Moderate-severe Erectile Dysfunction Research Articles

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.

Erectile Dysfunction after Allogeneic Hematopoietic Stem Cell Transplant: Results from a Single Center Experience

▪Erectile dysfunction (ED) is a multidimensional disturbance of the erectile response involving organic, relational and psychological components, which has been reported to affect a significant proportion of patients after allogeneic hematopoietic stem cell transplant (HSCT). Although predictors for ED have been established in the general population, few studies have addressed which variables are associated with ED in HSCT patients.Aims of the study were to establish prevalence and extent of ED in 55 consecutive patients transplanted in our Institution between 2003 and 2015, and to identify within socio-demographic, medical and psychological domains eventual ED predictors.Patients were enrolled in the study upon informed consent. Inclusion criteria were age ≥ 18 years, continuous disease remission, and ≥ 6 months from HSCT. Exclusion criteria were concurrent malignancy, major psychiatric disorder or mental retardation, and hormonal replacement.ED was assessed and measured by the International Index of Erectile Dysfunction (IIEF15).Patient socio-demographics were collected by an ad hoc schedule.Medical data were obtained from hospital records. The andrological visit included testicular measure, penis and genital skin inspection, and penile ultrasound and elastosonography. Free testosterone (FT), inhibin B, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, thyroid stimulating hormone (TSH), free triiodothyronine 3 (FT3), FT4, cortisol, and adrenocorticotropic hormone (ACTH) levels were measured.Anxiety was quantified by the State-Trait Anxiety Inventory (STAI), depression by the Zung Self-rating Depression Scale (SDS).Differences between groups were analyzed by the non-parametric Mann-Whitney test and the Fisher's exact test when testing quantitative and categorical variables, respectively. Logistic regression analysis was used to estimate the association of the variables predictive for ED, when including into the association model the relevant covariates. Chronic graft versus host disease (cGVHD) was diagnosed according to NIH criteria.Fifty-two (94.5%) of the 55 patients eligible for the study returned the self-administered questionnaires and underwent the andrological visit: 32 had acute leukemia, 7 non-Hodgkin lymphoma, 4 myelodysplastic syndrome, 4 chronic myeloproliferative disease, 3 multiple myeloma, 2 B cell chronic lymphocytic leukemia.Median time from HSCT to study assessment was 19 (6-108) months. Thirty-nine patients (75%) had hypogonadism, while 10 (19.2%) presented genital cGVHD, with post-HSCT phimosis in 7 cases, meatal scarring in 2, lichen sclerosis-like lesions in 1. At penile ultrasound and elastosonography, 12 (23%) and 7 (13.5%) patients had a medium-hard and hard penile elasticity.FT and inhibin B were below the range limit in 34 (65.4%) and 33 (63.5%) patients, while FSH was above in 47 (90.4%), thus indicating a large prevalence of gonadal failure. Three patients (5.7%) had a mild hypotyrodism. No prolactin, cortisol or ACTH alterations were observed.Forty-seven (90.4%) of the 52 participants declared a stable sexual partner: the 5 patients [median age 42 (19-50) years, 1 with cGVHD] who reported not having any sexual activity due to partner absence were excluded from the analysis of ED predictors according to IIEF15 requirements.ED was reported by 31/47 (66%) patients: it was severe in 42% cases, moderate in 22.6%, moderate to mild in 6.4% and mild in 29%. There was no difference between patients with and without ED in terms of time from HSCT [25 (6-108) vs 15 (6-79) months, p=0.32].In univariate analysis higher age, low education level, and cGVHD (excluding the isolated genital one) were significantly associated to ED, while the same variables in addition to hypertension maintained their significance in the subgroup of patients with moderate-severe ED only (Table 1). In a logistic regression model, age and cGVHD were the only variables independently associated with ED (any grade, p=0.02 and moderate-severe, p=0.0001, respectively).Our study confirms that ED is a frequent long-term complication of HSCT, with cGVHD being a major predictor. We suggest that an early screening of sexual dysfunction and a close partnership between HSCT clinicians and andrologists could help to implement reliable prevention strategies and/or prompt interventions for patients suffering from ED. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Is There Any Association Between Uric Acid to High-density Lipoprotein Cholesterol Ratio and Erectile Dysfunction?

Objective: Elevated uric acid (UA) and low levels of high-density lipoprotein (HDL) cholesterol are associated with cardiovascular events and mortality. Erectile dysfunction (ED) has been considered an early marker of cardiovascular disease (CVD). Therefore, this study aimed to investigate the uric acid/ HDL ratio (UHR) as a nowel marker in patients with ED. Materials and Methods: The study included 147 patients with a mean age of 50 years (range 32-76 years). Retrospective analyses were performed on the patients who were admitted to urology outpatient clinics. The laboratory parameter results were retrieved from the hospital medical records, and the UHR value was calculated. Patients were categorized into three groups according to the International Index of Erectile Function (IIEF) score. UHR was compared between groups, and its predictive value was evaluated using regression analysis and ROC curve analysis. Results: Age was found to be significantly different in all three groups (Groups 1-2, p=0.001; Groups 1-3, p=0.000; Groups 2-3, p=0.001). It was observed that the degree of ED increased with age. The values of UA and HDL were similar in all groups (p&gt;0.05). In contrast, the UHR value was statistically significantly higher 0.15 (0.083-0.288, p =0.047) in the moderate-severe ED (Group 3). ROC curve analyses revealed that UHR predicted severe ED (IIEF 5-11) with 42.9% sensitivity and 87.3% specificity (AUC:0.66, CI 95% 0.538-0.781, p=0.019). Conclusion: UHR may serve as a severe ED indicator in patients admitted to the cardiology outpatient clinic since it has a significant association with a low IIEF score.

Association Between Erectile Dysfunction and Carotid Subclinical Atherosclerosis in HIV-Infected Patients

Erectile dysfunction (ED) is frequent in HIV-infected patients, and it can be associated with atherosclerosis and cardiovascular events. So, the objective was to evaluate whether the presence of moderate-severe ED was a marker of subclinical atherosclerosis (SCA) in HIV-infected patients. A cross-sectional study was conducted in a cohort of HIV-infected patients. The presence of ED was assessed using the International Index of Erectile Function (IIEF-5) questionnaire. The presence of SCA was determined by calculating the mean carotid intima-media thickness with Doppler ultrasound. A logistic regression analysis was performed to check the variables associated with SCA. One hundred thirty-nine men of 45 (10) years of age were included, of which 130 (94.9%) received antiretroviral therapy. In 30 (22%) patients, the Framingham score was higher than 10%. In 36 (25.9%) patients, ED was detected in a moderate-severe degree and in 53 (38.1%), SCA was detected. In the multivariate analysis, variables independently associated with the presence of SCA were as follows: older age [odds ratio (OR) = 1.22, confidence interval (CI) 95%: 1.1 to 1.35, P < 0.001] and moderate-severe ED (OR = 4.68, CI 95%: 1.18 to 18.5; P = 0.028). Variables associated with moderate-severe ED were as follows: age (OR = 1.107, CI 95%: 1.041 to 1.17, P < 0.001) and having antibodies for hepatitis C virus (OR = 5.12, CI 95%: 1.54 to 17.03, P < 0.001). HIV-Infected patients often have moderate-severe ED, especially the elderly and coinfected patients with hepatitis C virus. ED can be an early clinical manifestation of incipient atherosclerosis, so its presence should involve a deep control of cardiovascular risk factors and using a regimen with a better atherogenic profile.

Potential Protective Effect of Osteocalcin in Middle-Aged Men with Erectile Dysfunction: Evidence from the FAMHES Project

In a similar manner to erectile dysfunction (ED), osteocalcin (OC) is also said to be associated with cardiovascular disease (CVD); however, the effect of OC in ED is unclear. This study was conducted based on the Fangchenggang Area Male Health and Examination Survey (FAMHES) project that ran between September and December 2009. ED was evaluated using the International Index of Erectile Function (IIEF-5). OC was shown to be associated with mild (unadjusted: OR = 0.647; P = 0.016) or moderate (unadjusted: OR = 0.453; P = 0.007) ED. Meanwhile, higher OC levels were more prominently associated with ED (unadjusted: OR = 0.702; P = 0.014). When subdividing the groups by age, the correlation between OC and ED presented in those aged 40–49 years, even in the multi-adjusted model, for those with moderate (OR = 0.255, P = 0.044) and severe (OR = 0.065, P = 0.005) ED. The relationship between OC and ED was also associated with a high level of testosterone, non-obesity, drinking, and non-metabolic syndrome. In summary, OC may play a protective role in middle-aged (40–49 years) men with moderate-severe ED, especially those with a high level of testosterone, non-obesity, drinking, and non-metabolic syndrome.

Erectile dysfunction in patients with plaque psoriasis: the relation of depression and cardiovascular factors.

Psoriasis is a chronic inflammatory skin disease and seems to be associated with erectile dysfunction (ED). ED is a predictor of future cardiovascular disease. It is important to identify ED early and investigate cardiovascular problems in psoriasis patients. The sample consisted of 191 psoriasis patients and 191 healthy men. One hundred and one of 191 (52.9%) patients with psoriasis were indicative of ED, compared with 40.3% in control group, reflecting an age-adjusted odds ratio of 1.965 in favor of the psoriasis group. A univariate analysis in the psoriasis group indicated that age, hypertension, hyperlipidemia, diabetes mellitus and depressive symptoms were the risk factors for ED. The multivariate logistic regression model indicated that increasing age, hypertension, hyperlipidemia and depressive symptoms were independent risk factors for ED in psoriasis. The more severe depressive symptoms increased the risk of ED and especially moderate-severe ED. The diagnosis of ED may help prevent emotional and physical discomfort in men and aid in identifying reversible cardiovascular risk factors. Screening of ED may become a part of routine care in the management of psoriasis patients.

Determinants of Sexual Impairment in Multiple Sclerosis in Male and Female Patients with Lower Urinary Tract Dysfunction: Results from an Italian Cross-Sectional Study

Sexual dysfunction (SD) is prevalent in multiple sclerosis (MS) patients and affects quality of life. Furthermore, lower urinary tract dysfunction (LUTD) is common in MS patients. This study aims to evaluate the relationship between SD, neurological disability, depression, anxiety, and urodynamic alterations in patients with MS and LUTD. From January 2011 to September 2013, 135 consecutive patients with MS in remission phase and LUTD underwent first urodynamic examination, according to the International Continence Society criteria. Depression and anxiety were evaluated with the Hamilton Depression Scale (HAM-D) and the Hamilton Anxiety Scale (HAM-A), neurological impairment was assessed using the Expanded Disability Status Scale (EDSS), and SD was investigated with the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF-15). Multivariate logistic regression analyses were carried out to identify variables for predicting female sexual dysfunction (FSD) (FSFI < 26.55), male SD (IIEF-15 < 60), or moderate-severe erectile dysfunction (IIEF-EF ≤ 16), after adjusting for confounding factors. Total IIEF-15 and all subdomains (all P < 0.01), total FSFI, FSFI-arousal, FSFI-lubrication, and FSFI-orgasm (all P < 0.05) were lower in subjects with EDSS ≥ 4.5. We found inverse relationship between IIEF-15 and relative subdomains with EDSS (all P < 0.01) and between FSFI and relative subdomains with EDSS (all P < 0.01), HAM-D (all P < 0.01), and HAM-A (all P < 0.01). Continuous EDSS (odds ratio [OR] = 1.54; P = 0.03) and categorical EDSS (≥4.5) (OR = 6.0; P = 0.03), HAM-D (OR = 4.74; P = 0.03), and HAM-A (OR = 4.10; P = 0.02) were significantly associated with FSD (FSFI < 26.55). Detrusor overactivity (DO) was an independent predictor of moderate-severe ED (IIEF-EF ≤ 16) (OR = 2.03; P < 0.01), and of FSD (OR = 9.73; P = 0.04). Neurological disability, depression and DO are significantly predictive of SD in MS patients, irrespective of gender. An EDSS ≥ 4.5 may significantly predict the presence of SD.

Cardiovascular Risk Assessment Using High-Sensitivity C-Reactive Protein in Patients with Erectile Dysfunction

Background: Erectile dysfunction (ED) is associated with cardiovascular events. High-sensitivity C-reactive protein (hsCRP) is a cardiovascular risk marker. The aim of this study is to determine whether hsCRP is useful in evaluating ED. Methods: In 121 patients with ED, age, ED type and severity, time since onset of ED, weight, height, BMI, body fat percentage, waist and hip circumference, hsCRP and hormone profile were studied. Patients were classified as low or moderate-high cardiovascular risk based on hsCRP levels. A descriptive and univariate study was performed. A logistic regression was used to establish factors associated with low versus moderate-high cardiovascular risk and hsCRP. Results: Most patients had moderate-severe ED (70%). 74% had a moderate-high cardiovascular risk based on hsCRP levels, and 33.9 and 34.7% had hypogonadism according to total (TT) and free testosterone. In the univariate analysis, a relationship between hsCRP and TT and physical examination variables was observed (p < 0.05). In the multivariate analysis, TT was found to be a predictor (OR: 0.676; 95% CI: 0.491-0.029). Higher cardiovascular risk was found in the hypogonadic group (OR: 5.51; 95% CI: 1.185-25.662) and waist- to-hip ratio (p = 0.008; OR: 1.361; 95% CI: 1.075-1.612). Conclusions: A majority of patients with ED have high cardiovascular risk based on hsCRP levels and there is an association with hypogonadism and obesity.

1215 DO UROLOGIC PROCEDURES SUCH AS PROSTATE NEEDLE BIOPSY AND VASECTOMY CAUSE ERECTILE DYSFUNCTION?

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation1 Apr 20101215 DO UROLOGIC PROCEDURES SUCH AS PROSTATE NEEDLE BIOPSY AND VASECTOMY CAUSE ERECTILE DYSFUNCTION? Dan Lewinshtein, Jason Kim, Stephen Lukasewycz, and Christopher Porter Dan LewinshteinDan Lewinshtein More articles by this author , Jason KimJason Kim More articles by this author , Stephen LukasewyczStephen Lukasewycz More articles by this author , and Christopher PorterChristopher Porter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.717AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prior studies suggest that prostate needle biopsy (PNB) and vasectomy may cause erectile dysfunction (ED). We explored the relationship between a prior PNB or vasectomy and rates of ED. METHODS We reviewed a prospectively organized database of 890 patients who underwent transrectal ultrasound (TRUS)-guided PNB. ED was modeled as a categorical variable as either any, moderate-severe, or severe based on International Index of Erectile Function (IIEF) scores. Binary logistic regression was used to evaluate the predictive ability of PNB and vasectomy. They were adjusted for age in multivariate analysis.IIEF scores were obtained prior to each biopsy procedure. RESULTS Median age and IIEF score were 63 years and 19 points, respectively. According to IIEF scores, 22%, 11%, 15%, 34% had severe, moderate, mild-moderate, and mild ED, respectively. 18% had no ED. Vasectomy status was available in 391 patients, of whom 41% had prior vasectomy. On univariate analysis, age (OR=1.1, p<0.001), prior PNB (OR=1.83, p<0.002) and prior vasectomy (OR=0.41, p<0.001) were all associated with moderate-severe ED. Only age (OR=1.1, p<0.001) and vasectomy (OR=0.39, p<0.002) were predictive for severe ED. On multivariate analysis, age was predictive for moderate-severe (OR=1.08, p<0.001) and severe (OR=1.09, p<0.001) ED, while vasectomy was protective against moderate-severe (OR=0.41, P<0.001) and severe (OR=0.41, p<0.003) ED. PNB status was no longer significant (p>0.05) after adjustment for other covariates. CONCLUSIONS Age is a strong predictor of ED. Prior vasectomy is associated with a reduced risk of ED. Prior PNB, after adjustment for other variables, does not increase the risk of ED. Furthermore, ED was common in this cohort, and thus patients undergoing definitive therapy for prostate cancer should be counselled appropriately prior to treatment. Seattle, WA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e470 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dan Lewinshtein More articles by this author Jason Kim More articles by this author Stephen Lukasewycz More articles by this author Christopher Porter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...