Erectile Dysfunction Research Articles

Deciphering phosphodiesterase-5 inhibitors from Aframemum melegueta: computational models against erectile dysfunction.

The online version contains supplementary material available at 10.1007/s40203-024-00284-3.

Evaluation of the Efficacy and Safety of On-Demand Tadalafil Alone or Combined With Lidocaine Spray for Treating Patients With Comorbid Erectile Dysfunction and Premature Ejaculation: A Randomized Controlled Trial

Background To evaluate the efficacy and safety of on-demand 20 mg tadalafil alone or combined with lidocaine spray for treating patients with comorbid erectile dysfunction (ED) and premature ejaculation (PE). Methods This randomized controlled trial included 98 patients with comorbid ED and PE, randomly assigned to the experimental group (n = 50, tadalafil alone) or the active control group (n = 48, tadalafil combined with lidocaine spray). Patients took tadalafil 30 min before sexual intercourse, while the combination therapy group also used lidocaine spray 5 min before intercourse. After 12 weeks of treatment, changes in the International Index of Erectile Function (IIEF-5), Chinese Index of Premature Ejaculation (CIPE-5), Intravaginal Ejaculatory Latency Time (IELT), and Sexual Satisfaction Score (SSS) were evaluated. Results Both groups showed significant improvement in IIEF-5 scores, but the difference between groups was not significant (F = 0.89, p = 0.45). The active control group showed significant improvement in CIPE-5 scores (p < 0.001), while the experimental group showed no significant change (p > 0.05). IELT in the active control group increased significantly from 25.7 s to 198.6 s (Z = 6.03, p < 0.001), while the experimental group showed no significant change (Z = 0.74, p = 0.46). SSS improved significantly in the active control group (p < 0.001) but not in the experimental group (p > 0.05). The incidence of adverse events was similar in both groups (14% vs 20.8%, p = 0.575). Conclusion Tadalafil combined with lidocaine spray is superior to tadalafil alone in improving symptoms, prolonging IELT, and enhancing sexual satisfaction in patients with comorbid ED and PE, with comparable safety. This combination therapy provides a new approach for improving treatment strategies for patients with comorbid ED and PE. Large-scale, multi-center randomized controlled trials are needed to further validate these findings.

Development and validation of a prediction model for ED using machine learning: according to NHANES 2001–2004

Erectile Dysfunction (ED) is a form of sexual dysfunction in males that imposes significant health and financial burdens globally. Despite its high prevalence, diagnosing ED remains challenging due to the limitations of current diagnostic methods and patients’ reluctance to seek medical help. Currently, some studies have used machine learning techniques for developing ED prediction models, but the performance and interpretability of existing models need to be further improved. This study utilized data from the National Health and Nutrition Examination Survey (NHANES) for the years 2001 to 2004, adhering to the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) statement. After excluding male respondents who did not meet the study criteria, a total of 3,869 participants were included. Gradient boosting decision tree (GBDT) algorithms (XGBoost, CatBoost, LightGBM) were used to develop the ED prediction model. Data preprocessing, feature selection, model evaluation, and interpretability analysis were performed to ensure the reliability and effectiveness of the model. The model evaluation results revealed that the AUC values are XGBoost: 0.887 ± 0.016; LightGBM: 0.879 ± 0.016; CatBoost: 0.871 ± 0.019. The F1-Scores are XGBoost: 0.695 ± 0.023; LightGBM: 0.681 ± 0.025; CatBoost: 0.681 ± 0.025. The Recall values are XGBoost: 0.789 ± 0.026; LightGBM: 0.739 ± 0.030; CatBoost: 0.711 ± 0.030. These results confirmed that the XGBoost model is the best-performing ED prediction model in this study. Interpretability analysis results of the XGBoost model showed that age, obesity, cardiovascular risk factors, prostate-related diseases, and socioeconomic status are key features for predicting ED, playing a significant role in the ED mechanism. Therefore, we believe the ED prediction model trained in this study has strong predictive performance and high interpretability. This model can help to expand the diagnostic options for ED, improve the diagnosis rate of ED, and assist doctors in early intervention for patients with ED, ultimately improving patient prognosis.

Safety and efficacy evaluation of intracavernosal injection of platelets rich plasma in treatment of vasculogenic erectile dysfunction

ABSTRACT Objectives The study’s objective is to compare platelet-rich plasma (PRP) injections to placebo in terms of effectiveness and safety for patients with vasculogenic erectile dysfunction (ED). Methods This randomized placebo-controlled clinical trial was done on 50 male patients with organic vasculogenic ED and sexually active in a stable heterosexual relationship for a period of over three months. The patients were randomized into two main groups: Group (A) (n = 25) underwent PRP treatment. Group (B) (n = 25) control underwent placebo treatment. Results The two groups under study differed in a statistically significant way regarding the achievement of minimal clinically important differences (MCID) at 3 months and 24 months. Statistically significant variations existed between the mild subgroup and placebo regarding achieving MCID after 3 months and 24 months. The level of satisfaction was statistically significantly higher in the PRP group. A statistically significant variation was present between the mild subgroup and placebo at 3 months and 24 months in terms of changes from baseline in the erectile function domain of the International Index of Erectile Function (IIEF-EF) questionnaire score in each subgroup. Conclusions PRP is an effective alternative modality of treatment in cases of ED, and they offer an intermediate stage between pharmaceutical therapy and surgical interventions at least in mild and mild to moderate cases where unsatisfactory results or unpleasant side effects compel the patients to abandon all hope on medical treatment.

The multifaceted nature of diabetic erectile dysfunction: uncovering the intricate mechanisms and treatment strategies

BackgroundOne of the most common complications of diabetes mellitus is diabetic erectile dysfunction (DMED), a condition that has grown more common in recent years and has a significant impact on patients’ daily lives. The complicated pathophysiological changes of DMED, involving vascular, neurological, muscular, and endocrine variables, have not been well addressed by any one treatment technique, and no widely approved treatment strategy has been developed.AimThe objective of this study was to thoroughly examine the complex nature of the pathogenic mechanism of DMED and discover new therapeutic approaches that could improve DMED symptoms.MethodsStudies and review articles from the past 10 years were considered.ResultsThe pathogenesis of DMED encompasses vascular dysfunction, endothelial cell damage, cavernous smooth muscle defects, neurological dysfunction, endocrine/metabolic factors, leukomalacia fibrosis, and psychosocial factors, elucidating complex interplay among the mechanisms underlying DMED. It underscores the need of integrating traditional herbal medicine, energy-based medicine treatments, and advanced techniques like stem cell and gene therapy to enhance therapeutic outcomes. Furthermore, it expresses optimism on the therapeutic potential of new nanobiomaterials in DMED.ConclusionThrough integrating a complete description of DMED etiology and current therapy methods, this work offers a helpful resource for researchers, doctors, and patients dealing with this difficult condition.

Sexual dysfunction among long-term survivors of Hodgkin lymphoma.

Survival rates from childhood cancer continue to increase, with an ongoing interest in long-term survivorship. Although infertility and gonadal failure are well recognized in Hodgkin lymphoma (HL) survivors, sexual dysfunction is less studied. The objective of this study was to compare the prevalence of sexual dysfunction in HL survivors with that in matched community controls. Long-term survivors of HL (n=186; female, 51.61%; mean age at diagnosis. 14.41 years [range, 3.01-22.60 years]; current mean±standard deviation age, 36.73±7.93 years) and matched community controls (n=182; female, 50.55%; mean±standard deviation age, 36.41±9.02 years) completed a comprehensive, in-person clinical assessment, laboratory battery, and the International Index of Erectile Function or the Female Sexual Function Index questionnaire. Male survivors had increased levels of erectile dysfunction (18.89% vs. 6.67%; p=.0239) but indicated no difference in sexual desire. Female survivors had a higher prevalence of sexual dysfunction compared with female controls (46.88% vs. 15.22%; p<.0001) and an increased prevalence of moderate-to-severe loss of sexual desire (38.04% vs. 23.26%; p=.0361). Female survivors with sexual dysfunction indicated increased levels of anxiety (p=.0184), depression (p=.0153), and worse physical and mental health (p=.0141 and p=.0419, respectively). Male survivors with erectile dysfunction had higher rates of anxiety and impaired physical health (p=.0147 and p=.0266, respectively). Sexual dysfunction was prevalent in this childhood and adolescent Hodgkin lymphoma survivor cohort and was associated with effects on quality of life. Health care providers must recognize the need for screening and intervention in this group to hopefully contribute to improved overall quality of life.

Multifactor Quality and Safety Analysis of Semaglutide Products Sold by Online Sellers Without a Prescription: Market Surveillance, Content Analysis, and Product Purchase Evaluation Study.

Over the past 4 decades, obesity has escalated into a global epidemic, with its worldwide prevalence nearly tripling. Pharmacological treatments have evolved with the recent development of glucagon-like peptide 1 agonists, such as semaglutide. However, off-label use of drugs such as Ozempic for cosmetic weight loss has surged in popularity, raising concerns about potential misuse and the emergence of substandard and falsified products in the unregulated supply chain. This study aims to conduct a multifactor investigation of product quality and patient safety risks associated with the unregulated online sale of semaglutide by examining product availability and vendor characteristics and assessing product quality through test purchases. We used a complex risk and quality assessment methodology combining online market surveillance, search engine results page analysis, website content assessment, domain traffic analytics, conducting targeted product test purchases, visual quality inspection of product packaging, microbiological sterility and endotoxin contamination evaluation, and quantitative sample analysis using liquid chromatography coupled with mass spectrometry. We collected and evaluated 1080 links from search engine results pages and identified 317 (29.35%) links belonging to online pharmacies, of which 183 (57.7%) led to legal pharmacies and 134 (42.3%) directed users to 59 unique illegal online pharmacy websites.Web traffic data for the period between July and September 2023 revealed that the top 30 domains directly or indirectly affiliated with illegal online pharmacies accumulated over 4.7 million visits.Test purchases were completed from6 illegal online pharmacies with the highest number of links offering semaglutide products for sale without prescription at the lowest price range. Three injection vial purchases were delivered; none of the 3 Ozempic prefilled injection pens were received due to nondelivery e-commerce scams.All purchased vials were considered probable substandard and falsified products, as visual inspection indicated noncompliance in more than half (59%-63%) of the evaluated criteria. The semaglutide content of samples substantially exceeded labeled amounts by 28.56%-38.69%, although no peptide-like impurities were identified. The lyophilized peptide samples were devoid of viable microorganisms at the time of testing; however, endotoxin was detected in all samples with levels ranging between 2.1645 EU/mg and 8.9511 EU/mg. Furthermore, the measured semaglutide purity was significantly low, ranging between 7.7% and 14.37% and deviating from the 99% claimed on product labels by manufacturers. Glucagon-like peptide 1 agonist drugs promoted for weight loss, similar to erectile dysfunction medications more than 2 decades ago, are becoming the new blockbuster lifestyle medications for the illegal online pharmacy market. Protecting the pharmaceutical supply chain from substandard and falsified weight loss products and raising awareness regarding online medication safety must be a public health priority for regulators and technology platforms alike.

Association of erectile dysfunction and peripheral arterial disease in NHANES 2001-2004: a cross-sectional study

ObjectiveTo evaluate the association between Erectile dysfunction (ED) and peripheral arterial disease (PAD) in adult American males using a large database.MethodsThe relationship between ED and PAD prevalence among participants in the 2001-2004 National Health and Nutrition Examination Survey (NHANES) database was assessed using a series of statistical analyses. ED was evaluated based on a single-item measure of self-reported erection problems from the Massachusetts Male Aging Study. PAD was defined as ankle-brachial index (ABI) &amp;lt; 0.9 in at least one leg. Multifactorial logistic regression models were used to investigate the association between ED and PAD.ResultsA total of 2394 participants were enrolled, of whom 905 individuals (37.8%) were diagnosed with ED. After adjusting for confounding variables, the association between ED and PAD remained positive, with an odds ratio of 2.05 (95% confidence interval 1.24-3.39). Subgroup analysis revealed that the relationship between ED and PAD was significant in patients aged &amp;gt;50 years old, without hypertension, without diabetes, without cardiovascular disease, without high cholesterol, former smokers, low physical activity levels, and a body mass index of 25-30 (P &amp;lt; 0.05). In addition, all subgroups analyzed were evaluated for any potential interaction, and no statistically significant association was discovered.ConclusionsIn a sample of US adults aged ≥40, this cross-sectional study found that ED is related to a higher occurrence of PAD. ED may be an independent predictor of PAD, and thus it should be considered in the treatment of patients with ED.

Cancers and erectile dysfunction: a Mendelian randomization study

PurposeCancer often coexists with erectile dysfunction, yet the causal relationship between them remains unclear. This study aims to investigate the causal link between tumors and ED through Mendelian randomization.MethodData on 13 different cancers, including lung cancer, colorectal cancer, testicular cancer, lymphoma, esophageal cancer, pancreatic cancer, thyroid cancer, bladder cancer and brain cancer were collected from various databases. ED data, comprising 2,205 cases and 164,104 controls, were sourced from the FinnGen project. Primary methods for MR analysis included IVW, MR-Egger, weighted median, and weighted mode.ResultsIVW results revealed associations between colorectal cancer (OR=1.17;95% CI 1.02-1.13, p=0.0252), prostate cancer (OR=1.63;95% CI 1.52-1.75, p&amp;lt;0.001) and liver cancer (OR=0.93;95% CI 0.88 -0.99, p=0.012) with ED.ConclusionMendelian randomization analysis supports that prostate cancer and colorectal cancer are associated with an increased risk of Erectile Dysfunction, whereas liver cancer is linked to a decreased risk of ED. No evidence suggests that ED contributes to an increased risk of prostate cancer.

Harnessing the regenerative effects of human amniotic stem cells (hAFSCs) on restoring erectile function in a bilateral cavernous nerve crush (BCNC) injury rat model.

Intracavernous (IC) injections of stem cells has been shown to ameliorate cavernous nerve (CN)-induced erectile dysfunction (ED). However, the regenerative effects underlying the recovery of erectile function (EF) in human amniotic fluid-derived stem cells (hAFSCs) remain unclear. In the bilateral cavernous nerve crushing (BCNC) injury rat paradigm, we sought to ascertain the effects of hAFSC treatment on EF recovery during the incipient phase. Three groups of 45 male rats were used in this study: sham (Group 1), saline IC injection after BCNC (Group 2), and hAFSC intracavernous injection (ICI) after BCNC (Group 3). hAFSCs from the fourth passage showed potential to differentiate into trilineage cells. All animals were subjected to EF analysis on the 28th day post-injection and tissues were retrieved for histopathological and immunohistochemical analyses. IC injections of hAFSC significantly improved EF parameters in BCNC-ED rats at 28 days post-injury. AFSC treatment enhanced the smooth muscle condition and increased the smooth muscle/collagen ratio, as evidenced by histological analysis. Immunohistology revealed increased expression of 𝛼-SMA andvWf in the corpus cavernosum and enhanced expression of nNOS in the dorsal penile nerve in BCNC-ED rats (p < 0.05). Western blotting showed that hAFSC treatment significantly increased α-SMA expression in the hAFSC group compared with that in the BCNC group. Electron microscopy revealed significantly elevated myelination in the CN (p < 0.05), maintenance of smooth muscle structures, and restoration of EF in BCNC-ED rats treated with hAFSC. hAFSC treatment increased EF in BCNC-ED rats at a single dose. As BCNC-ED resembles ED caused by radical prostatectomy (RP), this therapy has high potential for ED patients after RP surgery.

Sildenafil citrate induces prostatic hyperplasia in BPH model rats and aged rats

Erectile dysfunction (ED), a prevalent disease among middle-aged and elderly males, significantly impacts both patient and partner quality of life. Phosphodiesterase type 5 inhibitor (PDE5i) represents an effective therapeutic method for ED. Given their widespread global utilization, concerns arise regarding potential reproduction-related problems arising from clinical use. During the extensive development of PDE5i, we speculated that the potential of these inhibitors to variably induce prostatic hyperplasia, but this field remains unexplored. In order to verify the male reproductive toxicity of PDE5i, sildenafil citrate at doses of 5, 10 and 20 mg/kg was administered in BPH model rats and aged rats. Anatomical and pathological analyses indicate a compelling association between sildenafil citrate administration and the promotion of prostatic hyperplasia in both BPH model rats and aged rats. Serum analysis showed that serum prostate-binding protein (PBP) exhibited a non-significant but increasing trend following administration of sildenafil citrate to BPH model rats. Furthermore, significant increase in serum levels of E2 and T, as well as T in dorsal lobe prostate tissue of aged rats, were observed compared to the model control group. These results confirm the hypothesis that sildenafil citrate has reproductive toxicity in males.

Modified calculation of the IIEF6-a more accurate assessment of erectile function in middle-aged men.

The Erectile Function Domain of the International Index of Erectile Function (IIEF6) is inaccurate in assessing erectile function in men who are not practicing sexual intercourse. Improvement through a modification was recently tested on patients after radical prostatectomy. This study examines the application of this modification in a population-based cohort of middle-aged men. To assess the feasibility of a modified IIEF6 in a population-based random sample of 50-year old men in Germany. 4924 men were included. IIEF6, Erection Hardness Score (EHS), and causes for the absence of sexual intercourse within the previous 4weeks were assessed. Modified calculation (double weighting of non-intercourse IIEF6 questions) was applied in case of absence due to external circumstances. Impact of the modification on erectile dysfunction (ED) prevalence and agreement between IIEF6 and EHS in ED classification. As a result of the modified calculation, ED prevalence in the overall study sample decreased by 6.2% to a rate of 27.2%. Agreement between IIEF6 and EHS was increased from 2.7% to 73.4% in men with no sexual intercourse due to external circumstances. An additional inquiry into the reason for the absence of sexual intercourse and modified calculation enhances the accuracy of IIEF6 in evaluating erectile function of the individual man. This study comprises a large population-based sample. As the study population was exclusively 50-year-old men, results may not be representative of the population average. A more accurate evaluation of an individual man's erectile function may be achieved by using a modified version of the IIEF6.

Sexual dysfunctions in inflammatory bowel disease: role of Mediterranean diet and quality of life.

Dietary factors and chronic gastrointestinal diseases are frequent determinants of sexual dysfunctions (SD). Whether inflammatory bowel diseases (IBD) are associated with SD is not well known as well as the role of diet and quality of life (QoL). To evaluate the prevalence of SD in a cohort of IBD patients and assess the role of clinical-demographic variables, adherence to Mediterranean diet (MD) and QoL. This is a cross-sectional observational study involving 301 patients (134 females and 167 males); 119 had Crohn's Disease and 182 had ulcerative colitis. SD were assessed through the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). Adherence to MD was evaluated by the MD Score. QoL was investigated by the 12-item Short-Form Health Survey (SF-12) which yields summary scores of physical (PCS) and mental (MCS) health. Multiple logistic regression was used to identify predictors of SD. Prevalence of SD in females was 61.9%, while 52.1% of males had erectile dysfunction. No differences in the prevalence of SD were found between CD and UC in both males and females. IBD activity, as defined by patient-reported outcomes, was significantly associated with SD in both sexes. In females, MD adherence score (OR 0.8, 95% CI 0.653-0.974, p=0.027), PCS (OR=0.936, CI 95%=0.891-0.983, p=0.008), and MCS (OR 0.9, 95% CI 0.906-0.985, p=0.008) were protective against SD, whereas in males a higher PCS was associated with a lower probability of SD (OR 0.9, 95% CI 0.891-0.978, p=0.004) DISCUSSION: IBD patients had a significant prevalence of SD which occurred more frequently in females than in males. Disease activity is associated with a higher likelihood of SD in both sexes, whereas dietary factors are differentially associated with SD in males and females. A better QoL is associated with a lower risk of SD. SD is prevalent among men and women with IBD. Adherence to MD, PCS and MCS in females as well as PCS in males were protective against SD. The assessment of sexual function in IBD patients could be relevant in order to reach an early diagnosis and a timely treatment.

Benefits of Tadalafil and Sildenafil on Mortality, Cardiovascular Disease, and Dementia

BackgroundErectile dysfunction and lower urinary tract symptoms, from benign prostatic hyperplasia and bladder neck obstructions, are prevalent in men and associated with an increased risk of cardiovascular diseases. Phosphodiesterase-5 (PDE-5) inhibitors, such as tadalafil and sildenafil, are used to treat erectile dysfunction and may also offer cardiovascular benefits due to their vasodilatory effects. This study evaluates the impact of these PDE-5 inhibitors on all-cause mortality, cardiovascular disease, and dementia in middle-aged men with erectile dysfunction and lower urinary tract symptoms over a 3 year follow-up period. MethodsThis longitudinal study analyzed data from 50 million US men using the TriNetX database. Men at least 40 years of age prescribed tadalafil or sildenafil after an erectile dysfunction diagnosis, or tadalafil after lower urinary tract symptom diagnoses, from 2004 to 2021 were included. Three-year outcomes assessed included all-cause mortality, cardiovascular disease, and dementia, comparing men on PDE-5 inhibitors to those not on these medications. Propensity matching was performed for demographics and eight pre-existing conditions. ResultsThe final cohort included 509,788 men with erectile dysfunction and 1,075,908 with lower urinary tract symptoms. Tadalafil and sildenafil were associated with significantly reduced risks of all-cause mortality (RR 0.66/0.76), myocardial infarction (0.73/0.83), stroke (0.66/0.78), venous thromboembolism (0.79/0.80), and dementia (0.68/0.75) in erectile dysfunction patients, with tadalafil showing more significant benefits. In lower urinary tract symptom patients, tadalafil was similarly associated with reduced mortality, cardiovascular disease, and dementia. ConclusionsIn conclusion, tadalafil and sildenafil use in erectile dysfunction patients reduced mortality, cardiovascular disease, and dementia risks, with tadalafil providing more benefits. Tadalafil also conferred similar benefits to patients with lower urinary tract symptoms.

Elucidating the Signaling Pathways Involved in Erectile Dysfunction

Background: Erectile Dysfunction (ED) is a common sexual disorder among men aged 20 years and over. It is predominantly characterized by alterations in the key physiological pathways regulating erectile function, such as nitric oxide and Ras homolog gene family member A (RhoA)/Rho-associated protein kinase (ROCK). Beyond these pathways, multiple molecular signaling networks are involved in ED pathogenesis. Objective: This review aims todescribe the major signal transduction pathways that impact erectile function and contribute to the introduction of the pathogenesis of ED. Methods: A literature review of ED was performed from 2000 to 2023 using PubMed, Scopus, and Embase. “ED” and “related signaling pathway”, “molecular mechanisms” terms were used. Results: Further basic and clinical studies are required to define the underlying molecular mechanisms of ED. The signaling pathways that were not affected by phosphodiesterase type 5 inhibitors (PDE5i) may be the reason for the reduced efficacy of this first-line treatment option in a variety of conditions. Conclusion: There is still a need for a deeper description of the molecular mechanisms in terms of fibrosis, angiogenesis, apoptosis, inflammation, oxidative stress, autophagy, and hypoxia to identify new possible targets underlying the pathogenesis of ED. This comprehensive review expounds on the principal signaling pathways, offering valuable insights that may catalyze the development of innovative and enhanced therapies for managing ED.

Erectile Dysfunction Risk Among Patients With Diabetes Mellitus Using Sodium-Glucose Cotransporter 2 Inhibitors.

The aim of this study was to explore the incidence of new-onset erectile dysfunction (ED) in diabetes mellitus (DM) patients with sodium-glucose cotransporter 2 inhibitors (SGLT2I) use compared with a control group of non-SGLT2I use by propensity score matching approach. Cox proportional hazards regression models were used to examine the effect of SGLT2I and risk factors on the risk of developing ED, presented as a hazard ratio with a 95% confidence interval. One lakhs fifty nine thousand seven hundred seventy three patients with DM using SGLT2I and 159,773 propensity score matching patients with DM who had never used SGLT2I were included. SGLT2I users had a higher risk of ED than the non-SGLT2I users (adjusted hazard ratio = 1.55, 95% confidence interval = 1.40-1.72). The likelihood of developing ED was higher in patients with SGLT2I use was found.

A Novel Multi-compartment Rotating Bioreactor for Improving ADSC-Spheroid Formation and its Application in Neurogenic Erectile Dysfunction.

The aim of this study was to construct a multicompartment synchronous rotating bioreactor (MCSRB) for batch-production of homogenized adipose-derived stem cell (ADSC) microspheres and treat neurogenic erectile dysfunction (ED). Firstly, an MCSRB was constructed using a centrifugal device and hinged trays. Secondly, influence factors (density, rotational speed) on the formation of ADSC-spheroids were explored. Finally, a neurogenic ED model was established to verify the effectiveness and safety of ADSC-spheroids for ED treatment. An MCSRB promoted ADSCs to gather microspheres, most of which were 90-130 μm in diameter. Supernatant from three-dimensional culture led to a significant increase in cytokine expression in ADSCs and migration rate in human umbilical vein endothelial cells (HUVECs) compared to control groups. The erectile function and pathological changes of the penis were improved in the ADSC-spheroids treatment group compared to the traditional ADSCs treatment group (p < 0.01). Efficient, batch, controlled and homogenized production of ADSC stem cell microspheres, and effective improvement of erectile dysfunction in neurogenic rats can be achieved using the MCSRB device.

What are options for my patients with erectile dysfunction who have an unsatisfactory response to PDE5 inhibitors?

What are options for my patients with erectile dysfunction who have an unsatisfactory response to PDE5 inhibitors?

Patient Preferences for Surgical Treatments for Benign Prostatic Hyperplasia: A Discrete Choice Experiment

Purpose: When symptoms of benign prostatic hyperplasia cannot or can no longer be treated by conservative treatment options adequately, various surgical treatment options are available. Different risks and benefits are associated with each type of surgery; the optimal choice depends on the patient's preference. This study analyzes patients' preferences and investigates patient characteristics that might influence patient preferences in Germany. Materials and Methods: We conducted an online discrete choice experiment based on 9 treatment attributes related to risks (probability of ejaculatory dysfunction, permanent incontinence, needing surgery again, and erectile dysfunction) and efficacy (frequency of daytime and nighttime urination, urgency and duration of urination, and time until symptoms improve) of surgeries. To estimate preferences, we applied a mixed-logit model. Subgroup analyses based on patients' characteristics were conducted. Results: Three hundred thirty participants completed the discrete choice experiment. Overall, participants preferred a lower risk of ejaculatory dysfunction, lower urgency and duration of urination, lower probability of permanent incontinence, lower frequency of nighttime and daytime urination, and lower probability of needing another surgery. Moreover, a faster onset of overall symptom reduction was preferred. Several patient characteristics especially characteristics related to a patient's sexual life seem to influence patients' preferences. Conclusions: Significant preference heterogeneity could be observed in this study, and subgroup analyses suggest differences in preferences in relation to patients' characteristics. These findings highlight the need for individualized treatment decisions. Physicians should evaluate patients' clinical but also inquire about a patient's personal situation and preferences to select the optimal treatment in collaboration with the individual patient.

Bioinformatics Combined With Experimental Modeling to Study the Molecular Mechanism of Xuefu Zhuyu Decoction to Improve Erectile Dysfunction Associated With Asthma in Rats.

Asthma is associated with chronic systemic inflammation, and inflammatory factors can damage vascular endothelial cells, thus impairing erectile function (ED). Xuefu Zhuyu decoction (XFZYD) can inhibit inflammation and promote angiogenesis, which in turn improves asthma as well as ED, but its exact mechanism of action is not yet clear. This study investigates the mechanism underlying the beneficial effect of XFZYD on asthma-associated ED. High-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was used to analyze the constituents of XFZYD, and network pharmacology analysis was used to predict the target genes of XFZYD. Sprague-Dawley rats in the asthma model with erectile dysfunction were divided into the model, XFZYD low-, medium-, and high-dose group (3.09, 6.17, and 12.34 g/kg), with drug intervention for 8 weeks. We assessed the interleukin 6 (IL-6), vascular endothelial growth factor A (VEGFA), and tumor necrosis factor (TNF) protein levels in the penile tissue. We discovered that after treatment with XFZYD (3.09, 6.17, and 12.34 g/kg), the number of erections significantly increased (1.17 ± 0.41, 1.50 ± 0.55, and 1.67 ± 0.52), the density of endothelial cells in the corpus cavernosum of the penis increased, the expression level of IL-6 was reduced (7.5%, 21.2%, and 24.4%), the expression level of VEGFA was reduced (7.8%, 25%, and 28.4%), and the expression level of TNF was reduced (13.5%, 30.6%, and 32.4%). The in vivo experiments indicate that XFZYD may improve ED in asthma model rats by inhibiting inflammation and reducing vascular permeability. This study provides new insights into the mechanism of action of XFZYD in the treatment of asthma leading to ED.