International Index Of Erectile Function Score Research Articles

Evaluation of psychological stress, cortisol awakening response, and heart rate variability in patients with chronic prostatitis/chronic pelvic pain syndrome complicated by lower urinary tract symptoms and erectile dysfunction.

Mental stress and imbalance of its two neural stress systems, the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis, are associated with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and erectile dysfunction (ED). However, the comprehensive analyses of psychological stress and stress systems are under-investigated, particularly in CP/CPPS patients complicated by lower urinary tract symptoms (LUTS) and ED. Participants were 95 patients in CP/CPPS+ED group, 290 patients in CP/CPPS group, 124 patients in ED group and 52 healthy men in control group. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Index of Erectile Function-5 (IIEF-5) and the International Prostate Symptom Score (IPSS) were used for assessing the disease severity of CP/CPPS, LUTS and ED. Psychometric self-report questionnaires including the Beck Anxiety Inventory (BAI), Perceived Stress Scale (PSS), Type A Personality Test (TAPT) and Symptom Checklist 90 (SCL-90) were completed for distress from physical symptoms. Twenty-five subjects per group were randomly selected for further investigating the changes of the HPA axis and ANS. Saliva samples were taken on 3 consecutive days at 8 specific times with strict reference to time of morning awakening for evaluation of free cortisol. Heart rate variability (HRV) as marker of the ANS was measured using 24 h electrocardiography, and time-and frequency-domain variables were analyzed. The BAI and SCL-90 scores were significantly higher in the CP/CPPS+ED, CP/CPPS and ED groups compared with the control group (p < 0.01). The PSS scores of both groups with ED were significantly higher than the control group (p < 0.01). Compared with the CP/CPPS group, the differences of PSS, SCL-90 and TAPT scores were statistically significant in CP/CPPS+ED patients (p < 0.01). The IPSS scores were shown to have significantly positive correlations with BAI (r = 0.32, p < 0.0001), PSS (r = 0.18, p < 0.01) and SCL-90 (r = 0.19, p < 0.01) in the CP/CPPS patients. However, in all subjects, the IIEF-5 scores were shown to have significantly negative correlations with BAI (r = -0.17，p < 0.001), PSS (r = -0.25，p < 0.0001), SCL-90 (r = -0.20，p < 0.001) and quality of life score in NIH-CPSI (r = -0.14，p = 0.0075). Cortisol awakening response (CAR) parameters and diurnal cortisol levels did not significantly vary between the four groups. Time-dependent parameters of HRV also did not differ significantly across groups. In the frequency domain analysis, low frequency (LF) was significantly lower in ED patients when compared with CP/CPPS+ED patients (p = 0.044) and healthy controls (p = 0.005), high frequency (HF) power was significantly higher in healthy controls compared to patients with ED (p < 0.001), CP/CPPS (p < 0.001) and CP/CPPS+ED (p < 0.001), and the CP/CPPS+ED group had significantly higher LF/HF ratio than the control group (p = 0.001). CP/CPPS and ED patients score exceedingly high on most psychosocial variables. The symptom scores of LUTS and ED positively correlate with the severity of psychological stress. Our findings also suggest that the ANS sympathovagal imbalance is associated with ED and LUTS in CP/CPPS, whereas HPA axis activity is not.

Hyperestrogenism is associated with sexual function impairment in men – findings from a cross-sectional, real-life study

High estrogens levels have been associated with higher rates of heart attacks, strokes, and prostate cancer. Moreover, hyperestrogenism is believed to be harmful to male sexuality. We aimed to investigate the impact of hyperestrogenism on sexual functioning in the real-life setting. Data from 481 men seeking first medical help for new-onset ED at a single andrology centre were analyzed. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All patients completed the International Index of Erectile Function (IIEF) categorized according to Cappelleri's criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estrogen (E2) levels >42.6 pg/mL (Tan RS et al. 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and IIEF scores. Overall, 88 (18.3%) patients had serum estrogen levels suggestive for hyperestrogenism. Men with hyperestrogenism were older [median (IQR) 46 (34-58) vs. 44 (32-55) years; p<0.001], had more comorbidities [CCI≥2: 18 (20.5%) vs. 28 (7.1%); p<0.001] and higher serum testosterone (TT) levels [5.4 (4.2-7.3) vs. 4.3 (3.1-5.7); p=0.02] than those with normal E2 values. A higher rate of severe ED was found in men with elevated E2 levels (48.9% vs. 30%; p=0.02). Moreover, the IIEF-orgasmic function (IIEF-OF) domain was lower in ED men with hyperestrogenism than those with normal E2 values [6 (3-10) vs. 9 (6-10), p=0.03]. Serum E2 levels were correlated with TT levels (rho 0.25, p<0.001), but negatively correlated with IIEF-OF scores (rho -0.17, p=0.005) and IIEF-EF scores (rho -0.32, p<0.001) (Figure 1). At multivariable logistic regression analysis, hyperestrogenism (OR 2.37, p=0.03) was associated with severe ED after accounting for age, BMI, CCI and serum T values. One out of five men seeking first medical help for ED showed elevated serum E2 values in the real-life setting. Hyperestrogenism was associated with orgasmic function impairment and higher severity of ED. None

The earthquake's effect on the men's sexual function; 1 year after the earthquake's occurrence: A cross-sectional study.

Sexual dysfunctions are one of the health problems after natural disasters that are usually less attention. The purpose of this study was to evaluate the effect of the earthquake on men's sexual functions 1 year after the earthquake. This study was a descriptive-analytical cross-section study that took place a year after the Kermanshah earthquake. The population studied was all men living in the Kermanshah earthquake. Demographic, socioeconomic, psychological, health situations, facilities availability, and environmental situations after the earthquake and International Index of Erectile Function (IIEF) were randomly distributed among men affected by the earthquake. Participants returned the questionnaires through the mail. Based on the IIEF cut-point score, men were divided into two groups: those with sexual dysfunction (Group A) and without sexual dysfunction (Group B). In this study, 225 married men participated. The prevalence of sexual dysfunction in earthquake-affected men was 44.9%. The mean total IIEF scores in the A and B groups were 43.47 ± 7.82 and 62.11 ± 6.39, respectively. There was a significant difference between the total and all subcategories IIEF scores in the two groups (p < 0.001). There was a statistically significant difference between the age (p < 0.001), child numbers (p < 0.017), current live location (p < 0.001), social support after the earthquake (p = 0.033), underlying disease (p < 0.001), availability of sanitary toilets (p < 0.001) and bathrooms (p = 0.002), and total IIEF scores between the two groups (p < 0.001). Approximately half of the earthquake-affected men had sexual dysfunctions. The men's age, child numbers, current live location, social support, underlying disease, and availability of sanitary toilets and bathrooms were influential in the severity of men's sexual dysfunctions after the earthquake. Therefore, crisis managers, policymakers, psychiatrists, and psychologists should pay enough attention to men's sexual dysfunction after earthquakes.

The impact of the coronavirus disease 2019 (covid-19) on male sexual health

<h3>Objectives</h3> During the Coronavirus Disease 2019 (COVID-19) pandemic, there was an increase in the amount of men seeking treatment at urology outpatient clinics for sexual complaints. However, it is unknown whether this condition is directly related to COVID-19. The impact of COVID-19 on male sexual health was explored in the present study. <h3>Methods</h3> Individuals in the male sexual health cohort of our clinic were retrospectively examined. Men who applied to our clinic in the last 6 months and had a history of COVID-19 afterward were invited for an assesment at the 3rd month post COVID-19. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), and prolactin (PRL) levels were all measured. Furthermore, the Premature ejaculation diagnostic tool (PEDT), the Chronic prostatitis symptom index (NIH-CPSI), the International Index of erectile function-5 (IIEF-5), the Beck depression inventory (BDI), and the Beck anxiety inventory (BAI) scores were recorded. The pre-covid and post-covid data of the subjects were compared. <h3>Results</h3> The mean age of the participants was 34.8±7.7, the mean body mass index was 26.82±5.3, and the mean modified Charlson comorbidity index was 0.2±0.41. COVID-19 severity was mild in 19/25 (76%) and moderate in 6/25 (24%) of the subjects. LH, FSH, TT, and PRL levels did not differ between precovid and postcovid periods (p>0.05). There was no significant change in PEDT, NIH-CPSI, IIEF-5, or BAI scale scores in the postcovid period (p>0.05), although there was an remarkable decrease in BDI scores as compared to the precovid period (p>0.05). <h3>Conclusions</h3> While there was no difference in sex hormone levels or scale scores used to assess premature ejaculation, erectile dysfunction, chronic prostatitis, or anxiety, we noticed an unanticipated decrease in depression levels in individuals recovering from COVID-19. More precise results on the impact of COVID-19 on male sexual health could be revealed in future cohort studies with higher case numbers. <h3>Conflicts of Interest</h3> The authors declare no conflict of interest.

The impact of the coronavirus disease 2019 (covid-19) on male sexual health

During the Coronavirus Disease 2019 (COVID-19) pandemic, there was an increase in the amount of men seeking treatment at urology outpatient clinics for sexual complaints. However, it is unknown whether this condition is directly related to COVID-19. The impact of COVID-19 on male sexual health was explored in the present study. Individuals in the male sexual health cohort of our clinic were retrospectively examined. Men who applied to our clinic in the last 6 months and had a history of COVID-19 afterward were invited for an assesment at the 3rd month post COVID-19. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), and prolactin (PRL) levels were all measured. Furthermore, the Premature ejaculation diagnostic tool (PEDT), the Chronic prostatitis symptom index (NIH-CPSI), the International Index of erectile function-5 (IIEF-5), the Beck depression inventory (BDI), and the Beck anxiety inventory (BAI) scores were recorded. The pre-covid and post-covid data of the subjects were compared. The mean age of the participants was 34.8±7.7, the mean body mass index was 26.82±5.3, and the mean modified Charlson comorbidity index was 0.2±0.41. COVID-19 severity was mild in 19/25 (76%) and moderate in 6/25 (24%) of the subjects. LH, FSH, TT, and PRL levels did not differ between precovid and postcovid periods (p>0.05). There was no significant change in PEDT, NIH-CPSI, IIEF-5, or BAI scale scores in the postcovid period (p>0.05), although there was an remarkable decrease in BDI scores as compared to the precovid period (p>0.05). While there was no difference in sex hormone levels or scale scores used to assess premature ejaculation, erectile dysfunction, chronic prostatitis, or anxiety, we noticed an unanticipated decrease in depression levels in individuals recovering from COVID-19. More precise results on the impact of COVID-19 on male sexual health could be revealed in future cohort studies with higher case numbers. The authors declare no conflict of interest.

The relationship between serum 25-hydroxy vitamin D and arteriogenic erectile dysfunction.

This study aimed to assess the relationship between 25(OH) levels and erectile dysfunction (ED), particularly arteriogenic ED (A-ED). From September 2020 to January 2022, 150 patients diagnosed with ED by the International Index of Erectile Function-5 (IIEF-5) questionnaire were included. All patients were classified as organic ED and psychological ED by nocturnal penile tumescence and rigidity (NPTR) examination. Organic ED patients were divided into A-ED and NA-ED by penile doppler ultrasound (PDU) examination. Finally, 150 patients complaining of ED were enrolled in our study. 25(OH)D levels were significantly lower in patients with organic ED (18.24 ± 6.04 ng/ml) than in patients with psychogenic ED (20.90 ± 8.79 ng/ml) (p=0.032). In A-ED and NA-ED, the mean of peak systolic flow velocity (PSV) values was 18.94 ± 5.28 cm/s and 51.57 ± 15.42 cm/s (p < 0.001), and the mean of 25(OH)D was 15.66 ± 5.86 ng/ml and 20.48 ± 5.90 ng/ml, respectively (p < 0.001). The results showed that 25(OH)D levels were positively correlated with IIEF-5 scores and the PSV values in A-ED patients. The 25(OH)D cut-off value differentiating between A-ED and NA-ED was 15.05 ng/ml. Low 25(OH)D levels may be an independent risk factor for ED, especially A-ED. ED patients should routinely undergo serum 25(OH)D level measurement, and 25(OH)D replacement therapy is necessary for patients with low vitamin D levels.

The Efficacy and Safety of Thrice vs Twice per Week Low-Intensity Pulsed Ultrasound Therapy for Erectile Dysfunction: A Randomized Clinical Trial

A recent sham-controlled clinical study has shown that low-intensity pulsed ultrasound twice per week can safely and effectively treat patients with mild-to-moderate erectile dysfunction (ED). However, large-scale clinical trials are needed to verify its efficacy and safety and determine a reasonable treatment interval. To study whether low-intensity pulsed ultrasound therapy thrice per week is non-inferior to twice per week in patients with mild-to-moderate ED. A randomized, open-label, parallel-group, non-inferiority clinical trial was conducted in 7 hospitals in China. A total of 323 patients with mild-to-moderate ED were randomized (1:1) into thrice per week (3/W) and twice per week (2/W) groups. Low-intensity pulsed ultrasound was applied on each side of the penis for 16 sessions. The primary outcome was response rate using the minimal clinically important difference in the International Index of Erectile Function (IIEF-EF) score at week 12. Secondary outcomes included Erection Hardness Score (EHS), Sexual Encounter Profile, Global Assessment Question, and Self Esteem and Relationship Questionnaire. Response rates in 3/W and 2/W groups were 62.0% and 62.5%, respectively. Treatment effect in the 3/W group was noninferior to that of the 2/W group, with rate difference lower bound of -0.01% [95% confidence interval -0.11 to 0.10%] within the acceptable margin (-14.0%). No significant difference was found among secondary outcomes. IIEF-EF score showed a significant increase from baseline in the 3/W group (16.8 to 20.7) and 2/W group (17.8 to 21.7), and the percentage of patients with EHS ≥3 increased in the 3/W (54.9% to 84.0%) and 2/W (59.5% to 83.5%) groups. There was no significant difference in response rate between the 2 groups after controlling for strata factors and homogeneous tests. No treatment-related adverse events were reported. Low-intensity pulsed ultrasound therapy displays similar efficacy and safety for mild-to-moderate ED when administered thrice or twice per week for 16 sessions. This study provides two options to suit patients' needs. This is a large-sample, randomized, controlled, noninferiority trial study. Short-term follow-up and mostly younger patients are the main limitations. Low-intensity pulsed ultrasound therapy thrice and twice per week showed equivalent therapeutic effects and safety for mild-to-moderate ED in a young and generally healthy population. This therapy warrants further investigation of its potential value in rehabilitation of ED.

Influence of transurethral enucleation with bipolar of the prostate on erectile function: Prospective analysis of 51 patients at 12-month follow-up.

Transurethral enucleation with bipolar (TUEB) is a safe and effective surgery for benign prostatic obstruction (BPO). However, few data exist concerning the influence of TUEB on erectile function (EF) in patients with BPO. To evaluate the influence of TUEB on EF in patients with BPO at 3- and 12-month follow-up. We prospectively enrolled 51 patients who underwent TUEB from June 2016 to April 2020. We evaluated maximum urinary flow rate (Qmax), postvoid residual urine (PVR), International Prostate Symptom Score (IPSS), quality of life (QoL), and International Index of Erectile Function-5 (IIEF-5) preoperatively and at 3- and 12-month follow-up. We classified the patients according to their preoperative IIEF-5 score into group 1 (IIEF-5 ≥10; n = 24) and group 2 (IIEF-5 <10; n = 27), and for further evaluation of EF, into subgroups a: severe (IIEF-5 5-7), b: moderate (8-11), c: mild to moderate (12-16), d: mild (17-21), and e: no erectile dysfunction (22-25). Data are displayed as median or median (interquartile range). The study comprised 51 patients with a median age of 75 (70.5-79.5) years. Median prostate and transition zone volumes were 69.5 (46.5-78.8) mL and 30.5 (19-43) mL, respectively. Urinary function improved significantly when comparing respective preoperative, 3-month, and 12-month follow-up values: Qmax (7.6, 12.9, 15.2 mL/s), PVR (50, 0, 0 mL), IPSS (20.5, 9, 6), and QoL (5, 2, 2), respectively. There was no significant change in IIEF-5 score across the three time points: 9, 7, 8. The IIEF-5 score slightly but significantly increased between the preoperative and 12-month follow-up values in group 2 (5, 5, 6) and subgroup a (5, 5, 5). TUEB was effective and safe surgery for patients with BPO and showed no significant influence on EF at 12-month follow-up after TUEB in patients with BPO.

Evaluation of effect of robotic versus laparoscopic surgical technology on genitourinary function after total mesorectal excision for rectal cancer

ObjectiveBecause the recovery of genitourinary function after total mesorectal excision (TME) is affected by multiple factors, the role of robot-assisted TME technology in postoperative function in previous studies is still controversial. Our study aimed to evaluate the impact of robotic technology on the recovery of genitourinary function after TME for rectal cancer by analysing the correlations between influencing factors of genitourinary function and robotic surgery. MethodsBetween January 2017 and January 2020, patients with rectal cancer (cT1-3NxM0) were registered. Genitourinary function was assessed by the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF) test, Female Sexual Function Index (FSFI) and urodynamic examination before surgery and 1, 3, 6, and 12 months postoperatively. Genitourinary function was compared between the laparoscopic total mesorectal excision (L-TME) and robotic total mesorectal excision (R-TME) groups, and the correlative factors associated with postoperative genitourinary function were analysed using the generalized estimated equation (GEE). ResultsCompared with L-TME, R-TME showed a superior IPSS, voiding volume, residual urine volume and IIEF score during the early postoperative period. According to the GEE analysis, postoperative genitourinary function was positively correlated with laparoscopic anterior resection/abdomen perineal resection (LAR/APR) but negatively correlated with tumour size, tumour distance to anus, TNM, adjuvant chemotherapy, adjuvant radiotherapy, complete TME, circumferential resection margin (CRM), blood loss, diverting stoma, conversion, and anastomotic leakage. ConclusionDue to the important role of robotic surgical technology on the influential factors of postoperative genitourinary function and the superiority of identifying and preserving autonomic nerves, robotic technology is conducive to the early recovery of postoperative urogenital function while adhering to oncological dissection principles. No significant difference was found between the da Vinci R-TME and MicroHand R-TME groups.

STUDY OF SEXUAL FUNCTIONING, SEXUAL CONCERNS, AND SEXUAL SATISFACTION IN MALE STROKE SURVIVORS

Objective: The aim of this study was to study the sexual functioning, sexual concerns, and sexual satisfaction in males stroke survivors. The aim of this study was to determine the male sexual functions (1) libido/desire, (2) coital frequency, (3) sexual arousal, (4) erectile function using international index of erectile function (IIEF) score, (5) ejaculation using premature ejaculation diagnostic tool (PEDT) score, and (6) sexual satisfaction in male stroke survivors. Methods: It was a cross-sectional questionnaire study in the Neurological Rehabilitation department of a tertiary care Institute in 33 adult male stroke survivors in the age more than 21 years with at least 3 months of community dwelling post-discharge. The sexual functions recorded were (1) libido/ desire, (2) coital frequency, (3) sexual arousal, (4) erectile function using IIEF score, (5) ejaculation using PEDT score, and (6) sexual satisfaction. Results: Thirty-three eligible male stroke survivors in the age range from 25–54 years (mean 42.5 years) with post-stroke duration of 3–45 months (mean = 16.6 months) were included in the study. Of them, 14 had experienced stroke within 12 months and 19 had experienced stroke &gt;12 months ago. Thirteen participants were sexually inactive and reported no coitus due to a loss of erection. The sexually active stroke survivors reported a moderate recovery of libido (60%), coital frequency (60%), erectile function (63%), orgasm (32%), and sexual satisfaction (25%), while others had poor recovery. Erectile dysfunction was present in 16 cases, an-ejaculation in 18 cases, and premature ejaculation in nine cases. Hypertension and depression with a history of smoking posed a higher risk of erectile dysfunctions. Conclusion: Exploration of sexual dysfunctions and sexual counseling by clinicians should be part of the comprehensive stroke rehabilitation program in sub-acute care.

The efficacy and safety of low-intensity extracorporeal shock wave treatment combined with or without medications in Chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta-analysis.

We performed this systematic review and meta-analysis to investigate the efficacy and safety of Li-ESWT combined with or without medications for patients with Chronic prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). A comprehensive search was conducted of PUBMED, Cochrane Library, and Web of Science databases from inception to February 2022 for randomized controlled trials (RCTs) assessing the efficacy and safety of Li-ESWT with or without the combination of medications compared with the control group. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), Visual Analogue Scale/Score (VAS), International Index of Erectile Function (IIEF), and International prostate symptom score (IPSS) were used to assess the improvements of symptoms in CP/CPPS patients. 651 patients from 12 randomized controlled studies were included in this study. The total NIH-CPSI scores, pain domain scores, and quality of life (QOL) scores were significantly lower in the Li-ESWT group than those in the control group at the termination of treatment, and 1, 4, 12, and 24 weeks after treatment. And these scores were significantly reduced in the Li-ESWT group than in baselines. In the subgroup analysis, reductions of these scores lasted longer and were greater in Li-ESWT combined with medications than in Li-ESWT alone. In the Li-ESWT group, the VAS score; IIEF score; and IPSS score were significant improvements than those in control group at the termination of treatment, and 1, 4, and 12 weeks after treatment; 4, 12, and 24 weeks after treatment; and 1, 4, and 12 weeks after treatment, respectively. Li-ESWT is a safe, non-invasive, and effective option for patients with CP/CPPS, whether combined with medications or not, should be recommended for widespread use in clinical practice.

A systematic review and meta-analysis of sexual dysfunction in patients with hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition associated with significant psychosocial comorbidity. To date, the relationship between HS and sexual dysfunction has not been assessed through meta-analysis. A systematic review was performed by OVID Medline, EMBASE, Cochrane Central, PsycINFO via EBSCO, Web of Science, and LILACS. Original English language studies assessing HS and sexual function published prior to April 2020 were screened. Scores from the Female Sexual Function Index (FSFI), International Index of Erectile Function (IIEF), Arizona Sexual Experiences Scale (ASEX), Frankfurt Self-Concept Scale for Sexuality (FKKS SEX), and Dermatology Life Quality Index (DLQI) were analyzed. Sixteen studies met inclusion criteria, and nine were eligible for meta-analysis. Pooled mean FSFI score for female HS patients met criteria for sexual dysfunction (mean = 20.32, P < 0.001). Females with HS reported worse FSFI scores than controls (pooled mean difference = -5.704, P = 0.003, I2 =0). Mean IIEF score among males with HS was 47.96 (P < 0.001). Males with HS also reported worse IIEF scores than controls (pooled mean difference = -18.77, P = 0.00, I2 = 0). Females with HS performed worse on sexual function inventories than males with HS (SMD = -0.72, P = 0.009, I2 = 0). Both male and female HS patients reported significantly more sexual impairment than same-sex controls. Female HS patients also experience more sexual impairment than males and on average meet criteria for sexual dysfunction (FSFI <26.55). Clinicians should be aware that their patients with HS, especially females, may be suffering from sexual dysfunction and treated them appropriately.

Salvage partial gland ablation for recurrent prostate cancer following primary partial gland ablation: Functional and oncological outcomes.

Partial gland ablation (PGA) for localised prostate cancer (CaP) aims to eradicate clinically significant tumours while preserving healthy tissue, thereby decreasing the likelihood of side effects compared to whole-gland approaches. Although salvage radical prostatectomy (sRP) is a well-described salvage option in cases of PGA failure, the evidence supporting salvage PGA (sPGA) is limited. We hereby report the oncologic and functional outcomes of patients treated with sPGA following initial treatment with primary PGA (pPGA). We describe the findings of a retrospective review of patients who had a CaP recurrence after pPGA and then underwent sPGA, at 3 medical centers in Ontario, Canada, between 2005 and 2017. Oncological outcomes following sPGA were assessed for biochemical recurrence (BCR) and biopsy-proven recurrence (BPR). Functional outcomes were described using the international prostate symptom score (IPSS), international index of erectile function (IIEF), and rates of urinary incontinence (use of >1 pad/day). We identified 25 patients who underwent sPGA following pPGA (hemiablation in 48% and zonal ablation in 52% of the patients). The median length of time was 16.8 months (interquartile range [IQR] 14.0-19.1) from pPGA to sPGA and 47.06 months (IQR 19.9-171.3) from pPGA to date of last follow up. High intensity focused ultrasound (HIFU) was the only modality used in all patients. At baseline, the median age was 65 years (IQR 52-77) and median prostate specific antigen (PSA) level was 7.46 ng/mL (IQR 1-25). The median time from pPGA to BPR was 12.7 months (IQR 5.19-36). At BPR following pPGA, 4 patients (17%) had CaP grade group (GG) 1, 10 patients (42%) had GG2, 6 patients (25%) had GG3, and 4 patients (17%) had GG4 disease, with a median PSA of 3.58 ng/mL (IQR 0.67-19). The median length of follow up after sPGA was 27.3 months (IQR 14.5-86.3). Following sPGA, 13/25 patients (52%) had BCR with median time to recurrence of 14 months (IQR 2.5-82.15), with a recurrence-free survival of 24.5 months (95% confidence interval: 15.3-not reached). Of those 13 patients, 4 were managed with sRP, 4 were managed with salvage radiotherapy, 3 were managed with androgen-deprivation therapy, 1 had a third PGA with HIFU, and 1 was managed with active surveillance. The mean change from baseline to last follow up in IPSS and IIEF scores was +1.3 (P = 0.66) and -2.3 (P = 0.32), respectively. Urinary incontinence was reported by 9% of patients at baseline, with only one additional patient developing incontinence following sPGA. Our present study demonstrates that after a median follow-up of 27 months, sPGA for recurrent CaP following pPGA provides disease control in up to 50% of patients with nonsignificant detrimental effects on functional outcomes. Appropriate patient selection and adequate staging are important to consider before offering PGA to patients.

Early outcomes of short-course low intensity shockwave therapy (LiSWT) for erectile dysfunction: A prospective, randomized, double-blinded, sham-controlled study in Malaysia.

Low‐intensity shockwave therapy (LiSWT) has emerged as a promising non‐invasive treatment modality for erectile dysfunction (ED) yet the well‐designed randomized clinical trials are still lacking to prove its claimed benefits. A randomized, prospective, double‐blinded sham‐controlled study was conducted to evaluate the effectiveness and safety profile of short course LiSWT on vasculogenic ED patients. The International Index of Erectile Function‐5 (IIEF‐5) and Erection Hardness Score (EHS) questionnaires were used for evaluation. Patients underwent weekly sessions for 4 weeks and were re‐assessed at 1, 3 and 6 months post therapy. Fifty one patients were recruited and randomized into sham and treatment arms. The mean IIEF‐5 scores were significantly improved in the treatment arm compared to worsening of scores in the sham arm after 1 month (14.1 vs. 9.3 p < 0.001), 3 months (14.9 vs. 8.6, p < 0.001) and 6 months (14.2 vs. 7.9, p < 0.001) post treatment. A significant improvement of EHS was demonstrated at 1 month (2.4 vs. 1.8, p = 0.001, 3 months 2.7 vs. 1.7, p < 0.001) and 6 months (2.7 vs. 1.6, p < 0.001) in the treatment arm compared to sham arm. The success rate based on IIEF score increment more than five points was 26% in treatment arm and 0% in sham arm. Improvement in EHS score ≥3 in the treatment versus sham arm was 63% and 4%, respectively. There was no adverse effect reported. This 4‐week LiSWT protocol reflects better treatment compliance, and it prevents further deterioration of erectile function among this cohort of patients. This study proves that LiSWT is a well‐tolerated treatment with modest improvements in erectile function and hardness, among patients with vasculogenic ED.

COVID-19 pandemisine karşı alınan sosyal izolasyon önlemlerinin sağlık çalışanlarının erektil fonksiyonları üzerine etkileri: prospektif karşılaştırmalı bir çalışma

Objective: In this study, we aimed to investigate whether the anxiety caused by the COVID-19 pandemic on healthcare professionals with different duties, such as doctors, nurses, medical secretaries, and medical staff, causes erectile dysfunction (ED). Material and Methods: In between 1 May 2020 and 1 August 2020, volunteering male health workers who had regular sexual intercourse at least once a week for the last six months and who had not previously worked in COVID-19 clinics were included in the study. Before and 4 weeks after working in COVID-19 clinics, erectile function was determined by the International Index of Erectile Function-5 (IIEF-5) form. The Hamilton Anxiety Rating Scale (HAS) was used to evaluate anxiety disorders and their severity. Results: A total of 218 male health caregivers were included in the study. Among these, 56 (25.7%) were doctors, 81 (37.2%) were nurses, 46 (21.1%) were medical secretaries and 35 (16.1%) were the medical staff. The mean HAM-A score of the doctors measured 4 weeks after having worked in a COVID-19 clinic (3,32±4,68) was observed to be significantly higher compared to that measured before working (28,43±14,05) (p&lt;0.001). The mean IIEF-5 scores of the doctors measured 4 weeks after having worked in a COVID-19 clinic (16,34±4,11) was observed to be significantly lower compared to that measured before working (22,29±2,35) (p&lt;0.001). Conclusion: Our results indicate that healthcare professionals working in COVID-19 clinics have increased anxiety and ED, and physicians are affected more than the other healthcare professionals. Keywords: COVID-19, health professionals, erectile dysfunction, anxiety, hamilton anxiety scale

Prospective comparison of tadalafil 5 mg alone, silodosin 8 mg alone, and the combination of both in treatment of lower urinary tract symptoms related to benign prostatic hyperplasia

BackgroundMen with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), will have deterioration in the quality of life. Likewise, BPH can be complicated by damage to bladder function, bladder stones formation, hematuria, and impaired kidney function. The goal of treatment is to avoid all those effects caused by BPH.ObjectiveTo evaluate the efficacy of tadalafil alone, silodosin alone, and the combination of both in the treatment of LUTS associated with BPH.Patients and methodsPatients in our department with BPH who had LUTS were assigned randomly to three groups: A (101 patients) received tadalafil, 5 mg; B (102 patients) received silodosin, 8 mg; and group C (105 patients) received the combination of tadalafil, 5 mg, and silodosin, 8 mg. For all participants, we asses changes in the maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF) score, Post-voiding urine (PVR) and all results were recorded and analyzed with the (SPSS) and Microsoft Excel 2010.ResultsQmax, IPSS, PVR and IIEF score improved significantly more with the combination of tadalafil and silodosin than with either drug alone (p < 0.001). Three months after treatment, the mean Qmax values were 14.4 ml/sec in group A, 15.2 ml/sec in group B, and 15.8 ml/sec in group C; and the mean IPSSs were 17.6 in group A, 16.7 in group B, and 15.6 in group C (p < 0.001).ConclusionTadalafil and silodosin are effective treatment options in men with BPH who have LUTS, but the combination of both is more effective and feasible in treating LUTS of BPH.

Erectile dysfunction following hydrogel injection and hypofractionated radiotherapy for prostate cancer: Our experience in 56 cases.

The incidence of erectile dysfunction (ED) in men with organ-confined prostate cancer (PCa) submitted to hypofractionated radiotherapy (HRT) has been prospectively evaluated. From April 2018 to September 2020, 56 patients (median age 70 years) with cT1c PCa were treated by HRT directed to the prostate and seminal vesicle. Median PSA was 8.3 ng/ml; 20 patients (35.7%) vs. 28 (50%) vs. 8 (22.3%) had a PCa Grade Group 1 vs. 2 vs. 3, respectively. All patients underwent hydrogel injection of Space OAR and intraprostatic fiducials before HRT. The prescription dose was 60 Gy in 20 fractions 5 days/week over 4 weeks. During the follow up, PSA, genitourinary (GU) and gastrointestinal (GI) toxicities were evaluated. The sexual function was evaluated by International Index of Erectile Function - 5 (IIEF-5) before, 6 and 18 months from HRT; 32/56 (57.1%) men referred a normal sexual activity before HRT (median IIEF-5 score: 22). Median PSA level at median follow up of 18 months was 0.92 ng/ml and none used adjuvant therapy. One man (1.8%) referred a tardive grade 1 GU complication. At a median follow up of 6 and 18 months, 20/32 (62.5%) kept pretreatment sexual potency (median IIEF-5 score: 21). The 12/32 men who worsened the sexual function following HRT had a median age higher than patients without ED (78 vs. 67 years). The use of hydrogel injection and intraprostatic fiducials followed by HRT allowed to kept pretreatment sexual potency in 62.5% of the cases.

Urogenital dysfunction after laparoscopic surgery for rectal or sigmoid colon cancer

Background/objectiveUrogenital dysfunction is a common complication after surgery for sigmoid colon or rectal cancers and may result from various causes. Herein, we evaluated urogenital dysfunction and the associated factors after laparoscopic surgery at different follow-up times. MethodsWe conducted a prospective study on 91 patients who were diagnosed with sigmoid colon and rectal cancers and underwent laparoscopic surgery during 2014–2016.Voiding and male and female sexual dysfunctions following surgery were evaluated by the International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and Female Sexual Function Index-6 (FSFI-6), respectively. Urogenital function was compared at pre-surgery and 3 and 12 months postoperatively, and factors associated with urogenital dysfunction were identified. ResultsThe overall urinary function after surgery was better when compared to that at pre-surgery; however, there was deterioration in both male and female sexual functions. The mean preoperative IPSS, IIEF-5, and FSFI-6 scores were 9.35, 12.18, and 6.09, respectively. The mean differences among IPSS, IIEF-5, and FSFI-6 at 12 months postoperatively and pre-surgery were −3.08 (95% confidence interval [CI] −4.77 to −1.40), −2.57 (95% CI -4.33 to −0.80), and −2.58 (95% CI -4.73 to 0.42), respectively. Multivariate analysis demonstrated that age ≤60 years (odds ratio 4.22) and postoperative complications (odds ratio 2.77) were correlated with erectile dysfunction. ConclusionVoiding function improved after laparoscopic surgery in both sigmoid colon and rectal cancer patients. However, sexual function in both male and female patients was worse. Age ≤60 years and postoperative complications were strongly associated with male sexual dysfunction.

Evaluation of male sexual parameters in infertile couples with a history of abortion

IntroductionIt is thought that both individuals are affected psychologically and sexually in couples experiencing abortion. In addition to the stress caused by infertility, sexual life may also be negatively affected in couples who experience psychogenic wear, such as abortion and curettage. The aim of this study is to evaluate male sexual functions in infertile couples with a history of abortion and male infertility component. MethodsFive hundred forty-seven male patients’ data were evaluated retrospectively. Group 1 was the included the males of the couples without abortion history and the rest with abortion history was group 2. In addition to demographic data, abortion history, libido level, presence of morning erection and intercourse frequency were evaluated. Hormone levels of all patients were evaluated. After that we created sub-group 1 and sub-group 2 from these groups, respectively, due to whether the patients fulfilled the international index of erectile function (IIEF), Beck anxiety inventory (BAI) and Beck depression inventory (BDI). ResultsThere were not any significant differences between the groups regarding psychiatric scale scores, hormone levels, libido, intercourse frequency and IIEF scores. Only orgasmic dysfunction was significant in the males of the couples with abortion history. ConclusionMan is not affected from abortion process in which woman get involved. Men only have orgasmic dysfunction when there is one or more abortion history in couples.

MP01-19 MINIMALLY INVASIVE AND ENDOSCOPIC THERAPIES FOR BENIGN PROSTATIC HYPERPLASIA: HEAD-TO-HEAD COMPARISON OF SHORT-TERM OUTCOMES BY NETWORK META-ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP01-19 MINIMALLY INVASIVE AND ENDOSCOPIC THERAPIES FOR BENIGN PROSTATIC HYPERPLASIA: HEAD-TO-HEAD COMPARISON OF SHORT-TERM OUTCOMES BY NETWORK META-ANALYSIS Linda Hamed, Jamaal Jackson, and Ephrem Olweny Linda HamedLinda Hamed More articles by this author , Jamaal JacksonJamaal Jackson More articles by this author , and Ephrem OlwenyEphrem Olweny More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002513.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical options for the management of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) for prostates <80 g in size include endoscopic therapies i.e. mono- or bipolar transurethral resection of the prostate (mTURP, bTURP), vaporization or laser enucleation, as well as minimally invasive surgical therapies (MISTs) i.e. transurethral needle ablation (TUNA), transurethral microwave thermotherapy (TUMT), prostatic urethral lift (PUL), water vapor thermotherapy (Rezum) and aquablation. We performed a head-to-head comparison of short-term outcomes for these treatment options by network meta-analysis. METHODS: A systematic review of randomized controlled trials from 1998 to 2018 in men with prostates <100 g, moderate-severe LUTS (International Prostate Symptom Score (IPSS) ≥ 8) and maximum urinary flow rates (Qmax) <15 mL/s, treated using any of the above modalities and reporting outcomes at a minimum follow up of 1 year was performed, including trials with a sham arm. Multivariable random effects network meta-analysis was used to compare the treatments with respect to IPSS, quality of life (QOL), Qmax and international index of erectile function (IIEF) scores at 1 year. For each outcome, treatments were ranked from best to worst using the surface under the cumulative ranking curve (SUCRA) method. Referent treatment was mTURP. RESULTS: A total of 26 studies met inclusion criteria. 1-year IPSS and QOL scores for each treatment modality were statistically similar to those for mTURP. Qmax for PUL, Rezum and TUNA were statistically lower than for mTURP, while flow rates for all other modalities were similar. 1-year IIEF scores were not available for aquablation, TUMT or TUNA, but scores for vaporization PUL and Rezum were notably higher than for mTURP, while those for enucleation and bTURP were similar. By SUCRA, the treatment with the highest probability of best urinary function was enucleation, while Rezum had the highest probability of sexual function. CONCLUSIONS: Compared with mTURP, Rezum and PUL achieved inferior flow rates but better IIEF scores, while vaporization achieved similar flow rates and higher IIEF scores. These findings could be invaluable in counseling patients on surgical outcomes for BPH. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e9 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Linda Hamed More articles by this author Jamaal Jackson More articles by this author Ephrem Olweny More articles by this author Expand All Advertisement PDF DownloadLoading ...