Incidence Of Erectile Dysfunction Research Articles

Gout and the Risk of Incident Erectile Dysfunction: A Body Mass Index-matched Population-based Study.

Gout is the most common inflammatory arthritis. Erectile dysfunction (ED) is common in the general population; however, evidence regarding ED among patients with gout is limited. Our purpose was to study the association between incident gout and the risk of incident ED in the general population. We conducted a cohort study using The Health Improvement Network, an electronic medical record database in the United Kingdom. Up to 5 individuals without gout were matched to each case of incident gout by age, enrollment time, and body mass index (BMI). Multivariate HR for ED were calculated after adjusting for smoking, alcohol consumption, comorbidities, and medication use. We identified 2290 new cases of ED among 38,438 patients with gout (mean age 63.6 yrs) and 8447 cases among 154,332 individuals in the comparison cohort over a 5-year median followup (11.9 vs 10.5 per 1000 person-years, respectively). Univariate (matched for age, entry time, and BMI) and multivariate HR for ED among patients with gout were 1.13 (95% CI 1.08-1.19) and 1.15 (95% CI 1.09-1.21), respectively. In our sensitivity analysis, by restricting gout cases to those receiving anti-gout treatment (n = 27,718), the magnitude of relative risk was stronger than the primary analysis (multivariate HR 1.31, 95% CI 1.23-1.39). This population-based study suggests that gout is associated with an increased risk of developing ED, supporting a possible role for hyperuricemia and inflammation as independent risk factors for ED.

Эректильная дисфункция, ассоциированная с радикальной простатэктомией: целесообразность и способы сохранения потенции

Erectile dysfunction (ED) associated with radical prostatectomy (RP) affects 25-75% of patients and has a significant negative impact on their quality of life AIM: To analyze the maintenance of erectile function after RP depending on the type of endoscopic access and nerve-sparing. This retrospective study comprised 231 patients with localized prostate cancer, who underwent surgery between February 2015 and February 2016. Surgery was performed using one of three approaches: laparoscopic, extraperitoneoscopic or robot-assisted. Nerve-sparing surgery was chosen were based on the Briganti nomogram (low risk of extraprostatic extension), Partins table, and taking into account the patients desire to maintain EF. EF and the quality of life were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire and the QoL (Quality of Life) scale. Nerve-sparing RP was performed in 153 patients. Nerve-sparing RP did not differ significantly from non-nerve sparing RP with regard to operative time (p=0.064) and blood loss (p=0.073). According to the pathomorphological study, the prostatic capsule was intact, and surgical margins were negative in all cases. The incidence of significant ED and complete loss of erectile function was greater in patients after non-nerve sparing RP compared with nerve sparing RP [(5.0 (0-10.0) vs. 6.5 (0.8-19,0) points according to the IIEF-5 scale, p=0.271)]; 96.2% versus 72.2% (p<0.001). Nerve-sparing RP had a statistically significant better effect on the quality of life: 1.63+/-1.16 points against 1.88+/-1.02 points (p=0.035). The best outcomes were observed in patients undergoing robot-assisted RP. Nerve-sparing RP resulted in a lower rate of ED. This advantage without compromising the completeness of resection allows us to consider nerve-sparing RP as an appropriate and validated modality of preventing erectile dysfunction in properly selected patients.

Age at First Presentation for Erectile Dysfunction: Analysis of Changes over a 12-yr Period

BackgroundThe awareness regarding erectile dysfunction (ED) may have increased over the past decade due to the widespread availability of phosphodiesterase type 5 inhibitors and the growing knowledge of a link between ED and men’s overall health. ObjectiveWe examined whether the increased awareness of ED has led to observable changes in patient characteristics among first-time assessments for ED. Design, setting, and participantsData was collected from 1586 men seeking their first medical attention for ED at a single academic center during 2005–2017. InterventionPatients completed the International Index of Erectile Function (IIEF) to assess ED. Outcome measurements and statistical analysisLocal polynomial regression models explored the relationship between patient characteristics and the year of first-time assessment. Linear and logistic regression models estimated the association between the time at first assessment and the investigated outcomes. Restricted cubic splines tested the nonlinearity for continuous variables. Results and limitationsWe observed a nonlinear correlation between age and year of assessment (p=0.0003); the probability that a patient aged <40 yr presented for ED increased from 13.5% in 2006 to 21.7% in 2017 (p=0.002). Patients assessed over the last period were significantly healthier (Charlson Comorbidity Index≥1; odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92–0.99, p=0.02). We observed an increase in the rate of smokers (OR: 1.19, 95% CI: 1.14–1.23, p<0.0001) and in regularly physically active men (OR: 1.05; 95% CI: 1.01–1.08, p=0.008) over the same period. No changes were observed in terms of baseline IIEF-Erectile function scores over time. The single center design is the main limitation of the study. ConclusionsAge at first presentation for ED significantly decreased over the past decade. Physicians should carefully assess EF even at younger age groups, suggesting lifestyle modifications and relevant treatments for comorbid conditions as soon as possible. Patient summaryPatients presenting for erectile dysfunction (ED) are younger than they were 10 yr ago. These findings may suggest an increase in ED awareness. Likewise, this age reduction could represent a worrisome increase in terms of ED incidence in young men.

Sport, infertility and erectile dysfunction

In the last decades a growing interest has been dedicated to prevention, diagnosis and therapy of male genital pathologies, such as varicocele, infertility and erectile dysfunction in the population involved in sport activities. High incidence (up to 30%) of varicocele has been reported in a population of athletes and up to 60-80% in the subgroup of body-builders. The incidence of varicocele specifically increases with hours of training, in a linear model. Controversial data come from literature about the effects of physical activity on fertility, with prevalence of trials demonstrating worsening of seminal parameters. Furthermore, it has been demonstrated that physical stress in healthy male athletes can interfere with LH levels. Bicycling is one of the major risk factors for erectile dysfunction, with incidence of 13-24%. This is due to the prolonged compression of perineal arteries leading to reduced chronic penile perfusion. Bioengineering studies have been the basis for industry to produce specifically shaped saddles that significantly reduce and minimize compressive effects. Finally, high frequency of lower urinary tract symptoms (LUTS) in cyclists has been related to increased incidence of erectile dysfunction in comparison with normal population.

Correlations between diabetes mellitus and sexual dysfunction disorders

Disorders of male sexual dynamics are associated with a number of cardiovascular risk factors such as hypertension, dyslipidemia, diabetes, or smoking. Diabetes mellitus is a frequent cause of erectile dysfunction, through complex mechanisms. It is considered that diabetes doubles the risk for an erectile dysfunction, and this can develop a decade earlier than in other men. The mechanisms implicated include the involvement of the large and small vessels, but also the diabetic neuropathy. Often, the erectile dysfunction draws the attention to a possible diabetes mellitus. The incidence of erectile dysfunction in Romania was estimated at 3% for young people aged 15-25, 7% for those aged 25 to 45 and 22% for men aged 45-55 years old. It is estimated that 150 million men worldwide suffer from erectile dysfunction and their number will double by 2025. For diabetic patients, the prevalence of erectile dysfunction is more than 50%. The purpose of this paper is to analyze the association of erectile dysfunction with diabetes mellitus and its major comorbidities, dyslipidemia and hypertension. The study is retrospective, with data from 1385 patients being collected during the 2005-2014 period, which showed sexual dysfunction. The data analyzed were collected anamnestically and refer to the presence of risk factors and personal pathological antecedents. The age of patients with sexual dysfunction was between 18 and 86 years old, of which 284, or 20.50%, had hyperglycemia. In 8.44% of all patients, the association of erectile dysfunction with diabetes mellitus, dyslipidemia and hypertension was present, in 13.57% the erectile dysfunction was as­so­cia­ted with diabetes mellitus and hypertension, and in 24.69% only with hypertension and dyslipidemia. Of the car­dio­vas­cular risk factors, hypertension is most commonly as­sociated with erectile dysfunction, and the most com­monly associated risk factor for high blood pressure is dyslipidemia. However, the study also revealed that of the 284 patients with hyperglycemia and erectile dysfunction, 60.21% were new cases of hyperglycemia. Thus, we can say that in most cases with diabetes or hyperglycemia, erectile dysfunction preceded the detection of metabolic disease.

Essential role of brain-derived neurotrophic factor (bdnf) in diabetic erectile dysfunction.

Erectile dysfunction (ED) is a worldwide problem threatens men's health. The incidence of ED in diabetic patients is higher than that in the healthy population. The incidence of peripheral and autonomic neuropathy is significantly higher in diabetic patients than in normal men. Vasomotor nerves play an important role in the regulation of erectile function. Degeneration of autonomic and sensory nerves is a common type of diabetic neuropathy (DNP) and is closely related to erectile function. Brain-derived neurotrophic factor (BDNF) has been demonstrated to improve diabetic erectile dysfunction in rat models and in humans. However, this process has not yet been fully elucidated yet. In this article, we summarise the mechanisms by which BDNF improves diabetic erectile dysfunction.

Reporting Erectile Function Outcomes After Radiation Therapy for Prostate Cancer: Challenges in Data Interpretation

BackgroundChoice of prostate cancer treatment is frequently influenced by the expected chance of treatment-induced side effects such as erectile dysfunction (ED). However, great discrepancy in cited ED rates exists in the contemporary radiation therapy literature. AimTo analyze the reported ED rates and cause of discrepancies and explore the strengths and limitations in the literature on radiation-induced ED. MethodsWe performed a PubMed literature search and reviewed the literature on ED rates associated with external-beam radiotherapy and brachytherapy from the past 10 years. Eighteen studies were eligible for inclusion and subsequently reviewed. OutcomesVariables required for interpretation of erectile function outcomes, including patient demographics, treatment characteristics, and sexual function outcomes. ResultsA large variety in the reported incidence of ED was found among studies. In part, these differences resulted from large variations in (i) study populations, (ii) patient characteristics, (iii) treatment characteristics, (iv) prescription of androgen deprivation therapy, (v) means of data acquisition, (vi) definitions of ED, (vii) temporal considerations, and (viii) erectile aid use. Relevant data required for adequate appraisal of sexual function outcomes were not always reported. Clinical ImplicationsBased on the present findings, we present general recommendations for reporting of erectile function outcomes after radiotherapy for prostate cancer. These should improve future reports. Strengths and LimitationsThis is the first report that presents general requirements on reporting erectile function outcomes in the setting of radiotherapy for prostate cancer. We did not conduct a formal meta-analysis because we focused on concepts of research design; this might be considered a limitation. ConclusionIn this review, we have highlighted the strengths and deficiencies of the current literature on ED after external-beam radiotherapy and brachytherapy for prostate cancer. We have made general recommendations to achieve some degree of standardization among reports and improve clinical interpretability.Wortel RC, Incrocci L, Muhall JP. Reporting Erectile Function Outcomes After Radiation Therapy for Prostate Cancer: Challenges in Data Interpretation. J Sex Med 2017;14:1260–1269.

Coffee Intake and Incidence of Erectile Dysfunction.

Coffee intake is suggested to have a positive impact on chronic diseases, yet its role in urological diseases such as erectile dysfunction (ED) remains unclear. We investigated the association of coffee intake with incidence of ED by conducting the Health Professionals Follow-Up Study, a prospective analysis of 21,403 men aged 40-75 years old. Total, regular, and decaffeinated coffee intakes were self-reported on food frequency questionnaires. ED was assessed by mean values of questionnaires in 2000, 2004 and 2008. Multivariable adjusted Cox proportional hazards models were used to compute hazard ratios for patients with incident ED (n = 7,298). No significant differences were identified for patients with incident ED after comparing highest (≥4 cups/day) with lowest (0 cups/day) categories of total (hazard ratio (HR) = 1.00, 95% confidence interval (CI): 0.90, 1.11) and regular coffee intakes (HR = 1.00, 95% CI: 0.89, 1.13). When comparing the highest category with lowest category of decaffeinated coffee intake, we found a 37% increased risk of ED (HR = 1.37, 95% CI: 1.08, 1.73), with a significant trend (P trend = 0.02). Stratified analyses also showed an association among current smokers (P trend = 0.005). Overall, long-term coffee intake was not associated with risk of ED in a prospective cohort study.

AB090. Tobacco smoking and erection dysfunction: a systematic review

BackgroundThe aim of this review was to investigate the correlation between smoking and erectile dysfunction (ED).MethodsISI Web of Science. PubMed and Google Scholar databases (until June 2017) were searched for relevant publications on the correlation between smoking and erectile dysfunction.ResultsA total of 163 studies were reviewed. Tobacco smoke, an aerosol produced by the incomplete combustion of tobacco, is proved to be harmful to several organs. A wealth of researches showed tobacco smoking is a high-risk factor for ED. Multiple human studies and animal researches analyzed the correlation and possible mechanism between smoking/nicotine and ED.ConclusionsAlmost all the researches showed the clear evidence that tobacco smoking is indeed quite harmful to erectile function. Dose-response relation also confirmed that long term or high quantity of nicotine intake may lead to higher incidence of ED. Smoking may impact on penile vascular endothelial cells and the release of acetylcholine in cerebral cortex. Multiple signal pathways are involved in the smoking-induced ED. Researches also revealed that smoking cessation could, to a certain extent, improve erectile function.

Erectile Dysfunction in Young Myocardial Infarction Survivors: Evaluation, Follow Up.

Erectile dysfunction significantly affects quality of life in young men. Authors have evaluated erectile function in men with coronary artery disease (CAD) and the relationship between the degree of erectile dysfunction (ED) and the age of their first acute myocardial infarction (AMI). The incidence of erectile dysfunction in three groups of patients of AMI survivors was investigated: AMI survivors younger than 45 years, AMI survivors older than 65 years, and normal male population aged between 30 and 60 years. Erectile function was assessed by the International Index of Erectile Function (IIEF-5) questionnaire. In post-AMI male patients younger than 45 years (n = 76), mild ED occurred in 26% and severe in 7%. In the older AMI group, mild ED occurred in 52% and severe in 38%. In the control group age matched to younger survivors, 96% denied ED and only one control patient had a score of 20 on the IIEF-5. A paradoxical result was observed in patients using beta blockers (BB), who had better scores than the group without BB. Statin treatment had a positive influence on the score in questionnaires. Those on statins had an average score of 21.0 ± 4.9 vs. without statin 17.7 ± 5.7, p = .03. The current findings identified that the prevalence of ED is relatively high in young patients with CAD and is related to treatment of the CAD. The overall increase in ED presence suggests that the background of their coronary event is not due to destabilization of single focused atheroma but may reflect a generalized atherosclerotic process.

Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors.

Erectile dysfunction (ED) is an important health concern that can significantly affect a man's psychosocial well-being. ED has traditionally been considered a disease of old age; however, contemporary evidence suggests a growing incidence of ED in men younger than 40 years. The process of achieving an erection is multifaceted; there are many potential mechanisms that can be disrupted. It is critical to identify the specific causes of ED before proceeding with potentially costly and invasive therapeutic options. Advances in diagnostic and treatment modalities offer opportunities to identify and manage young men with ED. To provide an update on the prevalence and risk factors of ED in young men and to provide a framework to guide clinicians in identifying and managing the affected young man. Comprehensive review of the literature pertaining to ED in young men. ED in young men was assessed by outlining the prevalence according to recent epidemiologic studies. The pathophysiology, diagnostic considerations, risk factors, and etiologies were reviewed. Large multinational studies have estimated the prevalence of ED in young men to be as high as 30%. Several studies have stratified the etiologies of ED into psychogenic and organic causes. Psychogenic etiologies of ED include depression, anxiety, and partner-related difficulties. These patients tend to experience sudden onset of symptoms, with decreased libido and good quality of spontaneous or self-stimulated erections. Organic etiologies include vasculogenic, endocrinologic, neurogenic, iatrogenic, and structural components. These patients usually experience gradual onset of symptoms and a low to normal libido. Conservative treatments such as phosphodiesterase type 5 inhibitors continue to be the mainstay treatment. ED in young men is an increasingly common condition. A careful diagnostic evaluation should focus on the identification of any underlying etiology to ensure appropriate management of patients. Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors. Sex Med Rev 2017;5:508-520.

Gout and subsequent erectile dysfunction: a population-based cohort study from England

BackgroundAn association has been suggested between gout and erectile dysfunction (ED), however studies quantifying the risk of ED amongst gout patients are lacking. We aimed to precisely determine the population-level absolute and relative rate of ED reporting among men with gout over a decade in England.MethodsWe utilised the UK-based Clinical Practice Research Datalink to identify 9653 men with incident gout age- and practice-matched to 38,218 controls. Absolute and relative rates of incident ED were calculated using Cox regression models. Absolute rates within specific time periods before and after gout diagnosis were compared to control using a Poisson regression model.ResultsOverall, the absolute rate of ED post-gout diagnosis was 193 (95% confidence interval (CI): 184–202) per 10,000 person-years. This corresponded to a 31% (hazard ratio (HR): 1.31 95%CI: 1.24–1.40) increased relative risk and 0.6% excess absolute risk compared to those without gout. We did not observe statistically significant differences in the risk of ED among those prescribed ULT within 1 and 3 years after gout diagnosis. Compared to those unexposed, the risk of ED was also high in the year before gout diagnosis (relative rate = 1.63 95%CI 1.27–2.08). Similar findings were also observed for severe ED warranting pharmacological intervention.ConclusionsWe have shown a statistically significant increased risk of ED among men with gout. Our findings will have important implications in planning a multidisciplinary approach to managing patients with gout.

MP45-03 AGE RELATED PENILE HEMODYNAMIC IMPAIRMENT AND FIBROSIS: POSSIBLE ROLE OF GIV-WNT SIGNALING PATHWAYS

You have accessJournal of UrologySexual Function/Dysfunction: Basic Research & Pathophysiology I1 Apr 2017MP45-03 AGE RELATED PENILE HEMODYNAMIC IMPAIRMENT AND FIBROSIS: POSSIBLE ROLE OF GIV-WNT SIGNALING PATHWAYS Tung-Chin (Mike) Hsieh, Sadhna Kanoo, Jay Parikh, Valmik Bhargava, and M. Raj Rajasekaran Tung-Chin (Mike) HsiehTung-Chin (Mike) Hsieh More articles by this author , Sadhna KanooSadhna Kanoo More articles by this author , Jay ParikhJay Parikh More articles by this author , Valmik BhargavaValmik Bhargava More articles by this author , and M. Raj RajasekaranM. Raj Rajasekaran More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1421AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pathophysiology/ molecular mechanisms of age-related penile hemodynamic impairment are unclear. Previous studies suggest age-related increase in tissue fibrosis in several organs including male genital tissues leading to impaired hemodynamics and male erectile dysfunction (ED). We tested the hypothesis that increased penile/ perineal (ischiocavernosus; ICM) muscle fibrosis during advanced aging is mediated by a novel fibrogenic cascade involving GIV/girdin and Wnt signaling pathways. A clear understanding of these molecular mechanisms involved in penile fibrosis would enable development of optimal strategies to treat ED. METHODS Young (n=3; 9 months) and old (n=6; 36 months) New Zealand White rabbits were anesthetized and penile tissue microcirculatory blood perfusion (perfusion units- PU) was measured using a novel PeriCam PSI system. Blood perfusion measurements were made before and after an intracavernosal injection of vasoactive agent- PGE1 (50 ng). Penile (corpus cavernosum) and ICM tissues were harvested and paraffin sections of these tissues were subjected to: (1) trichrome staining (marker of fibrosis) followed by image analysis for evaluation of fibrosis and (2) immunostaining for specific markers of fibrosis: 1. [beta]-catenin (central mediator of Wnt pathway) and 2. GIV/girdin. RESULTS Representative tracings of time-course of penile blood perfusion measurements in response to intracavernosal PGE1 as well as age-related penile perfusion changes in young and old rabbits are shown in figure A. Photomicrographs of showing trichrome as well as immunostaining for fibrosis markers (GIV and [beta]-catenin) are depicted in Fig B. A significant impairment in penile perfusion (Fig A) and increased fibrosis of penile/ICM tissues was observed in old rabbits (Fig B) when compared to the young animals. Immunostaining studies revealed positive labelling for both GIV and and [beta]-catenin and increased immunoreactivity in the tissues from old rabbits (Fig B). CONCLUSIONS Our findings suggest age-related increase in penile/ perineal muscle (ICM) fibrosis may contribute to increased incidence of ED in older men. Targeting GIV-Wnt pathways may be beneficial in preventing age-related ED for the aging population. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e612 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Tung-Chin (Mike) Hsieh More articles by this author Sadhna Kanoo More articles by this author Jay Parikh More articles by this author Valmik Bhargava More articles by this author M. Raj Rajasekaran More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP09-17 5-ALPHA REDUCTASE INHIBITORS FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA DOES NOT INCREASE THE RISK OF ERECTILE DYSFUNCTION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Medical & Non-surgical Therapy1 Apr 2017MP09-17 5-ALPHA REDUCTASE INHIBITORS FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA DOES NOT INCREASE THE RISK OF ERECTILE DYSFUNCTION Katrina Hagberg, Hozefa Divan, Rebecca Persson, Susan Jick, and J. Curtis Nickel Katrina HagbergKatrina Hagberg More articles by this author , Hozefa DivanHozefa Divan More articles by this author , Rebecca PerssonRebecca Persson More articles by this author , Susan JickSusan Jick More articles by this author , and J. Curtis NickelJ. Curtis Nickel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.325AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES 5-alpha reductase inhibitors (5ARIs) have been reported to increase the risk of erectile dysfunction (ED) in patients treated for benign prostatic hyperplasia (BPH); however BPH itself is an ED risk factor (potential confounding by indication). We conducted a cohort study with nested case-control analyses using the United Kingdom's Clinical Practice Research Datalink to estimate the risk of ED in men who used 5ARIs for the treatment of BPH. METHODS We identified men aged 40+ with BPH who received at least one prescription for a 5ARI (finasteride or dutasteride), alpha blocker (AB), or both. Exposures were classified as 5ARI only, 5ARI+AB, and AB only. Cases were men who had a first ED diagnosis or treatment (surgery or phosphodiesterase type-5 inhibitor prescription) during follow-up. We calculated incidence rates (IRs) and adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs). We also conducted a nested case-control analysis to control for major confounders and calculated adjusted odds ratios (ORs) with 95%CIs. RESULTS We identified 71,849 men, among whom 5,814 were identified as new cases of ED over the 20 year study period (1992-2011). The incidence rate of ED was lowest among users of 5ARI only (15.3 per 1000 person-years) and similar among users of 5ARI+AB (19.2 per 1000 person-years) and AB only (20.1 per 1000 person years). The risk of ED was not elevated with use of 5ARI only (IRR=0.92, 95%CI 0.85-0.99) or 5ARI+AB (IRR=1.09, 95%CI 0.99-1.21) in comparison with AB only. In the nested case-control analysis, ORs were 0.94 (95%CI 0.85-1.03) for 5ARI only and 0.92 (95%CI 0.80-1.06) for 5ARI+AB, compared to AB only, and remained null regardless of number of prescriptions or exposure timing. The risk of ED increased with longer duration of BPH, independent of exposure. CONCLUSIONS In a large, 20 year, real world observational study, 5ARI therapy for BPH does not significantly increase the risk of clinically meaningful incident ED compared to AB treatment. Risk of ED increased with longer duration of BPH. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e106-e107 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Katrina Hagberg More articles by this author Hozefa Divan More articles by this author Rebecca Persson More articles by this author Susan Jick More articles by this author J. Curtis Nickel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Erectile dysfunction and exposure to ambient air pollution in a nationally representative cohort of older men

BackgroundLittle is known about the association between air pollution and erectile dysfunction (ED), a disorder occurring in 64% of men over the age of 70, and to date, no studies have been published. To address this significant knowledge gap, we explored the relationship between ED and air pollution in a group of older men who were part of the National Social Life, Health, and Aging Project (NSHAP), a nationally representative cohort study of older Americans.MethodsWe obtained incident ED status and participant data for 412 men (age 57–85). Fine particulate matter (PM2.5) exposures were estimated using spatio-temporal models based on participants’ geocoded addresses, while nitrogen dioxide (NO2) and ozone (O3) concentrations were estimated using nearest measurements from the Environmental Protection Agency’s Air Quality System. The association between air pollution and incident ED (newly developed in Wave 2) was examined and logistic regression models were run with adjusted models controlling for race, education, season, smoking, obesity, diabetes, depression, and median household income of census tract.ResultsWe found positive, although statistically insignificant, associations between PM2.5, NO2, and O3 exposures and odds of incident ED for each of our examined exposure windows, including 1 to 7 year moving averages. Odds ratios (OR) for 1 and 7 year moving averages equaled 1.16 (95% CI: 0.87, 1.55) and 1.16 (95% CI: 0.92, 1.46), respectively, for an IQR increase in PM2.5 exposures. Observed associations were robust to model specifications and were not significantly modified by any of the examined risk factors for ED.ConclusionsWe found associations between PM2.5, NO2, and O3 exposures and odds of developing ED that did not reach nominal statistical significance, although exposures to each pollutant were consistently associated with higher odds of developing ED. While more research is needed, our findings suggest a relationship between air pollutant exposure and incident cases of ED, a common condition in older men.

The role of dietary polyphenols in the management of erectile dysfunction-Mechanisms of action.

The incidence of erectile dysfunction (ED) is on the increase and it is estimated that it will affect about 322 million men globally by the year 2025 if adequate measures are not taken to curb it. Natural polyphenols in plant based diets have gained public interest in recent times due to their roles in the prevention of various disease that implicate free radicals/reactive oxygen species and recently on ED. However, the role of polyphenols in the management of ED has not been explored due perhaps to limited data available. Hence this study which reviewed the role of dietary polyphenols in the management of ED and their mechanisms of action. Literature search was carried out in several electronic data bases such as Pubmed, Google Scholar, Medline, Agora and Hinari from1972 to 2016 to identify the current status of knowledge on the role of polyphenols in the management of erectile dysfunction. Progress made so far in this direction suggests inhibition of arginase, acetylcholinesterase, angiotensin converting enzyme, rho-kinase II; activation of endothelial and neuronal NO synthase; decreased synthesis of luteinizing hormone and testosterone reduction; activation of silent information regulator 2-related enzymes (sirtuin1) as well as free radical/reactive oxygen species inhibition as the mechanisms through which the polyphenols identified in this review exert beneficial roles in the management of ED.

Erectile Dysfunction in Male Adults With Atopic Dermatitis and Psoriasis

IntroductionPatients with psoriasis have increased risk of cardiovascular disease, but data on atopic dermatitis (AD) are less clear-cut. However, it is well-established that erectile dysfunction (ED) can serve as a risk marker for coronary disease. AimTo investigate the incidence, prevalence, and risk of ED in men with psoriasis and AD. MethodsThe sample included all Danish men at least 30 years old. In patients with AD and psoriasis, we determined disease severity based on use of systemic therapy. We performed a cross-sectional study (January 1, 2008) using logistic regression to estimate the prevalence and odds ratio of ED. Moreover, in a cohort study design, patients were followed from January 1, 2008 through December 31, 2012, and Cox regression models were used to estimate adjusted hazard ratios of new-onset ED. Models were adjusted for potential confounding factors, including age, socioeconomic status, health care consumption, smoking, alcohol abuse, diabetes, and cholesterol-lowering drug use. Main Outcome MeasuresThe outcome was initiation of pharmacotherapy used for treatment of ED. ResultsThe sample consisted of 1,756,679 Danish men (age range = 30–100 years), of which 2,373 and 26,536 had adult AD (mild = 1,072; severe = 1,301) and psoriasis (mild = 21,775; severe = 4,761), respectively. Mean ages (SDs) were 53.0 (14.6), 46.7 (12.0), and 56.3 (13.8) years for the general population, patients with AD, and patients with psoriasis, respectively. Prevalences of ED were 8.7%, 6.7%, and 12.8% for the general population, patients with AD, and patients with psoriasis, respectively. Adjusted odds ratios (logistic regression) of ED were decreased in patients with AD (0.68; 0.57–0.80) but increased in those with psoriasis (1.15; 1.11–1.20). Adjusted odds ratios for mild and severe AD were 0.63 (0.48–0.82) and 0.72 (0.58–0.88), respectively, and those for psoriasis these were 1.16 (1.11–1.21) and 1.13 (1.03–1.23). Adjusted hazard ratios (Cox regression) were 0.92 (0.76–1.11) for AD and 1.14 (1.08–1.20) for psoriasis. The ED risk was not increased in men with mild AD (0.85; 0.63–1.14) or severe AD (0.97; 0.76–1.24) but was significantly increased in men with mild psoriasis (1.13; 1.09–1.20) and severe psoriasis (1.17; 1.04–1.32). ConclusionWe found an increased prevalence and risk of ED in men with psoriasis, whereas the risk was comparable to (and even slightly lower than) the general population for men with AD.Egeberg A, Hansen PR, Gislason GH, et al. Erectile Dysfunction in Male Adults With Atopic Dermatitis and Psoriasis. J Sex Med 2017;14:380–386.

Incidence of De Novo Erectile Dysfunction after Urethroplasty: A Prospective Observational Study.

PurposeDe novo erectile dysfunction (ED) is a known complication after urethroplasty. Incidence and natural history of de novo ED after urethroplasty is underreported. We assessed the incidence of de novo ED after urethroplasty.Materials and MethodsConsecutive consenting urethroplasty (n=48) patients aged 21 to 50 years from February 2014 to July 2016 with normal preoperative erectile function as determined by an International Index of Erectile Function-5 (IIEF-5) score ≥22 were included and interviewed at 3, 6, and 12 months.ResultsIn patients with anterior stricture (n=40), substitution urethroplasty (SU) was performed in 22 patients (55.0%) and end-to-end anastomotic urethroplasty (EEAU) in 18 patients (45.0%). Their mean IIEF-5 score was 24.15±0.8 preoperatively, 20.10±4.2 at 3 months (p<0.001), 22.70±2.3 at 6 months (p=0.0012), and 23.70±1.7 at 12 months (p=0.03), showing a recovery of erectile function with time. All 8 patients with pelvic fracture urethral injury (PFUI) underwent progressive perineal urethroplasty. Their mean IIEF score was 24.0±1.2 preoperatively, 18.8±5.4 at 3 months (p=0.002), 20.9±3.5 at 6 months (p=0.37), and 22.0±1.5 at 12 months (p=0.427). The incidence of ED was similar at 1 year postoperatively between patients with anterior stricture and PFUI and between patients who underwent EEAU or SU for anterior stricture.ConclusionsIncidence of ED at 1 year after PFUI is similar to that after surgery for anterior stricture in patients with normal preoperative erectile function. Among the cases of anterior stricture, recovery was better with SU at 3 months and was similar between SU and EEAU at 1 year.

Impact of renal transplant on gonadal function

Objectives: We aimed at creating a clinical profile of end-stage renal disease patients' gonadal function and assessing the impact of renal transplant on gonadal dysfunction. We studied the influence of age, vascular anastomosis, dialysis vintage, and immunosuppression on sexual dysfunction. Materials and Methods: Twenty adults were included. Hormones (luteinizing hormone [LH], follicle-stimulating hormone [FSH], testosterone, prolactin (PRL), and estrogen), menstrual history and International Index of Erectile Function (IIEF)-5 questionnaires were assessed before and after renal transplantation. Hormone evaluation was done by chemiluminescent microparticle immunoassay technology. Results: Seventeen patients were male and three patients were female. Native kidney diseases were chronic glomerulonephritis (10%), IgA nephropathy (20%), autosomal dominant polycyctic kidney disease (5%), diabetic nephropathy (5%), focal segmental glomerulosclerosis (5%), renal calculus disease (5%), membranous nephropathy (5%), and pauci-immune vasculitis (5%). Fifteen males had erectile dysfunction (ED) before transplant. Eleven patients showed an increase and six patients showed a decrease in IIEF scores posttransplantation. Statistically significant changes were observed in the mean levels of testosterone, LH, PRL, and FSH. Age at transplant showed a negative correlation with IIEF score. In five patients with an end to side anastomosis to the external iliac artery, all had an increase in IIEF score posttransplant. In 12 patients with an end to end anastomosis to the internal iliac artery, 5 patients (42%) had a decrease in IIEF score posttransplant. Conclusions: Incidence of ED was 88% in our study. About 65% patients showed an increase in IIEF score posttransplantation. Increasing age at the time of transplant was a significant risk factor for the presence of ED. Renal transplantation corrected hormonal abnormalities in men. About 100% of patients with an end to side arterial anastomosis showed improvement in IIEF scores. There was no effect of dialysis vintage and immunosuppression regimes on sexual dysfunction.

Prognostic Factors and Outcome of Management of Ischemic Priapism in Zaria, Nigeria.

Objectives:The objective of this study was to determine the nuances of management, prognostic factors, and outcome of ischemic priapism in patients seen at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.Patients and Methods:We retrospectively studied the case notes of all patients managed for ischemic priapism in the Ahmadu Bello University Teaching Hospital, Zaria, over a period of 10 years (2006–2015). The data extracted included patients’ age, occupation, duration of painful penile erection, and previous episodes. Addition information including precipitating factors, hemoglobin genotype, treatment, and complications was also retrieved. Data obtained were analyzed using SPSS version 20.Results:The records of a total of forty patients managed for priapism over the period under review were retrieved. Thirty-three (82.5%) of these patients had an operative intervention. The mean age was 23.7 years with a range of 8–53 years. Sixty percent of patients were young adults in their third decade of life. The minimum duration of erection at presentation was 18 h and a maximum period of 10 days with a mean of 105.5 h (4 days). Thirty-three patients (82.5%) had sickle cell anemia (HbSS). Erectile dysfunction (ED) accounted for 60% of all forms of postpriapism complications. Five patients (12.5%) had residual tumescence from fibrosis, and three patients had recurrence outside the immediate postoperative period. Duration of symptoms before surgical intervention, SSA and previous episodes were the most important prognostic factors.Conclusion:Priapism is a disease of the young, mostly sickle cell anemic patients. Late presentation remains the norm in our environment, hence a higher incidence of ED. The distal penile shunt is an effective means of achieving detumescence even with failed conservative management. Favorable outcome is highly dependent on the duration of erection and early intervention.