Higher Risk Of Erectile Dysfunction Research Articles

Causal relationship between sleep traits and erectile dysfunction: Evidence from Mendelian Randomization analysis

IntroductionAlthough several observational studies have explored the association between sleep traits and the risk of erectile dysfunction (ED), it remains controversial. In the present study, we included a wide range of sleep traits that are commonly observed in clinical practice. We investigated the causal relationship between these sleep traits and ED using univariate and multivariate Mendelian randomization (MR) methods.Material and methodsInstrumental variables (IVs) for eight sleep traits (insomnia, sleep duration, chronotype, and sleep apnea syndrome), five confounders (depression, body mass index, smoking initiation, alcohol consumption, and type 2 diabetes), and ED were derived from genome-wide association study (GWAS) data of individuals of European ancestry. The primary analysis technique used was the inverse-variance weighted (IVW) approach. Furthermore, several sensitivity analyses were conducted to evaluate heterogeneity, horizontal pleiotropy, and stability.ResultsMR analysis revealed that increased snoring, short sleep, and frequent insomnia, were associated with a higher risk of ED. Furthermore, we found evidence of a significant association between being a morning person and the risk of developing ED. This association persisted in multivariable MR analyses after adjusting for potential confounding factors. Sensitivity analysis suggested that the results were robust with no evidence of pleiotropy or heterogeneity.ConclusionsThis study provides further evidence supporting the association between genetically predicted snoring, insomnia, and an increased risk of ED. Additionally, the study highlights the causal relationship of short sleep duration and chronotype with ED.

Monocyte-to-high-density lipoprotein cholesterol ratio and the risk of erectile dysfunction: a study from NHANES 2001-2004.

The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) has become a novel inflammation marker with a possible association with erectile dysfunction (ED); however, there are fewer studies exploring the association between MHR and ED. This study sought to explore the association between MHR and ED. This study population was drawn from participants in two 2-year cycles of the National Health and Nutrition Examination Survey (2001-2002 and 2003-2004). MHR was calculated as the ratio of monocyte count (103 cells/μL) to high-density lipoprotein cholesterol (mg/dL). The relationship between MHR and ED was explored using survey-weighted logistic regression models with MHR as a continuous variable and divided into tertiles (tertile 1 [T1]: <0.01; T2: 0.01-0.014; T3: >0.014). We also used a smooth curve fit (penalized spline method) to characterize the dose-response relationship between MHR and ED. In addition, subgroup analyses based on age, body mass index, smoking, hypertension, diabetes mellitus, and cardiovascular disease were performed to further analyze the data. Sensitivity analyses were also conducted to further assess the stability of the results. The main outcome measure was the difference in ED prevalence between MHR levels. A total of 1361 participants were enrolled, with 513 (T1), 438 (T2), and 410 (T3) participants in the 3 MHR groups. After adjusting for all potential covariates, survey-weighted logistic regression analyses showed a significant association between MHR and ED (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.26-3.05). When MHR was used as a categorical variable, the adjusted OR for ED prevalence increased significantly with increasing MHR after adjusting for all potential covariates (T3 vs T1: OR, 2.14; 95% CI, 1.29-3.55). The dose-response curves showed that the prevalence of ED increased with increasing MHR. Easy to access and low cost, MHR is a convenient clinical tool that helps clinicians in the prevention and treatment of ED. The present study is the first to examine the association between MHR and ED nationally representative data. However, the study population was derived from a U.S. database, so the findings are limited to the U.S. population. Our study demonstrated that MHR levels were independently associated with ED and that ED patients had higher MHR levels, suggesting that MHR may be a valuable predictor for identifying people at higher risk for ED.

Association of METS-IR index with prevalence of erectile dysfunction in US adults: a cross-sectional study.

Insulin resistance (IR) is involved in the development of erectile dysfunction (ED). The purpose of this study was to assess the correlation between the metabolic score for IR (METS-IR) index and risk of erectile dysfunction in US adults. This study selected individuals from the National Health and Nutrition Examination Survey (NHANES). Logistic regression analysis, subgroup analysis, and dose-response curve analysis were carried out to assess the relationship between the METS-IR index and ED prevalence. This study ultimately included 1759 participants aged ≥ 20years, of whom 512 self-reported a history of ED. After adjusting for all confounders, each unit increase in METS-IR index was associated with a 3% increase in erectile dysfunction prevalence (OR = 1.03, 95% CI: 1.01-1.04). In almost all subgroups, an increased METS-IR index was associated with a higher prevalence of ED. The dose-response curve displayed a positive non-linear connection between METS-IR value and the prevalence of ED. The study found a positive association between the METS-IR index and ED. METS-IR is useful as a simplified IR evaluation index for early identification of people with high risk of ED.

Causal associations between prostate diseases, renal diseases, renal function, and erectile dysfunction risk: a 2-sample Mendelian randomization study.

Previous observational studies have found a potential link between prostate disease, particularly prostate cancer (PCa), and kidney disease, specifically chronic renal disease (CKD), in relation to erectile dysfunction (ED), yet the causal relationship between these factors remains uncertain. The study sought to explore the potential causal association between prostate diseases, renal diseases, renal function, and risk of ED. In this study, 5 analytical approaches were employed to explore the causal relationships between various prostate diseases (PCa and benign prostatic hyperplasia), renal diseases (CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, and kidney ureter calculi), as well as 8 renal function parameters, with regard to ED. All data pertaining to exposure and outcome factors were acquired from publicly accessible genome-wide association studies. The methods used encompassed inverse variance weighting, MR-Egger, weighted median, simple mode, and weighted mode residual sum and outlier techniques. The MR-Egger intercept test was utilized to assess pleiotropy, while Cochran's Q statistic was employed to measure heterogeneity. We employed inverse variance weighting MR as the primary statistical method to assess the causal relationship between exposure factors and ED. Genetically predicted PCa demonstrated a causal association with an elevated risk of ED (odds ratio, 1.125; 95% confidence interval, 1.066-1.186; P < .0001). However, no compelling evidence was found to support associations between genetically determined benign prostatic hyperplasia, CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, kidney ureter calculi, and the renal function parameters investigated, and the risk of ED. The risk of ED is considerably amplified in patients diagnosed with PCa, thereby highlighting the importance of addressing ED as a significant concern for clinicians treating individuals with PCa. This study's strength lies in validating the PCa-ED association using genetic analysis, while its limitation is the heterogeneity in study results. The results of this study suggest a potential link between PCa and a higher risk of ED.

Association between cardiometabolic index and erectile dysfunction among US adults: a cross-sectional analysis of the National Health and Nutrition Examination Survey 2001-2004.

The aim of this study was to assess the association between a new metabolic index, the cardiometabolic index (CMI) and erectile dysfunction (ED). The data for this study relied on the National Health and Nutrition Examination Survey (NHANES), a cross-sectional database, between 2001 and 2004. The CMI was calculated as the following formula: Triglyceride (TG) (mmol/L)/ High density lipid-cholesterol (HDL-C) (mmol/L) ×waist-height ratio (WHtR). The multivariate logistic regression analyses were conducted to assess the association between CMI and ED, supplemented by subgroup analysis and dose-response curves. Finally, a total of 1367 adult male participants were identified, and the mean CMI was 0.83 ± 0.02. Multivariate logistic regression analysis showed that in model 2 controlling for all potential confounders, CMI was significantly associated with ED (OR = 1.49, 95% CI: 1.09, 2.04) (p = 0.017). Subsequently, we convert the CMI from a continuous variable to a categorical variable (Tertiles). The results showed that male participants in CMI Tertile 3 group had a higher risk of ED than those in Tertile 1 group in model 2 (OR = 2.07, 95% CI: 1.12, 3.83, P = 0.024). The subgroup analysis of model 2 demonstrated that CMI was significantly associate with ED in participants aged ≥50 y (OR = 2.31, 95% CI: 1.35, 3.95, P = 0.005), body mass index (BMI) > 30 kg/m2 (OR = 1.78, 95% CI: 1.10, 2.90, P = 0.023), with hypertension (OR = 1.89, 95% CI: 1.63, 3.45, P = 0.020), with diabetes mellitus (OR = 1.67, 95% CI: 1.13, 2.47, P = 0.015), with cardiovascular disease (CVD) (OR = 1.54, 95% CI: 1.12, 2.10, P = 0.011) and smoking (OR = 2.07, 95% CI: 1.26, 3.39, P = 0.007). This study demonstrates a strong association between CMI and ED and an increased risk of ED with higher CMI levels. More prospective studies with large samples and good designs are needed to validate our results in the future.

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

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

Higher systemic immune-inflammation index is associated with increased risk of erectile dysfunction: Result from NHANES 2001-2004.

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) to investigate the association between the systemic immune-inflammation index (SII) and erectile dysfunction (ED) in adult males. The SII is a novel index derived from the counts of neutrophils, lymphocytes, and platelets in the peripheral blood and serves as a comprehensive indicator of the immune response and inflammation levels. The study included 3601 participants from the NHANES 2001-2004 cycle. Covariates such as age, race, marital status, education, smoking, alcohol consumption, BMI, hypertension, and diabetes were taken into account. Weighted analysis and logistic regression models were applied to assess the relationship between SII and ED, adjusting for potential confounding factors. The prevalence of ED was found to be 6.28%. Overall, there is a linear correlation between SII (nonlinear P > .05) and ED. After adjusting for various confounding factors, a significant association was observed between high levels of the SII and ED. The odds ratio (OR) for ED in individuals with high SII levels was 1.45 (95% CI: 1.01-2.17, P = .045). Subgroup analysis further identified specific participant subgroups with a significant association between SII and ED. Our findings suggest that higher levels of the SII are independently associated with an increased risk of ED in adult males. The SII may serve as a valuable biomarker for identifying individuals at higher risk of ED and may aid in the development of tailored treatment approaches. Further research is needed to explore the underlying mechanisms and potential therapeutic implications.

Risk of Sexual Dysfunction in Men Treated with Pelvic Radiation Therapy for Locally Advanced Rectal Cancer: 20 Years of Experience with 451 Patients

Radiation therapy (RT) is commonly used in the treatment of locally advanced rectal cancer (LARC), but data on its impact on men's sexual health is limited. Given the rising incidence of rectal cancer in younger men, sexual function is an important quality of life factor. We hypothesized that men with LARC treated with RT would be at increased risk of sexual dysfunction compared to men who did not receive RT. This is a single institution retrospective analysis of outcomes of men ≤50 years diagnosed with LARC between 1999 and 2019. Primary outcomes of erectile dysfunction (ED), ejaculatory dysfunction (EjD), and testosterone deficiency (TD) were assessed via ICD-9/10 codes, and TD was captured with free testosterone <300 ng/dL. Cumulative incidences were calculated with death as a competing risk and p values were calculated using Gray's test. Subdistribution hazard ratios from competing risk regression models were used. The combined study sample included 451 men: 347 received RT as part of their multimodality treatment, and 104 did not. Median time to last follow up was 5.6 years (IQR 3.3-8.7). Age at diagnosis, stage, and medical comorbidities for sexual dysfunction were similar between the two groups (p>0.05). Cumulative incidence estimates are shown in Table 1, showing a higher cumulative incidence of ED in the RT group, but no difference in EjD or TD between the 2 groups. On univariable analysis, RT, smoking, dyslipidemia, peripheral artery disease, depression, prostate cancer/hyperplasia, closed or current ileostomy, and undergoing rectal cancer surgery were all independent risk factors for ED (p<0.05). On multivariable analysis, RT maintained statistical significance as an independent risk factor for ED (HR 3.87, 95% CI 1.93-7.75, p<0.001). Within the RT group, IMRT compared to 3D (HR 1.54, 95% CI 1.02-2.32, p = 0.040) and groin RT (HR 2.60, 95% CI 1.21-5.59, p = 0.014) were independent risk factors for ED. Within the RT group, groin RT also approached significance as a risk factor for TD (HR 3.61, 95% CI 0.98-13.3, p = 0.054). No RT dose thresholds to external genitals or penile bulb were identified that increased risks of ED, EjD, or TD. RT for LARC independently increases risk of ED but not EjD or TD. IMRT might increase the risk of ED due to increased scatter dose to the genitals and including the inguinal nodes in the target volumes increases the dose to the genitals/testicles, which could translate into a higher risk for ED and TD. Future research on proton RT and prophylactic sildenafil is needed in men ≤50 to decrease the risk of ED.

Correlation between Motorcycle Riding and Erectile Dysfunction on Online Motorcycle Taxi Drivers.

Erectile dysfunction is a condition in which the patient is unable to achieve or maintain a sufficient erection for sexual intercourse. Transportation usage was believed to have a higher risk of erectile dysfunction. This study aimed to assess the correlation between activity and severity of erectile dysfunction among online motorcycle taxi drivers who use motorbikes. This research uses an observational analytic method with a cross-sectional approach with primary data collection from the respondents who work as online motorcycle drivers from January 2021 to March 2021. Data analyses were conducted using Mann-Whitney and Spearman statistical test. A total of 149 respondents met the inclusion and exclusion criteria contained in this study. It was found that the prevalence of erectile dysfunction in this study was 57.7%. There was a significant difference in the distance covered (km) by online motorcycle taxi drivers who experienced erectile dysfunction compared to those who did not have erectile dysfunction (P=.050). In addition, there was a significant difference in length of work (year) among online motorcycle taxi drivers who experienced erectile dysfunction (P=.045). There was a significant difference in erectile dysfunction incidence based on the distance covered per day and length of work in online motorcycle taxi driver. No significant difference was found in the incidence of erectile dysfunction based on the length of motorbike drive per day. The more distance covered (km) and length of work (year) and the more severe the erectile dysfunction are based on international index of erectile function-5 score.

MP27-02 MICROARRAY ANALYSIS OF CORPORA CAVERNOSAL TISSUE FROM PEYRONIE'S AND PROSTATECTOMY PATIENTS WITH ERECTILE DYSFUNCTION IN COMPARISON TO A RAT CAVERNOUS NERVE RESECTION MODEL

You have accessJournal of UrologyCME1 Apr 2023MP27-02 MICROARRAY ANALYSIS OF CORPORA CAVERNOSAL TISSUE FROM PEYRONIE'S AND PROSTATECTOMY PATIENTS WITH ERECTILE DYSFUNCTION IN COMPARISON TO A RAT CAVERNOUS NERVE RESECTION MODEL Timothy Searl, Samuel Ohlander, Kevin McVary, and Carol Podlasek Timothy SearlTimothy Searl More articles by this author , Samuel OhlanderSamuel Ohlander More articles by this author , Kevin McVaryKevin McVary More articles by this author , and Carol PodlasekCarol Podlasek More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003255.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostatectomy patients are at high risk of erectile dysfunction (ED) that is refractory to PDE5 inhibitors. Cavernous nerve (CN) damage causes loss of innervation, smooth muscle apoptosis, and fibrosis, resulting in ED. We performed microarray and pathway analysis to identify mechanisms that are altered with ED, to find new targets for ED treatment. METHODS: Corpora cavernosal (CC) tissue was obtained from Peyronie’s (control, n=3) and prostatectomy (control, n=3) patients undergoing prosthesis implant to treat ED. For our rat CN injury model, Sprague Dawley rats underwent bilateral CN resection (n=5) or sham surgery (controls, n=5) and C.C. tissue was harvested 2 days post surgery. RNA was extracted from CC tissue using TRIzol, DNase treated, and purified with Qiagen mini kit. Microarray analysis (HG 2.0 ST, RU34), and pathway analysis was performed (ShinyGO, WebGestalt. Ingenuity). A 2-fold change was used as threshold for differentially expressed genes (DEGs). FDR<0.05 was considered significant for enrichment terms. RESULTS: There were 197 DEGs in CC from prostatectomy patients. 112 of the 197 DEGs were non-protein-coding genes. The overall changed expression of these non-protein-coding genes expected to favor a reduction in cell growth compared with Peyronie’s control. In the rat, microarray detected 182 protein coding DEGs. Pathway Analysis identified changes in cell death, stress and cellular development. Examination of the role of individual genes found changes in proliferation and cell death. CONCLUSIONS: Prostatectomy patients display alterations in gene expression in their corpora cavernosa that are consistent with decreased growth, likely impacting tissue repair and regenerative processes. Non-protein-coding RNAs may play a crucial role in ED in prostatectomy patients. In the acute rat CN resection model, cell death and proliferation are followed by apoptosis domination. Prostatectomy patient results show penile remodeling continues in patients long after the acute surgical injury to the CN takes place, offering the opportunity for clinical intervention to reverse penile remodeling and improve erectile function. Source of Funding: NIH/NIDDK DK101536 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e362 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy Searl More articles by this author Samuel Ohlander More articles by this author Kevin McVary More articles by this author Carol Podlasek More articles by this author Expand All Advertisement PDF downloadLoading ...

Association of BMI with erectile dysfunction: A cross-sectional study of men from an andrology clinic.

Abnormal body mass index (BMI) is associated with an increased risk of erectile dysfunction (ED). However, the relationship between different BMI categories and the levels of ED severity remains unclear. In the current study, 878 men from the andrology clinic in Central China were recruited. Erectile function was assessed by the International Index of Erectile Function (IIEF) scores. Questionnaires included questions about demographic characteristics (age, height, weight, educational status), lifestyle habits (drinking, smoking, sleep time), and medical history. Logistic regression was used to examine the association between ED risk and BMI. The incidence of ED was 53.1%. BMI was significantly higher in men from the ED group than in those from the non-ED group (P = 0.01). Compared with the normal weight group, obese men had a higher risk of ED (OR = 1.97, 95% CI = 1.25-3.14, P = 0.004), even after adjustment for potential confounders (OR = 1.78, 95% CI = 1.10-2.90, P = 0.02). Moreover, the positive correlation between obesity and moderate/severe ED severity was confirmed by logistic regression analysis (moderate/severe ED, OR = 2.71, 95% CI = 1.44-5.04, P = 0.002), even after adjusting for potential confounders (OR = 2.51 95% CI = 1.24-5.09, P = 0.01). Collectively, our findings indicate a positive correlation between obesity and the risk of moderate/severe ED. Clinicians could pay more attention to moderate/severe ED patients to maintain a healthy body weight to improve erectile function.

The association between urinary organophosphate insecticide metabolites and erectile dysfunction in the United States.

Organophosphate (OP) insecticides are the main chemicals used in agriculture for pest elimination, and they have been linked with many diseases. However, there is no literature regarding the impacts of organophosphate insecticide metabolite exposure on erectile dysfunction (ED). We aimed to evaluate the correlation between 4 urinary organophosphate insecticide metabolites and the presence of ED in a representative sample of men aged 20 and older. The dataset including a total of 555 subjects was obtained from the National Health and Nutrition Examination Survey (NHANES) 2003-2004. ED was assessed by a question from a self-report questionnaire. Weighted proportions and multivariable logistic regression analysis were utilized to examine the relationship between organophosphate insecticide metabolite exposure and ED. In multivariable logistic regression analysis, diethylphosphate (DEP) was positively correlated with ED (OR 1.07; 95% CI 1.01-1.14; P = 0.033) after full adjustment. Men in DEP tertile 4 had a significant 33% higher risk of ED than those in tertile 1. Furthermore, in a subgroup analysis, our results showed that higher DEP levels were significantly associated with ED in the young age group (20 ≤ age ≤ 39). Our study revealed a significant association between organophosphate insecticide metabolite exposure and an increased risk of ED. Moreover, the correlations were more evident in the young age group. The evaluation of urinary organophosphate insecticide metabolite exposure should be included in the risk assessment of ED. Further study to investigate the underlying mechanism, such as how long the urinary metabolite is present, whether ED is reversible in this population by lowering DEP concentrations, and how exposure to this metabolite affects erectile tissue, is warranted.

44 BETA-BLOCKER TREATMENT OPTIONS AND RISK OF ERECTILE DYSFUNCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: Erectile dysfunction (ED) has a variety of causes. Certain antihypertensive medications usage is known to exacerbate and increase the risk of ED. One type of antihypertensive agent associated with a greater risk of ED is beta-blockers. Among the available options of beta-blocker, further comparison needs to be done to evaluate which beta-blocker has a lower risk of ED. Objective: This study aimed to assess which beta-blocker has a lower risk of ED. Methods: Search for published articles using the PRISMA (Preferred Reporting, Items for Systematic Reviews and Meta-Analysis) method conducted on PubMed, Cochrane Library, and Medline databases published in the last 20 years on “beta-blocker” and “erectile dysfunction”. Further systematic review and meta-analysis using RevMan version 5.4 were performed based on the included published articles. Results: Based on 6 studies included with total of 1578 participants, 5 kinds of beta-blocker used on the participants include atenolol (17,8%), bisoprolol (31,1%), carvedilol (10,8%), metoprolol (9,8%), and nebivolol (30,5%). Nebivolol (RR = 0.87: 95% CI: 0.79-0.95) found to has the lowest risk ratio compared with another beta-blocker such as carvedilol (RR = 1.00: 95% CI: 0.92-1.09), metoprolol (RR = 1.05: 95% CI: 0.94-1.17), atenolol (RR = 1.07: 95% CI: 0.98-1.16), and bisoprolol (RR = 1.37: 95% CI: 1.01-1.87). Conclusions: Nebivolol is a beta-blocker option recommended to avoid ED because of its lower risk of ED compared with other beta-blockers. Bisoprolol was found to be associated with a higher risk of ED, followed by atenolol, metoprolol, and carvedilol, respectively.

Migraine Is Associated With High Risk of Erectile Dysfunction: A Systematic Review and Cumulative Analysis

Migraine, a common chronic primary headache, has been found to be associated with a high risk of erectile dysfunction (ED). The present study aims to summarize all the evidence related to this topic and demonstrate a quantified result on the association between migraine and ED, which has not been reported in the literature. MEDLINE, Excerpta Medica Database, and Cochrane Library were systematically searched for identifying the eligible studies (2000-2021). This study was registered in the PROSPERO (ID: CRD42021248013). The combined effects were synthesized with the relative risks (RR) or standard mean differences (SMD) with 95% confidence intervals (CI). 6 trials with a total of 51,657 participants were included, of which 6,175 were men with migraine. The pooled analysis indicated that migraine was associated with a significantly higher risk of ED as compared to the non-migraine general population (RR=1.63, 95%CI: 1.34 to 2.0, P < .001). Consistently, men with migraine have a significantly lower IIEF-5 score than healthy controls (SMD=-3.64, 95%CI: -6.4 to -0.89, P=.01). Stratification analysis on the mean age indicated that the association between migraine and ED was much stronger in the migraine patients with age < 40 years (RR=32.29, 95% CI: 6.41-162.64, P < .001; I2=0.0 %, P=.837) than in those with age > 40 years (RR=1.75, 95% CI: 1.11-2.78, P=.017; I2=89.2%, P=.002). Sensitivity analysis indicated that no single study had dominated the combined RR and the heterogeneity. ED is a common disease among migraine men, especially those patients whose age is under 40 years old. It shows a 32-fold increased risk of ED compared to the healthy controls. Migraine-induced ED may be correlated with multiple factors, that is, chronic illnesses, chronic pain, and psychosocial causes (like anxiety and depression). Since phosphodiesterase-5 inhibitors (ie, sildenafil) might induce or exacerbate migraine, thus it is not recommended to prescribe these drugs for patients with migraine-mediated ED. The present study provides evidence that migraine is associated with a significantly high risk of ED, especially in those aged < 40 years. The pathophysiological mechanisms of this action deserve further study. He W, Yang Y, Liang H, et al. Migraine Is Associated With High Risk of Erectile Dysfunction: A Systematic Review and Cumulative Analysis. J Sex Med 2022;19:430-440.

Daily Dose of 5 mg Tadalafil Safely Improves Erectile Function and Liver Function Enzymes in Smokers

Background: Smokers are known to have a higher risk of erectile dysfunction. We examined how daily consumption of low-dose tadalafil affected erectile function and circulation in smokers and assessed the medication safety. Methods: Men aged over 20 years with current smoking status were selected to complete four weeks of treatment with 5 mg tadalafil daily. Erectile function was measured using the International Index of Erectile Function (IIEF), and additional tests included measuring various serum parameters, electrocardiogram, and nail capillary blood flow. Results: The IIEF scores, capillary blood flow, and serum liver function enzyme levels significantly improved. There were no reported adverse side effects. Conclusions: Smokers who were administered 5 mg tadalafil daily for four weeks had improved International Index of Erectile Function scores, dilated capillary vessels, and improved blood liver function enzyme levels; proving not only safety of usage and its effectiveness but also possible features that can indicate usages of the drug in other purposes.

Prevalence of erectile dysfunction among smokers in southwestern Saudi Arabia

Background: Erectile dysfunction (ED) is the failure to develop or maintain erections that are adequate for sexual performance. ED is increasing in prevalence and incidence worldwide. According to the latest epidemiologic studies, around 10% of men aged 40 to 70 have severe or complete ED. An additional 25% of men in this age group have moderate or sporadic ED. The literature is replete with evidence that smoking has a negative impact on erectile function independent of age or comorbidities. Methods: This cross-sectional study was conducted in the southwestern region of Saudi Arabia, from March-2021 to June-2021. Data on demographic characteristics, erectile dysfunction, and smoking habits was collected by self-administered questionnaire. The descriptive statistics were calculated to measure significant differences among variables, and the chi-square test and t-test were used at 5% level of significance. The data analysis was done by using Statistical Package for Social Sciences (SPSS)-version 20 software (IBM Corp., Armonk, NY, USA). Results: Out of 500 distributed questionnaires, 450 questionnaires were returned, yielding a response rate of 90.0%. Of 450 patients, the average (SD) age was 33.6 (8.9) years and 55.6% were sexually active (N = 250). Thirty six percent of sexually active respondents were smokers. Independent of age, smokers were at higher risk of having ED. Conclusions: Smoking was associated with higher risk of ED. So, health-policy makers should start an awareness campaign to educate people about the adverse effects of smoking on men’s health. The government should also support these programs for the public.

Erectile dysfunction among Thai patients with COVID-19 infection.

BackgroundErectile dysfunction (ED) is suspected to be the symptom manifestation of COVID-19. However, scarce data was presented this day. Our study was conducted to determine the prevalence of ED and its associated factors among Thai patients with COVID-19.MethodsSexually active males with COVID-19, hospitalized between May and July 2021 at one university hospital in Bangkok, were screened for erectile dysfunction by the International Index of Erectile Function 5 (IIEF-5). Demographic data and COVID-19 treatment history were collected. Mental health status, including depression and anxiety, was evaluated with the Thai Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), respectively. The sample size was calculated, and logistic regression was used to analyze the association.ResultsOne hundred fifty-three men with COVID-19 were recruited. ED prevalence was 64.7%, of which severity was mostly mild. Logistic regression, adjusted for age, BMI, and medical comorbidities, portrayed a significant association between ED and mental health status. Higher risk of ED was found in participants with major depression [adjusted OR 8.45, 95% CI: 1.01–70.96, P=0.049] and higher GAD-7 total score [adjusted OR 1.15, 95% CI: 1.01–1.31, P=0.039].ConclusionsThai patients with COVID-19 had high prevalence of ED, which was associated with mental disorders. Thus, screening for mental problems is recommended in individuals with COVID-19 and ED.

Posttraumatic stress disorder and the risk of erectile dysfunction: a nationwide cohort study in Taiwan

BackgroundThis study aimed to investigate the association between posttraumatic stress disorder and the risk of developing erectile dysfunction.MethodsIn this population-based retrospective cohort study, we used Taiwan’s National Health Insurance Research Database to analyze patients who were newly diagnosed with posttraumatic stress disorder (PTSD) between 2000 and 2013, with a 1:3 ratio by age and index year matched with patients in a non-PTSD comparison group, for the risk of erectile dysfunction.ResultsIn total, 5 out of 1079 patients in the PTSD group developed erectile dysfunction, and 3 out of 3237 patients in the non-PTSD group (47.58 vs. 9.03 per 100,000 per person-year) developed erectile dysfunction. The Kaplan–Meier analysis showed that the PTSD cohort had a significantly higher risk of erectile dysfunction (log-rank, p < 0.001). The Cox regression analysis revealed that the study subjects were more likely to develop an injury (hazard ratio: 12.898, 95% confidence intervals = 2.453–67.811, p = 0.003) after adjusting for age, monthly income, urbanization level, geographic region, and comorbidities. Psychotropic medications used by the patients with PTSD were not associated with the risk of erectile dysfunction.ConclusionsPatients who suffered from PTSD had a higher risk of developing erectile dysfunction.

A Cross-Sectional Observational Study on the Coexistence of Erectile Dysfunction and Premature Ejaculation.

IntroductionThe interplay between erectile dysfunction (ED) and premature ejaculation (PE) needs more studies to clarify.AimTo evaluate the risk factors and temporal relationship for the coexistence of ED and PE.MethodsThe data were derived from clinical history.Main Outcome MeasureThe diagnosis of ED and PE was based on self-report and validated questionnaires.ResultsBased on the chief complaint, 1,893 participants were recruited as ED group and 483 participants as PE group from 2014 to 2020. One third of ED and PE groups reported comorbid PE and ED. Of the ED group, 4.1% (n = 77) had lifelong PE, 18.0% (n = 341) had acquired PE and 9.7% (n = 184) had subjective or natural variable PE. Of the PE group, ED was reported in 22.0% (n = 40) of lifelong PE, 33.9% (n = 65) of acquired PE, and 37.6% (n = 41) of subjective or natural variable PE, P < .01. With adjustment of potential confounders, the ED severity was associated with increased risk of acquired PE, while acquired PE was associated with higher risk of ED than lifelong PE. In cases of comorbid lifelong PE and ED (n = 117), 22.2% reported the onset of both dysfunctions being about the same time, whereas 77.8% reported ED occurred behind PE with an average 23.3 years lag. In cases of comorbid acquired PE and ED (n = 406), 52.2% reported the onset of both dysfunctions being about the same time, 34.2% reported ED happened behind PE and 13.5% reported PE emerged behind ED.ConclusionOrganic pathogenesis was least likely to be responsible for the link between PE and ED. When acquired PE and ED coexist, treating ED first or concomitantly according to their temporal order is an appropriate management algorithm.Chieh‑Wen Chin, Chia Mu Tsai, Jen-Tai Lin, et al. A Cross-Sectional Observational Study on the Coexistence of Erectile Dysfunction and Premature Ejaculation. Sex Med 2021;9:100438.

Significant Increase of Erectile Dysfunction in Men With Post-stroke: A Comprehensive Review

Men with erectile dysfunction (ED) are considered to be at risk from stroke events. Conversely, post-stroke patients are also at high risk of ED, whereas a quantitative result from all the relevant studies has not been previously addressed. Therefore, we have performed a comprehensive review and meta-analysis on this issue. This study was registered on PROSPERO (ID No. CRD42021226618). Twenty studies with a total of 3,382 stroke events were included, of which six studies were included for quantitative analysis, and the remaining 14 studies were calculated for the ratio of ED. Synthetic results from four eligible studies providing the ED cases showed that stroke patients were associated with a significantly higher risk of ED than the general population [pooled relative risk (RR) = 3.32, 95% confidence interval (CI): 1.25–8.82, P = 0.016]. Men with stroke were also found to be associated with a significant decline in International Index of Erectile Function −5 (IIEF-5) score as compared with the healthy controls [three studies, standard mean differences (SMD) = −1.8, 95% CI: −2.94 to −0.67, P = 0.002]. The prevalence of ED in post-stroke patients among 14 studies ranged from 32.1 to 77.8%, which was dramatically higher than that of the general population. The result of the GRADE-pro revealed that the quality of the evidence in this study was moderate. The present study has confirmed the high prevalence of ED in men with stroke. ED in stroke patients is a result of both neurological and psychological factors. Rehabilitative interventions rather than phosphodiesterase-5 (PDE-5) inhibitors are recommended to improve the erectile function for those survivors with ED.