Moderate ED Research Articles

Long-Term Patient-Reported Quality of Life and Functional Outcomes After Chemoradiation Using Intensity Modulated Radiotherapy for Anal Cancer

Few studies have long-term follow-up assessing patient-reported outcomes (PROs) after intensity-modulated radiation therapy (IMRT)-based chemoradiation (CRT) for squamous cell carcinoma of the anus (SCCA). There is poor agreement between physician-graded toxicity and PROs regarding quality of life (QOL) in patients with SCCA. Therefore, we surveyed SCCA survivors ≥ 2 years out from CRT with validated PRO instruments assessing bowel, bladder, and sexual function.We identified 248 patients with SCCA treated with definitive IMRT-based CRT at a large tertiary cancer center from 2010-2018, who were alive and without recurrence. Patients were asked to complete five PRO instruments: Fecal Incontinence QOL Scale (FIQOL), Low Anterior Resection Syndrome Score (LARS), International Consultation on Incontinence Questionnaire (ICIQ), male and female lower urinary tract symptoms (MLUTS and FLUTS, respectively), International Index of Erectile Function (IIEF), and Female Sexual Function Index (FSFI). FIQOL, LARS, IIEF, and FSFI scores were dichotomized and logistic regression used to identify predictors of QOL scores.One hundred eight (44%) patients completed the PROs. Respondents' median [interquartile range, (IQR)] age was 66 [59-72] years, 80% were female, and 95% were white. Median [IQR] gross tumor volume (GTV) was 45 [27-71] cc; dose to GTV was 50 Gray (Gy), 54 Gy and 58 Gy in 25%, 53%, and 22%, respectively. Median [IQR] time from CRT was 51 [37-84] months. Median [IQR] FIQOL score was 14.3/20 [11.2-16.1]; higher is better. Larger GTV size (OR 0.99; P = 0.03) was associated with lower FIQOL score. Sixty-one (56%) patients met major LARS criteria. There was a trend towards a higher incidence of major LARS with GTV dose ≥ 54 Gy (OR 2.39; P = 0.08). Men had median [IQR] ICIQ MLUTS voiding and incontinence scores of 5/20 [2-6] and 1/24 [1-3], respectively. Women had median [IQR] ICIQ FLUTS voiding and incontinence scores of 1/12 [1-3] and 5/20 [3-8], respectively; higher is worse. Fifty-nine (55%) patients reported being sexually active in the last month. Men had a median [IQR] IIEF score of 14/25 [6-19]; higher is better. Only age (OR 1.17; P = 0.04) was significantly associated with IIEF ≤ 11 (moderate or severe ED). Women had a median [IQR] FSFI score of 20.2/26 [13.6-24.9]; higher is better. Age < 65 was associated with sexual dysfunction, defined as FSFI < 26.55 (OR, 5.5; P = 0.04). Forty (37%) patients disagreed or strongly disagreed that they were prepared for long-term side effects. Seventy (65%) patients agreed or strongly agreed that educational materials would have been helpful.SCCA survivors experience significant long-term bowel and sexual toxicities from modern CRT. Larger tumors and higher RT doses may be associated with worse function. Interventions to reduce toxicities and improve patient education are needed.

Prevalence of Metabolic Syndrome in Men with Erectile Dysfunction

Abstract Background Erectile dysfunction, as defined by the International Consultation on Sexual Medicine, is the consistent and recurrent inability to acquire or sustain an erection of sufficient rigidity and duration to engage in satisfactory sexual intercourse. Objectives The aim of this study was to identify the prevalence of MetS among patients with ED. Patients and Methods This was a cross sectional study conducted on 200 patients attending the Andrology clinic of Dermatology, Venereology and Andrology department, Ain-Shams University starting from March 2019 till December 2019. The 15-question IIEF Questionnaire is a validated, multi- dimensional, self-administered investigation that has been found useful in the clinical assessment of ED and treatment outcomes in clinical trials. Results The mean ± SD of age of patients with ED in our study was 58.3 ± 20.1 years. Out of the 200 patients, 110(55%) of them had BMI (25-29.9). and over 30 in 35(17.5%) patients. The mean ± SD of WC was 41.4±4.9 inches. Among the 200 patients, hypertension was present in 125(62.5%) and smoking in 165 (82.5%) patients. Among the 200 patients, 96 (48%) patients had MetS. Among 200 patients, 90 (45 %) had mild, 54 (27.0 %) had moderate. and 56 (28 %) had severe ED. A significant association was determined between the presence of MetS and severity of ED. The prevalence of moderate and severe ED was significantly higher in patients with MetS than patients without MetS. There was a negative significant correlation between IIEF scores and age, systolic BP, and diastolic BP. Conclusion Among the 200 patients, 96 (48%) patients had MetS. Incidence of moderate to severe ED was higher among patients with MetS versus those without. There was a negative significant correlation between IIEF scores and age, systolic BP, and diastolic BP.

Evaluation of Therapy Effectiveness in Men with Different Erectile Dysfunction Severity

Sexual health is an integral part of everyone’s quality of life. Sexual harmony depends on a man’s sexual desire and erectile function. The most common disorder of male sexual health is erectile dysfunction. Improving the treatment of patients with this pathology helps to improve both physical and mental health and thus improve the quality of life. The objective: the aim of the study was to evaluate the efficacy and safety of combination course therapy and monotherapy in patients with erectile dysfunction. Materials and methods. The observation included 89 men with erectile dysfunction of mixed genesis aged 25 to 50 years with mild to moderate severity. All patients were divided into three groups. The I group of 32 patients with moderate ED, received during the month in the morning Bodrex 1 sachet 60 minutes before meals and in the evening Strondex one spray into the oral cavity (12,5 mg sildenafil), regardless of the presence or absence of sexual activity in this day and an additional 30 minutes before sexual intercourse from 12,5 to 25 mg, followed by a comparative assessment of clinical results immediately after treatment in relation to a group of patients (II group – 32), also with moderate ED who received sildenafil in tablet form dose of 25 mg 1 hour before sexual intercourse, but not more often than once a day. The third group (III group – 25) of patients consisted of men with mild ED, who received during the month only Bodrex in the morning 1 sachet 60 minutes before meals, with comparing clinical data before and after treatment. Bodrex and Strondex preparations are presented on the market by the pharmaceutical company Geolik Pharm Marketing Group. Results. The use of course combination therapy (Strondex + Bodrex) in the treatment of patients with moderate ED was found to be significantly more effective than sildenafil monotherapy at a dose of 50 mg on demand before sexual intercourse, as evidenced by subjective assessment of patients and objective data. Namely, the integrative indicator «erectile function» in this group of patients improved almost twice, while in the second group of patients this indicator improved by 62,9% (p&lt;0,05). Accordingly «оverall satisfaction" in group I patients improved 2,3 times, and in group II patients 1,8 times. Dopplerosonography of the penis in patients with moderate ED showed a probable decrease in hemodynamics in the corpora cavernosa, which indicated the presence of vascular factor with impaired vascular endothelial function (p&lt;0,05). After treatment, a more pronounced increase in cavernous blood flow occurred in group I, namely an increase in peak systolic velocity by 69,5%, while in group II by 38,5% (p1&lt;0,05). It was noted that the concentration of ET-1 in the serum of patients with moderate ED was 3 times higher than the average in the group of almost healthy men, which may indicate severe endothelial dysfunction (p&lt;0,05). Accordingly, after treatment, the level of ET-1 in the blood of patients decreased in group I, who received combination therapy, by 44,2%, while in group II by 28,3% (p1&lt;0,05). Before treatment, the majority of patients with moderate ED, namely 78,1%, could not have sexual intercourse due to insufficient erection. After treatment in 53,1% of group I patients receiving combination therapy (Strondex + Bodrex), erection was completely restored, while in group II erection was completely restored in 28,1% of patients. Also, according to the obtained data, it should be noted a significant positive dynamics of all integrative indicators of IIEF on the background of taking Bodrex in patients with mild ED (p&lt;0,05). An increase in the baseline «erectile function» by 1,4 times, contributed to an increase in sexual satisfaction and sexual satisfaction in general by 2,3 times. The mean peak systolic rate of cavernous blood flow before treatment in this group of patients was lower compared with the control group by 21,2% (p&lt;0,05). This indicator improved after treatment by 21,7%, and became not significantly different from this indicator in the control group of almost healthy men (p1&lt;0,05; p2&gt;0,05), which indicated the normalization of hemodynamics in penis. In patients with mild ED, the concentration of ET-1 in the serum was 1,7 times higher than in the control group (p&lt;0,05). After treatment, this index decreased by 1.5 times, approaching the rate in the group of almost healthy men (p2&gt;0,05). Before treatment in this group, no patient had a complete erection, and less than half of the patients (45,5%) had a pratial erection. After a course of treatment with Bodrex, complete erection was restored in 68,2% of patients, and a total of 86,4% of patients were able to have sexual intercourse. Conclusions. The use of combination course therapy (Strondex + Bodrex) in patients with moderate ED and course monotherapy (Bodrex) in patients with mild ED contributes to a more stable clinical effect, as evidenced by the dynamics of the data.

Evaluation of immediate and short-term efficacy of DualStim therapy with and without intracavernosal umbilical cord-derived Wharton's jelly in patients with erectile dysfunction: Study protocol for a randomized controlled trial

IntroductionErectile dysfunction (ED) affects a significant portion of the United States population and causes negative psychological burdens that affects men and their partner's quality of life and satisfaction. Extracorporeal shock therapy (ESWT) utilizing focused ESWT and radial ESWT in Low-intensity shock wave therapy has been used to treat ED with some success. Wharton's Jelly (WJ) is a biologic substance with large amounts of stem cells, growth factors, cytokines and extracellular components. The use of combined focused and radial ESWT (DualStim therapy) with injected WJ have potential uses in ED that may have advantages over current treatments. MaterialsA randomized, single-blinded, controlled clinical trial will be conducted to evaluate the efficacy and safety of DualStim therapy and intracavernosal injection of WJ in moderate to severe ED. A total of 60 patients with moderate to severe ED will be enrolled and treated with DualStim therapy with intracavernosal injection of WJ or saline for a period of 7 weeks. The International Index of Erectile Function – Erectile Function score will be used to gauge the treatment related changes in relation to the subject's baseline. The scores will be recorded at baseline and compared to follow-ups 1,3 and 6 months post-treatment. Any adverse events or severe adverse events will be recorded in the corresponding case report forms. Sexual Encounter Profile, as well as the Global Assessment Questionnaire and the Erection Hardness Score will be used to determine the sexual activity improvement from baseline leading to optimal penetration at follow-ups 1,3 and 6 months post-treatment. DiscussionThis clinical trial is one of the first studies to determine the immediate and short-term efficacy of DualStim therapy, with and without intracavernosal injection of formulated umbilical cord-derived WJ to improve and/or restore erectile function in patients with moderate to severe ED. This study will also provide insight into the safety and efficacy of WJ. We anticipate clinically significant improvement in patients suffering from moderate and severe ED treated with DualStim therapy with WJ compared to their baseline and DualStim with saline.

PROLONGED OBSERVATION OF SEXUAL DISORDERS BY HYPERTONIC PATIENTS AFTER NURSING INTERVENTION

Objective: Objective of this prolonged work was to observe progress in severity of erectile dysfunction as an expression of endothelial damage) by hypertensive patients with or without cardiovascular organic changes after one year nursing intervention on modifiable lifestyle risk factors in half of recruited probands. Design and method: Method: The presence and severity of ED in the group of 200 hypertensive patients, aged 40–70 years, were studied in the beginning and after one year. With half of the enrolled patients was performed periodic targeted nursing intervention (one year duration), focused on respect of the life style principles. Questionnaire method was used for data collection at the beginning and at the end of the annual reporting period, as well as after next 4 years. Questionnaires were focused on antropometric dates, lifestyle, QoL and ED. Results: Results: The research results showed that by hypertensive patients with organic CV changes is a higher incidence of moderate and severe ED than in hypertensive patients without organ changes. Those result were similar at start, as well as on the end of monitoring after 4 years. At the same time, a higher incidence of ED in the group of patients with organic complications than without them. In groups without nursing intervention was an increase in the number of patients with severe ED by 18% (group without organic complications), respectively 37% (with organic complications). The severity of ED by groups without intervention increased also, bud less intensive. The differences have been statistically significant. After 4 years monitoring – worsening of ED was observed, more intensive (statistically significant) by group of patients with cardiovascular organic changes. Conclusions: Conclusions: The results confirmed the assumption of a positive effect of targeted and repeated nursing interventions aimed at compliance with healthy lifestyle and quality of life on ED by hypertensive patients. In the end, paper makes recommendations regarding the highlighting of motivational factors affecting the adoption of healthy lifestyle and explains the role of nurses in applying the principles of secondary prevention of CV disease.

Correlation between the severity of erectile dysfunction and prostate size in patients with benign prostatic enlargement

BackgroundErectile dysfunction (ED) is persistent inability to achieve and maintain an erection for sufficient satisfactory intercourse. Lower urinary tract symptoms (LUTS) are defined as a constellation of storage, voiding and post-micturition symptoms following bladder outlet obstruction. Preservation of sexual function remains an important component of quality of life and should be considered in the management of patients with benign prostatic enlargement (BPE), and many data report evidence of a link between ED and BPE. This study aimed to evaluate the link between ED, size of the prostate and symptom in patients with BPE.MethodsBy simple random sampling, patients who presented at the Urology Clinic of the University of Abuja Teaching Hospital, Gwagwalada, with BPE were assessed for the presence of ED. Three questionnaires (a proforma, the IIEF-5 and the IPSS) were administered to all the patients that met the inclusion criteria to objectively assess ED and LUTS due to BPE without bias. Data obtained were analyzed using Statistical Package for Social Sciences version 20.0. P value of less than 0.05 shall be considered statistically significant.ResultsOne hundred and seventeen male patients with BPE were enrolled for the study. Ninety patients (76.9%) had ED while twenty-seven patients (23.1%) had no ED. Mean age of patients with severe ED was 64.00 years ± 7.07 while the mean age of patients with moderate ED was 64.13 years ± 7.26. Mean age of patients with mild to moderate ED, mild ED and no ED was 64.62 years, 59.90 years and 57.96 years, respectively. Patients with severe ED had the highest mean prostate volume of 122.95 cm3 ± 40.16. Mean prostate volume of 85.24 cm3 ± 40.23 was noted in patients who had moderate ED while a mean prostate volume of 76.42 cm3 ± 26.45 and 60.35 cm3 ± 21.39 was noted in patients with mild to moderate ED and mild ED, respectively. Patients with no ED had a mean prostate volume of 49.75 cm3 ± 15.55. P value (0.001) was significant.ConclusionThis study shows that erectile function has a direct relationship with prostate size. There was a positive correlation between ED and prostate size. Adopting a holistic approach in the management of ED and BPE will have laudable impact on patients’ performance.

Erektil Disfonksiyon Hastalarına Multidisipliner Yaklaşım Gerekir mi?

Aim: To investigate the effects of hormonal, metabolic and demographic variables on male sexual health and to discuss these relationships in a multidisciplinary context. Material and Methods: Erectile function, mean age, body mass index (BMI), comorbidities, medications, smoking and alcohol use of 286 male patients and 49 healthy participants who were admitted to the andrology clinics of Zonguldak Bulent Ecevit University and Samsun Gazi State Hospital were recorded. The erectile functions of a total of 335 participants were classified into 5 categories as; Category-1 (Normal), Category-2 (Mild), Category-3 (Mild-moderate), Category-4 (Moderate), Category-5 (Severe) erectile function using the International Index of Erectile Function (IIEF 1-5,15). Participants were grouped as; non-ED group, group A (n=49) and ED group as, group B (n=286). Patients in Group B with mild and moderate ED were grouped as Group BI (n=140), and those with moderate and severe ED were grouped as Group BII (n=146). The demographic, hormonal and metabolic characteristics of the cases in each category were statistically calculated and the groups were compared categorically. Results: The mean age of the patients in group A and group B were 50.2±8.6 and 52.3±10.1 years, respectively (p=0.185). In group A and group B, mean BMI values were 26.7 and 28.4 kg/m2, belly circumference 100cm and 103.3cm (Table 1). The prevalence of diabetes mellitus in Group A and B was 6.1% and 20.6% (p=0.001). Mean age and BMI values of group BI were 51.5±10.9 years and 28.2 ± 4.2 kg/m2, while it was calculated as 53.1±9.3 years and 29.0±3.9 kg/m2, respectively, in group BII. The mean umbilical circumference of the patients in groups BI and BII was calculated as 101.1±10.9 cm and 105.5±11.0 cm, respectively (p=0.001). Conclusion: Patients who apply to the andrology outpatient clinic with erectile dysfunction should be evaluated especially in terms of comorbidities such as diabetes, hypertension and obesity, and cases with coexistence should be treated with a multidisciplinary approach.

Self-Reported Sexual Function in Sexually Active Male Hodgkin Lymphoma Survivors.

IntroductionUnambiguous data on sexual dysfunction after Hodgkin lymphoma (HL) treatment are scarce.AimsTo form a baseline in this area, we compared patient-reported sexual function in sexually active male HL survivors in complete remission with a sexually active, age-matched, male Dutch sample population. Furthermore, we explored whether sociodemographic and clinical factors were associated with sexual dysfunction in HL survivors and investigated whether reporting to perceive sexual problems was indicative for sexual dysfunction.MethodsThis cross-sectional study included male patients with HL who were treated with chemotherapy and age-matched sexually active males.Main outcome measuresOutcome measures included the internationally validated International Index of Erectile Function (IIEF) and self-reported sexual problems by adding 3 items to the study-specific questionnaire.ResultsErectile dysfunction (ED) occurred in 23.3% of the HL survivors vs in 23.0% of controls: respectively 13.3% and 12.3% had moderate to severe ED. However, more HL survivors positively answered the question whether they did perceive sexual problems than controls (20.0% vs 7.0%; P = .087). More patients treated with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procabazine, and prednisone (BEACOPP) had sexual problems 33.3% vs 8.3% who were treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (P = .057). Importantly, we found that the mean IIEF score for erectile function was 15.7 in HL survivors who reported to perceive sexual problems (moderate ED) vs 28.3 (normal) in those without perceiving sexual problems.ConclusionIn general, sexual function of male HL survivors is comparable to that of matched normal controls. Perceiving sexual problems was associated with lower sexual function measured by the IIEF. None of the HL survivors who were treated with doxorubicin, bleomycin, vinblastine, and dacarbazine perceived sexual problems. However, one-third of HL survivors who were treated with BEACOPP did, including ED in one-third of the cases. This is an important consideration for daily clinical practice as BEACOPP is increasingly used as standard therapy in advanced-stage HL.Eeltink CM, Lissenberg-Witte BI, Incrocci L, et al. Self-Reported Sexual Function in Sexually Active Male Hodgkin Lymphoma Survivors. Sex Med 2020;8:428–435.

Longitudinal Risk of Developing Cardiovascular Diseases in Patients With Erectile Dysfunction—Which Patients Deserve More Attention?

BackgroundErectile dysfunction (ED) is widely considered as an early manifestation of cardiovascular diseases (CVDs), sharing similar risk factors. AimAssess rates and predictors of developing CVD and/or hypertension (HTN) over a long-term follow-up period using user-friendly and clinically reliable tools in men presenting with ED but without CVD/HTN or known vascular risk factors at baseline. MethodsData from 108 patients presenting between 2005 and 2011 with ED were analyzed. All patients were free from CVD and/or HTN (CVD/HTN) at baseline. Patients completed the International Index of Erectile Function (IIEF) at baseline and were followed up every 6 months with clinical assessment or phone interview. Kaplan-Meier analyses estimated the probability of developing CVD/HTN over time. Cox-regression models tested the association between patient baseline characteristics (for example, age, Charlson Comorbidity Index, baseline IIEF-EF, ED severity, alcohol intake, smoking), response to phosphodiesterase type-5 inhibitors (PDE5is), and the risk of developing CVD/HTN. ResultsOf all, 43 (40%) patients showed IIEF-EF scores suggestive of severe ED; 37 (39%) and 59 (61%) were nonresponders and responders to PDE5i, respectively. Median (interquartile range) age was 51 (41, 61) years. Median (interquartile range) follow-up was 95 (86-106) months. Overall, the estimated risk of developing CVD/HTN was 15% (95% confidence interval [CI]: 9-27) at 10-year assessment. Men with baseline severe ED had a higher risk of developing CVD/HTN (34%; 95% CI: 17-59, P = .03) at 10 years than patients with mild to moderate ED (5% [95% CI: 2-14]). At the Cox regression analysis, severe ED (Hazard ratio [HR], 4.62; 95% CI: 1.43, 8.89; P = .01) and baseline IIEF-EF score (HR, 0.92; 95% CI: 0.86, 0.99; P = .02) were associated to the risk of CVD/HTN overtime. Conversely, age and nonresponders to PDE5is (HR, 0.92; 95% CI: 0.32, 2.68; P = .9) were not associated to a risk of CVD/HTN over time. Clinical ImplicationsThe use of an easy and user-friendly tool, as the IIEF-EF domain score, would allow to reliably assess which men with ED at first presentation may deserve a different, more specific and detailed cardiologic investigation to prevent inauspicious CV events. Strengths & LimitationsA single-center-based, observational longitudinal study, raising the possibility of selection biases are the main limits. ConclusionsPatients with severe ED and lower baseline IIEF-EF but no vascular risk factors at first presentation have more than 30% risk of developing CVD/HTN in 10-year time. Those patients may benefit from medical preventive strategies to lowering the risk of CV events and HTN.Pozzi E, Capogrosso P, Boeri L, et al. Longitudinal Risk of Developing Cardiovascular Diseases in Patients With Erectile Dysfunction—Which Patients Deserve More Attention?. J Sex Med 2020;17:1489–1494.

The correlation between atherogenic indexes and erectile dysfunction

Aside from the ordinary plasma lipid level measurements, the ratios based on individual plasma lipid levels such as atherogenic index of plasma (AIP), Castelli’s risk index 1/2 (CRI-1/2), and atherogenic coefficient (AC) are the novel parameters to evaluate the patients with a high risk of CVD. In this study, we aim to evaluate the relationship between AIP, AC, and CRI-1/2 with increased risk of ED. Between April 2018 and February 2019, 253 patients, who were diagnosed as a vasculogenic ED in our clinic, were enrolled in the study. While the first group (n = 134) consisted of patients with moderate and mild ED (IIEF-EF: 17–30), the second group (n = 119) consisted of patients with severe ED. In addition to the mean values of lipid parameters; CRI-1 (total cholesterol/HDL), CRI-2 (LDL/HDL) AIP (log10(triglycerides/HDL), and AC (non-HDL/HDL) were calculated. The mean age was 44.02 ± 10.41 (24–70), and the mean BMI was 27.80 ± 4.12 (18.52 ± 41.97). However, CRI-1 and AIP values were found to be higher in the severe ED group compared to the mild ED group (CRI-1: 4.50 ± 1.47, 4.88 ± 1.30; p = .039; AIP: 0.489 ± 0.315, 0.617 ± 0.283; p = .007). Our results demonstrated that CR-1 and AIP have a positive correlation with the severity of ED. Moreover, we can suggest that patients with higher CR-1 and AIP values are likely to have more severe ED in the future.

Cross Sectional Survey of Priapism and Sexual Dysfunction in 353 Men with Sickle Cell Disease

Introduction: In both high and low income countries, life span in sickle cell disease (SCD) is increasing and quality of life is improving. Recent research activities have focused on decreasing SCD-related morbidities. However, limited research has been done on clinical epidemiology of priapism, sexual dysfunction and libido in men with SCD. As part of our ongoing Priapism in Nigeria (PIN) cohort to assess knowledge gap in clinical epidemiology of priapism and sexual dysfunction in men with SCD, we tested the hypothesis that sexual dysfunction is high in men with SCD compared to age/race matched men without SCD. Methods: We utilized a mixed method study design (cross-sectional survey and focus group discussions) in men, aged 18-40 years, with confirmed SCD and men without SCD as comparators for the survey. Participants were recruited from the adult sickle cell clinic and general outpatients department of Aminu Kano Teaching Hospital (AKTH) and Murtala Mohammed Specialists Hospital (MMSH) in Kano, Nigeria from February to July 2019. Priapism is defined as a purposeless painful erection, unrelated to sexual desire; and mostly occurs in the stuttering or recurrent ischemic form, which lasts less than 4 hours. We used the validated International Index of Erectile Function (IIEF) questionnaire to assess erectile dysfunction in this population. Additionally, we conducted 6 focus group discussions in Nigeria (3 sessions) and United States (3 sessions), respectively; in which we asked open ended questions about symptoms, experiences, beliefs and life impacts of priapism. Data were presented as means ± standard deviation or proportions with 95% Confidence Intervals. The t-test and Chi square test were used to compare demographic data. Similarly, domain-specific scores, which included: 1) erectile function, 2) sexual desire, 3) orgasmic function, 4) overall satisfaction with sex life, and 5) intercourse satisfaction- were compared between the two groups using t-test; where higher scores indicate better sexual function. Erectile domain was further sub-classified into normal (26-30), mild ED (22-25), mild-moderate ED (17-21), moderate ED (11-16) and severe ED (0-10). We considered alpha level of significance to be &lt;0.05. The focus group data was analyzed using an iterative inductive/deductive approach. Results: A total of 353 men with SCD and 250 men without SCD were evaluated; for the demographic features the only significant difference was in monthly income (p 0.007) with SCD being higher, table 1. The prevalence of any priapism episode (major or stuttering) in men with and without SCD was 31.72% (112 of 353) and 2% (5 of 250). Among men with SCD, 25.9% (29 of 112) and 74.1% (83 of 112) had major and stuttering priapism episodes, respectively. Based on the IIEF, the men with SCD when compared to men without SCD had significantly lower total mean scores (24.9 vs 29.6, p 0.0002), erectile function (9.9 vs 11.5, p 0.005), sexual desire (5.8 vs 7.1, p&lt;0.0001), and overall satisfaction with sex life (2.3 vs 3.5, p&lt;0.0001). No significant difference in orgasmic function (p=0.29) and intercourse satisfaction (p=0.12) was observed. Among the married men with and without SCD, 55% (21 of 38) and 84% (22 of 26) had normal erectile function, and 26.3% (10 of 38) and 11.5% (3 of 26) had severe erectile dysfunction, respectively. Based on the data from our focus groups with a total of 28 and 7 participants (n=35), in Nigeria and United States respectively, we were guided by biopsychosocial and socio-ecological models to develop a conceptual framework (not shown). We identified themes on cultural context, priapism (triggers, schema, episodes and coping strategies), emotional and sexual function impacts, with respective quotes (results not shown). Conclusions: In the largest cross-sectional and qualitative study of priapism in men with SCD to date, we demonstrated that priapism and sexual dysfunction are significant cause of morbidity when compared to men without SCD. Married participants with SCD have 2-fold greater proportion of severe erectile dysfunction than those without SCD. Our qualitative results revealed tremendous impact of priapism and sexual dysfunction in men with SCD. Participants with priapism experience shame, anxiety and depression, and declined sexual function. There was diversity in causal attribution and coping strategies of priapism. Disclosures Idris: Fogarty International Center: Research Funding.

Erectile dysfunction in patients of diabetes mellitus: a cross sectional study

Background: One of the independent risk factor for erectile dysfunction is diabetes mellitus. The present study planned to determine the prevalence and factors associated with ED in DM.Methods: A one year cross-sectional study on a total of 208 patients with type 1 or 2 diabetes. National Institutes of Health (NIH) approved questionnaire for International Index of Erectile Function (IIEF) was used to interview each patient to assess for ED.Results: In this study 12.98% of patients had ED score between 13 to 18 suggestive of mild to moderate ED and 9.62% with 19 to 24 scores suggestive of mild degree. The prevalence of erectile dysfunction was 32.21%. The mean age in patients with erectile dysfunction was significantly high (58.40±10.96 years) compared to those without erectile dysfunction (51.00±11.16 years) (p&lt;0.001) Of the 119 patients with duration of diabetes between one to five years 42.02% had ED and of the 3 patients with duration of more than five years 66.67% had ED (p&lt;0.001). Prevalence of ED was higher in patients with HbA1c levels between 7.0 to 8.5 (32.76%) and &gt;8.5 (37.07%). Prevalence of erectile dysfunction was higher in patients with history of smoking (63.64%) (p&lt;0.001) and alcohol intake (51.85%) (p&lt;0.001). The prevalence of erectile dysfunction was also significantly high in patients with history of hypertension (59.7%) (p&lt;0.001).Conclusions: The ED in patients with diabetes mellitus was significantly prevalent with age, duration of diabetes, history of hypertension, cardiovascular disease, glycemic control and hypertriglyceridemia.

Prevalence of erectile dysfunction in diabetic patients

IntroductionErectile dysfunction (ED) is one of the most common yet neglected medical problems which warrants screening at regular interval so that appropriate treatment can be delivered. The aim of this study was to determine the prevalence of erectile dysfunction in Type 2 diabetic men. Material and methodsThe study was conducted in Department of Medicine at Sir Ganga Ram hospital, New Delhi. All males diagnosed with type 2 Diabetes Mellitus between age group of 18–65, were included in the study. Non Diabetic males of same age group were also taken as control group. SHIM questionnaire was administered to all patients and controls. Association of ED with duration of diabetes (<5 yrs., 5–10 yrs., >10 yrs.) were compared. ResultsPrevalence of ED determined by SHIM score was 78.7% which is more than in the control group (46%). ED was significantly more in diabetic population than in non-diabetics. In present study, 21.4% of the diabetic males had No ED, 12.3% had mild ED, 30.9% had mild to moderate ED, 19.1% had moderate ED and 16.4% had severe ED. Longer duration of diabetes consistently increased the risk of ED. Duration of diabetes had a significant correlation with ED. ConclusionPrevalence of ED in was significantly more in diabetic population than in non-diabetics.

CPAP therapy improves erectile function in patients with severe obstructive sleep apnea

ObjectivesErectile dysfunction (ED) is highly prevalent in obstructive sleep apnea (OSA), however, the effect of continuous positive airway pressure (CPAP) therapy on erectile function has not yet been thoroughly investigated in these patients. MethodsNinety-four men with severe OSA (ie, with an apnea-hypopnea-index ≥ 30/h of sleep) were prospectively evaluated for the presence and severity of ED before and after 6–12 months of CPAP therapy. The abbreviated version of the International Index of Erectile Function, (the IIEF-5) was used to rate erectile function. Furthermore, all study participants responded to standard questionnaires of daytime sleepiness (Epworth Sleepiness Scale), quality of life (WHO Wellbeing 5 questionnaire) and depression (Major Depression Inventory). ResultsED as defined by an IIEF-5 score of ≤21 was present in 64 patients (68.1%). CPAP treatment significantly improved erectile function in those patients suffering from moderate and severe ED. Additionally, a trend for a correlation between the improvement of erectile function under CPAP and the hours of its use was observed. Finally, this effect was associated with larger improvements of quality of life in affected patients. ConclusionsED is very frequent in men with severe OSA and can at least partly be reversed by long-term CPAP therapy in most seriously affected patients. The beneficial effect on erectile function may depend on CPAP compliance and is accompanied by improvements of quality of life. Randomized controlled trials are needed to confirm these findings.

Micronuclei as a predictor for oral carcinogenesis

Objectives:The aim of the study was to provide a quantitative evaluation of oral mucosal micronuclei (MN) frequency as a biomarker for oral cancer susceptibility in carcinogenesis progression.Methods:60 patients were included in the study. 30 patients with biopsy proven epithelial dysplasia (ED, 15) and oral squamous cell carcinoma (OSCC, 15) comprised the study group and 30 patients with normal buccal mucosa, reporting for minor surgical procedures formed the controls. After informed consent, exfoliated cells were collected from the affected site using a premoistened wooden spatula and spread on precleaned slides, fixed, stained using modified rapid Papanicolaou method and subjected to microscopic examination. MN were identified and scored according to Tolbert et al. criteria.Results:Maximum patients with ED and OSCC were males and in age groups of 20–40 and 40–60 years, respectively. The most common site was the buccal mucosa. The maximum of MN count/500 cells in OSCC group was 11.93, 4.0 in ED and 1.46 in controls, with the mean and mean MN index ± SD distribution in the three groups showing high statistical significance (P = 0.000). A significant difference between mild and moderate ED and between moderately and well-differentiated OSCC was also observed.Conclusion:MN assays can help in early detection of premalignant and malignant lesions, thereby improving survival and reducing morbidity associated with treatment. MN index is thus a feasible and economical method for screening high-risk populations of oral cancer, to be able to timely identify genomic damage in order to prevent the cancer epidemic.

Cluster Analysis of Acute Care Use Yields Insights for Tailored Pediatric Asthma Interventions

We undertake this study to understand patterns of pediatric asthma-related acute care use to inform interventions aimed at reducing potentially avoidable hospitalizations. Hospital claims data from 3 Camden city facilities for 2010 to 2014 were used to perform cluster analysis classifying patients aged 0 to 17 years according to their asthma-related hospital use. Clusters were based on 2 variables: asthma-related ED visits and hospitalizations. Demographics and a number of sociobehavioral and use characteristics were compared across clusters. Children who met the criteria (3,170) were included in the analysis. An examination of a scree plot showing the decline in within-cluster heterogeneity as the number of clusters increased confirmed that clusters of pediatric asthma patients according to hospital use exist in the data. Five clusters of patients with distinct asthma-related acute care usepatterns were observed. Cluster 1 (62% of patients) showed the lowest rates of acute care use. These patients were least likely to have a mental health-related diagnosis, were less likely to have visited multiple facilities, and had nohospitalizations for asthma. Cluster 2 (19% of patients) had a low number of asthma ED visits and onetime hospitalization. Cluster 3 (11% of patients) had a high number of ED visits and low hospitalization rates, and the highest rates of multiple facility use. Cluster 4 (7% of patients) had moderate ED use for both asthma and other illnesses, and high rates of asthma hospitalizations; nearly one quarter received care at all facilities, and 1 in 10 had a mental health diagnosis. Cluster 5 (1% of patients) had extreme rates of acute care use. Differences observed between groups across multiple sociobehavioral factors suggest these clusters may represent children who differ along multiple dimensions, in addition to patterns of service use, with implications for tailored interventions.

Endothelial function in primary hyperaldosteronism vs essential arterial hypertension

Objective.To estimate and compare the endothelial function in patients with essential arterial hypertension (HTN) and primary hyperaldosteronism (PHA).Design and methods.Eighty-two patients were examined. Among them, PHA was verified in 19 patients, while 36 patients had essential HTN stage II (blood pressure (BP) elevation of 1st or 2nd degree), and 27 age-matching healthy people formed control group. The HTN duration in PHA patients was 1,95 ± 0,24 years, and in patients with essential HTN — 5,5 ± 0,5 years. Both patients and healthy peoples were examined within the hospital, in compliance with the hospital regime and diet. Endothelial function was assessed by several methods: the number of circulating desquamated endothelial cells (the method by Hladovec J.), reactive hyperemia test and evaluation of endothelium-dependent vasodilation (as a percentage of the brachial artery diameter increase), total blood nitrates and nitrites level (Griss-reaction method), nitric oxide excretion in urine.Results.Endothelial dysfunction (ED) was found in all patients with high BP. We found more profound ED in PHA patients compared to patients with essential HTN, which resulted in a significantly higher number of circulating endothelial desquamated cells, lower percentage of vasodilation response in reactive hyperemia test, decreased blood levels of total nitrites/nitrates and elevated nitric oxide urine excretion. Discriminant analysis was applied to range the severity of ED. Patients with essential HTN had moderate ED, while patients with PHA had severe ED. Conclusions. The proposed classification approach can be successfully applied for monitoring changesin ED and the effectiveness of treatment in patients with various diseases associated with BP elevation.

Longitudinal changes in erectile function after thulium:YAG prostatectomy for the treatment of benign prostatic obstruction: a 1-year follow-up study.

This study aimed to evaluate the impact of thulium:yttrium-aluminum-garnet (Tm:YAG) (RevoLix®) laser prostatectomy for the treatment of benign prostatic obstructions on erectile function (EF). A total of 208 patients who underwent Tm:YAG laser prostatectomies participated in this study. All cases were evaluated preoperatively and at 3, 6, and 12months postoperatively using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, and the International Index of Erectile Function (IIEF-5) questionnaires. Patients were divided into groups A (severe erectile dysfunction [ED]), B (moderate ED), and C (mild-to-normal ED), according to their IIEF-5 scores. The median patient ages were 69, 65, and 62years in groups A, B, and C, respectively. Significant improvements occurred in the IPSS and QoL score within the groups during the 12-month follow-up period. The IIEF-5 scores at 3months postoperatively were lower than the preoperative scores in groups B and C. The IIEF-5 scores subsequently improved during the 12-month follow-up period. The slope of the relationship between the IIEF-5 score and the time since Tm:YAG laser prostatectomy had a ß value of 0.2210 (95% confidence interval 0.103 to 0.338, p=0.0003); hence, each postoperative month was associated with an increase of 0.2210 in the IIEF-5 score. The IIEF-5 scores gradually increased and reached the preoperative levels by the 12-month follow-up assessment. Although the IIEF-5 score dropped significantly during the first 3months postoperatively, it improved over the following 12months. Tm:YAG laser prostatectomy did not impact on EF ultimately.

Does any association exist between Chronic Obstructive Pulmonary Disease and Erectile Dysfunction? The DECODED study

IntroductionErectile dysfunction (ED) is the inability to achieve or maintain an erection for satisfactory sexual activity. Recent studies have shown an association between ED and chronic obstructive pulmonary disease (COPD). However, this issue is often ignored. We aimed to evaluate the ED prevalence in COPD patients and its risk factors and to study the impact of dyspnea in sexual activity. MethodsCross-sectional study that included sexually active male patients with COPD. The International Index of Erectile Function (IIEF-5) questionnaire evaluated ED and the Respiratory Experiences with Sexuality Profile (RESP) was used to evaluate the impact of dyspnea on sexual activity. Risk factors for mild-moderate or moderate ED were determined using logistic regression. Results84 patients were consecutively assessed for eligibility, 67 were included (median age: 65 years, 13% never-smokers). Twenty two percent had COPD 2011-GOLD A; 22% GOLD B, 14% GOLD C and 42% GOLD D. Fifty-eight patients (87%) had some degree of ED: 26 (45%) mild, 20 (34%) mild-moderate and 12 (21%) moderate ED. ED occurred in all GOLD stages of COPD, mainly in GOLD B and D stages. Higher CAT score was independently associated to mild-moderate/moderate ED. Most patients (85%) reported dyspnea during their sexual activity but 72% had never talked about it with their physician. ConclusionsED is highly prevalent among COPD patients and it is more severe in patients with higher CAT scores. Dyspnea affects their sexual activity but this is not a topic often discussed between patients and doctors, something which needs to be improved.

PD69-04 SAFETY AND EFFICACY OF LOW-INTENSITY EXTRACORPOREAL SHOCKWAVE IN THE TREATMENT OF VASCULOGENIC ERECTILE DYSFUNCTION: A MULTI-CENTER, DOUBLE-BLIND, RANDOMIZED SHAM-CONTROLLED CLINICAL TRIAL

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II1 Apr 2017PD69-04 SAFETY AND EFFICACY OF LOW-INTENSITY EXTRACORPOREAL SHOCKWAVE IN THE TREATMENT OF VASCULOGENIC ERECTILE DYSFUNCTION: A MULTI-CENTER, DOUBLE-BLIND, RANDOMIZED SHAM-CONTROLLED CLINICAL TRIAL Zhongcheng Xin, Ruili Guan, Wanshou Cui, Xiaodong Zhang, Long Tian, Yi Xie, Hongen Lei, Jihong Liu, and Tao Wang Zhongcheng XinZhongcheng Xin More articles by this author , Ruili GuanRuili Guan More articles by this author , Wanshou CuiWanshou Cui More articles by this author , Xiaodong ZhangXiaodong Zhang More articles by this author , Long TianLong Tian More articles by this author , Yi XieYi Xie More articles by this author , Hongen LeiHongen Lei More articles by this author , Jihong LiuJihong Liu More articles by this author , and Tao WangTao Wang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3145AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the safety and efficacy of Low-intensity Extracorporeal Shockwave (LI-ESWT) in the Treatment of Vasculogenic Erectile Dysfunction. METHODS A multi-center, double-blind, randomized sham-controlled clinical trial was conducted. 70 patients (46 cases for LI-ESWT treatment group and 24 cases for the placebo group) at age 20-70 years, who had mild or moderate Vasculogenic ED evaluated with the International Index of Erectile Function erectile function domain (IIEF-EF) were recruited for this study. Screening, treatment and results were performed in sequence. 4 weekly sessions for the treatment stage: A total of 5000 shockwaves were applied for each treatment and 4 areas were conducted including: 900 shockwaves in right and left crura, and 1600 shockwaves in each site. Effectiveness was assessed according to the International Index of Erectile Function erectile function domain (IIEF-EF), questions 2 and 3 of the Sexual Encounter Profile (SEP), Global Assessment Question (GAQ) scores, and Erection Hardness Scale (EHS) at baseline and at 1 and 3 months after treatment. The study was approved by Peking University First Hospital ethics committee, and all patients signed an informed consent form. RESULTS For Full Analysis Set (FAS) and Per-Protocol Set (PPS), the average IIEF-EF increased significantly from 18.04±3.94 (17.90±3.77) at baseline to 22.02±4.13 (21.95±4.06) at 1 months post treatment, and was 22.54±3.98 (22.49±3.90) at the 3 months follow-up. The success rate by LI-ESWT is 67.39% (73.17%) after 1months post treatment VS 20.83% (23.81%) in the placebo group and is 69.57% (73.17%) after 3 months post treatment VS 20.83% (23.81%) in the placebo group by FAS (PPS). SEP, GAQ, EHS analysis were also significantly improved compared to the placebo controls (p<0.05). No side effects were reported in this study. CONCLUSIONS LI-ESWT in patients with mild or moderate Vasculogenic ED is a feasible, noninvasive and effective way for improving male ED. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1345-e1346 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Zhongcheng Xin More articles by this author Ruili Guan More articles by this author Wanshou Cui More articles by this author Xiaodong Zhang More articles by this author Long Tian More articles by this author Yi Xie More articles by this author Hongen Lei More articles by this author Jihong Liu More articles by this author Tao Wang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...