Mild-moderate Erectile Dysfunction Research Articles

The role of lipidic balance on erectile dysfunction in prostate cancer patients undergoing robotic surgery.

New indices of dyslipidemia, such as the Atherogenic Index of Plasma (AIP) or Castelli Risk Index I and II (CR-I/II), have been tested to predict erectile dysfunction (ED). The aim of this study was to assess the role of these lipidic scores in predicting severe ED and erectile function (EF) worsening in patients who underwent robot-assisted radical prostatectomy (RARP). Data from 1249 prostate cancer patients who underwent RARP at our single tertiary academic referral center from September 2021 to April 2023 were reviewed. RARP patients with a complete lipid panel were included in the final analysis. Two independent multivariable logistic regression models (LRMs) were fitted to identify predictors of ED severity and worsening in RARP patients. Among the 357 RARP patients, the median age was 70 (interquartile range [IQR]: 65-74), and the median BMI was 28.4 (IQR: 26-30.4). According to the preoperative IIEF5, 115 (32.2%), 86 (24.5%), 26 (7.3%), and 40 (11.2%) were mild, mild-moderate, moderate, and severe ED patients, respectively. After multivariable LRMs predicting severe ED, only the nerve-sparing (NS) approach (odds ratio [OR]: 0.09) as well as the preoperative IIEF5 score (OR: 0.32) were independent predictors (p < 0.001). After LRMs predicting EF worsening, only preoperative IIEF5 was an independent predictor (OR: 1.42, p < 0.001). The power of novel lipidic scores in predicting severe ED and EF worsening in RARP patients was low, and they should not be routinely applied as a screening method in this patient subgroup. Only preoperative IIEF5 and nerve-sparing approaches are relevant in EF prediction after RARP.

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.

(151) Safety and Feasibility of the COCKTAIL (Combining Shockwave Therapy and Platelet-Rich Plasma for Erectile Dysfunction) Trial: A Single Center, Randomized, Double-Blind, Sham-Controlled Study Update

Abstract Introduction Therapeutic approaches focusing on tissue neovascularization play a crucial role in the development of treatments for erectile dysfunction (ED). Autologous Platelet-Rich Plasma (PRP) and Low-Intensity Shockwave Therapy (SWT) are two restorative therapies that potentially target underlying causes of ED. Pre-clinical evidence suggests their angiogenic and regenerative properties, indicating a potential synergistic pathway to improve vasculogenic ED. Objective The primary objective aims to investigate and compare the treatment efficacy of PRP injection and SWT vs placebo injection/SHAM treatment in men with mild-moderate ED, as measured by IIEF. The secondary objective aims to study incidence of adverse events and safety of PRP injection and SWT treatment in men with mild-moderate ED, as measured by IIEF. Methods The COCKTAIL (Combining Shockwave Therapy and Platelet Rich Plasma) trial is a Phase II, single-center study assessing the safety and efficacy of PRP and SWT in combination for ED (NCT05048667). Thirty-five men with mild to moderate ED were enrolled based on International Index of Erectile Function-EF subdomain (IIEF-EF) questionnaire (12-25). Data from a cohort of men treated with PRP and SWT were analyzed, comparing it to men who received placebo saline injections and sham SWT. Patients received two PRP or placebo injections directly into the corpus cavernosum and penile SWT every week for 5 weeks. Assessment included pain scale evaluations, immediate post-procedure examination, and follow-up for complications. IIEF scores were recorded at baseline, 3-month, and 6-month follow-up visits. All statistics and analyses were conducted with IBM SPSS Statistics 27.0.1. Non-parametric tests were used for analysis. Mann-Whitney U test was used to compare independent groups (Group A vs. Group B) at different time points. Related Samples Wilcoxon -Signed Rank test was used for dependent repeated groups, the serial measurements of IIEF-EF scores at different time points for each patient within a specific group. Findings at p&amp;lt; 0.05 were considered statistically significant. Results The primary endpoint of this study was to investigate the incidence of Serious Adverse Events (SAEs). Encouragingly, no adverse events were reported, suggesting that the procedure appears to be safe for the participants. The median baseline IIEF scores for patients in Group A were 17 (±4), and at the three-month follow-up, the scores increased to 19 (±4), slightly dropping to 18 (±8) at six months. In Group B, the median baseline IIEF scores were 19.50 (±4), which improved to 20 (±7) at the three-month follow-up and further increased to 21 (±10) at six months. No statistical differences were found likely because this is an ongoing study, and we only have complete data for 12 men. We aim to accrue a total of 30 men in each arm and plan to complete the recruitment by January 2024 and complete the study by July 2024. Currently, both the investigators and the patients remain blinded. Conclusions The combination of PRP and SWT appears to be safe, as no adverse events were reported. Although preliminary data do not show differences between the treatment and sham groups currently, we intend to complete the trial to perform a comprehensive statistical calculation for efficacy. Disclosure No.

Erectile Dysfunction among Male Infertile Men Attending the Surgical Outpatient Clinic in a Tertiary Hospital in Nigeria over a 7-Year Period—A Single Surgeon’s Experience

Background: There is misconception about male Infertility and erectile dysfunction (ED) with poor health seeking behaviour in our clime. This study aims at finding the association between erectile dysfunction and male infertility in Ibadan. Methods: This was a retrospective comparative study that analysed records of all men with male infertility between May 2016 and April 2023 at the surgical outpatient in a tertiary hospital in Ibadan. Data included demography, social habit, the severity and prevalence of ED, and type of infertility. The data were analysed with a Statistical Package for the Social Sciences (SPSS) version 25. Logistic regression analysed the association between male infertility and erectile dysfunction. A p-value of &lt; 0.05 was regarded as statistically significant. Results: A total of 109 cases of male infertility of which 65 (59.6%) had ED. The overall mean age for primary and secondary infertility were 37.62 ± 6.95years and 40.62 ± 8.322 years respectively (t=2.892; p&lt; 0.004). The mean age for absence and presence of ED were 39.08 ± 6.61years and 39.56 ± 7.94years respectively (t=0.340; p= 0.734). There is association between alcohol consumption and ED (χ2=6.969; p&lt; 0.008). Similarly, statistically significant association between the ED and the type of infertility as mild, mild-moderate, and moderate ED were commoner among men with primary infertility and all men with severe ED had secondary infertility (χ2=12.283; p&lt;0.015). Conclusions: The prevalence of erectile dysfunction among male infertility was 59.6% with statistically significant association between the severity of ED and male infertility. Public awareness is advocated.

(381) Comparing Erectile Dysfunction (ED) Outcomes Following Priapism as an Adverse Effect of Intracavernosal Injectable Medications to Priapism due to Recreational use of Intracavernosal Injectable

Abstract Introduction Ischemic priapism is a urologic emergency which results in permanent erectile dysfunction if not managed immediately. We previously identified a large portion of ischemic priapism cases presenting to our institution caused by recreational use of intracavernosal injectable medications (ICI) for which patients did not have a prescription. Objective In the present study we identified a nearly equal number of men who presented with ischemic priapism as an adverse effect of ICI for which they did have a prescription. Our goal was to compare erectile function outcomes between these two populations in follow up. Methods Men presenting for ischemic priapism as an adverse effect of prescription ICI from January 2010 to December 2018 were contacted by mail, then via telephone. Standardized questions were asked of all participants on the topic of erectile dysfunction (five-item international index of erectile function (IIEF-5)). IIEF-5 results were compared to our previously described population of men with ischemic priapism caused by recreational use of ICI using the Student’s T-test of means. Results 13 men aged 23 – 68 (mean 51.9) were recruited. Ten men (77%) were white; the remaining three (23%) were black. All men confirmed diagnosis of ED prior to their priapism episodes and all men had their own prescription for ICI from a urologist. Seven men (54%) required phenylephrine irrigation, five (38%) achieved detumescence with cavernosal aspiration and saline irrigation alone, one (8%) required a distal shunt. Mean IIEF-5 for the population at time of phone interview was 12.5 (□ 7.4) signifying mild-moderate ED, which was not significantly different from the mean IIEF-5 of our priapism population due to recreational use of ICI (13.3 □ 4.0; p = 0.87; table 1). Conclusions Men who present with ischemic priapism as an adverse effect of prescription ICI appear to have similar functional outcomes compared to men with ischemic priapism due to recreational use of ICI as assessed by IIEF-5. This could also be interpreted as a better functional outcome considering that this population had pre-existing ED prior to their priapism episode and therefore did not lose erectile function. The adverse effect population also appears to require a shunt in the treatment of their priapism less frequently than the recreational ICI population. Disclosure No

ASSESSMENT OF CLINICAL FACTORS AND SERUM TESTOSTERONE ABOUT ERECTILE DYSFUNCTION IN HIV-INFECTED MEN

Objective: The objective of this study was to assess and correlate serum testosterone (ST) levels with erectile dysfunction (ED) and associated risk factors in human immunodeficiency virus (HIV)-positive men. Methods: The present correctional study was conducted among 75 HIV-positive patients. The study subjects were analyzed for ST levels and evaluated for ED using the international index of erectile function (IIEF-5). IIEF score was compared across depression severity assessed using a patient health questionnaire. Other variables, including age, the cluster of differentiation 4 (CD4+) count, antiretroviral treatment therapy, body mass index, and HIV duration, were also correlated with ED concerning ST levels. Results: The prevalence of ED among HIV-positive patients was 96%. The majority (54.67%) of patients had mild-moderate ED. Hypertension was found in 14.67% of the study population. The mean IIEF score was 16.15±2.93. The relationship between depression severity and IIEF score was statistically significant (p&lt;0.001). A weak positive correlation between CD4+ count and ED was found when ST was average (rs: 0.316, p=0.163). There was no correlation between age and abnormal ST and ED [rs: −0.459, p=0.003] Conclusion: The prevalence of ED and its effect on ST levels could help in better management among HIV-infected males. Mild-moderate depression played a significant role in causing ED in association with ST levels. The study suggests that testosterone supplementation, along with optimum treatment of depression in HIV patients, can be fruitful in treating ED.

The Clinical Impact of Physical Activity on the Diagnosis of Prostate Cancer and Postprostatectomy Functional Outcomes in the Elderly.

The effect of physical activity on prostate cancer is controversial. We aimed to investigate the effect of physical activity on prostate cancer detection and functional outcomes after radical prostatectomy. Between 2019 and 2020, 166 patients who underwent prostate biopsy were included. The physical activity scores of patients were evaluated by the Physical Activity Scale for the Elderly (PASE) questionnaire before the procedure. PASE scores were compared between the patients with and without prostate cancer and local and metastatic aggressiveness of cancer. Patients who underwent radical prostatectomy were followed up for 12 months to analyze the effect of physical activity on erectile dysfunction (ED) and urinary incontinence (UI). There was no significant difference between patients with and without prostate cancer in terms of PASE scores (187.7 vs. 195.5, p=0.665). PASE scores were also similar when separated according to D'Amico risk classification and metastatic events. Twenty-seven patients who underwent radical prostatectomy were evaluated in terms of functional outcomes at the first year of surgery. PASE scores of the patients with severe ED were lower than mild-moderate ED, but no statistically significant difference was observed (197.0 vs. 268.5, p=0.267). Patients with persistent UI had a significantly lower PASE score overall than continent patients (128.3 vs. 271.1, p=0.001), and PASE score was the only independent predictor of UI following radical prostatectomy. The effect of physical activity on prostate cancer development or aggressiveness could not be determined. Physical activity was associated with a reduced risk of UI following radical prostatectomy.

34 CORRELATION BETWEEN URIC ACID LEVEL AND ERECTILE DYSFUNCTION IN CONTROLLED HYPERTENSION MALE PATIENTS

Background: Uric acid (UA) is considered as a marker of atherosclerosis related to endothelial dysfunction, microvascular disease, and hypertension which plays a major role in erectile dysfunction (ED) Objective: The aim of this study was to investigate whether there is correlation between UA and ED in controlled hypertension male patients Methods: This is an observational analytic study with cross sectional approach which has done in Kandou Hospital from October to December 2021. Data analysis was using SPSS 22. This study has been done in 40 to 60-year-old-males, married, alive wife, sexually active at least three months, controlled hypertension. Uric acid was measured by blood serum. Erectile dysfunction was scoring by the International Index of Erectile Function (IIEF-5) questionnaire. The exclusion criteria are acute illness, chronic kidney disease, diabetes mellitus, dyslipidemia, stroke, cancer, obesity, smoking, alcoholic, autoimmune disease, underwent urologic surgery, not taking UA-lowering-therapy in 3 months, having communication problem. Data analysis was using p&lt;0.05 Result: There are 30 males. The age mean was 53.43 ± 7.45 years old. Uric-acid level mean was 6.84 ± 1.56 g/dl. There were 11 patients has mild-moderate ED with 7.85 ± 1.73 g/dl mean-UA level, 12 patients have mild ED with 6.58 ± 1.11 g/dl mean-UA level, and 7 patients has no ED with 5.67 ± 0.99 g/dl mean UA-level. Uric-acid level has significant negative correlation with IIEF-5 score in controlled hypertension male (r = -0.506, p = 0.004) Conclusion: There is significant correlation between UA level and IIEF-5 score in controlled hypertension male patients

Association between sarcopenia and erectile dysfunction in older males

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

The Role of Aerobic Exercise in Erectile Dysfunction: A Review of Randomized Controlled Trials

PURPOSE:This study aimed to determine the role or applicability of aerobic exercise in erectile dysfunction.METHODS:This narrative review was conducted by searching terms such as ‘impotence,’ ‘erectile dysfunction,’ ‘erection dysfunction,’ ‘sexual dysfunction,’ ‘aerobic exercise,’ ‘aerobic training,’ ‘cardiovascular exercise,’ ‘cardiovascular training,’ ‘human,’ ‘randomized controlled trials,’ and ‘randomized clinical trials’ in the titles or abstracts in PubMed, Google Scholar, Scopus, Wiley Online Library, and Science Direct databases.RESULTS: Nine articles met the inclusion criteria. Aerobic exercise of light (low)-vigorous (high) intensity was found to be effective in erectile dysfunction in seven articles.CONCLUSIONS: In case of mild-moderate erectile dysfunction accompanied by high blood pressure, obesity, physical inactivity, metabolic syndrome, acute myocardial infarction, and ischemic heart disease, it is suggested that following an aerobic exercise program has potential advantages. Further clinical research is required to compare nonlinear aerobic exercise with linear aerobic exercise in the population with erectile dysfunction.

Can High Visceral Adiposity Index Be a Risk Factor for Sexual Dysfunction in Sexually Active Men?

BackgroundTo our knowledge, there is no study in the literature that has investigated a cutoff value of the visceral adiposity index (VAI) for erectile dysfunction (ED) in men. AimTo show a possible relationship between ED and VAI levels representing adipose tissue dysfunction and to identify a cutoff value of the VAI for ED. MethodsThis prospective cross-sectional study included 276 participants in 5 groups: non-ED, mild ED, mild-moderate ED, moderate ED, and severe ED. The VAI was calculated. Fasting glucose, triglyceride, high-density lipoprotein, testosterone (T), prolactin, and estradiol were measured. Erectile function, sexual satisfaction, orgasm, desire, and general satisfaction scores were recorded using the International Index of Erectile Dysfunction 1–15 questionnaire. The participants were divided into BMI1 (<25.0), BMI2 (25–29.9), and BMI3 (>30.0) categories based on body mass index (BMI) and WC1 (<94 cm), WC2 (94–102 cm), and WC3 (>102 cm) categories based on waist circumference (WC). OutcomesThe VAI was investigated as an independent risk factor for ED, compared with BMI and WC. ResultsThe median VAI progressively increased, but a marked increase was recorded in groups 4 and 5 (P = .001). A significant increase in ED was observed for a VAI score higher than 4.33 (P = .001). Each integer increase of the VAI was associated with a 1.3-fold increased risk of ED. The odds ratio of ED for the VAI = 4.33 was 4.4 (P < .001). The WC and BMI significantly increased as the degree of ED increased (P = .001), but statistical analysis showed a significant decrease only in moderate and severe ED groups (P < .05). Starting from non-ED patients, serum triglyceride increased and high-density lipoprotein decreased progressively in all ED groups (P = .001). T/E2 slightly reduced as the severity of ED increased (P > .05). T decreased in ED groups (P = .022). Regardless of the ED level, other sexual subdomains decreased in ED patients (P = .001). The ED rates in 3 increasing BMI and WC categories were similar (P > .05). For VAI = 4.33, BMI ≥ 30.0 kg/m2, and WC > 102 cm, sensitivity and specificity were 61.2% and 73.8%, 31.6% and 90.5%, and 54.3% and 69.0%, respectively. Clinical ImplicationsThe VAI should be considered as a reliable independent risk factor for ED as a predictor of visceral adipose dysfunction. Strengths & LimitationsThe main strength is that this is the first study to investigate the association between the VAI and sexual dysfunction in men. The low number of participants is the limiting factor. ConclusionThe findings suggest that the VAI can be used as a reliable independent risk factor marker for ED as a predictor of visceral adipose dysfunction.Bolat MS, Kocamanoglu F, Ozbek ML, et al. Can High Visceral Adiposity Index Be a Risk Factor for Sexual Dysfunction in Sexually Active Men? J Sex Med 2020;17:1926–1933.

P0955IS THERE AN ENDOCRINE CONTRIBUTION TO THE SEXUAL DYSFUNCTION SEEN IN END STAGE RENAL DISEASE PATIENTS?

Abstract Background and Aims Male sexual dysfunction is commonly prevalent in patients with end stage renal disease (ESRD) and has been partly attributed to the concurrent state of hyperprolactinemia and hypogonadism, often observed in this patient population. The aim of this study was to evaluate the hormone profile and sexual function of ESRD patient, using validated questionnaires, in attempt to explore this association. Method This was a prospective study which included 98 patients with ESRD who followed in the outpatient department of a tertiary medical centre over a period of 1 year. Patients receiving treatment for hyperprolactinemia or those known to have an endocrine disorder were excluded in addition to patients receiving medical or surgical treatment for erectile dysfunction (ED) or premature ejaculation (PE). After filling the international index for erectile function-5 and the Arabic index for PE questionnaire, morning serum samples were taken from patients to measure testosterone and prolactin levels. Descriptive statistics was used to report frequency or means of variables. Chi-square test was used to examine associations between categorical variables. P&amp;lt;0.05 was considered statistically significant. Results Out of the 98 ESRD patients, 72 (73.6%) were treated with hemodialysis, 13 (13.2%) with peritoneal dialysis and 13 (13.2%) with medical treatment only. Diabetes mellitus was observed in all patients (type 1, 52%; and type 2, 48%), while hypertension, coronary heart disease and dyslipidemia were detected in 97.1%, 34.3% and 25.5%, respectively. The mean age, serum testosterone and prolactin levels were 52.4 ± 12.1 years, 12.95 ± 6.5 nmol/L and 514.2 ± 592.8mIU/L. Results of the PE index questionnaire revealed that 86 (87.7) patients had PE, 9 (9.1%) probable PE and 3 (3.1%) no PE. With IIEF-5, ED was detected in 96 patients; it was severe in 23 (23.5%), moderate- severe ED in 29 (29.4%), mild-moderate ED in 30 (30.4%) and mild in 14 (14.7%). 55 patients had high prolactin while 33 had low testosterone levels. Table 1 presents the IIEF-5 and PE questionnaire results in patients with low/normal testosterone and normal/high prolactin. No significant differences were observed in IIEF or PE levels between patients with low/normal testosterone and normal/high prolactin. Conclusion ESRD is commonly associated with sexual dysfunction that is more likely to be attributed to organic causes rather than solely to endocrine disturbances.

Prevalensi obesitas dengan disfungsi ereksi pada laki-laki lanjut usia di Kelurahan Padang Sambian Denpasar, Bali tahun 2018

Background: The high incidence of obesity in elderly men caused many risks, one of that risk is the occurrence of erectile dysfunction where this has not been widely recorded in Indonesia and Bali in particulary. Aim: The study aims to determine the prevalence of obesity with erectile dysfunction in elderly men in Padang Sambian Village, Denpasar, Bali. Method: This study is a descriptive cross-sectional study. The research subjects were 80 elderly men in Padang Sambian Village, Denpasar. Research data are primary data obtained from questionnaires and waist circumference measurements directly by researchers. Results and Conclusion: Elderly men who were obese were 78.8% while normal ones were only 21.3%. Samples with erectile dysfunction were 75 people (93.7%) and the remaining 5 people were normal. The mild erectile dysfunction is mostly suffered by people in the age of 50-54 , it’s around45.5%, the mild-moderate erectile dysfunction is the most suffered by people in the age of age 55-59 that is 47.1%, age 60-64 the most experienced mild and moderate-moderate erectile dysfunction of about 50%. In the age range of 65-69 mostly suffered mild-moderate erectile dysfunction, which is about 50%, and in the age range 70 years mostly suffered a mild erectile dysfunction, it’s around 100%. Most obese people with erectile dysfunction suffer a mild erectile dysfunction, which is around 44.4% while in normal samples most suffered a moderate erectile dysfunction which is as much as 47.1%.

277 Sustained Improvement in Erectile Function After Penile Plication for Peyronie’s Disease: Long-term Patient-reported Outcomes

Penile curvature due to Peyronie’s disease (PD) may be addressed with penile plication (PP), but the persistence of bothersome erectile dysfunction (ED) following this minimally-invasive treatment is unclear. We previously demonstrated comparable outcomes in penile curvature, length, pain and quality of life in men undergoing PP for either mild or severe PD. We hypothesized that erectile function would similarly be improved regardless of PD severity. To determine long-term sexual outcomes of men undergoing PP for mild and severe PD. We reviewed patients at our institution undergoing PP for PD between 2009-2017, via parallel tunical plication without degloving. Severe PD was defined as curvature ≥60⁰, biplanar curvature ≥35⁰, or hourglass deformity. A modified Peyronie’s Disease Questionnaire (PDQ) and standard International Index of Erectile Function (IIEF) were administered by telephone a minimum of 12 months postoperatively. Men were grouped by IIEF scores as follows: no ED (22-25), mild (17-21), mild-moderate (12-16), moderate (8-11) or severe ED (5-7).

Association of pupil responses with severity of erectile dysfunction in diabetes mellitus.

Purpose:To investigate the relation between erectile dysfunction (ED) severity and pupillary functions in patients with diabetes mellitus (DM).Methods:This prospective and observational study included 90 patients with type 2 DM and ED. Patients divided into three subgroups according to severity of ED: (i) Mild ED, (ii) Moderate ED and (iii) Severe ED groups. Thirty age-matched healthy subjects formed the control group. Main outcome measures were pupil diameter and average speed of pupil dilation. Static and dynamic pupillometry analysis was performed using the Sirius Topographer (CSO, Firenze, Italy).Results:Mean pupil diameter during static and dynamic pupillometry analysis were significantly greater in the control group than in the all study groups (P < 0.05). Mean pupil diameter in static pupillometry analysis was significantly different in each study group and pupil was more miotic in the Severe ED group than in the both Moderate and Mild ED groups (P < 0.05 for each). Dynamic pupillometry analysis revealed that mean pupil diameter and mean average dilation speed were significantly different in each study group throughout measurement period and the highest speed was observed in the Mild ED group and the lowest speed was observed in the severe ED group (P < 0.005 for each).Conclusion:Our study results suggest that abnormal pupil functions due to diabetic autonomic neuropathy may indicate the associated ED in patients with DM.

Prevalence and Associated Factors of Erectile Dysfunction among Married Men in Vietnam.

Sexuality is an essential part of life; however, erectile dysfunction (ED) has been one of the most common complaints among men with sexual health issues all over the world. ED includes dysfunction in erection and penile erectile pain. In Vietnam, ED is a subject a not readily discussed. Thus, relatively little is known about ED among Vietnamese men. To identify the prevalence of ED and its associated variables and the need for treatment of ED among married men in Vietnam. This was a cross-sectional study. A total sample size included 746 married men, aged 20-60 years, living in four representative wards of the Hue City and randomly selected by systematic sampling methods. Respondents completed a self-reported questionnaire. The International Index of Erectile Function (IIEF-5) scale was used to determine ED severity, and the Depression Anxiety Stress Scales (DASS-21) was used to measure depression, anxiety, and stress. Quality of life was assessed using the WHO Quality of Life score (WHOQoL). A multivariate logistic regression model was used to determine the relationships between independent variables and ED. Mean age of married men was 44.3 ± 8.7. Two-thirds (66.9%) of respondents experienced ED symptoms. In terms of severity, 40.8% reported mild ED; 20.3% mild-moderate ED; 5.0% moderate ED; and 0.8% severe ED. Depression, anxiety, and stress problems were 5.0, 3.6, and 2.8%, respectively. One-third (33.1%) of the respondents reported having low quality of life, and 32.6% reported having medium quality of life. The vast majority (86.9%) had consensual sex with their wives/partners. Variables associated with increased IIEF-5 score were increased WHOQoL score, increased body mass index (BMI), religion, and no consumption of alcohol. Increasing age, disease history, increased anxiety, and no consensual sex with their wife/partner were associated with a lower IIEF-5 score. If experiencing ED, 55.5% would seek help from medical doctors, 55.1% discussed it with their wives/partners, and 23.1% turned to their friends for help. The prevalence of ED was high, although only 5.8% experienced moderate to severe ED. The key factors associated with ED were age, religion, disease history, BMI, alcohol consumption, anxiety, quality of life, and consensual sex with their wives/partners. Sexual health education should be more specifically targeted for men, including the provision of local sexual health-care services for men.

Neuroactive steroid levels and psychiatric and andrological features in post-finasteride patients

Recent reports show that, in patients treated with finasteride for male pattern hair loss, persistent side effects including sexual side effects, depression, anxiety and cognitive complaints may occur. We here explored the psychiatric and andrological features of patients affected by post-finasteride syndrome (PFS) and verified whether the cerebrospinal fluid (CSF) and plasma levels of neuroactive steroids (i.e., important regulators of nervous function) are modified. We found that eight out of sixteen PFS male patients considered suffered from a DSM-IV major depressive disorder (MDD). In addition, all PFS patients showed erectile dysfunction (ED); in particular, ten patients showed a severe and six a mild-moderate ED. We also reported abnormal somatosensory evoked potentials of the pudendal nerve in PFS patients with severe ED, the first objective evidence of a neuropathy involving peripheral neurogenic control of erection. Testicular volume by ultrasonography was normal in PFS patients. Data obtained on neuroactive steroid levels also indicate interesting features. Indeed, decreased levels of pregnenolone, progesterone and its metabolite (i.e., dihydroprogesterone), dihydrotestosterone and 17beta-estradiol and increased levels of dehydroepiandrosterone, testosterone and 5alpha-androstane-3alpha,17beta-diol were observed in CSF of PFS patients. Neuroactive steroid levels were also altered in plasma of PFS patients, however these changes did not reflect exactly what occurs in CSF. Finally, finasteride did not only affect, as expected, the levels of 5alpha-reduced metabolites of progesterone and testosterone, but also the further metabolites and precursors suggesting that this drug has broad consequence on neuroactive steroid levels of PFS patients.

Chronic Administration of Tadalafil Improves the Symptoms of Patients with Amicrobic MAGI: An Open Study.

Aim of this study was to evaluate the effects of pharmacological treatment with Tadalafil 5 mg daily on symptoms and quality of sperm parameters in selected patients with amicrobic MAGI (male accessory gland inflammation). 120 patients with amicrobic MAGI (mean age 27.0 ± 6.0 years) with mild-moderate ED (erectile dysfunction) according to IIEF-5 (International Index of Erectile Function 5 Items) scores underwent pharmacological treatment with Tadalafil 5 mg daily for six months. Before and after treatment these patients were evaluated through IIEF-5, semen analysis (according to WHO Criteria, 2010), SI-MAGI (Structured Interview about Male Accessory Gland Inflammation), and ultrasound evaluation. Patients with PVE (prostate-vesciculo-epididymitis) showed a significant increase in the percentage of spermatozoa with total (16.0 ± 8.0 versus 30.0 ± 6.0%) and progressive motility (8.00 ± 10.0 versus 25.0 ± 6.00%). It was a significant reduction of the number of patients with complicated ultrasound forms (30.0 versus 52.0) and a significant increase of the number of patients with uncomplicated ultrasound form (90.0 versus 68.0). Finally, there was a significant reduction in the percentage of patients with alterations of sexual function different from DE, such as premature ejaculation (4.00 versus 8.00%), painful ejaculation (4.00 versus 10.0%), delayed ejaculation (12.50 versus 8.00%), and decreased libido (10.0 versus 25.0%).

Sexual functioning and health-related quality of life in men

Background:Although erectile dysfunction (ED) is common, little is known about the impact of ED on the quality of life (QoL) among African men.Materials and Methods:We used the International Index of Erectile Function (IIEF) to evaluate ED and the WONCA charts to assess QoL among employees of a university.Results:A total of 508 men with a mean age of 43 ± 10 years were studied. IIEF5 scores of <22 were present in 406 participants (77.9%). Mild ED, mild-to-moderate ED, moderate ED, and severe ED were present in 34.6%, 26.6%, 10.4%, and 5.7%, respectively. Systolic and diastolic blood pressure were significantly lower in those with ED. Marital status, alcohol, cigarette, physical inactivity, obesity, hypertension, diabetes mellitus, and antihypertensive drug use were not associated with ED. ED was associated with poor QoL in the domains of social activities (odds ratio [OR] = 4.35; 95% confidence interval [CI]: 1.01–18.7), and overall health (OR = 2.27; 95% CI: 1.07–4.82). However, there was no association of ED with poor QoL in the domains of physical fitness (OR = 1.46; 95% CI: 0.82–2.59), feelings (OR = 1.43; 95% CI: 0.75–2.72), daily activities (OR = 4.72; 95% CI: 0.61–36.4), and change in health (OR = 1.75; 95% CI: 0.58–5.26).Conclusion:ED negatively impacts QoL in men.

MP86-01 IS HYPERHOMOCYSTEINEMIA AN EARLY PREDICTOR OF ERECTILE DYSFUNCTION? EVALUATION OF INTERNATIONAL INDEX OF ERECTILE FUNCTION (IIEF) AND PENILE DOPPLER ULTRASOUND

INTRODUCTION AND OBJECTIVES: Erectile dysfunction (ED) is inability to achieve and maintain an erection to permit satisfactory sexual activity. Homocysteine (Hcys) is a sulphur-containing amino acid synthesized from the essential amino acid methionine. Experimental models have elucidated the role of Hyperhomocysteinemia (HHcys) as a strong and independent predictor for atherosclerosis progression and impaired cavernosal perfusion. The aim of this study is to investigate the serum levels of Hcys in our cohort of patients with ED, to compare these values with these of control population and to examine Hcys as a predictive marker for those patients who are beginning to complain mild-moderate ED. METHODS: A total of 431 patients were enrolled in the study. The whole cohort was asked to complete the IIEF questionnaire. The study population was divided in 3 main groups: Group A: 145 patients with no ED serving as a control group; Group B: 145 patients with mild or mild-moderate ED; Group C: 141 patients with moderate or severe ED. Each participant underwent blood analysis. All patients underwent baseline and dynamic penile Doppler ultrasonography. RESULTS: We found in our cohort mean Hcys plasma concentrations significantly higher than the cut-off point in both groups B and C (18.6 4.7 and 28.38 7.8 respectively). Mean IIEF score was 27.9 1.39, 19.5 2.6 and 11.1 2.5 for group A, B and C, respectively (p<0.0001). In the Penile Doppler Ultrasonography studies, a high significant inverse correlation was detected between the mean values of the 10th minute’s PSV and Hcys levels for the group B and C. CONCLUSIONS: This establishes a dose dependent association between Hcys and ED. Furthermore, we showed that Hcys was an earlier predictor of ED than Doppler studies, as the Hcys increase was present in patients with mild ED even before abnormal Doppler values. Source of Funding: none