Erectile Quality Research Articles

SCORING CORRESPONDENCE IN OUTCOMES RELATED TO ERECTILE DYSFUNCTION TREATMENT ON A 4-POINT SCALE (SCORE-4)

ABSTRACT Introduction The Erection Hardness Score (EHS), a validated single-item patient-reported outcome (PRO), may provide a simple method to capture erectile dysfunction (ED) symptoms and to monitor treatment outcome. Aim To map the relationship between the EHS, which was used as the anchor, and other validated PROs: International Index of Erectile Function (IIEF), Quality of Erection Questionnaire (QEQ), Sexual Experience Questionnaire (SEX-Q), and Self-Esteem and Relationship questionnaire (SEAR). Methods Data were from a trial of flexible-dose sildenafil (50 or 100 mg) in 209 men with ED. Main Outcome Measures A mixed-effects repeated-measures model with EHS as a categorical explanatory variable and each of the other PROs, as a separate dependent variable, was applied to analyze the longitudinal data from randomization to the end of the 10-week, double-blind, placebo-controlled phase and the 6-week open-label phase. EHS data, which were generated at each sexual encounter (event), were averaged per patient over the same recall period that preceded administration of the other PRO questionnaires. Results Scores on all domains of the IIEF and SEX-Q, as well as the SEAR total score and SEAR Sexual Relationship domain, discriminated on all EHS categories. The QEQ total score discriminated on all EHS categories except EHS 1 and EHS 2. Although the model did not impose any functional relationship between PRO score and EHS, an approximately linear relationship existed between the EHS and all other PROs, which was especially pronounced for those PROs that were more directly related to erectile quality or function. Conclusions The relationship between discrete EHS categories and PRO scores demonstrates the close correspondence of erectile hardness with erectile function (IIEF), erection quality (QEQ), overall sexual experience (SEX-Q), and ED-related psychosocial factors (SEAR) in men with ED. Cappelleri JC, Bushmakin AG, Symonds T, and Schnetzler G. S coring c orrespondence in o utcomes r elated to e rectile dysfunction treatment on a 4-point scale (SCORE-4). J Sex Med 2009;6:809–819.

The engineering analysis of bioheat equation and penile hemodynamic relationships in the diagnosis of erectile dysfunction: part I—theoretical study and mathematical modeling

The extent to which skin surface bioheat perfusion predicts penile physiological response such as an erection has not been extensively investigated. A biomechanical engineering study was performed to compare bioheat distribution on penile skin surface resulting from an induced erection at steady state to examine the efficacy of such method as an adjunct tool for the diagnosis and classification of erectile dysfunction (ED) due to different etiology. We based our arguments on the principle that blood vessel activity and perfusion to corpus cavernosa at the erect state are almost always higher than that in the flaccid state. Our results showed that a difference of 0.1-0.3 degrees C can be observed and hence used to develop database of 'smart diagnosis' for ED using the machine artificial intelligence. It is anticipated that such basic research into blood flow is critical, as blood perfusion into corpus cavernosa is the most influential factor determining functional erectile quality contributing to successful coitus. Increased understanding of the hemodynamic response profile contributes toward optimal treatment and thus enables clinicians to adopt an appropriate management scheme for ED.

Hyperhomocysteinemia: a novel risk factor for erectile dysfunction

Nitric oxide (NO), the key mediator synthesized by different NO synthase isoenzymes, plays an important role in endothelial function. It was recently shown that hyperhomocysteinemia is an important regulator of NO synthase. We investigated the role of homocysteine (Hcys) in erectile dysfunction (ED), which is associated with the defect in NO generation. Thirty-one nondiabetic patients and 33 control cases were evaluated. Patients with diabetes, coronary artery disease, vitamin B 12, or folate deficiency were excluded in the study. The International Index of Erectile Function questionnaire was used to gauge identified erectile quality. Fasting plasma glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, vitamin B 12, folic acid, and Hcys levels of patients were measured. Penile color Dupplex ultrasound was used to detect vascular abnormalities in nondiabetic patients with ED. Patients with ED were older than the control subjects (55.6 ± 8.4 vs 44.5 ± 4.7 years, respectively; P < .001). Patients with ED had higher fasting plasma glucose, total cholesterol, low-density lipoprotein cholesterol, and Hcys levels. There was a significant negative correlation between mean Hcys level and mean International Index of Erectile Function domain score ( P < .001). The penile color Doppler ultrasound findings showed that there was a negative significant correlation between mean Hcys level and the 1st, 5th, and 10th minute's peak-systolic velocity. Logistic regression analysis revealed that age and Hcys levels were the main determinants in ED. Hyperhomocysteinemia, known to be an important risk factor in endothelial dysfunction, seems to be an important determinant in ED. These data suggest that slightly elevated Hcys levels are significantly related with arterial and probably endothelial dysfunction in patients with ED.

Impact of Erectile Dysfunction on Confidence, Self-Esteem and Relationship Satisfaction After 9 Months of Sildenafil Citrate Treatment

The first double-blind, placebo controlled trial in the United States of the Self-Esteem And Relationship questionnaire revealed that treatment with sildenafil citrate improves erectile function and measures of quality of life in men with erectile dysfunction. We investigated long-term improvement, and correlations between improved erectile function and confidence, self-esteem and sexual relationship satisfaction in men with erectile dysfunction. This was a 36-week open label extension of the double-blind, placebo controlled trial. The blind was not broken. Patients were 18 years or older with clinically diagnosed erectile dysfunction. Erectile function was assessed using the International Index of Erectile Function. Self-esteem, confidence and relationship satisfaction were assessed using the Self-Esteem And Relationship questionnaire. Correlations were determined using Pearson's product moment coefficients. A total of 204 participants were enrolled in the open label extension, including 108 on placebo and 96 on sildenafil. In men who received placebo in the double-blind, placebo controlled phase mean erectile function scores and self-esteem, confidence and relationship satisfaction scores were increased significantly at week 36 of the open label extension (p < 0.0001). Men who received sildenafil in the double-blind, placebo controlled phase maintained high scores in the open label extension. Correlations between improved erectile function, and self-esteem, confidence and relationship satisfaction were strong and positive (p < 0.0001). Open label extension sildenafil after double-blind, placebo controlled placebo significantly improved erectile function, self-esteem, confidence and relationship satisfaction. Following an initial 12 weeks of double-blind, placebo controlled sildenafil therapy for erectile dysfunction improvements were sustained an additional 9 months. Positive correlations between erectile function, and self-esteem, confidence and relationship satisfaction suggest that improved erectile quality can improve long-term psychosocial quality of life.

Sexual function following treatment of localised prostate cancer with HDR-Ir-192 brachytherapy combined with external beam radiotherapy

Abstract Background Clinically localised prostate cancer can be treated with various modalities after which there are a comparable overall survival. In this study the sexual function and quality of life was evaluated in patients treated with brachytherapy combined with external beam radiotherapy (EBRT). Patients and methods One hundred and eleven patients with clinically localised prostate cancer were treated with HDR-Ir-192 brachytherapy in combination with EBRT from February 2000 to August 2003. An interview was conducted consisting of a questionnaire based on the International Index of Erectile Function (IIEF) and the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, concerning erectile function and quality of life. Results One hundred and three (96%) men consented for interview. The mean time following treatment was 28 months (range 6–36). Thirty-six men (35%) had normal erections at the time of interview, 23 men (22%) had no erections, 25 (25%), had variable erections whilst sexually active. Thirty men (29%) had had successful penetrative sexual intercourse in the 4 weeks preceding the interview each time they had attempted to do so. A further 15 (15%) had mostly successful penetration whenever they had tried during the previous 4 weeks. Nine (9%) had been unable to achieve penetration and 45 men (44%) had made no attempt at penetration. Importantly, 81 men (79%) indicated that their sexual function overall was reduced in comparison to the situation before treatment. Twenty-two men (21%) stated that their sexual function was unchanged and no man found that there had been an improvement as compared to pre-treatment. Conclusion A reasonable number of men (60%) had erections of variable quality at the time of interview following treatment. However, 79% of men stated that their overall level of sexual function was reduced post-treatment. We have insufficient comparative baseline data to enable us to make a direct comparison between pre- and post-treatment sexual function. Patients rated their general level of health and quality of life as good following treatment.

Investigation, Treatment, and Monitoring of Late‐Onset Hypogonadism in Males: ISA, ISSAM, and EAU Recommendations

Demographic data clearly demonstrate that the percentage of the population in the older age group is increasing. Androgen deficiency in the aging male has become a topic of increasing interest and debate throughout the world. Cross-sectional and longitudinal data indicate that the testosterone falls progressively with age and that a significant percentage of men over the age of 60 years have serum testosterone levels that are below the lower limits of young adult (age 20–30 years) men (1–4). The principal questions raised by these observations are whether older hypogonadal men will benefit from testosterone treatment and what will be the risks associated with such intervention. The past decade has brought evidence of benefit of androgen treatment of hypogonadal men on multiple target organs and the recent studies show short-term beneficial effects of testosterone in older men that are similar to those in younger men. This has been comprehensively reviewed and summarized by the Institute of Medicine in ‘Testosterone and Aging: Clinical Research Directions’ (5). Long-term data on the effects of testosterone treatment in the older population are limited mainly to effects on body composition and bone mass (6–11). Key questions of the effects of testosterone on patient reported outcomes and functional benefits that may retard physical or mental frailty of the elderly or improve the quality of life are not yet available. Specific risk data on the prostate and cardiovascular systems are needed.

Sildenafil was safe and improved erectile function and quality of life in men with moderately severe congestive heart failure

Source Citation Webster LJ, Michelakis ED, Davis T, Archer SL. Use of sildenafil for safe improvement of erectile function and quality of life in men with New York Heart Association classes II and ...

Nocturnal penile tumescence and rigidity testing in bicycling patrol officers.

A health assessment study was conducted in response to complaints of groin numbness in a bicycling police unit. Seventeen male cyclists were compared with 5 nonbiking men. The cyclists rode an average of 5.4 hours per day, and 91% indicated they experienced groin numbness on occasion. Each man wore the RigiScan Plus Rigidity Assessment System for one normal sleep session. Pressure measurements were also taken between the cyclist and the bicycle saddle. The percentage of sleep sessions that recorded an erectile event was significantly lower in the cyclists than it was in noncyclists (cyclists 27.1%; noncyclists 42.8%; P =.008). This duration percentage is negatively correlated with average hours a day that cyclists rode their bikes (r = -.41; P =.05), the number of days a week they rode (r = -.55; P =.009), and the average pressure exerted on the nose of the bike saddle (r = -.39; P =.08). The other measures of erectile quality (tumescence activity units [TAUs] and rigidity activity units [RAUs] of both the base and tip of the penis) were lower in the cyclists, but did not reach statistical significance. The number of hours cyclists rode during the day of RigiScan Plus assessment was negatively correlated with penis tip RAU (r = -.41; P =.04), and tip TAU (r = -.45; P =.04). These data suggest that prolonged bicycle riding may have negative effects on nocturnal erectile function and indicate a need for innovative bicycle saddle designs.

The Efficacy, Safety and Tolerability of Intracavernous Pnu-83757 for the Treatment of Erectile Dysfunction

Despite the introduction of sildenafil citrate many men with erectile dysfunction remain dependent on intracavernous therapy. While the majority achieves satisfactory results with currently available intracavernous preparations, all preparations have undesirable side effects, including priapism, fibrosis and post-injection pain. We determined the efficacy, safety and tolerability of the erectogenic potassium channel opener PNU-83757. We selected 66 men with erectile dysfunction of vascular etiology for intracavernous injection of PNU-83757 in a single dose, single blind, placebo controlled study. Of the 6 patients allocated into each of 11 dose groups 5 received active drug and 1 received placebo. Groups received progressive doses of PNU-83757 or placebo. Holter monitoring was performed at scheduled intervals. Heart rate, and systolic, diastolic and mean blood pressure were assessed at scheduled intervals. Blood samples were obtained for pharmacokinetic study. Patients were evaluated at regular intervals for adverse events. Investigators and patients evaluated efficacy. The first complete erection was observed at 10 mcg. Of the 25 patients receiving active drug in the 60 to 140 mcg. groups only 1 had no erectile response, 15 had partial erection and 9 had complete erection. No serious adverse events or cardiovascular effects were noted. The minimum effective dose for complete erection was 10 mcg. The erectile response reached a plateau between 60 and 140 mcg., suggesting minimal improvement in efficacy at higher doses. Patient evaluation of erectile quality corresponded well with that of investigators. PNU-83757 was efficacious and extremely well tolerated, and the only adverse events were mild. No cardiovascular side effects were observed at any dose. PNU-83757 intracavernous injections caused no post-injection pain in any patient, which may make PNU-83757 superior to alprostadil in a select group. Further study is required to evaluate the efficacy of PNU-83757 combined with other drugs and with sexual stimulation.

VENOUS PATCH GRAFT FOR PEYRONIE'S DISEASE. PART II: OUTCOME ANALYSIS

Purpose We evaluate the results of tunical incision and venous patch grafting for correcting penile deformity in Peyronie's disease. Materials and Methods In 112 patients with symptoms of Peyronie's disease for more than a year indications for surgery included penile shortening, persistent pain, severe curvature, penile narrowing or indentation and/or failure of previous surgery. Preoperative evaluation included determination of patient and partner expectation, potency status, circumcision status, measurement of penile length (short and long side) and saphenous vein, and color duplex ultrasonography to evaluate possible accessory vascular communication. Patients underwent plaque incision and venous patch grafting. The configuration, size and number of tunical incisions depended on the size and shape of the lesion. Lower and upper saphenous, and deep dorsal veins served as the graft materials. Postoperative followup was as long as 18 months. Results In 96% of patients the penis became straight, while residual curvature was 30 degrees in 3% and 15 degrees in 1%. In 94% of patients narrowing and indentation were absent and in 83% penile length was the same or longer postoperatively. Of the patients who were potent preoperatively 88% experienced the same or better erectile quality after surgery. In 10% of cases a change in sensation occurred lasting longer than 6 months. Overall satisfaction was expressed by 92% of men who believed that surgery improved the psychological state as well as the relationship with the partner. Conclusions The results are satisfactory and this procedure offers a reasonable solution for correction of Peyronie's disease.

Combined intracavernous injection of papaverine and stimulation (CIS) test.

The inhibitory effect of the overactivity of the sympathetic nervous system that results from outpatient clinical conditions leads to poor erectile response to intracavernous injection of papaverine. The effects of self manual genital stimulation for improvement of erectile quality in insufficient papaverine response were investigated in 171 impotent men. Twenty-nine (63.04%) of 46 patients who had a normal vascular system showed partial response to papaverine. Following self manual genital stimulation, full erection was achieved in all of them. Better erections were achieved in 28 of 42 patients with arterial disease. In patients subclassified as having slight, moderate, and severe arterial disease, improved erections were noted in 100%, 71.42%, and 64.28%, respectively. In the mixed vascular (arterial+venous) disease group (n = 46), the combined intracavernous injection of papaverine and stimulation (CIS) test led to a better erection in only 41.30%, whereas in the pure venogenic group (n = 37), this percentage was 66.66%. The inhibitory effect of the overactivity of the sympathetic nervous system is significantly reduced by the CIS test.

Patient-reported erectile dysfunction: a cross-validation study.

Previous work highlighting a significant correspondence between patient-reported sex history information and physiological indices of erectile functioning was cross-validated. The matched sample comprised of 46 older male veterans presenting with erectile dysfunction, with many experiencing chronic physical illnesses. All subjects underwent a comprehensive medical and psychological evaluation, followed by 2 consecutive nights of in-hospital Rigiscan diagnostic monitoring, to evaluate penile rigidity, tumescence, and duration of erectile episodes. Stringent criteria were employed to control for confounding of Rigiscan results, with elimination from the study for affective, thought, or sleep disorders. Results from the multiple regression analyses showed that patient reports of AM erections and erectile quality accounted for significant proportions of the variance in the Rigiscan criterion measures, with 3 of the 4 R2 values falling within the Herzberg criterion for cross-validation. Results confirm the diagnostic significance of patient self-report for the population of older, chronically ill men who present with impaired erectile functioning.

Assessment of erectile dysfunction in diabetic men: The clinical relevance of self-reported sexual functioning

Diabetes mellitus is commonly associated with erectile dysfunction (ED). Fifty-three diabetic male veterans presenting with ED underwent an extensive medical examination, psychological evaluation, and a detailed assessment of sexual functioning. They then underwent two consecutive nights of inhospital Rigiscan monitoring to assess erectile capacity. Multivariate analyses indicated that patient reports of a.m. erections and erectile quality were highly predictive of Rigiscan measures of penile tip and base rigidity and duration of erectile episodes. These results highlight the importance of attending to patient reports of specific sexual symptomatology in the evaluation of diabetic patients presenting with ED.

Treating Erectile Dysfunction with External Vacuum Devices: Impact Upon Sexual, Psychological and Marital Functioning

We evaluated prospectively the medical, sexual and psychosocial outcome of external vacuum devices in the treatment of erectile dysfunction. A total of 29 men regularly used such a device for 6 months and reported statistically significant improvements in erectile quality, frequency of intercourse attempts, frequency of orgasm and sexual satisfaction, as well as decreased psychiatric symptomatology, increased self-esteem and a trend toward improved marital satisfaction. Of the partners 18 reported improved sexual functioning, including increased frequency of orgasm, decreased masturbation and greater sexual satisfaction, with no changes in psychosocial parameters. The vacuum device was effective in producing erections in 89% of the men. Dropout, only 19% within 6 months, was primarily due to insufficient or pivoting erections and bruising. The most frequent adverse effects were blocked ejaculation and physical discomfort. Vacuum devices appear to provide a safe, effective, inexpensive, noninvasive treatment for erectile failure that enjoys high patient and partner acceptance.