Evaluation Of Erectile Dysfunction Research Articles

Shaping the future of men's sexual health: How artificial intelligence can assist in the management and treatment of erectile dysfunction

AbstractArtificial intelligence (AI) is a complex combination of multidisciplinary machines and systems that can replicate human‐like cognitive tasks to execute capabilities such as pattern recognition, decision‐making, and problem‐solving. Dating back to the 2000s, AI has been utilized in the medical field, however the interest in this subject has sharply increased over the past several years. Erectile dysfunction (ED) is an increasingly pervasive issue as men age, affecting up to 150 million men worldwide. In the field of men's health, AI has been employed to assist physicians in the evaluation and management of ED. This article aims to summarize the ways in which AI has been utilized in the management of ED, as well as the considerations that must be made when implementing this technology. AI can be utilized for virtual health assistance to protect patient privacy and increase access to care. Augmented reality can aid surgeons in real‐time during operations, as well as be utilized to prepare physicians for situations that they may encounter in the operating room. Pharmaceutical companies can benefit from AI in the interpretation of data, analysis of chemical compounds and in drug development. Additionally, AI can be used to assist patients in post‐procedure recovery in the form of rehabilitation and post‐treatment monitoring. While the utilization of AI in men's health is an exciting venture, there are tremendous ethical and practical considerations that have limited its use in the management of ED.

Can atherogenic indices and the triglyceride-glucose index be used to predict erectile dysfunction?

Atherosclerosis and insulin resistance play an important role in the development of erectile dysfunction (ED), and few studies have comprehensively evaluated more specific indicators like atherogenic indices and the triglyceride-glucose (TyG) index in the assessment of ED. This study aimed to reveal the role of atherogenic indices (atherogenic index of plasma [AIP], Castelli risk index-1/2 [CRI-1/2], and atherogenic coefficient [AC]) based on plasma lipid ratios, which have been used as more sensitive indicators of atherosclerosis in recent years, and the TyG index, a practical indicator of insulin resistance, in predicting vasculogenic ED. The study included a total of 199 patients who met the inclusion criteria and a total of 51 control subjects without ED complaints according to the International Index of Erectile Function (IIEF-5) scores (>21) between May 2021 and October 2022. For all participants, the demographic and biochemical parameters were evaluated, and atherogenic indices, namely CRI-1 (total cholesterol/high-density lipoprotein [HDL]), CRI-2 (LDL/HDL) AIP [log10(triglycerides/HDL)], and AC (non-HDL/HDL), as well as the TyG index [Ln {fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2}] were calculated. The TyG index, which is an indicator of insulin resistance, and atherogenic indices such as CRI-1, AIP, and AC were significantly associated with ED, and especially AIP and the TyG index seem to be more important in the evaluation of ED. According to the univariate analysis, the patient group had significantly higher CRI-1 (5.3 ± 1.4 vs 4.7 ± 1.3; P = .005), AIP (0.31 ± 0.26 vs 0.13 ± 0.2; P < .001), AC (4.1 ± 1.4 vs 3.70 ± 1.2; P = .026), and TyG (9.16 ± 0.71 vs 8.77 ± 0.52; P < .001) values compared with the control group. In the correlation analysis, a significant negative correlation was found between the AIP and TyG index and the IIEF-5 scores (r2 = 0.120, P < .001 between AIP and IIEF-5; r2 = 0.091, P < .001 between TyG index and IIEF-5). The multivariate analysis revealed AIP and the TyG index as independent predictive factors for ED. The use of atherogenic indices and TyG index in daily urology practice can help physicians in the diagnosis and follow-up of ED. The lack of sex hormone-binding globulin and free testosterone levels represents a limitation of our study. Another limitation is that the severity of ED was determined using the IIEF-5 scores, rather than a more objective method, such as penile artery ultrasound. Atherogenic indices and the TyG index can be used as inexpensive and practical markers to predict the severity of arteriogenic ED.

Evaluation of erectile dysfunction in patients with lumbosacral disc herniation

Objectives: Survey on erectile dysfunction in patients with lumbosacral disc herniation and evaluation of their clinical improvement after surgical treatment of spinal canal stenosis due to herniated disc. Materials and Methods: 35 patients with lumbosacral were treated with discectomy with posterior intervertebral fusion (PLIF) surgery from 10/2021 - 4/2022 at the Department of Neurology, Hue University of Medicine and Pharmacy Hospital. Patients were evaluated for erectile dysfunction and postoperative improvement using the IIEF-5, CSFQ-14, DASS-21, Oswestry scales. Results: The mean age was 48.49 ± 9.15 years old. 51.4% of patients had the most severe hernia at the L4-L5 disc, 28.6% L3-L4 and 20% L5-S1. 100% of patients with herniated disc have erectile dysfunction. Of which 40% had mild-moderate disorders, 34.3% had moderate disorders, 14.3% had severe disorders and 11.4% had mild disorders. The CSFQ-14 and DASS-21 scales were correlated with erectile dysfunction (p &lt; 0.05). Surgery significantly improved pain (VAS score), activity limitation (ODI and JOA), degree of erectile dysfunction, changes in sexual function, depression and anxiety, stress of the patient 1 month after surgery (p &lt; 0.05). Conclusions: Patients with lumbosacral disc herniation had a 100% erectile dysfunction rate with a mean IIEF-5 score of 11.69 ± 3.77. The CSFQ-14 and DASS-21 scores have a strong positive correlation with erectile dysfunction. Surgical treatment of spinal canal stenosis due to lumbosacral disc herniation improves the clinical status of herniated disc as well as improves erectile dysfunction in these patients. Key words: Erectile dysfunction, IIEF-5 erectile dysfunction questionnaire, CSFQ-14 scale, DASS-21 scale, Oswestry scale, disc herniation.

Atherosclerosis of the iliac arteries for the prediction of erectile dysfunction and epistaxis in men undergoing abdominal CT scan

BackgroundTo investigate the association between erectile dysfunction (ED) as well as epistaxis (ES) in relation to the extent of iliac atherosclerosis.MethodsIn this retrospective cross-sectional study, all consecutive male patients treated at our institution from 01/2016 to 12/2020 undergoing abdominal CT scan were evaluated. Patients (n = 1272) were invited by mail to participate in the study in returning two questionnaires for the evaluation of ED (IIEF-5) and ES. Patients who returned filled-in questionnaires within a 3-month deadline were included in the study. The extent of atherosclerosis in the common iliac artery (CIA) and the internal iliac artery (IIA) was assessed by calcium scoring on unenhanced CT. Stratification of results was performed according to reported IIEF-5 scores and consequential ED groups.ResultsIn total, 437 patients (34.4% of contacted) met the inclusion criteria. Forty-two patients did not fulfill predefined age requirements (< 75 years) and 120 patients had to be excluded as calcium scoring on nonenhanced CT was not feasible. Finally, 275 patients were included in the analysis and stratified into groups of “no-mild” (n = 146) and “moderate-severe” (n = 129) ED. The calcium score (r=-0.28, p < 0.001) and the number of atherosclerotic lesions (r=-0.32, p < 0.001) in the CIA + IIA showed a significant negative correlation to the IIEF-5 score, respectively. Patients differed significantly in CIA + IIA calcium score (difference: 167.4, p < 0.001) and number of atherosclerotic lesions (difference: 5.00, p < 0.001) when belonging to the “no-mild” vs. “moderate-severe” ED group, respectively. A multivariable regression model, after adjusting for relevant baseline characteristics, showed that the number of atherosclerotic CIA + IIA lesions was an independent predictor of ED (OR = 1.05, p = 0.036), whereas CIA + IIA calcium score was not (OR = 1.00031, p = 0.20). No relevant correlation was found between ES episodes and IIEF-5 scores (r=-0.069, p = 0.25), CIA + IIA calcium score (r=-0.10, p = 0.87) or number of atherosclerotic CIA + IIA lesions (r=-0.032, p = 0.60), respectively.ConclusionsThe number of atherosclerotic lesions in the iliac arteries on nonenhanced abdominal CT scans is associated with the severity of ED. This may be used to identify subclinical cardiovascular disease and to quantify the risk for cardiovascular hazards in the future.Trial registrationBASEC-Nr. 2020 − 01637.

Population-level prevalence, effect on quality of life, and treatment behavior for erectile dysfunction and premature ejaculation in Poland

The prevalence of erectile dysfunction (ED) and premature ejaculation (PE) has been investigated in many population-based studies in different regions of the world. However, reliable data are lacking for Eastern Europe. Therefore, the aim of this study was to analyze the prevalence, effect on quality of life, and treatment-related behaviors for ED and PE in a population-representative sample of Polish men. We used an Internet interview format and rigorously adapted, widely accepted instruments for ED and PE evaluation. The study included 3001 men, representative for age and place of residence and adequate proportions of respondents from urban and rural areas. The prevalence of ED was 30.1–61.1%, and the prevalence of PE was 19.3–38.1%; there were no differences between urban and rural areas. Whereas the prevalence of ED increased with age, the prevalence of PE did not increase. More than 50% of respondents with ED and more than 60% of respondents with PE had concerns about their quality of life. However, less than one fourth of participants with ED and PE were seeking treatment, most of whom received treatment. The results of our nationwide analysis, reflecting the entire Polish population of men, are consistent with other epidemiologic studies of ED and PE and may support educational campaigns and health improvement programs in Poland.

Characteristics of direct-to-consumer platforms offering erectile dysfunction treatment.

Due to the sensitivity and potential embarrassment of discussing erectile dysfunction (ED) in person, men are seeking treatment online. We sought to compare offerings of direct-to-consumer (DTC) platforms for ED treatment with respect to consultation, pricing, services, and privacy policy. Google was queried to identify DTC platforms offering ED treatment with the keywords: "telehealth erectile dysfunction," "telemedicine erectile dysfunction," and "online erectile dysfunction." Inclusion criteria were as follows: serving a majority of U.S. states, existing online only, providing both the consultation and prescription for phosphodiesterase type 5 inhibitors, and delivering the prescription to the patient. Fifteen DTC platforms met criteria. Ten provided free consultations; 4 bundled the consultation fee with the first month of the prescription, with 1 of these functioning as a subscription service. Fourteen (93%) relied on online intake forms and 10 (67%) advertised review by the prescriber within 2 business days. Only 4 (27%) platforms explicitly advertised physician-only consults. Direct contact with the prescriber would only occur if needed or if required by state law at 8 (53%) platforms. Purchasing sildenafil and tadalafil was advertised on all platforms. Minimum prices of sildenafil ranged from $0.50 to $35/pill (mean $5.16/pill, median $2.65/pill); tadalafil ranged from $0.50 to $9.80/pill (mean $4.70/pill, median $3.21/pill). In addition to ED therapy, 13 (86%) platforms offered treatment for other men's health issues. All platforms included a website privacy policy, but only 10 (67%) mentioned Health Insurance Portability and Accountability Act compliance, with 2 of these claiming to not be covered entities. Although DTC platforms are transparent with phosphodiesterase type 5 inhibitor medication and subscription pricing information, few offer direct contact with a physician to further discuss issues related to ED after completion of the online intake form. For comprehensive evaluation of ED in Health Insurance Portability and Accountability Act-compliant settings, in-person or telemedicine visits should be arranged with men's physicians.

(387) Evaluating Bias Against Prostate Cancer Survivors in Clinical Trials for Erectile Dysfunction

Abstract Introduction Approximately 250,000 men are diagnosed with prostate cancer every year in the United States with 90,000 radical prostatectomies (RP) performed yearly. Erectile dysfunction (ED) is a common side effect following prostate cancer therapies. The estimated incidence of erectile dysfunction (ED) varies in the literature after RP, however some studies have reported percentages as high as 75%. It is unclear whether there is exclusion bias among clinical trials evaluating erectile dysfunction therapies against prostate cancer survivors. We were interested to determine if clinical trials for ED had specific criteria that would exclude prostate cancer survivors. Objective To investigate how previous and current clinical trials evaluating ED interventions exclude prostate cancer survivors from enrollment. Methods We reviewed all registered trials under the category of “Erectile Dysfunction” on the website “clinicaltrials.gov”. Studies were excluded if an intervention for ED was not tested or if evaluation of ED was not a primary outcome. Exclusion criteria were examined for radical prostatectomy, androgen deprivation, pelvic radiotherapy for prostate cancer, or a history of prostate cancer whether treated or not. Results A total of n = 545 trials were reviewed. 169 trials were excluded because the primary end point did not assess ED outcomes. Thus, 376 trials were analyzed further for relevant exclusion criteria. Of the 376 trials, 48 (12.8%) were specifically for patients undergoing or status post radical prostatectomy, 8 (2.1%) for post-radiation prostate cancer survivors, 1 (0.3%) for after any intervention for prostate cancer including radical prostatectomy, radiation, and hormonal therapy, and 1 (0.3%) was for men with prostate cancer more generally. Among the 317 studies not specifically for prostate cancer survivors, 126 (39.7%) studies specifically excluded patients who had undergone RP and 167 trials (52.7%) had at least one exclusion criteria pertaining to prostate cancer history or treatment. 150 trials (47.3%) had no exclusions regarding prostate cancer interventions. A chi-square test of independence was performed to examine the relationship between exclusion criteria for prostate cancer history/therapies and intervention type. The relation between these variable was significant, χ2(7, N=317)=37.33, p=0.00. Prostate cancer related exclusions were more likely to be present than no-prostate cancer related exclusions among the examined trials not specifically designed for prostate survivors. Conclusions While erectile dysfunction is a common problem for prostate cancer survivors, over half of registered general erectile dysfunction intervention trials exclude patients with prostate cancer or who have had a therapeutic intervention for prostate cancer. Almost half of these clinical trials specifically exclude patients who have had a radical prostatectomy. Disclosure No

(493) Utilization of Intracavernosal Injection and Penile Ultrasound in the Evaluation of Erectile Dysfunction and Peyronie’s Disease

Abstract Introduction Intracavernosal injections (ICI) and penile duplex Doppler ultrasound (DDUS) play a diagnostic role for patients with erectile dysfunction (ED) and Peyronie’s disease (PD). They can help to identify vascular and anatomical changes that may guide medical and surgical management; however, contemporary utilization rates of ICI and penile DDUS have not recently been described. Here we use a multicenter database to determine utilization of ICI and penile DDUS in patients with ED and PD. Objective To evaluate the rates of ICI and penile DDUS in patients with ED and PD using a global database. Methods TriNetX is a research network of real-time data from 58 Healthcare Organizations globally. Using the International Classification of Diseases Tenth Edition (ICD-10) codes, we queried the network for adult men with ED (N52) being medically treated with phosphodiesterase (PDE)-5 inhibitors from 2002 - 2022. This included sildenafil, tadalafil, vardenafil, and avanafil. Current Procedural Technology (CPT) codes were utilized to identify patients who received penile DDUS (93980, 93981) and penile prosthesis (54400, 54401, 54405). ICD-10 codes were utilized to query the network for those with PD (N48.6) from 2002 – 2022. We then used CPT codes to search within this cohort for those who had ICI (54235) excluding patients that also had penile DDUS (93980, 93981). We separately queried for patients that had penile DDUS (93980, 93981). Finally, we queried for patient who received either evaluation method and had injection therapy (54200), penile plication (54360), or plaque excision +/− grafting (PEG) (54110, 54111, 54112). The analysis was run on June 30, 2022. Results The cohort with ED on a PDE-5 inhibitor in the TriNetX database included 613,323 patients. The cohort had a mean age of 63 +/− 13 years and racial demographics of 18% black and 70% white. 8,540 patients (1.4%) had a penile DDUS and 868 (0.1%) went on to penile prosthesis (Figure 1A). A second study cohort included 46,743 patients with Peyronie’s disease with a mean age of 62 +/− 13 years and racial demographics of 8% black and 73% white. ICI was performed in 2,960 (6.3%) PD patients: 568 (1.2%) then underwent injection therapy, 1,128 (2.4%) penile plication, and 142 (0.3%) PEG (Figure 1B). Penile DDUS was performed in 4,972 (10.7%) patients with PD: 955 (2.0%) then underwent injection treatment, 474 (1.0%) penile plication, and 255 (0.5%) PEG (Figure 1B). Conclusions For ED, penile DDUS is used in a low percentage of evaluations. For PD, penile DDUS is used more commonly than ICI only. After evaluation with penile DDUS, the most common therapy is injection. After an evaluation with ICI only, the most common therapy is penile plication. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast.

(352) Erection Hardness Score (EHS) Correlates With Resistive Index but Not Cavernosal Artery Dilation During Penile Doppler for Erectile Dysfunction and Peyronie's Disease

Abstract Introduction Penile Doppler Ultrasound (PDU) is a non-invasive diagnostic test used to assess organic erectile dysfunction (ED) and Peyronie’s disease and characterize functional changes in penile blood flow. Quantitative measurements taken during penile Doppler testing include changes in cavernosal artery diameter, the velocity of blood flow in the cavernosal artery in systolic and diastolic phases, and a calculated resistive index. It remains poorly understood which of these parameters best predict response to intracavernosal injection therapy and how they are influenced by comorbidities such as age, diabetes, smoking, hypertension, and obesity. Objective The objective of this study is to assess which parameters best predict response to intracavernosal trimix injection and determine the utility of measuring cavernosal artery diameter during penile Doppler testing. Methods This study is a single institutional retrospective cross-sectional review of men undergoing workup for organic ED and/or Peyronie's disease who elected to undergo penile Doppler testing. Only patients who received a standardized 30-1-10 trimix injection were included. Dosing was determined based on age and risk factors using a nomogram, and redosing was performed if the erection quality was below subjective optimal erection quality at home. Baseline cavernosal artery and plaque imaging were performed, and repeat measurements were obtained at 10 minutes following trimix injection. Results 93 men were included in the study with a median age of 59 (IQR 51-67). 47% carried a diagnosis of Peyronie's, 41% had hypertension, 29% were obese, and 30% were smokers. 40% met the criteria for venous leak (RI &amp;lt;0.8). Erectile hardness scale (EHS) scores of 1-4 were documented in 5, 21, 61, and 5 patients, respectively. Linear regression demonstrated no significant relationship between the change in cavernosal artery diameter and trimix dose, resistive index, comorbidities or other Doppler parameters measured. There was no direct relationship between the EHS scores and cavernosal artery dilation. However, there was a statistically significant relationship between EHS and age (p=0.004), trimix dose (p=0.008), and resistive index (p=0.001) on univariate regression. A multivariable model containing age, comorbidities, and these parameters correctly explained 31% of the variance demonstrated (p=0.001). Conclusions Provider-determined EHS scores were directly proportional to patient age, trimix dose, and resistive indices but not to changes in cavernosal artery diameter. Our findings suggest that this measurement may be safely omitted during the evaluation of organic ED and Peyronie’s Disease without changes in diagnostic or management pathways. Disclosure No

Prostat kanserinde minimal invaziv cerrahi tedavi sonrası erektil disfonksiyonun güncel literatür eşliğinde değerlendirilmesi

Evaluation of erectile dysfunction after minimally invasive surgical treatment in prostate cancer with current literature Prostate cancer is among the most frequently diagnosed cancers in men; Its prevalence is increasing gradually as a result of developing diagnostic methods. There are also new treatment methods that follow the developing diagnostic methods. The most common complication after prostate cancer treatment is erectile dysfunction. With the decrease in the age of diagnosis, this complication is more important and is being discussed today. In this review, we will present the effect of minimally invasive surgical treatments applied in prostate cancer on erectile function in the light of current literature. Keywords: prostate cancer, laparoscopic radical prostatectomy, robotassisted radical prostatectomy, erectile dysfunction

The flow index provides a comprehensive assessment of erectile dysfunction by combining blood flow velocity and vascular diameter

Dynamic duplex sonography (DUS) is not comprehensive in the evaluation of arteriogenic erectile dysfunction (ED). We introduced a new parameter, the flow index (FI), into the assessment of arteriogenic ED. A retrospective review of a prospective database was conducted. Patients undergoing DUS and pelvic computed tomography angiography for the evaluation of ED were included. The FI was calculated from peak systolic velocity (PSV) and the percentages of pelvic arterial (PLA) stenosis. Correlations between PSV, PLA stenosis, the FI, and erectile function were calculated. Eighty-three patients were included. Compared with PSV, the FI had better correlations with the erection hardness score (EHS) (rs = 0.405, P < 0.001 for FI; rs = 0.294, P = 0.007 for PSV). For EHS < 3, the areas under the ROC curve of FI and PSV were 0.759 and 0.700, respectively. In patients with normal DUS but EHS < 3, PLA stenosis was more severe (62.5% vs. 10.0%, P = 0.015), and the FI was lower (8.35 vs. 57.78, P = 0.006), while PSV was not different. The FI is better than PSV in the evaluation of arteriogenic ED. On the other hand, assessment of the pelvic arterial system should be included in the evaluation of ED.

The role of penile elastography in the evaluation of erectile dysfunction in patients with chronic obstructive pulmonary disease

IntroductionIn this study, we aimed to measure the change in penile stiffness by evaluating corpus cavernosum (CC) with shear wave elastography (SWE) in patients with chronic obstructive pulmonary disease (COPD).Material and methodsSeventy outpatient patients aged 50–80 years who were diagnosed with COPD were evaluated using SWE. Patients were divided into 2 groups according to the International Index of Erectile Function-5 (IIEF-5) questionnaire (IIEF-5 >17: Group A, IIEF-5 <17: Group B). The measurements were made in both transverse and longitudinal sections.ResultsThe mean age of the patients was 60 ±7.9 years. The duration of COPD was significantly higher in Group B than in Group A (p = 0.003). The mean SWE values of right transverse mid-portion of corpus penis (RTM) and left transverse mid-portion of corpus penis (LTM) in Group B (21.1 ±5.6 kPa and 20.8 ±4.8 kPa, respectively) were significantly higher than in Group A (15.2 ±2.3 kPa and 15.8 ±2.7 kPa, respectively); (p <0.001 and p <0.001, respectively). There was a significant negative correlation between IIEF-5 scores and the duration of COPD (p <0.05). There was a significant negative correlation between IIEF values and RTM and LTM values of the patients (p <0.05 and p <0.05, respectively). There was a significant positive correlation between the duration of COPD and both RTM and LTM values (p <0.05 and p <0.05, respectively).ConclusionsIn our study, according to the SWE findings, we showed the effect of systemic changes created by COPD on penile tissue and the negative effect of this on erectile function in patients.

Fundamentals of the Treatment of Male Erectile Dysfunctions with Low Intensity Shock Waves

Male erectile dysfunction (ED) is one of the most common problems among men worldwide. No single diagnostic method evaluates all the variables of this complex condition. To achieve good therapeutic results, it is essential to base the treatment on an accurate diagnosis. Hemodynamic exploration by echo Doppler of the cavernous arteries, especially since the incorporation of intracavernous administration of vasoactive drugs, is a useful tool that allows the evaluation of erectile dysfunction in the arterial phase. It is also considered to be the choice in the assessment of the corporoveno-occlusive mechanism. Different treatment methods are used, being PDE5 (sildenafil and tadalafil), the treatment of the first choice in several conditions. The number of publications of low-intensity extracorporeal shockwave treatment (LIESWT) for ED has increased dramatically in recent years. Scientific evidence regarding the application of LI-ESWT for the treatment of erectile dysfunction is still controversial. Inclusion criteria of the studies and the wide variety of treatment protocols have been criticized. On the other hand, most of these studies report encouraging results with no short-term adverse effects, regardless of variation in LI-ESWT setup parameters or treatment protocols.

Association between sarcopenia and erectile dysfunction in older males

IntroductionIn advanced age, both sarcopenia and erectile dysfunction (ED) occur with similar underlying causes through different mechanisms. In our study we investigated the association between sarcopenia and ED in older men. MethodsA total of 193 male patients aged 60 years and older were included in the study. The presence of sarcopenia was investigated in accordance with EWGSOP2 diagnostic criteria. For evaluation of ED, we used the 5-question International Index of Erectile Dysfunction questionnaire with categories of no ED, mild-moderate ED, and moderate-severe ED. Total testosterone levels were measured. ResultsThe median age of the patients was 71.9 (range 60–93 years). The prevalence of sarcopenia was 24.9%, and moderate-severe ED was 49.2%. Moderate-severe ED was more common in patients with sarcopenia than those without (70.8% vs 42.1%, p < 0.001). After adjustment for age and Charlson Comorbidity Index, the presence of sarcopenia was significantly associated with moderate-severe ED with odds ratio (OR) of 2.71 (95% Confidence Interval [CI] 1.29–5.73, p = 0.009). The components of sarcopenia were assessed separately in multivariate analysis. Muscle strength and muscle mass were significantly associated with moderate-severe ED with OR of 0.93 (95%CI 0.89–0.98) and 0.68 (95%CI 0.54–0.86), respectively, whereas gait speed was not associated with moderate-severe ED. ConclusionThe presence of sarcopenia in older men is associated with an increased risk of moderate-severe ED. In addition, decreased muscle strength and decreased muscle mass are associated with an increased risk of moderate-severe ED. Prospective studies are needed to reveal the causality between sarcopenia and ED.

Effects of Sildenafil on spirometric pulmonary function parameters, pulmonary artery systolic pressure and BNP levels in patients with chronic obstructive pulmonary disease and erectile dysfunction

We aimed to investigate the effects of Sildenafil on pulmonary artery systolic pressure (PASP) as well as forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) and serum brain-type natriuretic peptide (BNP) levels in stable chronic obstructive pulmonary disease (COPD) patients with erectile dysfunction (ED). This was a prospective non-controlled interventional study that recruited COPD patients with ED between the ages of 49 and 79. International Index of Erectile Dysfunction Form (IIEF-5) was used for the evaluation of ED. Patients who had pulmonary artery systolic pressure &amp;#62;50 mmHg were included in the study. Single-dose Sildenafil 100 mg was administered orally to the patients. Before and after the drug ingestion, spirometry and echocardiographic measurements were performed, and serum BNP levels were measured as well. Forty-five male COPD patients with ED were included. Both percent predicted, and absolute FEV1 values increased significantly after the Sildenafil administration compared with baseline values (p&amp;#60;0.01). Similarly, the FEV1/FVC ratio also increased significantly with the Sildenafil administration compared to baseline values (p&amp;#60;0.01). Pulmonary artery systolic pressure significantly decreased from its baseline value with Sildenafil administration (p&amp;#60;0.01). Serum BNP values significantly reduced with Sildenafil administration compared to the pre-treatment values (p&amp;#60;0.01). This is the first study conducted in COPD patients with erectile dysfunction who had also pulmonary hypertension. The single-dose Sildenafil administration reduced PASP and serum BNP levels significantly. For the first time in the literature, we showed that the spirometric pulmonary function tests, namely FEV1 and FEV1/FVC ratio, improved significantly with the Sildenafil administration.

Evaluation of Erectile Dysfunction in Nonobese, Nondiabetic Men with Obstructive Sleep Apnea

Background: Erectile Dysfunction (ED) has affected people suffering from Obstructive Sleep Apnea Syndrome (OSAS) and multiple studies have confirmed this correlation. Objective: The objective of the is to identify the association between ED and Obstructive Sleep Apnea (OSA) in nonobese, nondiabetic men based on the International Index of Erectile Function (IIEF). Methods: This retrospective cross-sectional study included 143 nonobese, nondiabetic men with OSA (age, ≥20 years) who visited the Sleep Outpatient Clinic of the Otorhinolaryngology Department at Hospital Naval Marcílio Dias from May 2017 to August 2018. Patient age, body mass index (BMI), drinking, smoking, laboratory diagnosis of hypogonadism based on total testosterone levels, and sleep parameters (e.g., apnea–hypopnea index, rapid eye movement density, and minimum Oxygen Saturation [SatO2]) were considered. Analysis of variance was used to evaluate means. The chi-squared test and Fisher’s exact test were used to compare variables and Person’s correlation coefficient was used to analyze numerical variables. Results: The mean minimum SatO2 was 78.89%, and 46% of patients exhibited minimum SatO2 &lt;80%. Moreover, minimum SatO2 of &lt;80% and increasing age were associated with ED complaints based on IIEF scores,. A laboratory diagnosis of hypogonadism was associated with increased BMI, and aging was associated with SatO2. Conclusion: The results of the study revealed that oxygen desaturation of &lt;80% was related to complaints of ED from the IIEF. Moreover, a relationship between laboratory hypogonadism and increased BMI values, aging, and oxygen desaturation has been demonstrated. Therefore, we recommend polysomnography in patients with ED complaints.

PD30-07 THE COMBINATION OF BLOOD FLOW VELOCITY AND VASCULAR DIAMETER: THE FLOW INDEX IS BETTER IN THE EVALUATION OF ARTERIOGENIC ERECTILE DYSFUNCTION

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation II (PD30)1 Sep 2021PD30-07 THE COMBINATION OF BLOOD FLOW VELOCITY AND VASCULAR DIAMETER: THE FLOW INDEX IS BETTER IN THE EVALUATION OF ARTERIOGENIC ERECTILE DYSFUNCTION Wei-Lun Huang, Chi-Shin Tseng, Sheng-Yung Tung, Tzung-Dau Wang, Wen-Jeng Lee, Shih-Ping Liu, Hong-Chiang Chang, Yi-Kai Chang, and Yu-Hsiang Yang Wei-Lun HuangWei-Lun Huang More articles by this author , Chi-Shin TsengChi-Shin Tseng More articles by this author , Sheng-Yung TungSheng-Yung Tung More articles by this author , Tzung-Dau WangTzung-Dau Wang More articles by this author , Wen-Jeng LeeWen-Jeng Lee More articles by this author , Shih-Ping LiuShih-Ping Liu More articles by this author , Hong-Chiang ChangHong-Chiang Chang More articles by this author , Yi-Kai ChangYi-Kai Chang More articles by this author , and Yu-Hsiang YangYu-Hsiang Yang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002031.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The dynamic duplex sonography (DUS) measures the blood flow velocity but not the volumetric flow rate of blood, which is the blood volume infused per unit of time. In our experience, some patients with normal DUS result still have vasculogenic erectile dysfunction (ED), indicating that current measurements may be incomprehensive. In our study, a new parameter, the Flow Index (FI), was introduced for evaluating arteriogenic ED. METHODS: Patients receiving DUS and computed tomography angiography (CTA) for evaluation of ED were enrolled. ED was defined based on observed EHS after intracavernous injection of PGE1 during DUS exam. Patients with veno-occlusive dysfunction were excluded. Pelvic arterial (PLA) stenosis and cavernous arterial (CA) stenosis were measured by CTA. The volumetric flow rate of blood was velocity*π*radius2. We defined FI=PSV*(1-arterial stenosis%)2. FI of PLA (FIPLA) and CA (FICA) were calculated. Correlations between parameters were assessed. RESULTS: Eighty-three patients were included. Compared with PSV, FI had better correlations with EHS (Table) and better area under the receiver operating characteristic curve (AUC) for arteriogenic ED (Figure). Compared with patients without arteriogenic ED, patients with arteriogenic ED who had normal DUS had more severe PLA stenosis (62.50% vs 30.00%, P=0.02) and lower FIPLA (12.03 vs 42.17, P=0.01), while the PSV was not different (37.50 cm/s vs 39.90 cm/s, P=0.54). In patients with PLA stenosis, the odds of ED was higher (OR=4.88) and the FI was lower (56.00 vs 67.60, P=0.03 for FICA; 10.22 vs 58.53, P<0.01 for FIPLA), however, the PSV was not significantly different (35.00 cm/s vs 38.25 cm/s, P=0.38). CONCLUSIONS: FI is more comprehensive than PSV in evaluating arteriogenic ED, and PLA patency is one of factors determining penile perfusion. However, PSV may not be suitable for diagnosing arteriogenic ED in patients with PLA stenosis. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e534-e535 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wei-Lun Huang More articles by this author Chi-Shin Tseng More articles by this author Sheng-Yung Tung More articles by this author Tzung-Dau Wang More articles by this author Wen-Jeng Lee More articles by this author Shih-Ping Liu More articles by this author Hong-Chiang Chang More articles by this author Yi-Kai Chang More articles by this author Yu-Hsiang Yang More articles by this author Expand All Advertisement Loading ...

Evaluation of erectile dysfunction in patients with asthma.

The aim of the current study was to investigate Erectile dysfunction (ED) in asthma patients without comorbidity and the relationship between the level of asthma control and ED. Forty male patients aged 24-50years with controlled-to-uncontrolled asthma and 20 healthy volunteers were included in this study. The International Index of Erectile Function Questionnaire (IIEF) for ED was used. Evaluation of the IIEF scores for ED showed that 23 (57.5%) of the asthma patients and 4 (20.0%) of the controls had various degrees of ED, and the difference was statistically significant. In total, 25% of asthma patients had mild ED, 22.5% moderate ED, and 10% severe ED. Severe, moderate and mild ED was more frequent in the asthma group. Of the 23 patients who had various degrees of ED, 13 were in the uncontrolled asthma group. While all asthma patients with severe ED were in the uncontrolled asthma group, of the 9 asthma patients with moderate ED, 6 were in the uncontrolled asthma group, 2 were in the partially controlled asthma group and one was in the controlled asthma group. Additionally, of the 10 asthma patients with mild ED, 3 were in the uncontrolled asthma group, 2 were in the partially controlled asthma group and 5 were in the controlled asthma group. The current study showed that ED is frequent and more severe in asthma patients than controls with same age. A highly negative correlation was found between ED degree and asthma control severity.

Aromatase Inhibitors in Erectile Dysfunction

Hyperestrogenism may cause erectile dysfunction(ED) by impeding normal penile development,increasing venous vascular permeability and leakage(via VEGF) and by inhibiting testosterone(T)production. Estrogen excess can impair spermatogenesis and may increase the risk of estrogen-sensitive cancers(viz.breast cancer)[1,2]Weekly and biweekly letrozole(2.5 mg),an aromatase inhibitor,has been reported to normalize serum T in males with obesity related hypogonadism and poor sperm quality,respectively.[3,4]A 40-year old insulin requiring,normotensive,obese(BMI-26.9),diabetic(12 years duration) was evaluated for ED.T was 187 ng/dl and estradiol(E2) was 69 pg/ml(normal-11-44 pg/ml) with normal LH and prolactin levels. There was normalization of T(increased to 487 ng/dl) with 2.5 mg letrozole every 3 weeks. Another patient,55 year old male, insulin requiring,hypertensive,obese(BMI-28.8),diabetic(21 years duration) had normalization of T(401 ng/dl) with baseline low T(224.4 ng/dl) and normal E2(33 pg/ml) with T-E2 ratio of less than 10,with weekly 2.5 mg letrozole. There was one kg weight gain and 0.2 ng/ml increase in PSA in two years. These cases highlight the significance of estimating both T and E2 in the evaluation of ED. Moreover,it also highlights the efficacy and safety of weekly and even every 3-week 2.5 mg letrozole therapy.

Evaluation of erectile dysfunction in the ageing men using colour Doppler sonography

BackgroundErectile dysfunction (ED) is common among ageing men because of associated underlying risk factors which are peculiar to this category of patients. Endothelial dysfunction and replacement of cavernosal smooth muscles by collagen fibres are common in older men, making them prone to ED. It is either vasogenic, neurogenic, hormonal, cavernosal or psychogenic in origin, but vasogenic causes are the commonest. This study was aimed at establishing vasogenic causes among patients being evaluated for ED using Doppler ultrasound as this category of ED is amenable to either medical and/or surgical treatment.MethodsThe study was conducted from July 2015 to January, 2017 at Federal Medical Centre Abuja. Nineteen consecutive patients with clinical diagnosis of erectile dysfunction were evaluated with Doppler ultrasound scan using a high-frequency linear array transducer. The penile scan was done before and after intracavernosal injection of 20 µg of Prostaglandin E1 (PGE1). B-mode scan of the penis was done prior to intracavernosal injection of PGE1, and the spectral waveforms as well as peak systolic velocity (PSV) of the CA were recorded at 5 min interval, from 5 to 50 min post-intracavernosal injection of PGE1, using angle of insoation ≤ 60°.ResultsThe age range of the patients was fifty to sixty-six years (mean: 57.4 ± 4.3 years), while the PSV of CA varied between 21.4 and 104.4 cm/s (mean: 46.2 ± 19.2) among the entire patients, between 21.4 and 22.3 cm/s (mean: 21.9 ± 0.7) among patients with arteriogenic ED, and between 25.0 and 74.9 cm/s (mean: 45.0 ± 15.5) among those with venogenic ED. Arteriogenic ED was found in two patients (10.6%), while venogenic ED was observed in seven patients, which constituted 36.8% of the entire research participants. None had Peyronie’s disease, penile fracture, penile tumour or mixed arteriogenic and venogenic ED.Conclusion47.4% of the patients had vasogenic ED and venogenic ED was more common than arterioegenic ED in the age range considered. This categorization of ED with Doppler study is imperative before initiating therapy as treatment protocol for vasogenic ED is aetiologic specific.