Management Of Erectile Dysfunction Research Articles

A Review on Risk Factors, Diagnostic Innovations, and Plant Based Therapies for the Management of Erectile Dysfunction

Men of all ages frequently experience erectile dysfunction (ED) or impotence, and it is a difficult health issue that adversely affects the quality of life of those who experience it. There are multiple types of treatment strategies for ED available, depending on the origin and severity of ED, as well as any underlying medical issues. However, these therapeutics are known to have a number of negative health effects. In contrast, plant-based treatments are more effective for managing diseases due to their ability to modulate biological processes like inflammation, oxidative stress, and cell signaling molecules. Many medicinal plants have been reported to be quite helpful in the improvement of ED. In this review, ED and its causes, diagnostic methods, treatment strategies, and some of the most potent plant-based interventions against ED are discussed in greater detail, along with a description of their mechanisms of action and a brief discussion of approaches to increase their efficacy, with a focus on the management of ED using herbal interventions as complementary and alternative medicines. While there is hope that medicinal plants could provide lead substances for erectile dysfunction medications, additional investigation is necessary to ascertain the efficacy and security of these prospective treatments.

Icarifil® in Association with Daily Use of Tadalafil (5 mg) versus Standard Tadalafil Daily Dose (5 mg) or Alone: Results from a Controlled, Randomized Clinical Trial.

Background: The management of erectile dysfunction (ED) shows several grey zones and new treatments are required to reduce the percentage of patients discontinuing treatment. Here, we aim to evaluate the role of a natural mixture named Icarifil® (L-Citrulline, L-Carnitine, Eruca vesicaria, Panax ginseng, Tribulus terrestris, Turnera diffusa, Taurine, Vitamin E, Zinc) in the management of patients with ED. Methods: From September 2022 to March 2023, all patients attending 3 urological institutions due to ED were randomized to receive the following for 3 months: Icarifil® 1 sachet every 24 h (Group 1) or Icarifil® 1 sachet + tadalafil 5 mg 1 tablet every 24 h (Group 2) or tadalafil 5 mg 1 tablet daily (Group 3). All patients underwent urologic visits and dedicated questionnaires (IIEF-5, SEP-2, SEP-3) at enrollment and at the follow-up evaluation (3 months). Patient-Reported Outcomes (PROs) at the follow-up evaluation were used. The primary endpoint was the difference in the questionnaires at the follow-up visit compared to the one at enrollment among the study groups. Results: In the per-protocol analysis, 52 patients in Group 1, 55 in Group 2 and 57 in Group 3 were analyzed. At the follow-up evaluation, IIEF-5 scores improved in all the 3 groups between enrollment and the follow-up evaluation, but a statistically significant difference was reported between Group 2 (+7.4) and Group 1 (+4.1) or Group 3 (+5.1), (p < 0.001; p < 0.001). Moreover, 47 patients (94.0%) in Group 2 showed an improvement in the SEP questionnaires, when compared with the baseline, while 29 in Group 1 (56.9%) and 42 in Group 3 (82.3%) showed a statistically significant difference (p = 0.004; p = 0.003) among the groups. The PRO analysis reported better efficacy and patient satisfaction in Group 2 when compared with Group 1 or Group 3. Conclusions: In conclusion, Icarifil® is able to improve penile erectile function in mild-moderate ED and significantly improve the clinical efficacy of daily used tadalafil 5 mg. Icarifil® could represent an interesting alternative treatment in patients experiencing adverse effects or with contraindications for chronic treatment with PDE5-is.

(PM-17) THE ROLE OF PHOSPHODIESTERASE-5 INHIBITORS IN THE TREATMENT OF COMPLEX PENILE WOUNDS: A CASE REPORT AND LITERATURE REVIEW

Abstract Introduction/Objective Phosphodiesterase-5 inhibitors (PDE5i) are traditionally employed for the management of erectile dysfunction and lower urinary tract symptoms. However, their role in the healing of complex penile wounds remains scarcely discussed. This study aims to describe the case of a 27-year-old man who suffered from penile strangulation, treated with sildenafil. Additionally, a literature review concerning the use of PDE5i for the treatment of complex penile injuries will be conducted. Methods A 27-year-old man presented to the emergency room after a self-induced penile strangulation using a ring placed at the base of the penis. Extensive necrosis of the corpus cavernosum was identified through magnetic resonance imaging. Considering the psychosocial implications of penile amputation, organ preservation was chosen, and conservative treatment with sildenafil and daily local dressings was initiated. Thirty days after admission, Doppler ultrasound revealed symmetrical corpus cavernosum with normal echogenicity and usual blood flow patterns. Subsequently, the patient underwent superficial necrotic tissue debridement followed by partial skin grafting in a second stage, leading to hospital discharge after 55 days of hospitalization. Results PDE5 inhibitors enhance nitric oxide bioavailability, promoting vasodilation and improved tissue oxygenation, thereby facilitating various phases of the healing process. Evidence indicates their benefit in microvascular perfusion in skin and soft tissues. Reports suggest satisfactory outcomes of topical PDE5i application in radiation-induced lesions, implying their role in epidermal cell expansion, reduction of inflammatory infiltrates, enhanced vascularization, and decreased collagen deposition. Conclusion This study presents a successful case of sildenafil use in treatment of a complex penile wound, shedding light on an unconventional application of PDE5i. Financing No conflict.

A primer on the restorative therapies for erectile dysfunction: a narrative review.

Erectile dysfunction (ED) is a common condition that affects millions worldwide. Patients and urologists alike are seeking alternative therapies that can provide long-lasting results in the treatment of ED. This review provides a comprehensive overview of restorative treatments available for ED, such as platelet-rich plasma, stem cell therapy, and shockwave therapy. The aim of this narrative review is to provide a primer for urologists and general practitioners on the basics of implementing ED restorative therapies in their practice. The PubMed, MEDLINE, and Google Scholar databases were searched for articles in the English language through August 31, 2023, that included key terms such as "erectile dysfunction," "restorative therapy," "shockwave therapy," "platelet-rich plasma," "stem cell therapy," and "stromal vascular fraction." Reference lists of selected studies were manually reviewed to find articles not identified by the initial database search. Shockwave therapy has demonstrated effectiveness in treating ED, with devices like the Medispec ED1000 and Storz Duolith showing statistically significant improvements in patient scores for International Index of Erectile Function (IIEF)-Erectile Function scores in clinical trials. In reported studies of platelet-rich plasma injections, a substantial percentage of patients reached a minimal clinically important difference in the IIEF-Erectile Function scale after treatment. Studies of ED treatment with stem cell therapy, while limited and with small sample sizes, have demonstrated encouraging improvements in patient scores for the abridged 5-item version of the IIEF after treatment. Shockwave, platelet-rich plasma, and stem cell therapies are important, novel, noninvasive restorative treatments for ED that can provide relief for patients wishing to avoid a more invasive approach. While these therapies have shown promising results in clinical trials, more research is required to establish them as standardized and efficacious options in the management of ED.

Development and evaluation of sildenafil/glycyrrhizin-loaded nanofibers as a potential novel buccal delivery system for erectile dysfunction

Erectile dysfunction (ED) is a growing health condition that needs safe and effective therapy. One of the main common treatments is sildenafil which is used in clinics for managing erectile dysfunction by enhancing the blood supply to the penis. In the current study, sildenafil was formulated as nanofibers and mixed with the root extract of Glycyrrhiza glabra (glycyrrhizin) as a natural sweetener to be administrated in the buccal cavity for enhanced drug bioavailability, rapid drug absorption and improved patient compliance. The formulated dual-loaded nanofibers were evaluated by measuring diameter, disintegration, drug loading efficiency, drug release profile, and in vitro cell viability assessment. The results showed that the sildenafil/glycyrrhizin-loaded fibers had a diameter of 0.719 ± 0.177 μm and lacked any beads and pores formation on their surfaces. The drug loading and encapsulation efficiency for sildenafil were measured as 52 ± 7 µg/mg and 67 ± 9 %, respectively, while they were 290 ± 32 μg/mg and 94 ± 10 %, respectively, for glycyrrhizin. The release rate of sildenafil and glycyrrhizin demonstrated a burst release in the first minute, followed by a gradual increment until a complete release after 120 min. The in vitro cell viability evaluation exhibited that the application of sildenafil and glycyrrhizin is safe upon 24-hour treatment on human skin fibroblast cells at all used concentrations (i.e., ≤ 1,000 and 4,000 μg/mL, respectively). However, the application of sildenafil-glycyrrhizin combination (in a ratio of 1:4) demonstrated more than 80 % cell viability at concentrations of ≤ 250 and 1000 μg/mL, respectively, following 24-hour cell exposure. Therefore, sildenafil/glycyrrhizin dual-loaded PVP nanofibers showed a potential buccal therapeutic approach for erectile dysfunction management.

(109) Assessment of Artificial Intelligence and ChatGPT Quality in the Management of Erectile Dysfunction

Abstract Introduction Since November 2022, Artificial Intelligence (AI) chatbots have grown in popularity including urologic conditions. However, its accuracy and quality has not been evaluated systematically. In this study, we sought to assess the accuracy and quality of AI chatbots in the management of Erectile Dysfunction (ED). Objective We aim to evaluate the accuracy and quality of open-source language models in fielding common clinical questions pertaining to ED compared to board certified urologists. Methods Two AI open-source language models, ChatGPT and Google Bard, were fielded 15 standard questions related to ED some of which included causes, risk factors and treatment options of ED. Two board certified urologists were given the same questions on a standard survey. A third blinded board-certified urologist served as a grader using the AUA guidelines for ED on a Likert scale to assess the accuracy, robustness, and bias of each response. Urologist and AI responses were graded and aggregated using Likert scales. Results Overall AI responses were significantly more accurate (p&amp;lt;0.01), robust (p&amp;lt;0.01), and unbiased (p&amp;lt;0.01). Additionally, Google Bard had the highest scores all around followed by ChatGPT. The urologists’ responses were approximately 38% lower compared to the AI responses. Conclusions This study suggests that AI responses were superior compared to urologists in the areas of accuracy, robustness, and bias pertaining to the management of ED. Albeit, the chatbots have promising role in urologic conditions including ED, its widespread clinical use and adoption warrants further evaluation in the context of clinical decision making and enhancing patient care. Disclosure No.

(112) Penile Rehabilitation by Daily Intake of 5 mg Tadalafil for Erectile Dysfunction After Penile Fracture

Abstract Introduction Penile fracture is a rare complication to penile trauma, characterized by a sudden injury of the tunica albuginea of one or both corpora cavernosa of the penis. This commonly occurs during the erect state, when the tunica is thinner and under tension of fully engorged corpora cavernosa. Erectile dysfunction (ED) may occur in up to 12% of these patients due to organic and psychosexual factors including penile fibrosis. Objective This study aimed to assess the potential predictors of erectile dysfunction in patients who had penile fracture repair and the role of rehabilitation course of daily tadalafil 5 mg in management of ED following penile fracture. Methods From January 2022 to February 2023, 25 patients were included. Patients' baseline data as well as history including the time of presentation, the pattern and length of the tunical tear, and the presence of urethral injury, were obtained. After a week, all patients were followed up on and told to resume intercourse after at least two weeks if their wound had epithelialized. Only patients with a complaint of a weak erection, as determined by the Arabic validated version of the international index of erectile function (ArIIEF-5), were started on daily tadalafil 5 mg as a penile rehabilitation for at least one month, or until they regained their normal erection. The Hospital Anxiety and Depression Scale (HADS) was used for assessing patients. Patients with confounding disease as metabolic syndrome or mental illness were eliminated. Results Significant indicators predicting erectile dysfunction, according to the multiple logistic regression model, are the patients' age and the length of the tunical tear. A 1% increase in age was linked with a 73.6% rise in the probability of erectile dysfunction (p = 0.046), and a 1 cm increase in tunical tear length was associated with a 20.04 times increased risk of erectile dysfunction (p = 0.04). With a mean score of 20 on the Arabic-approved version of the internal index of erectile function, 5 of 9 patients with erectile dysfunction (55%) had improved erections after one month of penile rehabilitation, while only 4 of 9 patients (44%) required an additional month of treatment. Conclusions We propose that patients with penile fractur be counselled about erectile dysfunction and begin penile rehabilitation as soon as possible following repair to regain a normal erection. Disclosure No.

(195) Penile Implants: Restoring Erectile Function Regardless of Age. A Mini–Case Series

Abstract Introduction Given the overall aging of the population, erectile dysfunction has become an increasingly relevant issue among the elderly. When elective surgery is offered, the patient's age is often taken into consideration as a potential limiting factor. Moreover, the importance of addressing the quality of life and sexual satisfaction of older men tends to be overlooked in the management of erectile dysfunction. Objective The aim of this study is to investigate the safety of implanting penile prostheses (PP) in patients aged 90 years and older, as well as the potential complications associated with this age group. Methods The database of patients was screened between the years 2003 and 2023, to identify patients at least 90 years and older who underwent the implantation of penile prosthesis by a single surgeon at two large volume centers. We collected demographic information for the patients, including their past medical and surgical history, medication list, anesthesia perioperative assessment and recommendations, details of the surgical procedure, intraoperative and postoperative recovery period, as well as clinic follow-up. Results Between 2003 and 2023, a total of 2000 men underwent PP surgery at the two centers. Out of the total number of patients, only two were 90 years or older at the time of implantation. One patient was a first timer, while the other had two previous PP surgeries over the span of 15 years for mechanical failure reasons. Both surgeries were performed using different device types, without any intraoperative or postoperative complications. At their three and six months follow up visits, both patients demonstrated the ability to cycle the implant smoothly, reported satisfactory penetrative intercourse with their partners, and improved sexual intimacy through Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. They were followed for a total of 1 year with no long-term negative effects. Conclusions Despite reporting only two cases in this specific cohort, it demonstrates that implantation of PP is a safe and effective treatment for elderly men with ED. Maintaining satisfactory sexual activity in this age group is vital and achievable through inflatable penile prosthesis (IPP) insertion. There are several complex factors that must be considered prior to operating on an older patient due to medical comorbidities and age. However, with proper patient selection, pre-operative counseling and optimization, this operation can be effectively performed in patients who are at least 90 years old. Simply, age is not a limitation to undergo penile implant. Disclosure No.

(202) Comparative Study of the Efficacy of Avanafil and Atorvastatin Daily Dose in Management of Vasculogenic Erectile Dysfunction

Abstract Introduction Erectile dysfunction (ED) is defined as the “consistent inability to attain or maintain a penile erection, or both, sufficient for adequate sexual relations”. ED is not only a medical problem but affects the marital relations and patient's self-esteem and causes the quality of life to decrease. which in turn causes the patient to go into depression or develop anxiety. In the past, erectile dysfunction was considered, in most cases, to be a purely psychogenic disorder, but current evidence suggests that more than 80% of cases have an organic aetiology. Causes of organic erectile dysfunction can now be broadly divided into nonendocrine and endocrine. Of the nonendocrine aetiologies, vasculogenic (affecting blood supply) is the most common and can involve arterial inflow disorders and abnormalities of venous outflow (corporeal veno-occlusion). Avanafil is a second-generation phosphodiesterase type 5 inhibitor approved for erectile dysfunction by the FDA on 2012 and by EMA in 2013. With a high selectivity for phosphodiesterase type 5 isoform AND faster onset of action compared with other PDE5 inhibitors, it offers more tolerability and less adverse events. Atorvastatin is 3-hydroxy-methylglutaryl (HMG)-CoA reductase inhibitor act on the rate-limiting step in cholesterol biosynthesis (the conversion of HMG-CoA to mevalonate) and are effective in treating dyslipidemia. statins reverse endothelial dysfunction by decreasing the action of oxidized low-density lipoprotein (LDL) on endothelial cells, resulting in an increase of NO activity. Objective is to evaluate and compare the efficacy of avanafil and atorvastatin daily dose in management of patients with vasculogenic erectile dysfunction. Methods A 60 adult heterosexual males complaining of vasculogenic erectile dysfunction proven by penile duplex were collected from outpatient andrology clinics of Al-Azhar University Hospitals. The patients were divided into two treatment groups: (Group A): 30 patients received daily dose of 100 mg avanafil. (Group B): 30 patients received daily dose of 40 mg atorvastatin, The main outcome measures and the difference in penile duplex ultrasound results and IIEF-EF scores between the two groups are evaluated and compared at the end of the study, Age of patients between 20 and 50 years, established diagnoses of Vasculogenic erectile dysfunction, Normal lipid profile, Normal Total and Free testosterone levels and No contraindications to the study medications were included criteria. However patients who failed to fulfill any of the inclusion criteria, psychogenic or neurogenic erectile dysfunction, dyslipidemia Patients with Renal or Hepatic insufficiency and Patients with advanced cardiovascular diseases such as heart failure and coronary artery disease on antianginal drugs especially nitrates were excluded. Results Our study revealed statistically significant improvement in Penile Doppler ultrasonography parameters (PSV, EDV&amp; RI) and IIEF-EF scores in avanafil group compared to atorvastatin group. Conclusions avanafil 100 mg daily dose leads to significant improvement in men with vasculogenic erectile, while atorvastatin 40 mg caused no significant differences, neither positively nor adversely. In summary, avanafil at dose of 100 mg can be a therapeutic appropriate choice in cases of vasculogenic ED. Disclosure No.

Sub-gluteal ligation of the internal pudendal vein for management of veno-occlusive erectile dysfunction (Shaeer's Vein Ligation-I): the cadaveric study.

Vein ligation for veno-occlusive erectile dysfunction is being abandoned due to the recurrence rate. Among the reasons for failure is inability to ligate the deep system of veins; the internal pudendal vein. The vein exits the pelvis in the gluteal region, from the lesser sciatic foramen to the greater sciatic foramen, coursing over the ischial spine and sacro-spinous ligament, under the gluteus maximus. This work aims to verify feasibility of the first surgical procedure to ligate the internal pudendal vein through the gluteal approach. This cadaveric study involved five formalin-fixed cadavers. A surface anatomical landmark was designed to identify the ischial spine, at the intersection of two lines: a vertical line from posterior superior iliac spine to ischial tuberosity, and a horizontal line extending from sacro-coccygeal joint, laterally. An incision is cut encompassing the target point. Subcutaneous fat is dissected down to the gluteus maximus, which is split along the direction of its fibers. The vein can be found crossing over the ischial spine. "Shaeer's Vein Ligation - I" appears to be surgically feasible. A protocol for a surgical study is registered at clinicaltrials.gov, and is open for participation.

(165) Assessing Artificial Intelligence Quality in the Evaluation and Treatment of Erectile Dysfunction

Abstract Introduction Since November 2022, Artificial Intelligence (AI) chatbots have grown in popularity including in urologic conditions. However, their accuracy and quality has not been evaluated systematically. In this study, we sought to assess the accuracy and quality of AI chatbots in the management of Erectile Dysfunction (ED). Objective We aim to evaluate the accuracy and quality of open-source language models in fielding common clinical questions pertaining to ED compared to board certified urologists. Methods Two AI open-source language models, ChatGPT and Google Bard, were fielded 15 standard questions related to ED some of which included causes, risk factors and treatment options of ED. Two board certified urologists were given the same questions on a standard survey. A third blinded board-certified urologist served as a grader using the AUA guidelines for ED on a Likert scale to assess the accuracy, robustness, and bias of each response. Urologist and AI responses were graded and aggregated using Likert scales. Results Overall AI responses were significantly more accurate (p&amp;lt;0.01), robust (p&amp;lt;0.01), and unbiased (p&amp;lt;0.01). Additionally, Google Bard had the highest scores all around followed by ChatGPT. The urologists’ responses were approximately 38% lower compared to the AI responses. Conclusions This study suggests that AI responses were superior compared to urologists in the areas of accuracy, robustness, and bias pertaining to the management of ED. Albeit, the chatbots have promising role in urologic conditions including ED, its widespread clinical use and adoption warrants further evaluation in the context of clinical decision making and enhancing patient care. Disclosure No.

(316) Age Is Not a Number When It Comes to Penile Prosthesis Implantation. A Mini–Case Series

Abstract Introduction Given the overall aging of the population, erectile dysfunction has become an increasingly relevant issue among the elderly. When elective surgery is offered, the patient's age is often taken into consideration as a potential limiting factor. Moreover, the importance of addressing the quality of life and sexual satisfaction of older men tends to be overlooked in the management of erectile dysfunction. Objective The aim of this study is to investigate the safety of implanting penile prostheses (PP) in patients aged 90 years and older, as well as the potential complications associated with this age group. Methods The database of patients was screened between the years 2003 and 2023, to identify patients at least 90 years and older who underwent the implantation of penile prosthesis by a single surgeon at two large volume centers. We collected demographic information for the patients, including their past medical and surgical history, medication list, anesthesia peri-operative assessment and recommendations, details of the surgical procedure, intra-operative and postoperative recovery period, as well as clinic follow-up. Results Between 2003 and 2023, a total of 2000 men underwent PP surgery at the two centers. Out of the total number of patients, only two were 90 years or older at the time of implantation. One patient was a first timer, while the other had two previous PP surgeries over the span of 15 years for mechanical failure reasons. Both surgeries were performed using different device types, without any intra-operative or postoperative complications. At their three and six months follow up visits, both patients demonstrated the ability to cycle the implant smoothly, reported satisfactory penetrative intercourse with their partners, and improved sexual intimacy through Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. They were followed for a total of 1 year with no long-term negative effects. Conclusions Despite reporting only two cases in this specific cohort, it demonstrates that implantation of PP is a safe and effective treatment for elderly men with ED. Maintaining satisfactory sexual activity in this age group is vital and achievable through inflatable penile prosthesis (IPP) insertion. There are several complex factors that must be considered prior to operating on an older patient due to medical co-morbidities and age. However, with proper patient selection, pre-operative counseling and optimization, this operation can be effectively performed in patients who are at least 90 years old. Simply, age is not a limitation to undergo penile implant. Disclosure No.

(155) Transcutaneous Electrical Neural Stimulation Improves Overall Satisfaction in Patients with Erectile Dysfunction

Abstract Introduction Transcutaneous electrical neural stimulation (TENS) therapy has demonstrated the potential to augment peripheral blood flow towards the musculature, thereby enhancing oxygen supply to the working muscles. Erectile dysfunction (ED) is a pathological condition characterized by compromised blood flow to the penis. In theory, TENS therapy can enhance penile blood circulation and alleviate the symptoms associated with ED. Objective Therefore, we aimed to assess the effects of penile TENS therapy on reducing ED symptoms and improving erectile function (EF). Methods We conducted a pilot cohort trial following approval from the Institutional Review Board (IRB), in which we enrolled patients presenting with clinical ED at our clinic. The TENS therapy intervention comprised ten sessions lasting 20 min each, administered over a period of 5 weeks. Two TENS patches were used, with one patch positioned at the base of the penis and the second patch placed on the perineum. The intensity of TENS therapy was determined using a scale ranging from 0 to 10, with the patients selecting the maximum intensity that they could tolerate without experiencing pain. Baseline and post-therapy questionnaires were administered using the International Index of Erectile Function (IIEF) as the primary outcome measure. A paired t-test was conducted to assess the results, which are presented as the mean difference (MD) along with a 95% confidence interval. Results Ten patients, all of whom were already receiving oral PDE5i medications ED were enrolled. However, specific drugs, dosages, and regimens were not standardized across patients, although they maintained the same treatment regimen throughout the study period. The mean baseline total testosterone level was at 527.9 ng/dL. On average, the intensity of TENS therapy administered to the patients was 6.58. A statistically significant improvement in the IIEF total score was seen with an MD of 5.6 (95% CI:0.35, 10.85; p = 0.03). Additionally, a statistically significant difference was observed in the IIEF overall satisfaction domain, with an MD of 1.20 (95% CI:0.14, 2.26; p = 0.03). However, no significant differences were found in IIEF erectile function, desire, orgasm, and intercourse satisfaction subdomain scores. Furthermore, none of the patients reported any adverse effects associated with TENS therapy. Conclusions These findings suggest that TENS therapy has the potential to improve the overall satisfaction of patients with ED. Further research with larger sample sizes and randomized controlled trials are warranted to validate these initial findings and to elucidate the full potential of TENS therapy in ED management. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Disclosures: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.

(187) The SAPOC Technique: Slices Around Point of Maximal Curvature at Time of IPP placement in Severe Peyronie's Disease

Abstract Introduction Placement of an inflatable penile prosthesis (IPP) is indicated for patients with severe Peyronie's disease and erectile dysfunction (ED). Most cases involving plaque incision and graft placement are performed at the point of maximal curvature which result in a large defect that requires placement of a large graft while postoperative penile shortening remains a significant concern among patients. Objective To present a video of a novel modification of the multiple slit technique (MUST) for the treatment of severe PD and ED during IPP placement. This technique involves multiple relaxing incisions made around the point of maximal curvature (POMC) which minimizes the size or even the need of a graft while allowing for length restoration. Methods This technique involves elevation of the neurovascular bundle for dorsal or lateral curvatures along with elevation of the urethra for ventral curvatures. After the POMC is identified, 2 to 4 transverse relaxing incisions (slices) are made around the POMC approximately 1 to 1.5cm apart in order to minimize the size of the defect and hence the need or size of the graft. Each slice allows for maximal restoration of length. Results The SAPOC technique results in correction of curvature and length restoration. Conclusions The SAPOC technique at the time of IPP placement is a novel, safe and feasible technique for the management of complex PD and ED. This technique allows the surgeon to complete the procedure without graft placement in some occasions which theoretically will decrease operative time. It also provides for length restoration which will increase patient satisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for Boston Scientific and Coloplast.

(234) How Age and Obesity Influence Erectile Dysfunction: Evaluation Based Upon Penile Color Duplex Doppler Ultrasound

Abstract Introduction Color duplex Doppler ultrasound (CDDU) is an objective and reliable diagnostic tool for documenting penile hemodynamics. Objective vascular testing provides a physiologic diagnosis of erectile dysfunction (ED) and helps direct appropriate therapy even in this age of ED management including oral drugs. Although age and diabetes are known to be the major etiological factors in development of ED, it is not clear whether obesity as such also plays any role or not. Objective The main objective of this study is to retrospectively assess the penile CDDU hemodynamic parameters of obese men with ED in comparison to non-obese ED men in relation to age. Methods A total of 271 men including obese and non-obese who were diagnosed with ED visiting our Andrology clinic were included in this study. Initial ED was determined by using the International Index of Erectile Function (IIEF) score. Penile CDDU data was retrospectively collected from these ED patients, and parameters mainly peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were used for analysis. RI (=PSV-EDV/PSV) was calculated, and different types of penile vascular status were established based on our previously published SOP guidelines for standardization of penile CDDU parameters. Statistical analysis was performed using MedCalc statistical software version 22.009 (MedCalc Software bv, Ostend, Belgium). Results Our study results revealed that with advancement of age the occurrence of vascular changes in obese men were higher in comparison to non-obese men with ED. Table 1 summarizes the influence of obesity on the prevalence of penile vascular status in different age groups of obese and non-obese men with ED. Surprisingly, higher number of obese men showed non-vascular, venous and mixed vascular components compared to non-obese ED patients. Among these obese groups of all ages, the venous leakage was prevalent than arterial or mixed components. Conclusions Our current analysis indicates that besides age, obesity is also one of the major risk factors in altering the penile hemodynamics with increased incidence of veno-occlusive dysfunction (VOD) in ED patients. In addition, this demonstrates the utility of performing CDDU and diagnosing the presence of VOD in further understanding the pathophysiology of obesity associated ED, and an important determining factor in such patient care. Disclosure No.

L-arginine–phosphatidylcholine thermoresponsive gel for enhanced transdermal delivery and L-929 cell cytotoxicity evaluation

The vasodilator effect of the semi-essential amino acid, L-arginine (LA) is crucial in the clinical management of angina pain and erectile dysfunction. Moreover, the limited bioavailability and the drug’s polar nature navigate the development of new formulation strategies for effective transdermal delivery, especially for the penile route. Thus, herein, we prepared the L-arginine–phosphatidylcholine (LA–PC) complex by solvent evaporation technique and converted it into a thermoresponsive gel (LA–PC gel). The optimized complex was selected for the preparation of gel using poloxamer 407, lactic acid, and purified water. Simultaneously we prepared the LA thermoresponsive gel (LA gel). The gels were characterized for their appearance, particle size, pH, osmolality, spreadability, SEM, FTIR, viscosity, TEM, viscoelastic properties, and skin permeability using the Strat-M® membrane at low pH for effective and safe penile and vaginal delivery. We observed that the LA–PC gel showed the smallest droplet size (<100 nm), a zeta potential of −59 mV indicates its stability with good viscoelastic behavior. The in vitro skin permeation reveals that; at 15 min, the permeation of LA for LA–PC gel, was 33.20% with a flux of 2.19 mg/cm2/min, and in the case of LA gel, the permeation of LA was only 18% at 45 minutes with a flux of 1.02 mg/cm2/min. The in vitro cytocompatibility was conducted using an L-929 cell line, and we found that both gels were nontoxic up to 100 µg/mL concentration. In summary, LA–PC gel could have a significant impact on the quick and sustained release, compared to LA gel.

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

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

Biodegradable nano black phosphorus based SDF1-α delivery system ameliorates Erectile Dysfunction in a cavernous nerve injury rat model by recruiting endogenous stem/progenitor cells

Stem cell (SC) therapy has been shown high prospects in erectile dysfunction (ED) treatment. Without ethical issues and risks of immune rejection and tumorigenesis of exogenous SC therapy, endogenous stem/progenitor cells (S/PCs) have a better potential for ED management, and their homing and redistribution are controlled by SDF1-α/CXCR4 axis. Considering black phosphorus nanosheet (BPNS) has emerged as an efficient and safe drug vehicle due to its large surface area, biodegradability, and the ability to retain and slowly release its loaded drugs, BPNS is utilized to load SDF1-α, a chemokine for S/PCs, to construct the BP@SDF1-α complex to efficiently recruit stem cells (SCs) by injury-site injection and thus ameliorate ED within the bilateral cavernous nerve injury (BCNI) rat models. We find that BP@SDF1-α can efficiently recruit exogenous SCs and endogenous S/PCs to corpus cavernosum and main pelvic ganglion (MPG) by local administration. Of note, ascribing to endogenous S/PCs recruitment, it also successfully alleviates ED in BCNI rat models by enhancing the protein expression levels of α-SMA, CD31, and nNOs, and eliciting less collagen deposition in the penis after its combined injection at corpus cavernosum and MPG. Thus, this study provides a new insight into the treatment of ED with endogenous S/PCs.Biodegradable Nano Black Phosphorus based SDF1-α delivery system ameliorates Erectile Dysfunction in a cavernous nerve Injury Rat Model by recruiting endogenous Stem/Progenitor cells

New developments in erectile dysfunction treatments: A role for regenerative medicine

Erectile dysfunction is a highly prevalent issue related to the sexual wellness of millions of men worldwide. While conventional therapies have been successful for many, there remains a significant subset of individuals who do not respond adequately or experience undesirable side effects. This article reviews the emerging field of regenerative medicine as a potential breakthrough in the management of ED. Regenerative therapies, especially platelet-rich plasma (PRP) therapy along with stem cell therapy, provide novel approaches to tackling the fundamental causes of ED. By harnessing the body's natural healing mechanisms, these treatments hold promise for restoring erectile function and improving patients' quality of life. This review explores the mechanisms of action, benefits, and current research findings related to regenerative therapies for ED, emphasizing their potential to revolutionize the treatment landscape for this prevalent condition. As ongoing research continues to shed light on their safety and efficacy, regenerative therapies may pave the way for a brighter future in the management of erectile dysfunction.

Pentaclethra macrophylla leaves reduce blood glucose level, improve sexual behavior and modulate critical enzymes associated with diabetes-erectile dysfunction morbidity in rats.

This research work studied the phenolic composition of Pentaclethra macrophylla (PM), the inclusion of dietary supplementation of PM leaves on sexual functions and its connection to inhibit enzymes (arginase and phosphodiesterase-5) and nitric oxide level, linked to type 2 diabetes-induced erectile dysfunction in rats. Gallic acid, chlorogenic and ellagic acids, Kaempferol, and epicatechin etc. was spotted with High performance liquid chromatography-diode array detector from PM extract. Twenty-five (25) rats were used for the study. Five rats were placed with basal diet; diets not supplemented with PM leaves (normal rat group) while twenty rats were made diabetic by feeding them with high fat diet for two weeks, prior to single injection with 35 mg/kg of streptozotocin (STZ). After checking with glucometer, experimental animals with blood glucose level >250 mg/dL were accepted as diabetic. The diabetic rats were subsequently divided into four groups of five rats each (n=5). The diabetic rats were placed on basal diet, or diets supplemented with PM leaves (10 % or 5 % inclusion) or sildenafil citrate (SC). The result revealed that PM supplemented diets caused significant (p<0.05) reduction in blood glucose level, and augmented erectile function by inhibiting arginase and PDE5 activities as well as enhancing nitric oxide level. In conclusion, dietary inclusion of PM leavescould serve as a potent nutraceutical source in hyperglycemia induced erectile dysfunction management.