardial infarction, stroke and venous thromboembolism. Erectile dysfunction (ED), especially for vasculogenic ED, is a vascular disorder of cavernosal vascular bed. In this prospective pilot case-control study, we investigated plasma homocysteine levels in 32 ED patients and 20 healthy control men. Related patients characteristics including age, weight, height, marital status, smoking and drinking status, level of education were collected and analysed as well as penile colour Doppler ultrasound parameters. ED patients were further categorised into mild, moderate and severe ED based on 5-item of the International Index of Erectile Function. Higher homocysteine levels were observed in ED patients as compared with controls (p<.05). A multivariate logistic regression with likelihood ratio test revealed that homocysteine and penile peak systolic blood flow velocity (PSV) levels posed significant indicators for ED (chi-square of likelihood ratio=20.42, df=2, p<.005) as well as moderate and severe ED occurrence (chi-square of likelihood ratio=28.50, df=2, p<.005). The threshold value of homocysteine concentration to discriminate ED and control subjects was 12.65μmol/L by performing receiver operating characteristic curve analyses. These data suggested that elevation of homocysteine levels was associated with an increased risk of ED.

Erectile Dysfunction in Male Survivors of Childhood Cancer-A Report From the Childhood Cancer Survivor Study.

With survival rates higher than 80%, the number of survivors from pediatric cancer continues to increase. Late effects resulting from cancer and cancer therapy are being characterized, but little information exists on sexual health for men who have survived childhood cancer. To assess erectile dysfunction (ED) in men who survived childhood and adolescent cancers and to identify potential risk factors for ED. In total, 1,622 men and 271 eligible brothers in the Childhood Cancer Survivor Study cohort completed the Male Health Questionnaire, which provided information on sexual practices and sexual function. Combined with demographic, cancer, and treatment information from medical record abstraction, results of the Male Health Questionnaire were analyzed using multivariable modeling. The International Index of Erectile Function was used to identify ED in subjects. International Index of Erectile Function. Survivors (mean age= 37.4 years, SD= 7.3 years) reported significantly lower sexual activity in the year before the survey than the brothers (mean age= 38.8 years, SD= 8.5 years) without cancer. ED was reported by 12.3% (95% CI= 10.4-14.3) of survivors and 4.2% (95% CI= 2.0-7.9) of brothers. Survivors showed significantly higher relative risk (RR) for ED (RR= 2.63, 95% CI= 1.40-4.97). In addition to older age, survivors who were exposed to higher-dose (≥10 Gy) testicular radiation (RR= 3.55, 95% CI= 1.53-8.24), hadsurgery on the spinal cord or nerves (RR= 2.87, 95% CI= 1.36-6.05), prostate surgery (RR= 6.56, 95% CI= 3.84-11.20), or pelvic surgery (RR= 2.28, 95% CI= 1.04-4.98) were at higher risk for ED. Men who have survived childhood cancer have a greater than 2.6-fold increased risk for ED and certain cancer-specific treatments are associated with increased risk. Attention to sexual health, with its physical and emotional implications, and opportunities for early detection and intervention in these individuals could be important.

The interaction of serum testosterone levels and androgen receptor CAG repeat polymorphism on the risk of erectile dysfunction in aging Taiwanese men.

Testosterone has been found to play important roles in men's sexual function. However, the effects of testosterone can be modulated by androgen receptor (AR) CAG repeat polymorphism. It could also contribute to the risk of erectile dysfunction (ED). The aim of this study is to evaluate the interaction of serum testosterone levels and AR CAG repeat polymorphism on the risk of ED in aging Taiwanese men. This cross-sectional data of Taiwanese men older than 40 years were collected from a free health screening held between August 2010 and August 2011 in Kaohsiung city, Taiwan. All participants completed a health questionnaires included five-item version of the International Index of Erectile Function (IIEF-5) and the International Prostate Symptoms Score, received a detailed physical examination and provided 20 cm3 whole blood samples for biochemical and genetic evaluation. The IIEF-5 was used to evaluate ED. Serum albumin, total testosterone (TT), and sex hormone-binding globulin levels were measured. Free testosterone level was calculated. AR gene CAG repeat polymorphism was determined by direct sequencing. Finally, 478 men with the mean age of 55.7 ± 4.8 years were included. When TT levels were above 330 ng/dL, the effect of testosterone level on erectile function seemed to reach a plateau and a significantly negative correlation between AR CAG repeat length and the score of IIEF-5 was found (r = -0.119, p = 0.034). After adjusting for other covariates, the longer AR CAG repeat length was still an independent risk factor for ED in subjects with TT above 330 ng/dL (p = 0.006), but not in TT of 330 ng/dL or below. In conclusion, both serum testosterone levels and AR CAG repeat polymorphism can influence erectile function concomitantly. In subjects with normal TT concentration, those with longer AR CAG repeat lengths have a higher risk of developing ED.

Erectile Dysfunction: Clinical and Epidemiological Aspects in Senegal

Introduction: The objective of our study was to analyze the clinical and epidemiologic aspects of erectile dysfunction in subjects with different comorbidities in Senegal. Patients and Methods: This was a retrospective study over a period of 2 years on patients who presented themselves for consultation for erectile dysfunction. The study was carried out in the regions of Dakar and Thies at the Ouakam geriatric center and the Saint Jean of god Hospital of Thies respectively. Results: We enrolled into the study 402 patients with erectile dysfunction. The average age of our patients was 47 ± 5 years. Patients aged more than 60 years were the most. The majority of our patients had less than secondary school level education, 211 in total representing 52.5% of the study population compared to 14.9% having post baccalaureate level. A large number of these patients had professional activities (53.3%), followed by retirees (29.6%). Polygamous patients were more in number (51.5%). In our study sample, we registered 120 active smokers (29.9%). A hundred and ten of our patients were sedentary for periods of 5 months to 22 years. The average length of time before seeking help for erectile dysfunction in our patients was 2.8 years. Severe erectile dysfunction was predominant in the smoking group (54.2%) compared to (9.9%) in the non-smoking group. We found a large proportion of severe and moderate erectile dysfunction (66.3%) and (31.7%) respectively in diabetic than non-diabetic patients. Severe erectile dysfunction was more in hypertensive and diabetics. Severe erectile dysfunction was more present in hypertensive plus smokers (83.9%) than in non-smoking hypertensive patients (68.6%). Severe ED was found more in hypertension and diabetic subjects. Conclusion: Erectile dysfunction is most frequently related on one side to socio-environmental factors, and to co-existing comorbidities on the other side.

EFFECT OF PLASMA ANGIOTENSIN CONVERTING ENZYM IN ERECTILE DYSFUNCTION

Objective:The aim of this study was to know the effect of aging and I/D angiotensin converting enzymes (ACE) gene polymorphisms in modulating plasma ACE level in erectile dysfunction(ED) subjects.Material &amp; method:This case control study carried out in Makassar with 83 male subjects (49 ED subjects and 34 normal subjects). International Index of Erectile Function-5 was used for ED diagnosis while plasma ACE level and genotyping ACE gene examined with ELISA test and Rigat PCR method respectively.Results:The data showed that plasma ACE level siginificantly higher in ED group compared to normal group, while the plasma ACE level consistently raised following the increased of age in ED group but did not statistically significant (p&gt;0.05) compare to normal group. DD genotype in ED group had mean plasma ACE higher compared to ID and II subjects eventhough did not statistically significant.Conclusion: The high level of ACE plasma appeared to have a pivotal rule in ED mechanisms as well as in older ED subjects. DD genotype partly modulated the raising of plasma ACE in ED subject comprared to ID and II genotype. Keywords: Plasma ACE level, erectile dysfunction.

Levels of human erythrocyte membrane-bound and cytosolic glycohydrolases are associated with oxidative stress in erectile dysfunction patients.

Oxidative stress (OS) and production of NO, by endothelium nitric oxide synthetase (eNOS), are involved in the pathophysiology of erectile dysfunction (ED). Moreover, OS induces modifications of the physicochemical properties of erythrocyte (RBC) plasma membranes and of the enzyme content of the same membranes. Due to their role in signalling early membrane alterations in OS-related pathologies, several plasma membrane and cytosolic glycohydrolases of human RBC have been proposed as new markers of cellular OS. In RBC, NOS can be activated and deactivated by phosphorylation/glycosylation. In this regulatory mechanism O-β-N-AcetylGlucosaminidase is a key enzyme. Cellular levels of O-GlcNAcylated proteins are related to OS; consequently dysfunctional eNOS O-GlcNAcylation seems to have a crucial role in ED. To elucidate the possible association between RBC glycohydrolases and OS, plasma hydroperoxides and antioxidant total defenses (Lag-time), cytosolic O-β-N-AcetylGlucosaminidase, cytosolic and membrane Hexosaminidase, membrane β-D-Glucuronidase, and α-D-Glucosidase have been studied in 39 ED patients and 30 controls. In ED subjects hydroperoxides and plasma membrane glycohydrolases activities are significantly increased whereas Lag-time values and cytosolic glycohydrolases activities are significantly decreased. These data confirm the strong OS status in ED patients, the role of the studied glycohydrolases as early OS biomarker and suggest their possible use as specific marker of ED patients, particularly in those undergoing nutritional/pharmacological antioxidant therapy.

The SIAMS-ED Trial: A National, Independent, Multicentre Study on Cardiometabolic and Hormonal Impairment of Men with Erectile Dysfunction Treated with Vardenafil.

Increased cardiovascular risk has been associated with reduced response to proerectile drugs. The Italian Society of Andrology and Sexual Medicine (SIAMS) promoted an independent, multicenter study performed in 604 men (55 ± 12 yrs) suffering from erectile dysfunction (ED) to assess multiple health outcomes and response to 6-month vardenafil challenge in a real-life setting. Overall, 30.8% men had metabolic syndrome. Cardiovascular risk stratification revealed a greater number of ED subjects with moderate risk of a major adverse cardiovascular event than the general population (P < 0.01). Age-adjusted pulse pressure was positively correlated with ED severity and negatively with androgens and waist circumference (P < 0.01). A decline in total testosterone was observed with increasing arterial pulse pressure (P < 0.05), which was not accompanied by compensatory LH rise. Follow-up on 185 men treated with vardenafil in an nonrandomized, open, single-arm trial documented a significant rise in IIEF-5 (delta = 6.1 ± 4.8) that was maintained in men with high cardiovascular risk. Mild adverse events occurred in <5%, with no differences between cardiovascular risk classes. In summary, ED is a frequent symptom in patients with an elevated, but often unknown, risk of future cardiovascular events. Androgens predict vascular resistance in ED patients. Vardenafil's response and safety profile were preserved in subjects with higher cardiovascular risk.

Erectile dysfunction and central obesity: an Italian perspective

Erectile dysfunction (ED) is a frequent complication of obesity. The aim of this review is to critically analyze the framework of obesity and ED, dissecting the connections between the two pathological entities. Current clinical evidence shows that obesity, and in particular central obesity, is associated with both arteriogenic ED and reduced testosterone (T) levels. It is conceivable that obesity-associated hypogonadism and increased cardiovascular risk might partially justify the higher prevalence of ED in overweight and obese individuals. Conversely, the psychological disturbances related to obesity do not seem to play a major role in the pathogenesis of obesity-related ED. However, both clinical and preclinical data show that the association between ED and visceral fat accumulation is independent from known obesity-associated comorbidities. Therefore, how visceral fat could impair penile microcirculation still remains unknown. This point is particularly relevant since central obesity in ED subjects categorizes individuals at high cardiovascular risk, especially in the youngest ones. The presence of ED in obese subjects might help healthcare professionals in convincing them to initiate a virtuous cycle, where the correction of sexual dysfunction will be the reward for improved lifestyle behavior. Unsatisfying sexual activity represents a meaningful, straightforward motivation for consulting healthcare professionals, who, in turn, should take advantage of the opportunity to encourage obese patients to treat, besides ED, the underlying unfavorable conditions, thus not only restoring erectile function, but also overall health.

Frequency of sexual activity and cardiovascular risk in subjects with erectile dysfunction: cross-sectional and longitudinal analyses

Erectile dysfunction (ED) is risk factor for cardiovascular (CV) events. The relationship between sexual activity and incident major adverse cardiovascular events (MACE) in subjects at high CV risk is conflicting and never investigated in ED subjects. The aim of this study was to investigate relationships between frequency of sexual attempts and incident MACE and to retrospectively explore its main determinants in subjects with sexual dysfunction. A consecutive series of 2187 subjects (mean age 49.9±11.6years old) attending the Outpatient Clinic for sexual dysfunction was retrospectively studied. A subset of the previous sample (N=1687) was enrolled in a longitudinal study. Frequency of sexual intercourse (coital and non-coital) was assessed using a standard question ('During the last 3months how many sexual attempts per month did you have?'). In the whole sample, sexual attempts were an age- and testosterone-dependent phenomenon, while no association between frequency of sexual intercourse and ED or premature and delayed ejaculation, was observed. However, when the same analysis was performed according to age tertiles (I=17-46, II=47-59, III=60-88years old), ED was significantly associated with a higher risk of reduced sexual intercourse in younger (hazard ratio=1.857 [1.066-3.234]; p=0.029), but not in middle-aged or older individuals. The marital component, as assessed by SIEDY Scale 2, played a major role in regulating sexual frequency in all age bands. Depressive symptoms represent another independent risk factor for reduced sexual activity (adj r=-0.139; p<0.0001), in an age-dependent manner. When longitudinal data were analysed, a higher frequency of sexual intercourse significantly reduced the risk of MACE even after adjusting for known CV risk factors for this cohort. Identifying among mild-to-moderate ED subjects those with lower frequency of sexual activity might provide an opportunity to modify their behaviour and to discover subthreshold comorbidities, possibly preventing forthcoming CV events.