Erectile Dysfunction Research Articles

EFFECT OF PELVIC FLOOR MUSCLE BIOFEEDBACK ON IMPROVED ERECTILE FUNCTION IN PATIENTS WITH LOWER URINARY TRACT SYMPTOMS: PRELIMINARY STUDY

Objective: This study aims to determine the effect of giving pelvic floor muscle biofeedback on improving erectile function in patients with LUTS. Improvement in erectile function was assessed by IIEF (International Index of Erectile Function), EHS (Erectile Hardness Score), and pelvic floor muscle strength. Improvement in LUTS symptoms was assessed by an IPSS (International Index of Prostate Symptoms). Material & Methods: This research was a randomized controlled trial study on outpatients at Cipto Mangunkusumo General Hospital. The research subjects were divided into 2 groups, the treatment group received 10 sessions of pelvic floor muscle biofeedback and home exercise. The control group only received home exercise. Results: There were 21 LUTS patients with ED. A total of 10 subjects (50%) had mild ED, 4 subjects (20%) had moderate ED, and 6 subjects (30%) had severe ED. From the results of the study, it was found that the scores for IIEF, IPSS, EHS, slow twitch, and fast twitch were improved in the treatment group (p-value <0.05), whereas in the control group there were only improvements in IIEF and IPSS scores (p-value <0.05). Conclusion: There was an improvement in erectile function (increased IIEF score, EHS score, decreased IPSS score, and increased pelvic floor muscle strength) after pelvic floor muscle biofeedback in ED patients with LUTS for 10 sessions. Keywords: Biofeedback, erectile dysfunction, pelvic floor muscle exercises, lower urinary tract symptoms (LUTS).

Association between serum albumin levels and erectile dysfunction in American Adults: A cross-sectional study from NHANES 2001-2004.

The aim of this study is to investigate the association between Serum Albumin Levels (ALB) and erectile dysfunction (ED) within the U.S. general population. We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) 2001-2004 cycles. Serum albumin was analyzed both as a continuous variable and categorized into quartiles. Erectile dysfunction (ED) was assessed via self-reported questionnaires. The association between serum albumin and erectile dysfunction was evaluated using weighted logistic regression models across four models: (1) Crude model (unadjusted); (2) Model 1: Adjusted for age, race, poverty-to-income ratio (PIR), marital status, education level, and body mass index (BMI); (3) Model 2: Adjusted for factors in Model 1 plus physical activity, smoking status, drinking status, and Healthy Eating Index (HEI-2015); (4) Model 3: Adjusted for factors in Model 2 plus remaining potential covariates. A generalized additive model (GAM) was employed to examine non-linear associations, followed by subgroup analyses and interaction tests. A total of 2925 participants were included in the study, of which 747 were diagnosed with ED. After adjusting for all covariates, a significant negative association was found between ALB and ED (OR: 0.53, 95% CI: 0.29-0.97, P = 0.04). Higher ALB quartiles were significantly correlated with a decreased risk of ED [Q4 vs. Q1: OR: 0.56 (0.35-0.90), P = 0.02; P for trend = 0.03]. The GAM and smoothed curve fit indicated a linear relationship between ALB and the risk of ED. Stratified and interaction tests further substantiated the inverse relationship between ALB and ED prevalence. This study revealed an inverse association between ALB and ED. Therefore, it is important for clinicians to recognize the assessment of ALB in patients.

Analysis of Risk Factors Associated with Organic Erectile Dysfunction in Patients with Type 2 Diabetes Mellitus and Erectile Dysfunction.

Diabetes mellitus is a common metabolic disorder, and diabetic erectile dysfunction (DMED) is one of its common complications. The differentiation of the types of erectile dysfunction (ED) is fundamental to treatment, yet there is a lack of simple and efficacious tools for this purpose in clinical practice. In this study, we endeavor to predict ED types using commonly available clinical data from diabetic patients, aiming to develop and assess a risk prediction model for organic erectile dysfunction in individuals with type 2 diabetes. The study was a retrospective analysis. Data were obtained from the hospital's internal medical record system. We selected and analyzed the clinical data of 250 patients with type 2 diabetes. Lasso regression was used for risk factor selection, and the selected variables were included in a multivariate logistic regression analysis to establish the risk prediction model. Internal validation was performed using the bootstrap method, and the discrimination, calibration, and clinical effectiveness of the model were evaluated using the C-index, calibration curve, decision curve analysis (DCA), and receiver operating characteristic (ROC) curve. Among the 250 patients, 168 (67.2%) were diagnosed with organic ED. The risk factors included in the logistic regression analysis were the duration of diabetes, low-density lipoprotein cholesterol (LDL-C), red blood cell distribution width (RDW), intima-media thickness of the carotid artery, diabetic retinopathy, diabetic nephropathy, and peripheral neuropathy. The C-index was 0.827 (95% confidence interval (CI) = 0.772-0.882). The distribution curve of the predicted values and the calibration curve of the model were well fitted. The decision curve analysis (DCA) suggested that using the model could be clinically beneficial when the threshold probability was between 28% and 100%. By combining the duration of diabetes, carotid artery intima-media thickness, diabetic retinopathy, diabetic nephropathy, peripheral neuropathy, RDW, and LDL-C, this study preliminarily establishes a risk prediction model for organic ED in patients with type 2 diabetes mellitus. The model demonstrates good predictive performance.

Structure-based method for the discovery of selective inhibitors of PED 5 in erectile dysfunction therapy from the Pacific oyster peptides (Crassostrea gigas): Peptidomic analysis, molecular docking, and activity validation.

Erectile dysfunction (ED) is a male sexual disorder mainly caused by a reduction in the cellular concentration of cyclic guanosine monophosphate (cGMP), which is degraded by phosphodiesterase type-5 (PDE-5). Oyster protein (OP) and its hydrolysates have been used for centuries to address male erectile dysfunction, however the mechanisms and evidence supporting their efficacy remain unclear. In this study, OP was hydrolyzed using trypsin to produce peptides that inhibit PDE-5. Following separation by ultrafiltration and Sephadex G-25, a total of 3202 peptides were identified. Virtual screening and molecular docking were employed to identify PDE-5 inhibitory peptides and elucidate their interaction mechanisms with PDE-5. Five peptides with the sequences FLF, LMF, LLW, FGPF, and IPW demonstrated strong interactions with PED5. The results indicated that the key binding sites critical for docking included Phe820, Gln817 and Val782 of the target receptor PED-5. The highest inhibition rate observed for FGPF was 94.6 %, while the inhibition rates for IPW and FLF were 89.0 % and 87.6 %, respectively. The lowest inhibition rate was recorded for LLW at 68 %. These findings suggest that these five peptides have the potential to serve as PDE-5 inhibitors in the health food industry and medicine.

Robotic Waterjet Resection for Men With Prostate Cancer Suffering From Lower Urinary Tract Symptoms.

To evaluate the impact of Aquablation on circulating tumor cells (CTCs) in men with localized prostate cancer. This prospective study included subjects with biopsy-positive mpMRI visible lesions (PIRADS ≥3) who underwent Aquablation. Ten mLblood samples were collected before, during and after the procedure to measure CTC counts using an immunofluorescence assay. The mean age of participants was 63.4 years, with a baseline PSA of 8.9 ng/mLand a prostate volume of 60.3mL. All subjects experienced reduced IPSS scores and stable or improved SHIM and MSHQ-EjD scores. Detectable CTCs were found in 80% of subjects before Aquablation, 100% immediately after Aquablation, 20% on post-op day 2, and 60% on post-op day 7. The mean number of CTCs per patient 10mLblood draw was 1.2 preoperatively, 3.2 immediately post-op, 0.2 on day 2, and 1.0 on day 7. Prostate volumes decreased significantly at 3 and 6 months, with corresponding reductions in PSA levels. There were no adverse events reported. Specifically, no instances of incontinence, erectile dysfunction, ejaculatory dysfunction, or rectal toxicity were observed. At 6-month follow-up, all baseline mpMRI lesions were no longer visible on mpMRI and follow-up biopsies showed no grade group progression. In an active surveillance population, Aquablation resulted in improved urinary function, stable or improved sexual function, and a transient spike in CTCs lasting <2 days that did not result in any oncologic concern. Aquablation may be considered a safe option for men with localized prostate cancer who require treatment for LUTS due to BPH.

Impact of a post-myocardial infarction sexuality education session on erectile dysfunction, anxiety and depression

Impact of a post-myocardial infarction sexuality education session on erectile dysfunction, anxiety and depression

The prevalence of sexual dysfunction and erectile dysfunction in men with multiple sclerosis: A systematic review and meta-analysis

The prevalence of sexual dysfunction and erectile dysfunction in men with multiple sclerosis: A systematic review and meta-analysis

Anti-Inflammatory Activities of Some Plants of Genus Alpinia: Insights from In Vitro, In Vivo, and Human Studies.

This narrative review intends to provide thorough information on the anti-inflammatory activities of Alpinia plants, the largest genus of the family Zingiberaceae. The articles were searched on the PubMed database using 'Alpinia AND anti-inflammatory activity' as the keywords, filtered to articles published from 2020 to 2024 and free full-text. Of the approximately 248 members of the genus Alpinia plants, the most commonly studied for their anti-inflammatory activities are A. galanga, A. officinarum, A. zerumbet, and A. oxyphylla. Only A. galanga, A. officinarum, and A. zerumbet have been studied in humans. Studies in animal models revealed that the plants contributed as exogenous antioxidants, reduced proinflammatory cytokines, inhibited proinflammatory enzymes, improved gastric acid and gastrointestinal motility, and promoted ulcer healing. The terpenoids, flavonoids (such as kaempferol, quercetin, and galangin), and diarylheptanoids obtained from the rhizomes of these plants may crucially play important roles in their anti-inflammatory activities. These plants did not show toxicity toward numerous normal cell lines (RAW 264.7, IEC-6, HepG2, MT-4, NIH-3T3, Vero cells, human peripheral blood mononuclear cells, and HaCaT) but were toxic to cancer cell lines (HT29). In humans, A. galanga was studied for its effects as psychostimulants improving mental health, improving sperm motility, and erectile dysfunction. Similarly, A. officinarum could improve sperm morphology and idiopathic infertility, whereas A. zerumbet worked as a cardio-myorelaxant in patients with cardiovascular diseases.

High Throughput Virtual Screening of Phosphodiesterase type-5 (PDE-5) inhibitors against Erectile Dysfunction from Saussurea lappa roots: An Integrated Approach Utilizing GC-MS, Machine Learning, Docking, Molecular Dynamics, and DFT based analysis

High Throughput Virtual Screening of Phosphodiesterase type-5 (PDE-5) inhibitors against Erectile Dysfunction from Saussurea lappa roots: An Integrated Approach Utilizing GC-MS, Machine Learning, Docking, Molecular Dynamics, and DFT based analysis

Ablation of IGFBP5 expression alleviates neurogenic erectile dysfunction by inducing neurovascular regeneration.

To investigate the therapeutic potential of eliminating insulin-like growth factor-binding protein 5 (IGFBP5) expression in improving erectile function in mice with cavernous nerve injury (CNI)-induced erectile dysfunction (ED). Eight-week-old male C57BL/6 mice were divided into four groups: a sham-operated group and three CNI-induced ED groups. The CNI-induced ED groups were treated with intracavernous injections 3 days before the CNI procedure. These injections included phosphate-buffered saline, scrambled control short hairpin RNA (shRNA), or shRNA targeting mouse IGFBP5 lentiviral particles. One week after CNI, erectile function was evaluated and the penile tissue was then harvested for histological examination and western blot analysis. Additionally, the major pelvic ganglia (MPG) and dorsal root ganglia (DRG) were cultured for ex vivo neurite outgrowth assays. Following CNI, IGFBP5 expression in the cavernous tissues significantly increased, reaching its peak at day 7. First, ablation of IGFBP5 expression promotes neurite sprouting in MPG and DRG when exposed to lipopolysaccharide. Second, ablating IGFBP5 expression in CNI-induced ED mice improved erectile function, likely owing to increased neurovascular contents, including endothelial cells, pericytes, and neuronal processes. Third, ablating IGFBP5 expression in CNI-induced ED mice promoted neurovascular regeneration by increasing cell proliferation, reducing apoptosis, and decreasing Reactive oxygen species production. Finally, western blot analysis demonstrated that IGFBP5 ablation attenuated the JNK/c-Jun signaling pathway, activated the PI3K/AKT signaling pathway, and increased vascular endothelial growth factor and neurotrophic factor expression. Ablating IGFBP5 expression enhanced neurovascular regeneration and ultimately improved erectile function in CNI-induced ED mice.

A New Strategy for Obesity Treatment: Revealing the Frontiers of Anti-obesity Medications.

Obesity dramatically increases the risk of type 2 diabetes, fatty liver, hypertension, cardiovascular disease, and cancer, causing both declines in quality of life and life expectancy, which is a serious worldwide epidemic. At present, more and more patients with obesity are choosing drug therapy. However, given the high failure rate, high cost, and long design and testing process for discovering and developing new anti-obesity drugs, drug repurposing could be an innovative method and opportunity to broaden and improve pharmacological tools in this context. Because different diseases share molecular pathways and targets in the cells, anti-obesity drugs discovered in other fields are a viable option for treating obesity. Recently, some drugs initially developed for other diseases, such as treating diabetes, tumors, depression, alcoholism, erectile dysfunction, and Parkinson's disease, have been found to exert potential anti-obesity effects, which provides another treatment prospect. In this review, we will discuss the potential benefits and barriers associated with these drugs being used as obesity medications by focusing on their mechanisms of action when treating obesity. This could be a viable strategy for treating obesity as a significant advance in human health.

A Combination of Punica granatum Fruit Rind and Theobroma cacao Seed Extracts Enhances Sexual Function in Aging Males in a Randomized, Double-blind, Placebo-controlled Study.

Introduction: LN18178 is a standardized, synergistic combination of Punica granatum fruit rind and Theobroma cacao seed extracts, which has been reported to increase serum testosterone levels in young and aging males. Methods: The present 84-day randomized, double-blind, placebo-controlled study assessed the efficacy of LN18178 on the sexual function of aging male volunteers (age: 40-70 years; serum total testosterone: ≥ 300 ng/dL). The subjects with mild to moderate erectile dysfunction [5-item version of the International Index of Erectile Function (IIEF-5) scores 17-25] and low sexual desire (score < 3 on items 11 and 12 of IIEF) participated in this investigation. One hundred and twenty men were randomly allocated into either the LN18178 or placebo group (n=60); they took either 400 mg of LN18178 or a matched placebo capsule daily with breakfast. Results: Post-trial, the LN18178-supplemented participants reported significant (P < 0.05) improvements in total and domain scores of the Derogatis Interview for Sexual Functioning-Self Reporting Male (DISF-SR-M) questionnaire, as well as substantial improvements in IIEF-5 (International Index of Erectile Function-5) and erection hardness scores (EHS). Comparative analysis also revealed significant improvements in the multi-dimensional fatigue inventory (MFI) and general health survey (GHS) scores. LN18178 supplementation substantially (P < 0.05) increased the six-minute walk distance and hand-grip strength compared to placebo. The participants' hemato-biochemical parameters, urinalysis, and vitals were within the normal range. Conclusion: LN18178 enhances sexual function, libido and improves psychological well-being, as well as neuromotor function and general well-being in aging males. LN18178 supplementation is safe and well tolerated by the participants.

Prevalence and Associated Factors of Erectile Dysfunction in Chronic Kidney Disease Patients in Douala, Cameroon

Prevalence and Associated Factors of Erectile Dysfunction in Chronic Kidney Disease Patients in Douala, Cameroon

Effect of Donor Sperm on Quality of Life in Patients with Severe Oligoasthenosperm After ICSI Failure.

To explore the effects of donor sperm on reproductive quality of life, sleep quality and erectile function in patients with severe oligoasthenospermia after the failure of intracytoplasmic sperm injection (ICSI), and to provide targeted reference for intervention. From January 2021 to December 2023, patients with severe oligoasthenospermia who received assisted pregnancy treatment in Obstetrics and Gynecology Hospital Affiliated to Tongji University were selected as the study objects. Among them, 82 cases using sperm donor assisted pregnancy after ICSI failure were set as the observation group, and 82 cases using propensity score 1:1 matching ICSI failure after ICSI assisted pregnancy were set as the control group. The levels of serum total testosterone, reproductive quality of life, sleep quality and erectile function of the two groups were compared using the general data questionnaire, FertiQoL, Pittsburgh Sleep Quality Index (PSQI) and International erectile Function Index -5(IIEF-5). There was no significant difference in social demographic data and serum total testosterone level between the two groups after matching propensity score (P>0.05). The total score of FertiQoL and PSQI in the observation group were higher than those in the control group, and the incidence of erectile dysfunction was higher than that in the control group, with statistical significance (P<0.05). The use of donor sperm for pregnancy after ICSI failure in patients with severe oligoasthenospermia has a great impact on their reproductive life, sleep quality and erectile function. Medical staff should pay attention to the quality of life and erectile function of these patients, and formulate targeted measures to help these patients cope positively.

The Triglyceride and Glucose Index is Associated with the Severity of Erectile Dysfunction

The Triglyceride and Glucose Index is Associated with the Severity of Erectile Dysfunction

TARGETING BIOLOGICAL AGING MECHANISMS OF LOWER URINARY TRACT SYMPTOMS IN OLDER MEN WITH AN EXERCISE INTERVENTION

Abstract Physical frailty is associated with lower urinary tract symptoms (LUTS) severity and progression among older men with suspected benign prostatic hyperplasia (BPH). Prospective cohort studies have consistently demonstrated that both physically inactive and frail men are more likely to develop BPH or experience LUTS progression. The combination of aerobic plus resistance exercise has been demonstrated in clinical trials to have pleotropic effects that delay, prevent, or treat many frailty-related conditions that often co-occur with LUTS and BPH, including cardiovascular disease, diabetes, and erectile dysfunction. Although it has never been tested in humans, pre-clinical mouse models of BPH demonstrate improved voiding behaviors after exposure to exercise and exercise is known to improve several mechanisms that are implicated in human LUTS/BPH pathophysiology, including insulin resistance, endocrine dysregulation, and mitochondrial dysfunction. The recently launched PROUD study (NCT06225479; MPIs: Bauer, Kenfield) is a 2-arm pilot randomized controlled trial among physically inactive older men with LUTS/BPH testing the effect of a 12-week remote exercise intervention versus health education control. Outcomes include: 1) feasibility, acceptability, fidelity, and safety; 2) changes in LUTS, urologic and physical function, and physical activity; and 3) feasibility of detecting exercise-induced change in novel frailty-related mechanistic measures. This symposium session will review the scientific rationale, key study design and analytic decisions, enrollment progress thus far, and collaborative opportunities using stored biobank specimens.

Normosmic Hypogonadotropic Hypogonadism, Pituitary Hypoplasia, and Testicular Microlithiasis as Presentation of 45XY Robertsonian Translocation

Male hypogonadism is characterized by the failure of the testes to produce normal levels of testosterone, sperm, or both. It can manifest as either primary hypogonadism (testicular dysfunction) or secondary hypogonadism (hypothalamic pituitary dysfunction). Testosterone is critical for the development of male physical characteristics and plays an essential role in maintaining muscle mass, bone density, sexual function, and overall mood and energy levels. Hypogonadism, either primary or secondary, can present in various stages of life with different associated symptoms. Most commonly prepubertal age males present with delayed puberty, whereas adult males present with symptoms of decreased libido, erectile dysfunction, fatigue, overall lack of energy and infertility. This report describes a case of hypogonadotropic hypogonadism, testicular microlithiasis, and pituitary hypoplasia associated with a 13;14 Robertsonian translocation, an uncommon and incompletely understood etiology of hormonal dysfunction and infertility.

PREVALENCE OF ERECTILE DYSFUNCTION AFTER PELVIC RADIOTHERAPY

Erectile dysfunction (ED) is a common complication among male cancer survivors undergoing pelvic radiotherapy, significantly impacting their quality of life. Despite its high prevalence globally, data on ED among Pakistani cancer survivors remain limited. Objective: To determine the prevalence, severity, and associated risk factors of ED among male patients undergoing pelvic radiotherapy at Nishtar Medical University and Hospital, Multan. Methods: This prospective observational study included 50 male patients aged 50–85 years undergoing pelvic radiotherapy for malignancies. Baseline and six-month follow-up assessments of erectile function were conducted using the International Index of Erectile Function (IIEF-5) questionnaire. Factors associated with ED, including age, comorbidities, and treatment parameters, were analyzed using SPSS version 26.Results: The prevalence of ED six months post-radiotherapy was 61%. Advanced age (≥65 years) and diabetes were significant risk factors, with 71.4% and 88.9% of patients, respectively, developing ED. Moderate and severe ED accounted for 42.9% and 35.7% of cases, respectively. Cultural stigma and limited healthcare resources were additional barriers to managing ED in the Pakistani context. Conclusion: ED is highly prevalent among male patients undergoing pelvic radiotherapy, with advanced age and diabetes being significant contributors. These findings underscore the need for routine ED screening, culturally sensitive counseling, and targeted interventions to improve the quality of life for cancer survivors in Pakistan.

Effect of aqueous extracts of pausinystalia yohimbe trunk bark on castration-induced sexual impotence in male rats

Medicinal plants have occupied since ancestral times a place of choice in the treatment of many pathologies that affect man, following the example of sexual impotence. The aim of the present study was to investigate the effect of an aqueous extract of P. yohimbe trunk bark on castration-induced sexual impotence in male rats. The animals were castrated using the slightly modified Roubinian technique. Fifteen days after castration the animals were divided and treated as follows: one batch distilled water control (0.5ml/100g W.O.), one batch testosterone enanthate (0.2ml/kg subcutaneously), one batch yohimbine (10mg/kg) and three batches aqueous extract of P. yohimbe (100, 250 and 500 mg/kg W.O.). The animals were dosed for seven days. On the last day, each animal was mated with a female previously treated with 600 µg of 17 β-Oestradiol. The study parameters were sexual mounts, number of erections, number of ejaculations and latency time between two consecutive mounts. In other castrated animals, previously treated with testosterone enanthate (0.2 ml/kg subcutaneously), the aqueous extract of P. yohimbe (100, 250 and 500 mg/kg) was administered and the study parameters were observed as before. Analysis of the results shows that the aqueous extract of P. yohimbe bark (100, 250 and 500 mg/kg) alone and the two reference molecules activate the sexual parameters compared with distilled water (0.5 ml/100g). The same result was observed when the administration of the extract was followed by that of the reference molecules. P. yohimbe trunk bark contains phytoandrogens and acts by potentiating the action of natural testosterone. The extract is an important remedy for the treatment of sexual impotence.

MODERN APPROACHES IN DIAGNOSTIC AND TREATMENT OF PRIAPISM IN MEN INJURED AS A RESULT OF COMBAT ACTIONS

Introduction. Priapism is a frequent painful erection that lasts more than 4 hours and is not caused by sexual stimulation, occurs when blood is blocked in the penis and cannot leave it. It is believed that the increase in the frequency of priapism directly depends on the prevalence of intracavernous injections of vasoactive substances in the treatment of erectile dysfunction. Aim. To evaluate the pathogenetic features of the development of priapism, as one of the forms of sexual dysfunction, in men injured as a result of combat operations (combat trauma) and to optimize treatment methods. Materials and methods. The study included 14 priapism patients who were treated at the urology clinic in 2022-2024. Priapism as a complication developed in 2 (4.4%) of 45 patients after intracavernous injection of 20 μg of prostaglandin E1 (PGE1) (group 1), in 1 (10%) of 10 patients after sequential injection of 20 μg of PGE1 and 0,5 mg of phentolamine (group 2), in 3 (20%) of 15 patients after injection of 2% solution papaverine (group 3). In 5 patients, priapism occurred against the background of systematic use of anticoagulants (low molecular weight heparin) in the treatment of severe vascular pathology (phlebothrombosis, thrombophlebitis) (group 4). In another 3 patients, the cause that led to priapism was not found, so the idiopathic form was established (group 5). Results. It was shown that in 3 cases, the duration of priapism in patients with psychogenic ED was insignificant, since all patients were warned about the possible development of priapism before the injection of the vasoactive drug and recommended to seek medical help immediately in case of its occurrence. Three out of three patients with a previous diagnosis of mixed erectile dysfunction (with an organic vascular component) failed to restore erectile function after shunting. Three out of four patients diagnosed with idiopathic priapism reported the absence of erections during several months of postoperative follow-up. In no case was there a recurrence of priapism in the postoperative period. Conclusions. The obtained data allow us to recommend prostaglandin E1 as the drug of choice among vasoactive substances for intracavernous use due to its highest safety. Unilateral transcaputal puncture of the cavernous body (Winter shunt) in patients with ischemic priapism made it possible to achieve detumescence in 100% of cases without subsequent recurrence and restore erectile function in 40% of patients.