Moderate Erectile Dysfunction Research Articles

Clinical efficacy of intracavernous injection of platelet lysate for erectile dysfunction

BackgroundAmong the emerging treatments for erectile dysfunction (ED), platelet-rich plasma (PRP), known for its ability to enhance tissue repair and regeneration, stands out as a promising therapeutic approach. In this innovative study, we aimed to assess the efficacy of intracavernous injections of platelet lysate (PL), a derivative of PRP, in improving erectile function among ED patients.MethodsWe enrolled twenty-six patients, aged between 35 and 70 years (mean age 51.6 ± 11.3 years), who had been experiencing ED for over six months and had an International Index of Erectile Function-5 (IIEF-5) score of 21 or less. Participants received autologous PL injections intracavernously every two weeks for a total of five administrations. We assessed Erection Hardness Score (EHS) and International Index of Erectile Function-5 (IIEF-5) bi-weekly for 16 weeks and conducted penile Doppler ultrasounds pre- and post-treatment to record peak systolic velocity (PSV) and resistance index (RI).ResultsBefore treatment, the mean EHS was 2.15 ± 0.88 and IIEF-5 was 10.92 ± 5.28. Remarkable improvements were observed post-treatment, with the EHS significantly increasing to 3.15 ± 0.83 (p < 0.05) and IIEF-5 to 17.23 ± 5.26 (p < 0.05). Penile Doppler ultrasound exhibited an increase in both PSV and RI post-treatment, with the rise in RI being statistically significant.ConclusionsOur findings indicate that intracavernous injections of PL substantially enhance erectile function, as evidenced by improvements in EHS, IIEF-5, and the RI of penile Doppler ultrasound, without hemorrhagic events or other adverse reactions apart from temporary pain at the injection site during the 16-week follow-up period. These encouraging results suggest that PL injections are a safe and effective treatment modality for patients with moderate ED, potentially providing a less invasive and more physiologically friendly alternative to current ED management strategies.Trial registrationThe study received approval from the Institutional Review Board of National Taiwan University Hospital (IRB Number 202008061RIPC, date of registration 08/28/2020).

Assessment of Sexual Dysfunction in Male Patients with Young-Onset Parkinson’s Disease: A Case-Control Study

Introduction: There is a need for a comprehensive assessment of sexual dysfunction in patients with young-onset Parkinson’s disease (PD) to better understand its impact on this population. This study aimed to assess sexual dysfunction in patients with young-onset PD. Methods: This case-control study was conducted using a self-administered International Index of Erectile Function Scale (IIEF) questionnaire. The questionnaire included questions related to sexual function, including the ability to achieve and maintain erection and sexual desire. The participants included 30 individuals with young-onset PD and 30 controls without PD who were matched for age and gender. Results: The study enrolled 30 patients with an average age of 37.2 ± 5.29 years and PD symptom duration ranging from less than two years to over two years. Most patients were classified as having stage 2 or 3 PD and exhibited a range of symptoms, such as bradykinesia, tremors, rigidity, and postural instability. The findings revealed that 40% of the PD group experienced moderate erectile dysfunction, while 23.33% reported severe dysfunction, in contrast to the absence of dysfunction observed in the control group. The analysis indicated that patients with a disease duration of less than two years had higher scores across all five components of the IIEF questionnaire. Furthermore, anxiety, depression, increased medication use, and disease severity significantly affected sexual function. Conclusion: This study highlights the impact of young-onset PD on sexual function and underscores the importance of the early recognition and management of sexual dysfunction in patients with PD.

Safety and efficacy of platelet-rich plasma injection for treatment of erectile dysfunction: a prospective randomized controlled study

BackgroundAffected sexual relationships affect both the quality of life of men and women. Platelet-derived therapies are becoming increasingly popular in various medical and surgical fields because of their ability to aid in tissue healing and vascular remodeling. This study aimed to assess the safety and effectiveness of platelet-rich plasma (PRP) injections in treating patients with erectile dysfunction (ED).ResultsFifty-two participants with mild to moderate ED were divided into two groups: group A, who received three PRP penile injections, and group B, who received three saline injections (5 ml for each injection site). The International Index of Erectile Function (IIEF) was used to evaluate all participants. A month after the last injection, the PRP group's IIEF was 16.12 ± 1.25, while the placebo group's was 15.99 ± 1.21 (p = 0.683). Following a 3-month period, the IIEF for the PRP group was 16.44 ± 1.17, while the placebo group's was 16.31 ± 1.06 (p value = 0.653). Following a 6-month period, the IIEF for the PRP group was 16.35 ± 1.45, while that for the placebo group's was 16.23 ± 1.19 (p = 0.727). In terms of IIEF, there was no significant difference between the two groups after one, three, and six months of treatment.ConclusionIn brief, our research revealed no data to support the application of PRP injections in the management of mild-to-moderate ED.

Kidney transplantation restores sex hormone profile and improves sexual function in ESRD patients with erectile dysfunction.

Erectile dysfunction (ED) and sex hormone profile disturbances are common in ESRD patients. To assess the effect of kidney transplant (KT) and Hemodialysis/peritoneal dialysis (HD/PD) on the serum sex hormone profile and sexual functions in ESRD patients with ED. A single-center, nonconcurrent cohort study included a hundred ESRD patients with ED, on regular HD/PD (group A, n = 50) and after KT (group B, n = 50) at Armed Forces Hospitals Southern Region, KSA. the mean age of patients was 47.3 ± 7.01 and 56.8 ± 9.6 years in groups A and B, respectively. The cohorts were comparable regarding patient demographics, apart from a higher incidence of comorbidities in group B. After KT the mean testosterone level was higher in Group B (13.64 ± 3.21 nmol/L vs 10.26 ± 3.26 nmol/L, p < 0.001). Similarly, LH and prolactin levels were lower in group B than in group A (p < 0.05). As regards sexual function, ED was reported in 92% of patients in group A compared to 42% in group B (p < 0.001). In groups A and B, mild ED was found in 48% and 14% of patients, while moderate ED was found in 16% and 8%, respectively. The mean total IIEF-15 score was 36.42 ± 9.33 and 43.87 ± 9.146 in groups A and B, respectively (p = 0.0001). Sexual desire and orgasm were significantly better in Group B. Our study showed that kidney transplantation could improve erectile function and restore normal sex hormone levels in ESRD male patients with ED, with better outcomes compared to HD/PD.

The potential role of intracavernosal injection of platelet-rich plasma for treating patients with mild to moderate erectile dysfunction: A GRADE-Assessed systematic review and meta-analysis of randomized controlled trials.

Platelet-rich plasma (PRP) has shown positive effects on enhancing erectile function in animal studies. Human clinical trials are limited and provide contradictory results. This review aims to conduct a meta-analysis of the available Randomized controlled trials (RCT) to assess the efficacy of PRP in males with ED. A systematic review was carried out following the Cochrane Handbook of Intervention and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered in PROSPERO (CRD42023441655). A total of three RCTs were included in the analysis for a total of 221 patients with mild to moderate ED. The patients receiving PRP reported significantly better improvement of IIEFEF score during 1,3- and 6-months follow-up compared to the placebo group (mean difference [MD] 2.66, 95% confidence interval [CI] 1.48 to 3.83, p < 0.01; MD 2.11, 95%CI 0.13 to 4.09, p = 0.04; MD 2.99, 95%CI 1.79 to 4.19, p < 0.01). The pooled analysis indicated that attainment of minimally clinical important difference (MCID) was significantly higher in patients receiving PRP compared to the placebo group during one and 6-month follow-up (odds ratio [OR] 5.51, 95%CI 1.2 to 254, p = 0.03; OR 5.64, 95%CI 2.05 to 15.55, p < 0.01; respectively). Encouragingly, no major AEs were reported in all three trials in the PRP and placebo groups (p = 0.99). This review highlights the potential role of PRP in providing short-term improvement of erectile function parameters for up to 6 months in mild to moderate ED patients. Future RCTs with longer-duration follow-ups and more standardized treatment protocols are necessary to gain sufficient details on PRP's long-term effectiveness and safety.

Exploring the relationship between earthquake exposure and severity of erectile dysfunction in southern part of Türkiye.

This study aimed to explore the impact of psychological stress on erectile dysfunction (ED) in male patients following the Gaziantep-Kahramanmaras earthquake. The investigation aimed to establish correlations between earthquake-induced stress and changes in sexual function using International Index of Erectile Function (IIEF), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) scores. A retrospective analysis was conducted on male ED patients from a Gaziantep urology clinic post-earthquake (March to August 2023). Patients with deteriorated erectile function post-earthquake (group 1) and those with pre-existing ED experiencing worsened symptoms post-earthquake (group 2) were included. Data collected encompassed sexual histories, IIEF scores, laboratory tests, and PHQ-9/GAD-7 evaluations. Patients were also evaluated mild and mild to moderate ED, moderate and severe ED according to IIEF erectile function. Seventy-six patients were evaluated (24 in group 1 and 52 in group 2). Significant reductions in total IIEF scores (58 to 40 in group 1 and 49 to 33 in group 2) were observed post-earthquake in both groups (p<0.001). PHQ-9/GAD-7 scores was 11.12±3.79/9.34±3.11 in mild and mild to moderate ED and 13.17±3.05/12.14±3.17 in moderate and severe ED (p=0.011, p<0.001, respectively). Negative correlations existed between PHQ-9/GAD-7 scores and IIEF erectile function (p<0.05) and total IIEF (p<0.05). This research suggests a plausible connection between the Gaziantep-Kahramanmaras earthquake and heightened ED cases. Psychological stress post-earthquake may contribute to worsened ED symptoms. Further investigations are warranted to comprehensively understand the interplay between natural disasters and sexual dysfunction, essential for optimizing patient care in challenging situations.

Evaluation of Erectile Dysfunction in Prediabetic Males at Tertiary Care Center in Central India.

Erectile dysfunction (ED) is a well-studied entity in diabetes mellitus (DM). As with DM, prediabetes also appears to be associated with changes in microvascular-related comorbidities. These include retinopathy, neuropathy, nephropathy, and ED. ED is a condition characterized by an inability to maintain penile erection for adequate sexual activity, either consistently or recurrently. Endothelial damage due to any cause corresponding to hyperglycemia signifies the relationship between prediabetes and ED. While the evaluation of ED in diabetics has been extensively studied worldwide, there is a paucity of knowledge about ED among prediabetics. The study type was observational and was conducted at a tertiary center in India. Adult males aged 18-50 years with prediabetes were included in the study over a duration of 18 months. Evaluation for ED was performed using the International Index of Erectile Function 5 (IIEF-5). A total of 139 participants were enrolled in the present study. The severity of ED was categorized as follows: 32.4% of participants had mild ED, 11.5% had mild-to-moderate ED, and 6.5% had moderate ED. A positive association was found between prediabetes-related parameters and ED. There is a significant prevalence of ED in prediabetic males compared to the general population, as found in our study. Overall, 50.3% of participants were found to have ED. We recommend exploring this subject with more structured and larger studies.

Efficacy and safety of low-intensity pulsed ultrasound (LIPUS) combined with tadalafil in the treatment of severe erectile dysfunction: a retrospective cohort study.

Low-intensity pulsed ultrasound (LIPUS) is an effective and safe treatment for mild to moderate erectile dysfunction (ED). This study aimed to investigate the efficacy and safety of combining LIPUS with tadalafil in treating severe ED. The data from 27 patients treated with LIPUS alone (group A) and 21 patients treated with a combination of LIPUS and daily 10 mg tadalafil (group B) were retrospectively analyzed. The LIPUS regimen consisted of twice-weekly treatments for 4 consecutive weeks. The treatment was considered effective if the change in International Index of Erectile Function-Erectile Function Domain (IIEF-EF) score after treatment was greater than or equal to the minimal clinically important difference (MCID) (the MCID for severe ED is 7 points). The effectiveness, IIEF-EF score, erectile hardness score (EHS), peak systolic velocity (PSV), end diastolic velocity (EDV), and adverse events were evaluated before treatment, 4 weeks after treatment, and 12 weeks after treatment. Compared to pre-treatment, both groups showed significant improvement in IIEF-EF score and EHS at 4 and 12 weeks after treatment (P<0.001), with no statistically significant difference between the two time points (P>0.05). The effective rate did not significantly differ between group A (9/27, 33.3%) and group B (10/21, 47.62%) at 4 weeks or between group A (9/27, 33.3%) and group B (12/21, 57.14%) at 12 weeks after treatment (P=0.32, P=0.10). However, in patients without comorbidities, the effective rate of group B (12/18, 66.67%) was higher than that of group A (9/25, 36.00%) at 12 weeks after treatment (P=0.047). After LIPUS treatment, the PSV level significantly increased and the EDV level significantly decreased compared with before treatment (P<0.05). No adverse events were reported. The study suggests that LIPUS has a therapeutic effect on severe ED patients, especially those without comorbidities. It may have a synergistic or overlapping effect with phosphodiesterase type 5 inhibitors (PDE5Is) on severe ED patients without comorbidities.

Adulthood cosmetic and sexual outcomes of the patients who underwent hypospadias repair in childhood.

This study aimed to assess the cosmetic and sexual outcomes of childhood hypospadias repair after puberty. Among 672 patients who underwent hypospadias repair between 2001 and 2017, 243 sexually active patients were included in the study. At their last visit, cosmetic and sexual evaluation were done through the Penile Perception Score, the Hypospadias Objective Scoring Evaluation, IIEF, MSHQ-EjD. The levels of erectile dysfunction(ED) severity were determined according to erectile function domain of IIEF. The median follow-up after the last surgery was 16 [IQR (13-18)] years, and median patient age at the time of study was 19.67 [IQR(18-22)] years. Patients were divided into two subgroups as follows: Group I; Repairs using grafts (n = 120, 49.4%) and Group II; Graft-free repairs (n = 123, 50.6%). The rate of dissatisfaction with penile appearance was higher in Group I (16.7% vs. 4.9%, p = 0.003). Mild ED was more frequent in Group I (14.2% vs. 3.3%, p = 0.007); while none of the patients had either moderate or severe ED. Other domains of sexual function were observed to be similar in both groups. The need for unwanted interventions due to complications, and surgeries requiring grafts were found to be risk factors for ED development and dissatisfaction with penile appearance in adulthood. Those who underwent graft-free hypospadias repair experience better cosmetic and sexual outcomes when compared to grafted repairs, yet, satisfactory results were achieved in almost 90% of the grafted repairs.

Erectile Dysfunction and Penile Bulb Dose Following Definitive Prostate Radiation Therapy

Background: Erectile dysfunction (ED) is a common side effect of prostate cancer treatment, affecting up to 50% of patients after radiation therapy. Objectives: This study aims to analyze the correlation between the dose received by the penile bulb (PB) and ED in men who underwent definitive radiation therapy for early-stage prostate cancer without androgen deprivation therapy. Methods: The study included 40 patients who received 3D conformal radiation therapy (3D-CRT) for localized prostate cancer and were reported to be potent before treatment, as determined by the International Index of Erectile Function (IIEF-15) questionnaire. The dose to the PB was measured using dose volume histograms (DVHs), and the IIEF-15 questionnaire was completed again 3 months after 3D-CRT. The Pearson correlation coefficient and linear regression test were used to examine the correlation between the ED score and PB doses. Statistical significance was considered if the P value was less than 0.05. Results: The mean age of the patients was 75.5 ± 5.70 years. The average ED score based on the questionnaire was 15 ± 10.55. Twenty percent of the patients had moderate ED, while 80% had mild ED (all patients reported a decrease in potency after 3D-CRT). However, the correlation between the ED score and the PB mean dose was not statistically significant. Conclusions: This study revealed ED in all prostate cancer patients after 3D-CRT, but no significant correlation was found between the dose received by the PB and radiotherapy-induced impotence.

How a population-based cohort of men estimate lifetime risk of prostate cancer in a survey before entering a prostate cancer screening trial in Sweden?

ObjectivesInvestigating men’s perceived lifetime risk of prostate cancer.DesignSurvey-based study to men invited for prostate-specific antigen (PSA) screening in the GÖTEBORG-2 trial between September 2015 and June 2020.Setting38 775 men in...

Assessment of prevalence of sexual dysfunction in patients having lower urinary tract symptoms with benign prostatic hyperplasia and effect of various treatment modalities on sexual function.

Sexual dysfunction affects a couple's relationship and quality of life of the patient and the partner irrespective of age. In Lower urinary tract symptoms (LUTS) with benign prostatic hyperplasia (BPH), sexual dysfunction is highly prevalent. This study aims to evaluate prevalence of sexual dysfunction in patients having LUTS with BPH and effect of various treatment on it. The study is hospital based prospective cross-sectional study. Total 106 patients were included in this study. Fifty-six patients underwent medical treatment and 50 patients underwent transurethral resection of prostate (TURP) according to lower urinary tract symptom score along with grades of prostate. We measured prevalence of lower urinary tract symptoms, erectile dysfunction (ED), ejaculatory dysfunction (EJD).We compared the pre and post treatment ED, EJD scores in both medical and TURP group. In our study, 11 (10.4%) patients had very mild ED, 12 (11.3%) had mild ED, 54 (50.9%) had moderate ED and 23 (21.7%) had severe ED. In our study, 11 (10.4%) patients had very mild EJD, 7 (6.6%) had mild EJD, 28 (26.4%) had moderate EJD and 2 (1.9%) had severe EJD. In medical group, ED pre-treatment versus ED post treatment was statistically significant (p = 0.0046), treatment of LUTS improves ED. EJD pre-treatment versus EJD post treatment was not statistically significant (p = 0.8368), treatment of LUTS associated with deterioration of EJD. In TURP group association of ED pre-treatment versus ED post treatment was statistically significant (p = 0.0319). Post TURP patients shows improvement in ED Association of EJD pre-treatment versus EJD post-treatment was statistically significant (p = 0.03000). Post TURP EJD deteriorate. We concluded that the severity of sexual dysfunction correlates with severity of LUTS. Ejaculatory function deteriorates after treatment of TURP compared to medical.

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.

(101) SHOCKWAVE THERAPY FOR THE TREATMENT OF POSTPARTUM STRESS URINARY INCONTINENCE: A PILOT STUDY

Abstract Introduction Stress urinary incontinence (SUI) is estimated to affect approximately 15% of adult women. Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a form of electrohydraulic acoustic shockwave that has been shown to be effective in animal models of SUI. The Urogold100® is a Li-ESWT device that is FDA-cleared for improving blood flow, connective tissue activation, and pain relief, and it has been shown in multiple studies to be effective for mild to moderate erectile dysfunction and chronic pelvic pain in both men and women. While Li-ESWT has been investigated for related urologic conditions, minimal research exists as to its potential effectiveness for SUI in women. Objective Our aim was to evaluate the effectiveness of Li-ESWT for women with postpartum stress urinary incontinence in a pilot study. Methods Email recruitment was carried out in a single sexual medicine practice. Four women underwent weekly treatments with Li-ESWT for 4-6 weeks. All patients were postpartum women between ages 43-55. Treatment specifics included 1000 shocks at 2.5 Hz (initial visit) and 3.0 Hz (subsequent visits) distributed over the perineum and urethral opening. Energy level was based on patient tolerance, beginning with 0.06 Mj/mm2 and increased up to 0.08 Mj/mm2 for subsequent visits. Evaluation measures included the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Bladder Diary, both administered prior to treatment initiation and after treatment completion. The ICIQ-SF allowed patients to self-assess their urine leakage over the past several weeks (amount and frequency) while the Bladder Diary required patients to record specific leakage incidences throughout a single day. Results Prior to treatment initiation, patients reported 1-3 small daily urine leaks via the NIDDK Bladder Diary. All patients either improved or remained the same in this assessment post-treatment; all patients reported 1 small daily leak after treatment completion. Results from the subjective ICIQ-SF varied: 1 patient reported worsening from 1 daily leak to 2-3 daily leaks, which she attributed to increased water intake. Two patients reported improvements (several daily leaks to 1 weekly leak; several daily leaks to 2-3 weekly leaks). One patient reported no change. Subjective reporting from patients indicated 3 of the 4 felt the treatment was improving their symptoms, and the fourth patient reported no changes. Conclusions Our pilot study indicates that 3 of 4 patients showed improvements in their objective Bladder Diary recordings with reduced frequency of urine leakage, and 2 of 4 patients noted improvements in their subjective ICIQ-SF reporting. 3 of 4 provided positive verbal feedback as well. Despite the limited sample size, the improvements seen in the objective leakage frequency recordings are encouraging findings that warrant future investigation in a larger cohort. Given the noninvasive nature, ease of use, and high patient tolerability of Li-ESWT, this treatment modality should be considered for investigation in a larger cohort with the goal of relieving symptoms of SUI. Disclosure No.

Frequency of Erectile Dysfunction in Patients with Type 2 Diabetes Mellitus Presenting with Peripheral Neuropathy at a Tertiary Care Hospital

Background: Erectile dysfunction (ED) is notably prevalent among patients with type 2 diabetes mellitus (T2DM), especially those suffering from peripheral neuropathy. The condition significantly impacts the quality of life and is often exacerbated by diabetes-related complications. Objective: This study aims to ascertain the frequency and severity of ED among patients with T2DM and peripheral neuropathy, and to examine the association between ED and variables such as age, duration of diabetes, and glycemic control. Methods: A prospective cohort study was conducted at the Baqai Institute of Diabetology and Endocrinology, Karachi, from July 2021 to September 2022. We included 115 male patients aged 35-65 years with T2DM and diagnosed peripheral neuropathy. ED was assessed using the Urdu version of the International Index of Erectile Function-5 (IIEF-5) questionnaire. Demographic details, medical history, and laboratory results were collected and analyzed using SPSS version 25. Statistical tests included chi-squared and one-way ANOVA, with a significance level set at p&lt;0.05. Results: The mean age of the participants was 50.97 ± 7.21 years, and the average duration of diabetes was 9.37 ± 6.56 years. The mean IIEF-5 score was 14.33 ± 6.0, indicating moderate ED. Severe ED was observed in 20% of the participants, moderate ED in 19.1%, and mild to moderate ED in 28.7%. The study found a significant association between the duration of diabetes and ED severity (p &lt; 0.001), while age and HbA1c levels did not show a significant correlation with ED status. Conclusion: ED is highly prevalent and severe among patients with T2DM and peripheral neuropathy, with disease duration being a significant predictor of ED severity. These findings underscore the need for early screening and targeted interventions in this population.

Association Between Socioeconomic Status and Erectile Dysfunction in Japanese Patients With Ulcerative Colitis: A Cross-Sectional Study.

Socioeconomic status is a risk factor for poor disease prognosis. No studies of patients with ulcerative colitis (UC) have investigated the association between socioeconomic status and erectile dysfunction (ED), although UC is independently positively associated with ED. Therefore, the purpose of this survey to evaluate this issue in Japanese patients with UC. The study enrolled 165 patients with UC. Education status (low, middle, high) and household income (low, middle, high) were classified in three groups using self-administered surveys. The information regarding the Sexual Health Inventory for Men (SHIM) was obtained using self-administered questionnaires. The definition of mild to moderate or severe ED and severe ED was SHIM score <17 and SHIM score <8, respectively. The prevalence of mild to moderate or severe ED and severe ED was 64.9% and 47.9%, respectively. In crude analysis, household income was inversely associated with mild to moderate or severe ED and severe ED. After adjustment for age, current drinking, current smoking, exercise habit, body mass index, mucosal healing, and duration of UC, high household income was independently and inversely associated with mild to moderate or severe ED (adjusted odds ratio [OR] 0.23, 95% confidence interval [CI] [0.05, 0.93], p for trend = .038) and severe ED (adjusted OR 0.26, 95% CI [0.07, 0.85], p for trend = .024). In contrast, no association between education status and ED was found. In conclusion, household income was independently and inversely associated with ED in Japanese UC patients.

Effect of Mirabegron in Men With Overactive Bladder and Erectile Dysfunction: A Prospective Observational Study.

As it has been observed that the erect penis has been the epitome of virility for the male community for decades, it became necessary to search for alternative treatments for the cause. So, the study was performed to evaluate the potential impact of mirabegron in men with mild to moderate erectile dysfunction (ED) and overactive bladder (OAB). It was a prospective, observational study that was carried out at the Department of Urology at Rajendra Institute of Medical Sciences, Ranchi, for a duration of two years and included a total of two hundred fifty patients. The individuals included had a diagnosis of mild to moderate erectile dysfunction (ED) along with symptoms of OAB. The overactive bladder questionnaire (OAB-q) score and the International Index of Erectile Dysfunction-5 (IIEF-5) score were used, respectively, to measure the impact of mirabegron on ED and OAB. Then, the changes in ED and OAB were evaluated at two, four, eight, and 12 weeks. Among the total 250 patients recruited, around 32.5% of them had mild ED, 17.5% were diagnosed with mild to moderate ED, and 50% suffered from moderate ED. The IIEF-5 scores improved by four points or more in 86.25%, 91.25%, and 71.25% of patients after four, eight, and 12 weeks, respectively. OAB-q scores were likewise shown to decline in the fourth (13.1 ± 4.3) and eighth (12.8 ± 4.2) weeks when compared to the baseline (17.4 ± 5.5). Also, adverse events reported did not hamper the progress of the study. The study concluded that mirabegron has a beneficial impact on controlling OAB symptoms among men diagnosed with mild to moderate ED. The effects last for only eight weeks, and then they decline. Furthermore, mirabegron was well-tolerated among patients and had no safety concerns with its use.

Irritable bowel syndrome and erectile dysfunction in medical students at a Peruvian university: an analytical cross-sectional analysis.

There is inconclusive evidence regarding the role of irritable bowel syndrome (IBS) in the development of erectile dysfunction (ED), especially among medical students due to high academic stress. To determine the association between IBS and ED in medical students from a Peruvian university in 2022. An analytical cross-sectional study was conducted with secondary data analysis on 133 medical students from a university in northern Peru during the 2021-II academic semester. The dependent variable was ED as measured with the 5-item International Index of Erectile Function, and the exposure variable was IBS as assessed with the Rome IV-Bristol questionnaire. The results were the prevalence rates of IBS and ED and the association of these variables. Of the 133 medical students surveyed, the median age was 22years (IQR, 19-24). The median score on the 5-item International Index of Erectile Function was 21 (IQR, 10-24). The prevalence of ED was 38.4% (95% CI, 30.05%-47.17%). Among the medical students 3% and 9% displayed moderate and severe ED, respectively, and 24.8%, 13.5%, and 24.1% showed moderate depressive, anxious, and severe symptoms. An overall 10.5% had IBS. Medical students with IBS had a 108% higher prevalence of ED than those without the syndrome (prevalence ratio, 2.08; 95% CI, 1.06-4.06). Other confounding variables were not significantly associated (P > .05). The results underline the importance of comprehensive sexual and mental health assessment, with an emphasis on the relationship between IBS and ED in medical students. Strengths include the use of validated and reliable instruments and rigorous biostatistical methods, and this is the first Peruvian investigation to explain the association between IBS and ED in medical students. Limitations include the cross-sectional design and nonprobability sampling, and there may be bias in applying the instruments. This study reveals a significant association between IBS and a higher prevalence of ED in these students.

(281) Low-Intensity Shockwave Therapy Combined with Tadalafil 5mg Daily has Better Efficacy for Mild and Moderate Erectile Dysfunction: The Preliminary Results of a Multicenter Clinical Study in China

Abstract Introduction Most clinical studies have demonstrated that low-intensity extracorporeal shockwave therapy (Li-ESWT) can improved erectile function in patients with erectile dysfunction (ED). The EAU guideline recommended to use Li-ESWT for mild vasculogenic ED patients. However, the therapeutic advantages of Li-ESWT combined with phosphodiesterase type 5 inhibitors (PDE5i) have not been explored clearly in clinical practice for mild and moderate ED patients. Objective To compare the therapeutic effects of Li-ESWT and Li-ESWT combined with PDE5i in mild and moderate ED patients with 8≤IIEF-5≤16 from a multicenter clinical study in China. Methods Patients with ED which IIEF-5 score is less than 22 and aged 18–60 years old were enrolled from three clinical centers from Jun. 2019 to Mar. 2023. The demographic data, International Index of Erectile Function-5 (IIEF-5), erectile hardness score (EHS) and self-reported symptom questions were collected. Patients were treated by a linear low-energy shock waves generator (Renova). Low-intensity shock wave (energy density of 0.09mJ/mm2) treatments were applied (once a week, 4 weeks in total, 5000 shocks each time). Patients in Li-ESWT combined with PDE5i group took 5mg of tadalafil once a day for one continuous month during ESWT. Comparative analyses of pre- and post-treatment and intergroup were used for statistics. Results In total, 42 ED cases (37.43±11.86 years) in Li-ESWT group and 116 cases (37.41±10.14 years) in combined group were enrolled for analysis. The IIEF-5 score and EHS in both groups were significantly improved after 1 month treatment (p&amp;lt;0.01). Compared with Li-ESWT group, patients in combined group significantly had higher self-reported efficiency (61.2% vs. 47.6%, p=0.013), IIEF-5 scores (15.34±7.15 vs. 13.96±7.71, p=0.039) and EHS (2.85±0.82 vs. 2.69±0.89, p=0.050). In the mild and moderate ED (with 8≤IIEF-5≤16) sub-group, 30 ED cases (36.81±10.99 years) in Li-ESWT group and 96 cases (36.80±10.69 years) in combined group were enrolled for analysis. The combined regimen showed better therapeutic advantages, including effective parameters IIEF-5(14.50±6.74 vs. 12.87±8.54, p=0.040), EHS (2.85±0.75 vs. 2.81±0.67, p=0.046) and self-reported efficiency (64.2% vs. 54.1%, p=0.001). Conclusions Li-ESWT can effectively improve erectile function in this multicenter clinical study in China, and the combination of Li-ESWT with daily use PDE5i had a better therapeutic effect on Chinese ED patients, especially on mild and moderate ED. Long-term follow-up with large sample study need to be developed for exploring the optimal therapeutic regimen. Disclosure No.

(201) Impact of a Natural Mixture with the Black Chocolate, Chili, Spices in Order to Improve Male Sexual Function

Abstract Introduction The Aztec emperor Montezuma was reported to have drunk up to fifty cups a day of chocolate with chili and spices in it. He had to keep up his stamina to satisfy his many wives. It is thought that the ingredients of this mixture dilates the blood vessels and creates energy and focus. Objective Referring to Montezuma, the purpose of this study was to verify whether is enough to drink every night one cup as Montezuma, by ED men making a nice intercourse with their partners’ women, at least once a week. Methods 101 patients with erectile dysfunction (ED) were enrolled between January 2014 and December 2017. Patients were classified as having mild (47), moderate (38) or severe (16) ED. Mean age was 50.3 years. A cup with black chocolate, chili and spices in it was administered by each patient, every night for 12 weeks. International Index of Erectile Function-Erectile Function (IIEF-EF) questionnaire was administered pre and post-treatment with all pts. Patients with concomitant medical diseases were excluded. Results IIEF-EF scores were significantly improved, with an increase of 79% in the mild ED group, an 83% improvement in the moderate ED group, and an improvement of 67% in the severe ED group compared with the baseline. The mean IIEF-EF scores for all patients showed significant improvement after 12 weeks of treatment (baseline 14.3±1.5 to 26.2 ±3.3; P= 0.01). Among other parameters penile rigidity and tumescence, showed significant improvement for all patients. No, significant side effects. Conclusions The black chocolate, chili and spices when mixed together, seem to work in synergy improving erectile function and in patients with ED, too. We reached the goal that nearly all patients performed a nice intercourse, once a week with their partners’ women. This study tell that what they quote about Emperor Montezuma are in fact true. Disclosure No.