Onset Of Erectile Dysfunction Research Articles

MP79-20 RISK STRATIFICATION FOR ERECTILE DYSFUNCTION AFTER PELVIC FRACTURE URETHRAL INJURIES: A PILOT STUDY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I1 Apr 2017MP79-20 RISK STRATIFICATION FOR ERECTILE DYSFUNCTION AFTER PELVIC FRACTURE URETHRAL INJURIES: A PILOT STUDY Paul H Chung, Cody Gehring, Reza Firoozabadi, and Bryan B Voelzke Paul H ChungPaul H Chung More articles by this author , Cody GehringCody Gehring More articles by this author , Reza FiroozabadiReza Firoozabadi More articles by this author , and Bryan B VoelzkeBryan B Voelzke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2504AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pelvic fractures with associated urethral injuries are associated with a high risk of erectile dysfunction (ED) perhaps due to the proximity of the cavernosal nerve to the bulbomembranous junction. We sought to compare the frequency and severity of new onset ED in pelvic fracture patients with and without urethral injuries and to identify potential risk factors for ED in the setting of pelvic injury. METHODS A retrospective analysis was conducted evaluating male patients treated for pelvic fractures with and without urethral injury at a level 1 trauma center between 2005 and 2016. The International Index of Erectile Function (IIEF) questionnaire was administered by telephone to assess post-injury ED. Additional questions regarding pre-injury sexual function, glans vascular symptoms, glans sensitivity, and an updated past medical history were also administered. A diagnosis of new onset ED was defined as the patient having no recollection of ED prior to injury and subsequently having an IIEF score of <22 after injury. Glans vascular symptoms were defined as having a cold glans during an erection. Penile sensitivity was described as either decreased or increased sensitivity of the glans penis. RESULTS Of the 118 patients, 42% (50/118) patients responded to the questionnaire: 21 (42%) with pelvic fracture urethral injuries (PFUI) and 29 (58%) with pelvic fractures alone. We observed a numerical increase in new-onset ED in the PFUI group (n=12, 57%) when compared to the pelvic fracture alone group (n=11, 38%, p=0.29). The mean post-injury IIEF score was higher for the PFUI group (18 ± 7.6) than the pelvic fracture alone group (13 ± 8.7, p=0.05), with the PFUI patients more frequently developing severe ED (IIEF <7) (p<0.05). There were no significant differences in glans vascular symptoms (p=0.33) or penile sensitivity (p=0.17) between the two groups. Age, comorbidities, concomitant injuries, pelvic fracture pattern, and need for pelvic angioembolization were not risk factors for developing ED in either cohort. CONCLUSIONS ED was more severe in patients with PFUI compared to patients with pelvic fractures alone. Based on our results, a larger prospective analysis is warranted to better characterize ED in pelvic fracture patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1080 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Paul H Chung More articles by this author Cody Gehring More articles by this author Reza Firoozabadi More articles by this author Bryan B Voelzke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD56-04 SALVAGE PROSTATE CRYOABLATION IN OLDER MEN

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II1 Apr 2017PD56-04 SALVAGE PROSTATE CRYOABLATION IN OLDER MEN J. Kellogg Parsons, Ashley Ross, Ahmed El Shafei, Asmaa Hatem, Britney Cotta, Kae Jack Tay, Thomas Polascik, Robert Given, Vladimir Mouraviev, and J Stephen Jones J. Kellogg ParsonsJ. Kellogg Parsons More articles by this author , Ashley RossAshley Ross More articles by this author , Ahmed El ShafeiAhmed El Shafei More articles by this author , Asmaa HatemAsmaa Hatem More articles by this author , Britney CottaBritney Cotta More articles by this author , Kae Jack TayKae Jack Tay More articles by this author , Thomas PolascikThomas Polascik More articles by this author , Robert GivenRobert Given More articles by this author , Vladimir MouravievVladimir Mouraviev More articles by this author , and J Stephen JonesJ Stephen Jones More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2593AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Outcomes of salvage prostate cryosurgery in older men remain undefined. We evaluated oncological and functional outcomes after salvage full gland prostate cryoablation in men over age 75 years. METHODS We identified 923 men who underwent salvage full gland prostate cryoablation for recurrent prostate cancer after primary radiotherapy, including 240 (26%) > 75 years at time of surgery. Primary outcomes were progression-free survival (PFS) using Phoenix criteria and post-treatment biopsy status. Secondary outcomes included post-treatment urinary incontinence, erectile dysfunction (ED), rectal fistulae, and urinary retention. RESULTS Mean follow-up was 26 months (SD±30). Compared to men ≤ 75 years, men > 75 years were more likely to have pre-treatment Gleason sum ≥7 disease (71% vs.63%, p=0.03) and less likely to have undergone neoadjvuant androgen deprivation therapy (29% vs. 37%, p=0.02) (Table 1). In Kaplan Meir analyses, there were no significant differences in 5-year PFS between groups: 61% versus 57% for men > 75 and ≤ 75 years, respectively (p=0.43) (Figure 1). Post-treatment biopsy was positive in 34% versus 29% of men >75 years and ≤ 75 years, respectively (p=0.5). Older men were more likely to have post-treatment urinary retention (23% versus 15%, p=0.003). There were no significant differences in recto-urethral fistulae (3% versus 2%, p=0.62), urinary incontinence (32% versus 30%, p=0.48), or new onset ED (54% versus 49%, p=0.63) between groups (Table 1). CONCLUSIONS Salvage whole gland cryoablation of the prostate in men > 75 years is associated with robust progression-free survival and functional outcomes comparable to younger men. Prostate cryoablation should be considered in older men with recurrent disease after primary radiotherapy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1116-e1117 Advertisement Copyright & Permissions© 2017MetricsAuthor Information J. Kellogg Parsons More articles by this author Ashley Ross More articles by this author Ahmed El Shafei More articles by this author Asmaa Hatem More articles by this author Britney Cotta More articles by this author Kae Jack Tay More articles by this author Thomas Polascik More articles by this author Robert Given More articles by this author Vladimir Mouraviev More articles by this author J Stephen Jones More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Dorsal Phalloplasty to Preserve Penis Length after Penile Prosthesis Implantation.

Following penile prosthesis implantation (PPI), patients may complain of a decrease in visible penis length. A dorsal phalloplasty defines the penopubic junction by tacking pubic skin to the pubis, revealing the base of the penis. This study aimed to evaluate the efficacy of a dorsal phalloplasty in increasing the visible penis length following PPI. An inflatable penile prosthesis was implanted in 13 patients with severe erectile dysfunction (ED) at the Kamal Shaeer Hospital, Cairo, Egypt, from January 2013 to May 2014. During the surgery, nonabsorbable tacking sutures were used to pin the pubic skin to the pubis through the same penoscrotal incision. Intraoperative penis length was measured before and after the dorsal phalloplasty. Overall patient satisfaction was measured on a 5-point rating scale and patients were requested to subjectively compare their postoperative penis length with memories of their penis length before the onset of ED. Intraoperatively, the dorsal phalloplasty increased the visible length of the erect penis by an average of 25.6%. The average length before and after tacking was 10.2 ± 2.9 cm and 13.7 ± 2.8 cm, respectively (P <0.002). Postoperatively, seven patients (53.8%) reported a longer penis, five patients (38.5%) reported no change in length and one patient (7.7%) reported a slightly shorter penis. The mean overall patient satisfaction score was 4.9 ± 0.3. None of the patients developed postoperative complications. A dorsal phalloplasty during PPI is an effective method of increasing visible penis length, therefore minimising the impression of a shorter penis after implantation.

Functional Variations in the NOS3 Gene Are Associated With Erectile Dysfunction Susceptibility, Age of Onset and Severity in a Han Chinese Population

BackgroundImpaired function of endothelial nitric oxide synthase (eNOS) is involved in the pathologic processes of erectile dysfunction (ED), and three functional polymorphisms (G894T, T-786C, and a tandem repeat of 27 bp in intron 4) in the NOS3 gene, which encodes eNOS, are associated with the clinical characteristics of ED in several populations. AimTo investigate the effect of these variations of NOS3 on ED phenotypes and the response to sildenafil in a Han Chinese population. MethodsThis case-control study enrolled 112 patients with ED and 156 age-matched healthy men. Their medical history and laboratory data were collected. ED severity and response to sildenafil were assessed using the five-item International Index of Erectile Function (IIEF-5) score. Routine polymerase chain reaction and Sanger sequencing were used to genotype the three polymorphisms of NOS3. OutcomesThe frequencies of alleles, genotypes, and haplotypes of the loci in patients and controls; the IIEF-5 scores of patients carrying the risk and non-risk genotype; and the frequencies of risk and non-risk genotypes in patients with different ages at onset and responses to sildenafil were assessed. ResultsThe frequencies of drinkers and diabetic and hyperlipidemic patients in the ED group were higher than those in the age-matched control group (P < .05). The distributions of alleles (G894T, P < .005; T-786C, P < .015), genotypes (G894T, P < 0.015; T-786C, P < .010), and haplotypes (G894T/T-786C, P < .015) of the NOS3 polymorphisms were significantly different between patients with ED and controls. An increased risk for earlier onset of ED was observed in the G894T risk genotype carriers (odds ratio = 3.572; P < .020). Patients with the risk genotype of T-786C exhibited lower IIEF-5 scores than patients with the non-risk genotype (8.2 ± 4.5 vs 12.2 ± 5.0; P < .015). The influence of the T-786C or G894T genotype on the response to sildenafil was not observed. Clinical TranslationThe detectable effect of NOS3 functional polymorphisms on ED suggests their application potential as a molecular biomarker in predicting ED susceptibility and severity in the Han Chinese population. Strengths & LimitationsThis study provides strong evidence that NOS3 functional variation is an independent risk factor for ED in the Han Chinese population, which should be confirmed in larger cohorts considering the limited number of subjects in this study. ConclusionThese results are the first to identify a clear association between NOS3 functional variation and ED susceptibility, age at onset, and severity in the Han Chinese population.Yang B, Liu L, Peng Z, et al. Functional Variations in the NOS3 Gene Are Associated With Erectile Dysfunction Susceptibility, Age of Onset and Severity in a Han Chinese Population. J Sex Med 2017;14:551–557.

260 Characteristics of Secondary, Primary, and Compensated Hypogonadism in Caucasian-European Men Presenting for New Onset Erectile Dysfunction – Results of A Cross-Sectional Survey

260 Characteristics of Secondary, Primary, and Compensated Hypogonadism in Caucasian-European Men Presenting for New Onset Erectile Dysfunction – Results of A Cross-Sectional Survey

Understanding the cellular basis and pathophysiology of Peyronie's disease to optimize treatment for erectile dysfunction.

Erectile dysfunction (ED) is a common condition that significantly impacts a man’s physical and psychological well-being. ED is often associated with Peyronie’s disease (PD), which is an abnormal curvature of the penis. Delayed treatment of or surgical invention for PD often results in ED and therefore unsatisfied patients. The pathophysiology of PD is incompletely understood, but has been studied extensively and based on our current understanding of PD physiology, many medical treatment options have been proposed. In this paper, we will review what is known about the pathophysiology of PD and the medical treatment options that have been trialed as a result. More investigations in regards to the basic science of PD need to be carried out in order to elucidate the exact mechanisms of the fibrosis, and propose new, more successful treatment options which should be implemented prior to the onset of ED.

Erectile dysfunction in fit and healthy young men: psychological or pathological?

Epidemiological studies consistently show that prevalence of erectile dysfunction (ED) increases with ageing. Nonetheless, complaints of ED even in younger men are becoming more and more frequent. Healthcare professionals working in Sexual Medicine but even those operating in different clinical contexts might be adequately prepared to answer this increasing requirement. ED in younger men is likely to be overlooked and dismissed without performing any medical assessment, even the most basic ones, such as collection of medical history and physical exam. This is due to the widespread assumption that ED in younger individuals is a self-limiting condition, which does not deserve any clinical evaluation or therapy and can be managed only with patient reassurance. However, evidence shows that, in younger subjects, organic, psychological and relational conditions can contribute to the pathogenesis of ED and all these conditions might be evaluated and treated, whenever necessary. Among the organic conditions contributing to the onset of ED, metabolic and cardiovascular (CV) risk factors are surprisingly of particular relevance in this age group. In fact, in younger men with ED, even more than in older ones, recognizing CV risk factors or conditions suggestive of cardio-metabolic derangements can help identifying men who, although at low absolute risk due to young age, carry a high relative risk for development of CV events. In this view, the assessment of a possible organic component of ED even in younger individuals acquires a pivotal importance, because it offers the unique opportunity to unearth the presence of CV risk factors, thus allowing effective and high quality preventive interventions.

Erectile dysfunction in anterior urethral strictures after urethroplasty with reference to vascular parameters

BackgroundRelation of erectile dysfunction (ED) with urethroplasty has long been a subject of debate. Very few studies on subcontinent population are available in this regard and still rarer are studies assessing vascular parameters of ED following urethroplasty. The objective of the study was to assess the incidence and prevalence of ED in patients of urethral stricture disease, and to find out effect of urethroplasty on ED after six months of operation including vasculogenic aetiology after operation. MethodsFrom January 2014 to December 2015, 35 subjects underwent urethroplasty. They were assessed pre- and postoperatively by International Index of Erectile Function (IIEF-5) and Pharmacological Colour Doppler Ultrasonography (PCDU) for a period of 6 months. ResultsPreoperative prevalence of ED assessed by IIEF was found to be 82.8%. Postoperative incidence of ED was 28.5% and new onset ED is 50%. There was no significant change in IIEF values and values of peak systolic velocity and resistive index of cavernosal artery over time. ConclusionThere is significant prevalence of ED with urethral stricture. Despite significant postoperative incidence of ED after urethroplasty, the surgical procedure per se does not result in ED.

Coronary Heart Disease, Diabetes, and Sexuality in Men.

Erectile dysfunction (ED) has been well recognized as a marker of increased cardiovascular risk for more than 15 years, especially in younger men. Early detection of ED represents an opportunity to intervene to decrease the risk of future cardiovascular events and limit the progression of ED severity. Evidence suggests there is a window of opportunity of 3 to 5 years from the onset of ED to subsequent cardiovascular events. This opportunity is usually missed if the onus is placed on the patient to seek care for his sexual problems. Unfortunately, these clear messages have not been incorporated into routine cardiovascular care. The reasons for these disparities within specialties are discussed in this article, in addition to management algorithms. Lifestyle modification is usually recommended as the first-line treatment to correct ED and lessen cardiovascular risk, but evidence suggests that this might be effective only in men without established cardiovascular comorbidities. In men with type 2 diabetes mellitus and established cardiovascular disease, lifestyle modification alone is unlikely to be effective. Cardiovascular medications are often associated with sexual dysfunction but changes in medication are more likely to be beneficial in men with milder recent-onset ED. A balanced view must be taken related to medication adverse events, taking into account optimal management of established cardiovascular disease. Testosterone deficiency has been associated with different metabolic disorders, especially metabolic syndrome and type 2 diabetes mellitus. Testosterone deficiency syndrome has been associated with an independent burden on sexual function globally and increased cardiovascular and all-cause mortality. Testosterone replacement therapy has been shown to improve multiple aspects of sexual function and, in some studies, has been associated with a decrease in mortality, especially in men with type 2 diabetes mellitus. Recent studies have suggested that phosphodiesterase type 5 inhibitors, the first-line medications to treat ED, could decrease cardiovascular and all-cause mortality, through multiple mechanisms, predominantly related to improved endothelial function.

Subclinical Vascular Disease and Subsequent Erectile Dysfunction: The Multiethnic Study of Atherosclerosis (MESA).

The association between subclinical cardiovascular disease and subsequent development of erectile dysfunction (ED) remains poorly described. Among multiple subclinical atherosclerosis and vascular dysfunction measurements, coronary artery calcium (CAC) score best predicts ED. After excluding participants taking ED medications at baseline, we studied 1862 men age 45 to 84 years free of known cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA) with comprehensive baseline subclinical vascular disease phenotyping and ED status assessed at MESA visit 5 (9.4 ± 0.5 years after baseline) using a standardized question on ED symptoms. Multivariable logistic regression was used to assess the associations between baseline measures of vascular disease (atherosclerosis domain: CAC, carotid intima-media thickness, carotid plaque, ankle-brachial index; vascular stiffness/function domain: aortic stiffness, carotid stiffness, brachial flow-mediated dilation) and ED symptoms at follow-up. Mean baseline age was 59.5 ± 9 years, and 839 participants (45%) reported ED symptoms at follow-up. Compared with symptom-free individuals, participants with ED had higher baseline prevalence of CAC score >100 (36.4% vs 17.2%), carotid intima-media thickness Z score >75th percentile (35.3% vs 16.6%), carotid plaque score ≥2 (39% vs 21.1%), carotid distensibility <25th percentile (34.6% vs 17.1%), aortic distensibility <25th percentile (34.2% vs 18.7%), and brachial flow-mediated dilation <25th percentile (28.4% vs 21.3%); all P < 0.01. Only CAC >100 (odds ratio: 1.43, 95% confidence interval: 1.09-1.88) and carotid plaque score ≥2 (odds ratio: 1.33, 95% confidence interval: 1.02-1.73) were significantly associated with ED. Subclinical vascular disease is common in men who later self-report ED. Early detection of subclinical atherosclerosis, particularly advanced CAC and carotid plaque, may provide opportunities for predicting the onset of subsequent vascular ED.

PS-08-009 Characteristics of secondary, primary, and compensated hypogonadism in Caucasian-European men presenting for new onset erectile dysfunction - results of a cross-sectional survey

PS-08-009 Characteristics of secondary, primary, and compensated hypogonadism in Caucasian-European men presenting for new onset erectile dysfunction - results of a cross-sectional survey

PD22-10 IMPACT OF COMBINATION THERAPY 5 - ARI + ALPHA - BLOCKERS ON ERECTILE DYSFUNCTION AND ALTERATION OF LIBIDO IN PATIENTS WITH LUTS / BPH: A SYSTEMATIC REVIEW WITH META-ANALYSIS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Medical & Non-surgical Therapy1 Apr 2016PD22-10 IMPACT OF COMBINATION THERAPY 5 - ARI + ALPHA - BLOCKERS ON ERECTILE DYSFUNCTION AND ALTERATION OF LIBIDO IN PATIENTS WITH LUTS / BPH: A SYSTEMATIC REVIEW WITH META-ANALYSIS Giorgio Ivan Russo, Vincenzo Favilla, Tommaso Castelli, Salvatore Privitera, Sebastiano Cimino, and Giuseppe Morgia Giorgio Ivan RussoGiorgio Ivan Russo More articles by this author , Vincenzo FavillaVincenzo Favilla More articles by this author , Tommaso CastelliTommaso Castelli More articles by this author , Salvatore PriviteraSalvatore Privitera More articles by this author , Sebastiano CiminoSebastiano Cimino More articles by this author , and Giuseppe MorgiaGiuseppe Morgia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1503AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Combination therapy with of 5-alpha reductase inhibitors (5-ARI) and alpha-blockers (AB) is the gold standard for the treatment of moderate-severe secondary to benign prostatic hyperplasia (BPH). Several clinical trials have already analyzed the overall impact of the medical treatment of LUTS/BPH on sexual sphere, but any one investigated the overall impact on erectile dysfunction (ED) and libido alterations (LA). The aim of this this systematic review and meta-analysis was to evaluate the impact of combination therapy on ED and LA from randomized clinical trial (RCT) METHODS We performed a search of the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Cochrane Database of Systematic Review, and Web of Science, until December 2014. We conducted a meta-analysis to determine the impact of combination therapy (5ARI + AB) in determining the onset of ED or LA. A p value < 0.10 was used to denote the presence of heterogeneity. RESULTS Of the 103 studies reviewed, only five RCT were included, involving 6131 participants. The overall prevalence of erectile dysfunction was of 7.93%, 6.47% and4.66%in patients treated with combination therapy, 5ARI and AB respectively. The overall prevalence of altered libido was of 3.69%, 3.37% and 2.37% in patients treated with combination therapy, 5ARI and AB respectively. Combination therapy 5ARI + AB was found to be associated with increased risk of ED (OR = 1.81; p <0.00001) and LA (OR = 1:58; p = 0.03) compared to monotherapy with AB. The combination therapy was found to increase the risk of ED (OR = 1.25; p = 0.04) compared to monotherapy with 5ARI, but not the risk of LA (OR = 1:03; p = 0.84). Analyzing the individual monotherapies, therapy with alpha-blockers significantly reduces the risk of ED (OR = 0.70; p <0.01) and LA (OR = 0.67; p = 0.0.1) compared to treatment with 5ARI. CONCLUSIONS Combination therapy 5ARI + ABis associated with a higher risk of ED. In addition, 5ARI monotherapy has the same risk of the combination of having LA. These results could be taken into account during the counseling therapy in patients with LUTS/BPH. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e465 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Giorgio Ivan Russo More articles by this author Vincenzo Favilla More articles by this author Tommaso Castelli More articles by this author Salvatore Privitera More articles by this author Sebastiano Cimino More articles by this author Giuseppe Morgia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Male sexual dysfunction in patients with chronic end-stage renal insufficiency and in renal transplant recipients.

The study was conducted from December 2011 to December 2012 on 95 patients between the ages of 20 and 65 years: 44 of which had been undergoing dialysis for over a year and 51 of whom had undergone kidney transplants more than 6 months before. Comorbidities were carefully recorded, erectile function was evaluated the with IIEF5 questionnaire and serum levels of total testosterone / free and prolactin were tested at early morning (7 AM). To assess the relationship between erectile dysfunction (ED) and clinical laboratory tests, Student's t-test statistical (quantitative variables), chi-square (qualitative variables), the uni and multivariate analysis were used. In patients undergoing dialysis and in recently transplanted patients a higher instance of ED was found (70% and 65% of cases respectively). Amongst dialyzed patients, patients aged over 50 suffer from ED more frequently. Patients aged over 50s represent 61% of the total number of patients suffering from ED, and just 31% of patients not suffering from ED, (p = 0.006); Hyperprolactinemia was found in 23% and 20% of both groups respectively. Fifty nine % of the dialyzed patients presented values of testosterone serum levels of less than 250 ng/dl with a significant difference between those who were suffering from ED and those who were not (65% of ED patients vs. 46%,of patients not affected from ED p = 0.019). This was found in only 37% of transplanted patients and there does not appear to be a statistically significant correlation with the onset of ED (p = 0.12). In patients over the age of 50, diabetes and a condition of hypotestosteronemia were significantly correlated with ED at univariate and multivariate analyses. The ED in patients with end stage chronic kidney failure (CKF) continues to have a strong prevalence, either in the patients who are undergoing dialysis or in those who have received transplants. In literature this issue is not sufficiently considered if not at all. Hypotestosteronemia is a risk factor for the onset of ED in end stage CKF patients. A significantly lower prevalence of hypogonadism among dialyzed patents and transplant recipients suggests that renal transplantation may be protective for the sexual capabilities of these patients.

New Onset of Erectile Dysfunction in a Cohort of Patients Enrolled in Active Surveillance for Low Risk Prostate Cancer: A Preliminary Study to Evaluate Incidence and Prognostic Factors

Objective: Active Surveillance (AS) is a viable alternative to surgery or radiotherapy dedicated to selected patients suffering from low-risk prostate cancer. Aim of the study was to evaluate the onset of Erectile Dysfunction (ED) in patients underwent to AS option and identify potential factors associated to the onset of ED. Methods: From January 2011 to May 2014 were prospectively assessed patients included in AS; we evaluated baseline comorbidity including Diabetes, Hypertension, Body Mass Index (BMI), International Prostate Symptoms Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) score. Were excluded from the assessment patients with baseline ED, defined as an IIEF-5 score < 22 and patient with follow-up less than 24 months. Results: Among the 28 patients underwent to AS aged between 48 and 67 years who meet the selection criteria, 16 (57%) developed new onset of ED with different degrees. At multivariate analysis, no comorbidity were statistically associated to ED even thought a correlation with the onset of E.D. and BMI, Diabetes, Hypertension and age were founded. Conclusions: AS is associated to a high occurrence of ED; among the comorbidities, BMI, Diabetes and Hypertension showed a correlation to a new onset of ED; additional studies are needed to confirm this hypothesis.

Adding liraglutide to lifestyle changes, metformin and testosterone therapy boosts erectile function in diabetic obese men with overt hypogonadism.

The aim of this retrospective observational study was to evaluate whether adding liraglutide to lifestyle changes, metformin (Met) and testosterone replacement therapy (TRT), by means of improving weight and glycaemic control, could boost erectile function in type 2 diabetic obese men with overt hypogonadism and erectile dysfunction (ED) in a 'real-life setting'. Forty-three obese, diabetic and hypogonadal men (aged 45-59 years) were evaluated because of complaining about the recent onset of ED. They were subdivided into two groups according to whether hypogonadism occurred after puberty (G1; n = 30: 25 with dysfunctional hypogonadism and 5 with acquired hypogonadotropic hypogonadism) or before puberty (G2; n = 13: 10 with Klinefelter's syndrome and 3 with idiopathic hypogonadotropic hypogonadism). Both G1 and G2 patients were given a combination of testosterone (T) [testosterone undecanoate (TU) 1000 mg/every 12 weeks] and Met (2000-3000 mg/day) for 1 year. In the poor responders (N) to this therapy in terms of glycaemic target (G1N: n = 16; G2N: n = 10), liraglutide (L) (1.2 μg/day) was added for a second year, while the good responders (Y) to T + Met (G1Y: 14/30 and G2Y: 3/13) continued this two drugs regimen therapy for another year. All patients were asked to fill in the International Index of Erectile Function (IIEF 15) questionnaire before starting TU plus Met (T1) and after 12 months (T2) and 24 months (T3) of treatment. Patients underwent a clinical examination and a determination of serum sex hormone binding globulin (SHBG), total testosterone (T) and glycosylated haemoglobin (HbA1c) at T1, T2 and T3. At T2, each patient obtained an improvement of ED (p < 0.01) and of the metabolic parameters without reaching, however, the glycaemic goals [HbA1c = >7.5% (>58 mmol/mol)], while T turned out to be within the range of young men. L added to TU and Met regimen in G1N and G2N allowed these patients to reach not only the glycaemic target [HbA1c = <7.5% (<58 nmol/mol)] and a significant reduction in body weight (p < 0.01), but also a further increase in SHBG (p < 0.05) and T (p < 0.01) plasma levels as well as a significant increment of IIEF score (T3). Conversely, at T3 G1Y and G2Y, who received the combined therapy with TRT and Met for the second year, showed a partial failure of that treatment given that there was no improvement of the IIEF score and they showed a significant rise in serum HbA1c (p < 0.05) and weight (p < 0.04) compared with the assessments at T2. These results suggest that TRT could improve clinical and metabolic parameters in obese, type 2 diabetic men with ED and overt hypogonadism (independently of when T deficit occurred). Furthermore, in case of insufficient metabolic control the addition of L to TRT and Met regimen allows to achieve serum T levels in the range of healthy men, as well as to reach glycaemic target and to lower weight, leading to a considerable improvement of ED.

RISK FACTORS IN SEVERE ERECTILE DYSFUNCTION POPULATION

Objective: To find the risk factors of severe erectile dysfunction. Material &amp; methods: This Cross sectional study subjects completed the questionnare at the time of diagnosing Erectile Dysfunction (ED). Amount of 297 ED patients with mean age of 49.08 ± 13.69 years were enrolled consecutively at Urology Outpatient Clinic from 2005 to 2012. The questionnaire consisted of marital status, educational status, and occupation, comorbidities, habits, and International Index of Erectile Dysfunction-5 (IIEF-5) questionnare. We compared population proportion of ED severity (severe vs not severe) between sociodemographic, comorbidities and habits group and we also compared the mean of ED onset age and ED duration between those groups. Results: Of the patients, 29.3% were classified as severe ED, and 70.7% were classified other than severe ED (mild, mild-moderate, etc). The median of ED onset age was 47 years (46.64 ± 13.77 years) and the median of ED duration was 52 weeks (126.75 ± 167.69 weeks) ranged from 1 to 1040 weeks. We found status of low education level, unemployed, not married and having diabetes mellitus could increase the risk of having severe ED in ED population with each prevalence ratio was 1.44 (1.12-1.87), 2.02 (1.20-3.42), 1.91 (1.10-3.30), 2.01 (1.30-3.12). Not married group was also found have an earlier mean of ED age onset (mean difference 6.78 (2.37-11.19) years. Conclusion: We found that education level, occupation status, marital status and diabetes mellitus contributes in determining ED severity.

Erectile dysfunction is a prognostic indicator of comorbidities in men with late onset hypogonadism

Introduction: The role of testosterone deficiency in erectile dysfunction (ED) is increasingly recognized; however, there is a need to clarify the nature of the relationship between ED and late onset hypogonadism (LOH).Aim: In this study, we sought to determine the correlators of ED severity amongst men with LOH.Methods: 130 patients diagnosed with LOH fulfilling the criteria of total testosterone ≤3.5 ng/ml (<12 nmol/l) and with an erectile function domain score <21 on the International Index of Erectile Function questionnaire (IIEF questions 1–5) were enrolled for a subsequent trial of Testosterone Undecanoate. Demographic data were recorded at baseline.Main outcome measures: Subjects completed three standardised questionnaires to assess sexual health including International Prostate Symptom Score (IPSS), Aging Males Symptoms (AMS) and IIEF Sexual Health Inventory for Men (SHIM). Patients were stratified by ED severity with SHIM scores of 1–7 considered severe ED, 8–11 moderate ED and 12–16 mild to moderate. Serum testosterone, sex hormone binding globulin (SHBG) and lipids (total cholesterol, triglycerides, high-density lipoprotein and low-density lipoprotein) were assessed along with plasma fasting glucose and HbA1c. Weight, BMI and waist circumference were also recorded.Results: A significant association was observed between severity of ED and mean weight (p = 0.000), waist circumference (p = 0.000), triglycerides (p = 0.009), total cholesterol (p = 0.027), HbA1c (p = 0.000), fasting glucose (p = 0.003) and AMS scores (p = 0.043). No significant differences were seen in testosterone fractions and SHBG levels between ED subgroups. A positive correlation existed between the prevalence of diabetes mellitus (type 1 and type 2) and ED severity in this cohort (p = 0.018).Conclusions: The descriptive data of our cohort show that increased severity of ED within LOH patients correlated with an increased waist circumference, hyperglycemia, hypertriglyceridemia, hyperlipidemia and a history of diabetes mellitus. Severe ED functions as a prognostic indicator of co-morbidities in men with LOH.

Prevalence of Diabetes Mellitus (DM) in a population of men affected by Erectile Dysfunction (ED).

A) to evaluate the prevalence of patients affected by Diabetes Mellitus (DM) in a population of men with Erectile Dysfunction (ED); B) to define the epidemiological, biochemical and therapeutic aspects. N.934 subjects referred at our Andrology Unit for ED were studied. The diagnosis of ED was evaluated using the IIEF-5 questionnaire (Total score ≤21). The prevalence of subjects affected by DM in a population of men with ED was 19.5% (182/934). The age ranges were: ≥55 years (108/182; 59.3%); ≥40<55 years (70/182; 38.5%); <40 years (4/182; 2.2%). HbA1c mean value was 7.9% ± 0.8%. No significant differences were found in DM onset timing or in anti-diabetic treatment. In n.125/182 cases (68.7%) the ED onset followed the diagnosis of DM; in n.34/182 cases (18.7%) it appeared at the same time; and in n.23/182 cases (12.6%) appeared before DM diagnosis. in n.18/182 subjects (9.9%) there was a concomitant hypotestosteronemia; these patients were treated only with testosterone replacement; this treatment was efficacious (IIEF-5 total score ≥22) in 8/18 subjects (44.4%). In n.146/182 subjects (80.2%) a treatment with PDE5-i was given. Of these 146 subjects, the therapy was given "on demand" to 108 subjects (efficacy in 50.9%; 55/108) and "once a day" to the remaining 38 subjects (efficacy 63.1%, 24/38) (p=0.428, n.s.). N.15/182 subjects (8.2%) were treated with intracavernous injections of Alprostadil (efficacy in 8/15, 53.3%). In n.3/182 subjects (1.6%) a penile prosthesis was implanted. DM is one of the most frequent organic causes of ED; there were many strategies to treat this symptom without interfering with the antidiabetic treatment. Finally, ED can be predictive of DM.

Calcification of the internal pudendal artery and development of erectile dysfunction in adenine-induced chronic kidney disease: a sentinel of systemic vascular changes.

Chronic kidney disease (CKD), erectile dysfunction (ED), and cardiovascular disease share common vascular etiologies and risk factors. Using a rat model, this is the first study to characterize the consequences of CKD in the onset and development of ED associated with differential regional vascular calcification and circulatory changes. Stable CKD was generated at 3 weeks in male Sprague-Dawley rats given dietary adenine and progressed until 7 weeks. Mineral content and morphometry were assessed in the internal pudendal arteries (IPAs), thoracic aorta, and carotid artery. Endothelial function was determined via changes in serum von Willebrand factor (VWF) and endothelium-dependent relaxation of the thoracic aorta. In severe CKD rats, calcium and phosphate content in all arteries increased, and pulse wave velocity was elevated. Distal IPA segments, in particular, were the first to calcify, but penile tissue per se did not. CKD rats had endothelial dysfunction, as indicated by a decrease in acetylcholine-mediated relaxation (∼40%) and an increase in serum VWF (∼40%), as well as increased lumen diameter (20%) of the distal IPA. Erectile function, assessed using a centrally acting dopaminergic agent, was significantly impaired by 7 weeks (∼40%). In CKD, the distal IPA appears to be more susceptible to vascular dysfunction and calcification. Additionally, the onset of ED may be an important sentinel of impending systemic vascular disease. To confirm this concept, future experimental and clinical studies will need to examine a range of vessel types and the use of supplementary methods to assess erectile function.

Prostate cancer survivorship: a review of erectile dysfunction and penile rehabilitation after prostate cancer therapy.

Prostate cancer diagnosis and treatment adversely affect quality of life for most men. The true incidence of erectile dysfunction (ED) after prostate cancer therapy is unknown, and the rates of ED in radical prostatectomy (RP) and radiation groups are similar, although the onset of ED is often later in patients treated with radiation therapy. Proposed pathophysiological mechanisms of ED include neurovascular injury, local inflammatory changes, damage to nearby supporting structures, cavernosal smooth muscle hypoxia with ensuing smooth muscle apoptosis and fibrosis, and corporal veno-occlusive dysfunction causing venous leakage. Penile rehabilitation aims to help men regain the ability to achieve erections sufficient for satisfactory sexual intercourse during rehabilitation from prostate cancer treatment, and ultimately to return to pretreatment erectile function. While there is no consensus on the ideal rehabilitation regimen, many sexual health experts agree that treatment should start as soon as possible to protect and/or prevent corporal endothelial and smooth muscle damage. Current management strategies for erectile function rehabilitation predominantly relate to patients who have had RP. Phosphodiesterase type 5 inhibitors, intracavernosal injection of vasoactive agents and vacuum erection devices are options which can be used in a rehabilitation program. Penile implants should be considered if patients do not respond to medical therapies. To facilitate informed decision making, patients should be presented with all treatment options, and told that rehabilitation and treatment for ED as early as possible after prostate cancer therapy will result in faster and better recovery of erectile function and preserve sexual continuity.