Erectile Function In Patients Research Articles

Liver transplantation improves erectile function in patients with end-stage liver disease: a systematic review and meta-analysis.

Liver transplantation (LT) has been recognized as the most effective therapy for end-stage liver disease (ESLD). However, the question of whether LT can improve erectile function in patients with ESLD remains controversial. Therefore, we conducted this meta-analysis to evaluate the association between LT and erectile dysfunction (ED). According to the PRISMA guidelines, studies were included after conducting searches in four databases from March 2024 onwards. These databases included PubMed, Cochrane Library, Web of Science, and Embase. The primary outcome of interest was to compare the International Index of Erectile Function (IIEF) scores between patients after and before LT. Standardized mean differences (SMDs) and their corresponding 95% confidence intervals (CIs) were utilized to assess the relationship between LT and ED. The results showed that the LT group had higher IIEF-5 domain scores for erectile function compared to the control group (SMD =-0.31, 95% CI: -0.53 to -0.09), P=0.007). No heterogeneity or publication bias was detected in the results. Additionally, the IIEF-15 domain score was also found to be improved after LT. Specifically, the LT group had higher domain scores for erectile function (SMD =-0.77, 95% CI: -1.07 to -0.48, P<0.001), orgasmic function (SMD =-0.82, 95% CI: -1.12 to -0.52, P<0.001), sexual desire (SMD =-0.89, 95% CI: -1.19 to -0.59, P<0.001), intercourse satisfaction (SMD =-0.92, 95% CI: -1.22 to -0.62, P<0.001), and overall satisfaction (SMD =-0.87, 95% CI: -1.17 to -0.57, P<0.001). It is suggested by our meta-analysis that LT may contribute to improvements in erectile function among men with ESLD. This improvement may be related to the remarkable improvement in endocrine hormone disorders observed after LT. However, future studies with better designs and larger sample sizes are still needed to confirm our conclusions. Additionally, attention to erectile function before and after surgery in patients with liver failure is crucial.

THE ANALYSIS STUDY OF RENAL TRANSPLANTATION BENEFITS PATIENTS WITH END-STAGE RENAL DISEASE BY IMPROVING ERECTILE FUNCTION: A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Renal transplantation is a highly effective treatment for end-stage renal disease (ESRD), addressing the impact of erectile dysfunction on quality of life. Erectile dysfunction, characterized by the inability to achieve and sustain an erection for good sexual activity, affects the physical and psychological well-being of individuals and their partners. However, research on the impact of renal transplantation on erectile dysfunction has yielded conflicting results. Understanding the beneficial impacts of renal transplantation on erectile dysfunction could potentially lead to more successful outcomes. Methods: Adhering to the PRISMA 2020 standards, this systematic investigation sought to examine complete English literature texts published from 2004 until 2024. Only editorials and review articles that had a Digital Object Identifier (DOI) and were published in the same magazine as the submission were considered for acceptance. We utilized many sources, such as ScienceDirect, PubMed, and SagePub, to acquire the literature. Result: The study examined over 40 papers sourced from reliable venues like Science Direct, SagePub, and PubMed. After selecting eight papers for further scrutiny, a comprehensive analysis of the complete corpus of literature was conducted. Conclusion: Renal transplantation has shown significant improvement in erectile function in patients with end-stage renal disease (ESRD), with a lower prevalence of erectile dysfunction and higher function scores. Factors such as pretransplantation IIEF-5 score, age, and anastomosis to the common iliac artery have significant associations with improved erectile function. However, the exact mechanism behind this effect remains unclear.

Evaluation of platelet-rich fibrin matrix combined with PGE-1 injection on erectile function in patients with refractory response to PDE5-I: a randomized placebo-controlled study.

We studied the effect of a platelet-rich fibrin matrix (PRFM) combined with prostaglandin E-1 (PGE-1) injection on erectile function in patients refractory to response for phosphodiesterase type 5 inhibitors (PDE5-Is). This randomized, double-blind, placebo-controlled study included 80 patients. The patients were randomly assigned to four groups and blinded together with the administrating physicians to the nature of the intracorporeal injection (ICI) therapies. Group (1) received saline, group (2) received platelet-rich fibrin matrix (PRFM), group (3) received prostaglandin E-1 (PGE-1), and group (4) received a combination of PRFM + PGE-1. The patients received ICI therapy weekly for 8 consecutive weeks. Clinical information and follow-up data were obtained at 1, 2, 3, and 6months. A significant increase occurred in the validated Arabic version of the International Index of Erectile Function (ArIIEF-5) score in group (4) compared to the other three groups (p value = 0.037). There was a significant difference in erection hardness scale (EHS) scores among all groups after receiving the different treatments (p = 0.004). A significant increase was seen in the ArIIEF-5 score in groups 4 and 3 compared to that in groups 1 and 2 (p < 0.001). There was also a significant increase in the arterial dilatation % in groups 4 and 3 compared to that in groups 1 and 2 (p = 0.019). The combination of PRFM plus PGE-1 had shown significant improvement in the ArIIEF-5 score, yet the patients still had mild to moderate ED.

Efficacy of Aphrodisiac Drugs Combination with Phosphodiesterase-5 (PDE5) Inhibitors in Patients with Erectile Dysfunction (Pilot Study)

Abstract Background Erectile dysfunction is a common medical disorder that primarily affects men older than 40 years of age. Many lines of treatments are used. An aphrodisiac is defined as any food or drug that arouses the sexual instinct, induces sexual desire and increases pleasure and performance. Aim of the Work The aim of this study to assess the efficacy of aphrodisiac drugs (Cavigen), in combination with Phosphodiesterase-5 (PDE5)”Sildenafil” Inhibitors in management of erectile dysfunction in men responding to Phosphodiesterase-5 (PDE5) inhibitors in patients with (IIEF) score: Mild (22-25), mild to moderate (17-21). Patients and Methods This study was a prospective, double-blind, case control placebo (pilot study) performed at the outpatient clinic of the Department of Urology and Andrology, Ain Shams University hospitals. The number of patients after the dropouts and exclusion were 40 patients, twenty in each group one group was administrated gingko biloba capsules(Cavigen) twice daily combined with phosphodiesterase 5 inhibitor (Viagra) on demand and the other one administrated placebo capsules similar to the ginkgo biloba twice daily combined with phosphodiesterase 5 inhibitor (Viagra) on demand. The study protocol was approved by our institutional review board. This study was performed in accordance with the Consolidated Standards of Reporting Trials (CONSORT) statement and all participants provided written informed consent before nrolment. Patients were recruited from February 2020 to August 2020 and the final results were obtained in August 2020. Results The present study enrolled two well matched groups, twenty patients in each group as regard base line characteristics including demographic data, pretreatment IIEF total score and pretreatment type of ED. The present study enrolled two well matched groups and both groups showed improvement but there was no significant difference between the studied groups as regard IIEF total score and type of ED at one- and three- months posttreatment. After 6 months posttreatment there was significant difference between the studied groups as regard IIEF total score and type of ED with superiority of combined treatment group. The amount of increase in total score of IIEF after 6 months was found significantly higher in study group (6.35±3.38) than control group (2.15 ± 2.13) with p-value &amp;lt;0.001. In both of studied groups, we found that there was statistically significant increase in the total score of IIEF after 1 month, 3 months and 6 months than pre study and also increase in the percentage of no ED cases after 1 month, 3 months and 6 months than pre study. Conclusion Our findings demonstrate that two Ginkgo Biloba capsules oral intake per day combined with PDE-5 inhibitors on demand were safe and effective for the improvement of erectile function in patients with mild and mild to moderate ED. Overall, Aphrodisiacs drugs seem to be a promising cure for ED and improvement of sexual health.

Comparing monotherapy with tadalafil or tamsulosin in men with benign prostatic hyperplasia: A case-control study.

Benign prostatic hyperplasia (BPH) is a chronic disorder that inflicts severe symptoms on middle-aged men. The current study compared the effects of tadalafil and tamsulosin on urological parameters after 3 and 6 months of therapy. A retrospective case-control study was conducted, in which 100 patients with moderately severe BPH were divided into two groups based on their treatment: 50 patients were given tamsulosin 0.4 mg/day and group 50 patients were administered tadalafil 5 mg daily. All patients continued therapy for approximately 6 months, and their urological parameters were assessed at baseline and after 3 and 6 months. There was no significant difference in the overall effect on the International Prostate Symptom Score at the end of the study using two-way ANOVA analysis (P = 0.448). The intercourse number was significantly improved by tadalafil compared to tamsulosin (P < 0.001). The prostatic-specific antigen, postvoiding residual, and prostatic volumes were not significantly different between tadalafil and tamsulosin (P = 0.198, 0.163, and 0.183, respectively). In conclusion, tadalafil, 5 mg once daily, appears to have similar efficacy to tamsulosin, with significant improvement in the patient's erectile function. Tadalafil can be used for 6 months for moderate-to-severe lower urinary tract symptoms.

Current treatment options for erectile dysfunction in kidney transplant recipients.

Erectile dysfunction (ED) and kidney dysfunction share common risk factors linked to conditions involving endothelial impairment, such as coronary artery disease, dyslipidemia, diabetes mellitus, hypertension, smoking, and obesity. Men with chronic kidney disease experience a high incidence and prevalence of ED. While a functional renal graft can alleviate the issue for some patients, a significant portion of recipients still experience ED (20%-50%). This narrative review describes the variety of current treatments modalities on ED in kidney transplant recipients (KTRs) and their clinical outcomes. MEDLINE, Web of Science, PubMed, and Google Scholar were used to find eligible articles pertaining to the treatment options of ED in KTRs. A total of 64 articles were evaluated. In KTRs, ED stems from a multifaceted etiology: anxiety, drug side effects, interference with penile vascularity, or the response of cavernosal muscle to neurotransmitters, along with changes in the endocrine milieu. A diverse range of treatments to restore erectile function has proven to be safe and effective for KTRs. Options include drug therapy, surgical interventions, intracavernosal injection therapies, vacuum erection devices, and extracorporeal shockwave therapy. The initial treatment approach may involve the use of a phosphodiesterase type 5 inhibitors at a low dosage, especially if testosterone-circulating levels align with the diagnosis of hypogonadism. The consideration of a combination therapy involving testosterone and phosphodiesterase type 5 inhibitors should be contemplated due to the associated beneficial effects. Extracorporeal shockwave therapy has shown positive short-term clinical and physiological effects on erectile function in patients who did not respond to first-line treatments, resulting in spontaneous erections sufficient for sexual penetration in 50% of cases. Penile implants should be considered as third-line options based on specific patient needs and compliance with clinical conditions.

Androgens and erectile dysfunction: from androgen deficiency to treatment.

Androgens play important roles in regulating the growth and development of the male reproductive system and maintaining libido and erectile function. The specific mechanisms by which androgen deficiency leads to erectile dysfunction (ED) are not yet fully understood. To understand the mechanisms and treatment of androgen deficiency-related ED. A literature search in the past 10years was conducted in PubMed and Google Scholar to determine the effects of androgen deficiency on erectile function and the treatment of androgen deficiency. Androgen deficiency can be caused by hypothalamic-pituitary lesions and injuries, testicular-related diseases and injuries, endocrine and metabolic disorders, the side effects of medication, and age. Androgen deficiency can lead to ED by inhibiting the NOS/NO/cGMP pathway (nitric oxide synthase/nitric oxide/cyclic guanosine monophosphate) and altering the expression of ion channel proteins, as well as by inducing oxidative stress, death, and fibrosis in penile corpus cavernosum cells. Testosterone replacement therapy is effective at improving the serum testosterone levels and erectile function in patients with androgen deficiency. For patients who need to maintain a low androgenic state, erectile function can be improved by lifestyle changes, treatment with phosphodiesterase type 5 inhibitors, low-intensity extracorporeal shock wave therapy, and stem cell therapy. Androgen deficiency can affect the structure and function of the penile corpus cavernosum, leading to ED. Areas of further study include how androgen replacement therapy can improve erectile function and how to improve the maintenance of erectile function in patients with hypoandrogenic status.

Anxiety, depression, urinary continence, and sexuality in patients undergoing radical prostatectomy: preliminary findings.

Evaluate the relationship between psychological distress, namely anxiety and depression, with urinary continence and recovery of erectile function in patients undergoing radical prostatectomy (RP). We retrospectively analyzed data from 33 consecutive patients who underwent RP in a single tertiary-referral academy between 01/2018 to 01/2019. We used the International Index of Erectile Function (IIEF-15), the Sexual Complaints Screener for Men (SCS-M), and the Hospital Anxiety and Depression Scale (HADS), validated questionnaires for the assessment of sexual function, anxiety, and depression experiences, respectively. These questionnaires were administered at the pre-surgical visit, after surgery, and at intermediate follow-ups (three, six, and twelve months). The analysis of the questionnaires completed during follow-up shows that erectile function is the most affected, with 90% erectile dysfunction (ED) at three months after surgery. In terms of emotional states, anxiety prevails in the first months following surgery and is statistically significantly associated with incontinence (p = 0.02). Depressive symptoms, on the other hand, appear later and prevail over anxiety at six months after surgery, although not statistically significant. In the early post-surgical phase anxiety and ED are the most frequently detected components, while depressive experiences and decreased desire, typical of later stages, have not yet fully emerged.

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

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

(204) Reliability of a Recalled IIEF-5 Score Collected 3 Months Post-Operatively in Assessing Pre-Operative Erectile Function in Patients Undergoing Radical Prostatectomy

Abstract Introduction Erectile function (EF) is a major concern for the patients after radical prostatectomy (RP). The precise evaluation of EF before RP is one of the crucial prognostic factors for its recovery after surgery. Due mainly to time constraints, most urologists routinely just ask vaguely a question about EF before surgery. Also, most patients need firstly to have a clear view of their oncologic status and no incontinence before visiting a sexual medicine specialist, usually after three months. So, three months after surgery, are they reliable to report their pre-operative EF? In the literature, there are evaluations one month or six months after surgery with mixed results concerning the reliability, but there is no evaluation of the recalled EF three months after RP. Objective To examine if the recalled pre-operative EF three months after surgery is in agreement with the real-time pre-operative EF collected just before surgery. Methods We recruited consecutive patients who underwent RP and consequently visited our Sexual Rehabilitation after RP Clinic. All patients completed the IIEF-5 questionnaire (the real-time IIEF-5 score), the day before the operation. Three months after RP, they were also asked to recall their preoperative baseline erectile function, completing a second IIEF-5 score (the recalled IIEF-5 score). In both questionnaires, the target period was the last 6 months before surgery. We excluded from the study patients with major psychiatric disorders and drug or alcohol abuse. The collection of the real-time and the recalled IIEF-5 score was conducted from two different investigators. Concerning the severity of erectile dysfunction, patients were divided into five categories according to their IIEF-5 scores: severe (1–7), moderate (8–11), mild to moderate (12–16), mild (17–21), and no ED (22–25). An interrator agreement analysis in distribution was performed using the kappa statistic to determine the degree of agreement between the IIEF-5 scores. Results We collected data from 55 men. The mean (± standard deviation) age and PSA was 67.5 (± 5.8) years and 9.96 (± 7.24) ng/ml. The real-time pre-operative IIEF-5 mean score and the recalled pre-operative IIEF-5 mean score and standard deviation (three months after the operation) was 17.8 (± 6.3). Concerning the different categories of erectile dysfunction, most patients (60%) were classified to no or mild erectile dysfunction for the real-time IIEF-5 score and similar percentage of patients (61.8%) were classified for no or mild erectile dysfunction for the recalled IIEF-5 score. The correlation of real-time and recalled IIEF-5 score was high, as the Pearson correlation co-efficient was 0.885 (p&amp;lt;0.001). Similar correlations were noted in the different questions of IIEF-5, too. The scatterplot created for the real-time IIEF-5 score and the recalled IIEF-5 score depicts nicely the correlation (Figure 1). In addition, the agreement between the categories of erectile dysfunction severity between the two different IIEF-5 questionnaires was substantial (kappa=0.613, p&amp;lt;0.001), as shown vividly in Table 1. Conclusions Patients reliably report their pre-operative EF even three months after radical prostatectomy. This finding may make clinicians use the IIEF-5 questionnaire to evaluate the EF before surgery and therefore, guide treatment appropriately. Disclosure No.

(366) Potential Effectiveness of Focused Vibration Treatment for Psychogenic Erectile Dysfunction: A Case Series

Abstract Introduction The current non-pharmacological treatment of psychogenic erectile dysfunction (pED) is based on cognitive-behavioral interventions that often involve the participation of the partner, such as desensitization procedures, sensory focusing, and couples counseling. However, it is important to note that in many cases, patients may not have a stable partner or their partner cannot participate in the treatment. The application of local mechanical vibration has shown promising results in increasing skin blood flow and nitric oxide production in healthy young adults. The relaxation of smooth muscle in the penis initiates and maintains an erection. The local release of nitric oxide from autonomic dilator nerves and vascular endothelium is crucial in initiating and sustaining this process. Technological advances have allowed the design of vibrating devices that men can use during sexual encounters. Objective To determine if the on-demand use of a focused vibration device can increase blood flow and promote relaxation of erectile tissue to improve erectile function in patients with pED. Methods Seven sexually active men diagnosed with pED based on criteria for Erectile Disorder from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and without a stable partner, were instructed to use a vibrating device called TENUTO II during their sexual encounters for duration of 8 weeks. This device generates focal vibrations on the penis and the perineal area in intervals of 10 seconds of vibration followed by 10 seconds of pause, with a frequency of 50Hz and an amplitude of 2mm. The five-item Spanish version of the International Index of Erectile Function (IIEF-5) questionnaire was used to assess symptoms before and after the procedure and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire was used for evaluating satisfaction with treatment. Results After the using the device, all patients enrolled with a mean age of 36.1 years (range 28-45) experienced an improvement in erectile function, mean IIEF-5 score pretreatment was 11(range 5–13) mean posttreatment IIEF score was 20 (range 18-27). No adverse effects were reported during the treatment. Conclusions This case series suggests that use of an on-demand focused vibration device could be a potentially effective and safe therapeutic option for men with pED. However, further studies with a larger number of participants and a more rigorous research design are needed to confirm these preliminary findings. Disclosure Yes, this is sponsored by industry/sponsor: MysteryVibe. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Mysteryvibe.

Erectile function in patients with metastatic renal cell carcinoma treated with first-line therapy.

Erectile function in patients with metastatic renal cell carcinoma treated with first-line therapy.

Evaluation of functional and oncological outcomes of localized prostate cancer after different minimally invasive therapeutic methods: A single center experience.

To study the functional and oncological results of minimally invasive treatment methods: cryoablation, brachytherapy, and high-intensity focused ultrasound (HIFU) therapy of localized prostate cancer in a single hospital. One hundred sixty patients with localized prostate cancer were treated with minimally invasive methods (53, 52, 55 patients with cryoablation, brachytherapy and HIFU therapy, respectively). Prostate-specific antigen and evaluation of post-procedure biopsies were used as an assessment. The review of functional indicators and quality of life was made with International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL) questionnaires. Patients after cryoablation showed worse results of oncological control according to positive repeat biopsies, best indicators were observed after brachytherapy. When considering the IPSS results, there were statistically significantly worse scores in the brachytherapy group in the early postoperative period, these differences do not reach statistical significance in the late period in the brachytherapy and cryoablation groups. Patients in the cryoablation group showed worse indicators of IIEF-5; in the early postoperative period; in the late follow-up period, the indicators of erectile function in patients in the cryoablation group did not statistically significantly differ from those in patients after brachytherapy. Patients after HIFU therapy showed fewer cases of de novo erectile dysfunction during the follow-up period of 3 years, higher average IIEF-5 scores, lower IPSS scores and better QoL results. The recurrence of prostate cancer was statistically significantly higher in the International Society of Urological Pathology (ISUP) 3 grade group. HIFU therapy had better urination indicators compared to other groups, that can be associated with the laser enucleation of prostatic hyperplasia. The advantage was noted in patients after HIFU therapy when comparing the parameters to the IIEF-5 thus, HIFU treatment had a better impact on patients' QoL with localized prostate cancer.

Erectile Dysfunction after Transuretheral Resection of the Prostate in Patients with Benign Prostatic Hyperplasia

Background: Benign prostatic hyperplasia (BPH) is commonly associated with lower urinary tract symptoms (LUTS) in aging men, which can significantly impact their quality of life. Transurethral resection of the prostate (TURP) is a standard treatment for BPH, yet its effects on erectile function remain controversial. Objective: To assess the impact of TURP on erectile function in patients with BPH and to evaluate the potential relationship between the relief of obstructive urinary symptoms and changes in erectile function postoperatively. Methods: This single-center, non-randomized study enrolled 177 male patients aged 50 to 80 years with a clinical diagnosis of BPH and an International Prostate Symptom Score (IPSS) greater than 8. Participants underwent monopolar TURP and were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire one month post-surgery. Data were analyzed using SPSS version 21 with Chi-square tests applied to examine the influence of age and IPSS scores on erectile function, considering a p-value ≤0.05 as significant. Results: The mean age of participants was 57.53 ± 6.96 years, and the mean resected prostate tissue weight was 122.82 ± 12.05 grams. Post-TURP, 44.6% of patients were found to have some degree of erectile dysfunction. However, no significant changes in erectile function were observed one month following TURP (p=0.602 for age, p=0.878 for IPSS score). Conclusion: TURP did not significantly affect erectile function one month postoperatively in BPH patients with severe urinary symptoms. While some improvement in erectile function was noted, the results suggest that the benefits of TURP on erectile function may not be immediate. Further longitudinal studies with larger sample sizes are required to provide more definitive conclusions.

Recording method of nocturnal penile tumescence to evaluate the efficacy of X-ray endovascular treatment of vasculogenic erectile dysfunction

Background. The vasculogenic form of erectile dysfunction (ED) is the most widespread of all forms of ED. As a rule, young men in the initial stages of the disorder are not ready to accept phalloprosthetics, making it a relevant concern to search for alternative ways of their sexual rehabilitation, including X-ray endovascular surgery. No less relevant is further improvement of the quality assessment methods for erectile dysfunction both for diagnostic purposes and for determining of efficacy of the treatment provided.Aim. To assess the quality of erectile function by monitoring nocturnal penile tumescence (NPT) in patients after X-ray endovascular treatment of vasculogenic ED.Materials and methods. Over 560 patients with suspected vasculogenic erectile disorder have been examined since 2012, with X-ray endovascular treatment provided to 121 patients with confirmed veno-occlusive ED. To assess the quality of erectile function in patients, we monitored NPT using an Androscan MIT registrar from January 2022 to September 2023, in each case one month before and after the surgical treatment of vasculogenic ED. Included in the study were 40 patients who underwent surgery with us, aged 25 to 48 years old (34.3 ± 7.4 years on average) and having vasculogenic ED, including those with veno-occlusive erectile disorders (n = 33), arterial insufficiency of the cavernous bodies (n = 5), hemodynamic and clinical signs of arteriovenous ED in the subcompensation stage (n = 2). Data were compared on changes in the penile diameter and duration of rigidity during NPT, reflecting the main hemodynamic indicators of the penile blood flow.Results. In the compensated stage of ED, the increase in the penile diameter during NPT was 20–30 %, with duration of tumescence being 43.2 ± 20 min; in the subcompensated stage, 10–30 % and 23 ± 21 min respectively. One month after treatment, these indicators were 45 ± 15 % and 76.3 ± 21 min respectively. After surgery, all patients demonstrated a recovery of the erectile function, and the linear and angle-independent blood flow indicators tended to normalize. The data obtained from the monitoring of NPT helped identify a correlation between the linear blood flow indicators, their derivatives, as well as the time and character of penile rigidity during NPT, making it possible to differentiate the types of vasculogenic ED and the criteria for its clinical compensation.Conclusion. At present, the instrumental diagnostics of ED is limited to the Doppler sonography of the penile vessels, which does not consider the multifactorial nature of the causes of erectile disorders in men of various ages. Registration of NPT using a standalone device allowing to reconduct the examination and to record the results graphically as erectograms can be used for minimally invasive objectification to confirm the recovery of the erectile function in the event of compensated and subcompensated stages of vasculogenic ED. However, further research is required into vasculogenic erectile disorders and the capacities for their assessment using NPT monitoring.

Impact of multiparametric magnetic resonance imaging targeted biopsy on functional outcomes in patients following robot-assisted laparoscopic radical prostatectomy.

Multiparametric magnetic resonance imaging guided prostate biopsy (mpMRI PBx) leads to a higher rate of successful nerve-sparing in robot-assisted laparoscopic prostatectomy (ns-RALP) for prostate cancer (PCa). This study aimed to evaluate the impact of mpMRI PBx compared to standard ultrasound-guided PBx on functional outcomes focusing on erectile function in patients following ns-RALP. All RALPs performed between 01/2016 and 06/2021 were retrospectively stratified according to (attempted) ns vs. non ns RALPs and were then categorized based on the PBx technique (mpMRI PBx vs. standard PBx). We compared RALP outcomes such as pathological tumor stage, rates of secondary nerve resection (SNR) and positive surgical margin status (PSM). Furthermore, we explored the association between PBx-technique and patient-reported outcomes assessed 12 months after RALP using the prospectively collected 26-item Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. Chi-square tests and logistic regression analysis were conducted. A total of 849 RALPs included 517 (61%) procedures with (attempted) ns. Among these, 37.5% were diagnosed via preoperative mpMRI PBx. Patients with a preoperative standard PBx had a 57% higher association of PSM (p = 0.030) compared to patients with mpMRI PBx and a 24% higher risk of erectile dysfunction (ED) 12 months post RALP (p = 0.025). When ns was attempted, we observed a significantly higher rate of SNR in patients who underwent a standard PBx compared to those who received a mpMRI PBx (50.8% vs. 26.7%, p < 0.001) prior RALP. In comparison, upgrading occurred more often in the standard PBx group (50% vs. 40% mpMRI PBx, p = 0.008). The combination of mpMRI PBx for PCa diagnosis followed by ns-RALP resulted in significantly fewer cases of SNR, better oncological outcomes and reduced incidence of ED 1 year after surgery. This included fewer PSM and a lower rate of postoperative tumor upgrading.

The effect of penile traction device in men with Peyronie's disease on penile curvature, penile length, and erectile dysfunction: a systematic review and meta-analysis.

Peyronie's disease (PD) results in curvature, pain, and erectile dysfunction (ED). Penile traction devices (PTDs) are a non-invasive treatment option for PD by applying mechanical forces to elicit biochemical responses that reduce curvature and improve penile function. In the present study, we systematically reviewed and analyzed the literature investigating the use of PTD to treat PD. We have conducted electronic and manual search strategies within the databases and included articles to find relevant studies. A total of Five studies met all the predefined inclusion criteria and were selected for inclusion in the review. Outcomes assessed are penile length, penile curvature, and erectile function (EF). The study population consisted of patients with PD, the intervention was penile traction therapy (PTT), the comparison was matched placebo or follow-up, and the study design was randomized controlled trials (RCTs) or cohort studies. The Cochrane risk of bias assessed the studies' quality for randomized studies and the Newcastle-Ottawa scale (NOS) for non-randomized observational studies. All statistical analyses were performed using R software. Results were considered statistically significant for P<0.05. Only five studies met inclusion and exclusion criteria and were published between 2014 and 2021. The sample sizes range [51-110], totaling 419, with a mean of 83.8 patients-the follow-up with a mean of 6.75 months. This meta-analysis evaluated the efficacy of PTD on curvature degree, penile length, and EF in patients. There is a significant positive effect on the curvature degree (P=0.0373), while there is no significant effect on penile length and EF (P=0.5315 and 0.1010), respectively. They are Indicating low heterogeneity with an estimated total heterogeneity of 0. Overall, the available evidence does not support the efficacy of the intervention for penile length or EF. The current evidence suggests that PTDs can be a safe and effective treatment option for men with PD to reduce penile curvature. However, further research, including more RCTs with extended follow-up periods, is needed to fully understand their efficacy and determine the ideal timing and patient subtypes that would benefit from PTD.

Сравнительная оценка эффективности использования препаратов с экстрактом предстательной железы в комплексной терапии пациентов с хроническим простатитом.

Introduction. Chronic prostatitis (СР) is an inflammation of the prostate tissue, including non-infectious genesis. This is the most common urological disease in men under 50 years of age and the third most common in people over 50 years of age. A promising and actively studied direction of conservative therapy of the inflammatory process in the prostate gland is the use of drugs of animal origin based on prostate extract. The purpose.This work is devoted to the comparative characteristics of drugs with prostate extract effectiveness in the complex therapy of patients with chronic prostatitis. Materials and methods. Retrospective analysis of medical records of 125 patients with a previously established diagnosis of СР of the II and IIIA, and IIIB categories aged from 22 to 55 years was performed. Depending on the preparation used with prostate extract in the complex therapy of CP, patients were divided into 5 groups. Preparations with prostate extract were used for 20 days. The effectiveness analysis included an assessment of the dynamics of the clinical picture, the results of laboratory and instrumental research methods, as well as questionnaire data on valid questionnaires I-PSS (International System for the Summary Assessment of Prostate Diseases, Lower Urinary Tract Symptoms (LUTS)), IIEF-15 (International Index of Erectile Function), NIH Chronic Prostatitis symptom Scale- CPSI. Results. The analysis of the results showed that the use of Vitaprost® in the complex therapy of СР is accompanied by a decrease in the number of leukocytes in the analysis of prostate secretion, positive dynamics in relation to the total score of the severity of pain syndrome and the patient's assessment of his condition on the NIH-CPSI scale of symptoms of chronic prostatitis, which may indicate a decrease in the inflammatory process in the prostate in general. The effectiveness of therapy in relation to erectile function on the IIEF-15 scale, reduction in the severity of symptoms on the IPSS scale and positive dynamics in relation to urination parameters was also noted. Conclusion. According to the results of the work carried out, it was the use of Vitaprost® that was accompanied by a significant decrease in the symptoms of CP and an improvement in the quality of life of patients, as well as erectile function of patients, an increase in the flow rate of urine, a decrease in the volume of residual urine and intensiveness of inflammation.

(219) AUTOLOGOUS PLATELET-RICH PLASMA IMPROVES ENDOTHELIAL AND TADALAFIL-INDUCED RELAXATIONS IN CORPUS CAVERNOSUM FROM PATIENTS WITH ERECTILE DYSFUNCTION

Abstract Objectives Available clinical evidence suggests the potential therapeutic use of intracavernosal injections of platelet-rich plasma (PRP) to treat erectile dysfunction (ED). However, the effects of PRP on human cavernosal function have not been elucidated. Our aim was to evaluate the effects of acute exposure to autologous PRP on relaxant capacity of human corpus cavernosum (HCC) from patients with ED. Methods HCC strips were obtained from four ED patients undergoing penile prosthesis insertion and giving informed consent. Previous to intervention, PRP and platelet-poor plasma (PPP) were obtained from patients by apheresis and stored at -20°C until functional procedures. Endothelial relaxation to acetylcholine (ACh) was evaluated before and after 60 min exposure to PRP or PPP (1% v/v) in organ chamber. Relaxant response to the PDE5 inhibitor, tadalafil, was also evaluated in PRP or PPP (1%) treated HCC from the same patient. Results Average age of patients was 67-years-old (range 61-71) while hypertension and smoking history was present in 3/4, diabetes in 2/4, and obesity in 1/4. Mean platelet content in PRP was 1,096x10 9 /L (range 786 to 1,284 x109/L) while negligible platelet content was obtained in any PPP. Exposure to autologous PRP but not PPP significantly enhanced (p&amp;lt;0.0001 by two-factors ANOVA) ACh-induced endothelial relaxations (pEC50 5.75±0.65 vs. 7.16±0.50; Emax 57.3±14.8% vs. 88.5±2.0%; before and after 1%PRP, respectively). Additionally, HCC treated with autologous PRP displayed augmented relaxant responses to tadalafil (p=0.0018 by two-factors ANOVA) with respect to those treated with PPP (pEC50 6.08±0.5 vs. 6.82±0.51 for PPP and PRP, respectively). Conclusions Acute exposure to autologous PRP improves endothelial function and functional response to PDE5 inhibition. These results support the reported clinical improvement of erectile function in patients with ED and suggest that PRP injection might induce a functional effect on cavernosal tissue in addition to the claimed restorative/regenerative effect. Conflicts of Interest None

The role of mechano-regulated YAP/TAZ in erectile dysfunction

Phosphodiesterase type 5 inhibitors (PDE5is) constitute the primary therapeutic option for treating erectile dysfunction (ED). Nevertheless, a substantial proportion of patients, approximately 30%, do not respond to PDE5i treatment. Therefore, new treatment methods are needed. In this study, we identified a pathway that contributes to male erectile function. We show that mechano-regulated YAP/TAZ signaling in smooth muscle cells (SMCs) upregulates adrenomedullin transcription, which relaxed the SMCs to maintain erection. Using single-nucleus RNA sequencing, we investigated how penile erection stretches the SMCs, inducing YAP/TAZ activity. Subsequently, we demonstrate that YAP/TAZ plays a role in erectile function and penile rehabilitation, using genetic lesions and various animal models. This mechanism relies on direct transcriptional regulation of adrenomedullin by YAP/TAZ, which in turn modulates penile smooth muscle contraction. Importantly, conventional PDE5i, which targets NO-cGMP signaling, does not promote erectile function in YAP/TAZ-deficient ED model mice. In contrast, by activating the YAP/TAZ-adrenomedullin cascade, mechanostimulation improves erectile function in PDE5i nonrespondent ED model rats and mice. Furthermore, using clinical retrospective observational data, we found that mechanostimulation significantly promotes erectile function in patients irrespective of PDE5i use. Our studies lay the groundwork for exploring the mechano-YAP/TAZ-adrenomedullin axis as a potential target in the treatment of ED.