Onset Of Erectile Dysfunction Research Articles

5 OUTCOME OF DORSAL BUCCAL GRAFT AUGMENTED ANASTOMOSIS FOR URETHRAL STRICTURES AFTER A FAILED RECONSTRUCTION

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery1 Apr 20115 OUTCOME OF DORSAL BUCCAL GRAFT AUGMENTED ANASTOMOSIS FOR URETHRAL STRICTURES AFTER A FAILED RECONSTRUCTION Erik Grossgold, Britton Tisdale, Christopher Bayne, Lisa Parrillo, Jeremy Tonkin, Kurt McCammon, and Gerald Jordan Erik GrossgoldErik Grossgold Norfolk, VA More articles by this author , Britton TisdaleBritton Tisdale Norfolk, VA More articles by this author , Christopher BayneChristopher Bayne Norfolk, VA More articles by this author , Lisa ParrilloLisa Parrillo Norfolk, VA More articles by this author , Jeremy TonkinJeremy Tonkin Norfolk, VA More articles by this author , Kurt McCammonKurt McCammon Norfolk, VA More articles by this author , and Gerald JordanGerald Jordan Norfolk, VA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.066AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Buccal graft augmented anastomosis (BGAA) can be an excellent option for bulbar urethral strictures that are not amenable to primary anastomotic techniques. This can be even more challenging when dealing with a previously reconstructed urethra. We performed this study to examine the outcomes and complications of BGAA for recurrent urethral strictures after a failed reconstruction. METHODS 76 patients underwent BGAA between 2000–2009. Of these, 28 (37%) had prior open urethral reconstruction. Their charts were retrospectively reviewed, and the patients were contacted by phone and asked about ongoing symptoms. Failure was defined as recurrent stricture requiring intervention. Patients underwent voiding urethrography at 3 weeks post-surgery, and cystourethroscopy at 6 months post-surgery. Patients were followed annually thereafter with subsequent endoscopic/radiographic studies performed in symptomatic patients. RESULTS Mean age was 46 years. Follow-up averaged 862 days (25 to 3424). Stricture etiology was idiopathic in 13 (46%), instrumentation in 5 (18%), perineal trauma in 4 (14%), post-hypospadias repair in 4 (14%), and post-infectious in 2 (7%). Mean stricture length was 6.4 cm (2 to 15). One graft was used in 16 patients (57%), and two were used in 12 (43%). All patients had at least one prior open reconstruction. 20 patients were available by phone, 4 had moved and/or changed their numbers, 3 did not return the call, and 1 patient was deceased. Of those contacted, 15 report no significant problems, 1 has improved force of stream on tamsulosin, 1 reports occasional post-void dribbling, 1 requires clean intermittent catheterization for neurogenic bladder secondary to multiple sclerosis, and 2 patients (10%) recurred. Both patients who recurred reported symptomatic improvement after subsequent urethrotomies. Post-operative complications include a pulmonary embolus in a patient found to have a coagulopathy. Occasional UTI was found in 7 patients (25%). New onset erectile dysfunction or subjective worsening of existing erectile dysfunction was reported in 4 patients (14%). 2 patients had post-operative scrotal paresthesias. 1 patient developed a viral gastroenteritis in the immediate post-operative period. CONCLUSIONS BGAA for recurrent urethral stricture disease after a failed reconstruction can be safe and effective with a success rate of 90%. Continued surveillance of these patients with longer follow-up is required to confirm these findings. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySiegel J, Panda A, Tausch T, Meissner M, Klein A and Morey A (2018) Repeat Excision and Primary Anastomotic Urethroplasty for Salvage of Recurrent Bulbar Urethral StrictureJournal of Urology, VOL. 194, NO. 5, (1316-1322), Online publication date: 1-Nov-2015.Blaschko S, McAninch J, Myers J, Schlomer B and Breyer B (2018) Repeat Urethroplasty After Failed Urethral Reconstruction: Outcome Analysis of 130 PatientsJournal of Urology, VOL. 188, NO. 6, (2260-2264), Online publication date: 1-Dec-2012. Volume 185Issue 4SApril 2011Page: e2 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erik Grossgold Norfolk, VA More articles by this author Britton Tisdale Norfolk, VA More articles by this author Christopher Bayne Norfolk, VA More articles by this author Lisa Parrillo Norfolk, VA More articles by this author Jeremy Tonkin Norfolk, VA More articles by this author Kurt McCammon Norfolk, VA More articles by this author Gerald Jordan Norfolk, VA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

921 INCIDENT HYPERTENSION AND RISK OF SUBSEQUENT ERECTILE DYSFUNCTION IN MEN WITH TYPE 1 DIABETES

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Basic Research1 Apr 2011921 INCIDENT HYPERTENSION AND RISK OF SUBSEQUENT ERECTILE DYSFUNCTION IN MEN WITH TYPE 1 DIABETES James Hotaling, Aruna Sarma, Rodney Dunn, Jeremy Soule, Ian DeBoer, Thomas Walsh, Patricia Cleary, Patrick Heagerty, Hunter Wessells, and DCCT/EDIC Study Groupe James HotalingJames Hotaling Seattle, WA More articles by this author , Aruna SarmaAruna Sarma Ann Arbor, MI More articles by this author , Rodney DunnRodney Dunn Ann Arbor, MI More articles by this author , Jeremy SouleJeremy Soule Charleston, SC More articles by this author , Ian DeBoerIan DeBoer Seattle, WA More articles by this author , Thomas WalshThomas Walsh Seattle, WA More articles by this author , Patricia ClearyPatricia Cleary Rockville, MD More articles by this author , Patrick HeagertyPatrick Heagerty Seattle, WA More articles by this author , Hunter WessellsHunter Wessells Seattle, WA More articles by this author , and DCCT/EDIC Study Groupe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.812AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine how the development of hypertension modulates the risk of incident erectile dysfunction (ED) over time in men with type I diabetes (T1D). METHODS The study cohort consisted of men enrolled in years 1–13 of the Epidemiology of Diabetes Interventions and Complications (EDIC) Study, the observational follow up of participants of the Diabetes Control and Complications Trial (DCCT). Erectile dysfunction was assessed yearly with a single question querying presence/absence of impotence. Incident hypertension was defined to occur when any of the following criteria were met on 2 consecutive occasions: SBP of 140 mmHg or higher, DBP of 90 mmHg or higher, or use of antihypertensive medications to treat high blood pressure. Cox proportional hazards models estimated the risk of incident ED associated with prior development of hypertension after adjustment for age, prior DCCT assignment to intensive or conventional glycemic treatment, and hemoglobin A1c (HbA1c) levels over time. RESULTS Of the 761 male subjects with a mean age of 35 years at DCCT closeout, 315 (41%) reported history of impotence at any point during the 13 years of follow-up. The median age of onset of ED was 50 years. The cumulative incidence of hypertension over the 13 years of EDIC was 48%. Incident hypertension was associated with a 1.6 times greater risk of subsequent ED (p=0.001) after adjustment for age, DCCT treatment arm and mean HbA1c levels during the DCCT and EDIC. Hazard ratios for age and diabetes variables are included in the table below. Hazard Ratios for Risk of ED HR p-value Incident Hypertension 1.6 0.001 DCCT Treatment Arm 1.0 0.8 DCCT Mean HbA1c 1.1 0.2 EDIC Mean HbA1c 1.4 Age 1.1 CONCLUSIONS We found an association between incident hypertension and development of subsequent ED in men with T1D that is independent of age and glycemic control. Although analyses are required to control for potential confounding effects of antihypertensive medications, these data suggest that the potential pathophysiological impact of hypertension on diabetes associated ED requires further investigation. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e369 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Hotaling Seattle, WA More articles by this author Aruna Sarma Ann Arbor, MI More articles by this author Rodney Dunn Ann Arbor, MI More articles by this author Jeremy Soule Charleston, SC More articles by this author Ian DeBoer Seattle, WA More articles by this author Thomas Walsh Seattle, WA More articles by this author Patricia Cleary Rockville, MD More articles by this author Patrick Heagerty Seattle, WA More articles by this author Hunter Wessells Seattle, WA More articles by this author DCCT/EDIC Study Groupe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Vena Cava Thrombectomy and Primary Repair After Radical Nephrectomy for Renal Cell Carcinoma: Single-Center Experience

Inferior vena cava (IVC) reconstruction for locally advanced renal cell carcinoma (RCC) includes resection with and without interposition grafting, patch graft, or primary repair. The proposed benefits of lateral venorrhaphy and primary repair are avoidance of foreign material, a more expeditious repair, and preservation of lower extremity venous outflow. A single-center retrospective review of 22 patients with RCC and IVC tumor thrombus treated with radical nephrectomy, lateral venorrhaphy, thrombectomy, and primary vena cava repair between July 2002 and June 2009 was carried out. Demographic data, diagnostic information, radiographic cross-sectional imaging, and procedural outcomes were examined. Among the 13 men and nine women, the mean age was 62.1 years (42-83); mean tumor size was 9.8 cm (3-17 cm), and 90% (n = 18) of the cases with RCC were identified pathologically as clear cell adenocarcinoma; on the basis of the classification system adopted by Neves, level I was for 50% (n = 11), level II for 32% (n = 7), level III for 9% (n = 2), and level IV for 9% (n = 2) of the patients. All patients underwent en bloc radical nephrectomy with tumor thrombus removal and primary IVC repair. Mean total operative time was 547.9 ± 138.5 minutes, whereas mean IVC cross-clamp time was 10.8 minutes (6-29 minutes). There were no intraoperative deaths or pulmonary embolism and all IVC margins were found to be pathologically negative. Postoperative complications included one pulmonary embolism, one exacerbation of chronic lymphedema, and two cases of new onset erectile dysfunction. Mean follow-up was 36.4 ± 23.2 months (6-92 months). There were no radiographic or clinically significant changes in mean IVC diameter during follow-up. Five late deaths (23%) occurred as a result of metastatic RCC over a mean period of 24 months (range, 12-48), but without any local recurrences. For advanced RCC with tumor thrombus extension into the IVC, lateral venorrhaphy and primary IVC repair avoids complicated caval reconstructions and results in high patency rates with a low local tumor recurrence rate.

P3 Posterior reversible encephalopathy with late postpartum eclampsia: a case report

Impaired 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.To investigate the effect of these variations of NOS3 on ED phenotypes and the response to sildenafil in a Han Chinese population.This 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.The 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.The 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.The 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.This 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.These 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.

Chronic inhibition of nitric‐oxide synthase induces hypertension and erectile dysfunction in the rat that is not reversed by sildenafil

Aetiology (case control) Level of Evidence 3b OBJECTIVE To evaluate the effect of N(G)-nitro-L-arginine methyl ester (L-NAME)-induced hypertension (HT) on erectile function in the rat and determine if the phosphodiesterase (PDE)-5 inhibitor, sildenafil, can reverse the effects of nitric oxide (NO) deficiency, as HT is a risk factor for erectile dysfunction (ED) and the NO synthase (NOS) inhibitor L-NAME induces NO-deficient HT. Thirty-six adult Sprague-Dawley male rats were divided into three groups, i.e. a control, L-NAME-HT (40 mg/rat/day in the drinking water for 4 weeks), and sildenafil-treated L-NAME-HT (1.5 mg/rat/day sildenafil, by oral gavage concomitantly with L-NAME). The erectile response expressed as a ratio of intracavernosal pressure (ICP)/mean arterial pressure (MAP), evaluated after electrical stimulation of the right cavernous nerve. The isometric tension of corpus cavernosum smooth muscle (CCSM) was measured in organ-bath experiments. NOS expression was determined immunohistochemically for neuronal (n)NOS and by Western blot analysis for endothelial (e) and inducible (i) NOS protein. cGMP levels were evaluated by enzyme-linked immunosorbent assay. The erectile response was diminished in the HT group. Nitrergic and endothelium-dependent relaxation was reduced, while the relaxation response to sodium nitroprusside and contractile response to phenylephrine were not altered in CCSM from L-NAME-treated rats. HT rats showed decreased expression of nNOS, whereas eNOS and iNOS protein expression was increased. Sildenafil partly restored endothelial and molecular changes in CCSM from HT rats, but did not reverse the decreased erectile response, even as cGMP levels returned to normal levels. Sildenafil treatment did not correct the ED in L-NAME-treated HT rats. Under sustained high blood pressure, up-regulation of PDE5 expression failed to reverse the depletion of neuronal NO and/or impaired nNOS activity. However, endothelium-dependent relaxation was restored. Drug targeting of neuronal dysfunction might delay the onset of ED in HT.

Effect of Testicular Sperm Extraction Outcome on Sexual Function in Patients With Male Factor Infertility

To document the effects of the outcome of testicular sperm extraction (TESE) procedures on erectile function in patients with male factor infertility. A total of 66 nonobstructive azoospermic patients were divided into 2 groups: group I, with sperm-positive results and group II, with sperm-negative results. The patients were evaluated with the International Index of Erectile Function-5 (IIEF-5) and Hospital Anxiety-Depression Scale. Hormones were analyzed before and 6 months after the procedure. Each group was compared with the use of the paired t test, where P <.05 was accepted as statistically significant. The mean patient age was 34.8 years (range 24-53). Of 66 cases, 26 (40%) experienced positive results for the TESE. The median IIEF-5 score before TESE for group I and group II was 22 (minimum: 11, maximum: 25) and 23 (minimum: 10, maximum: 25), respectively. The median IIEF-5 score after TESE for group I and group II was 23.5 (minimum: 10, maximum: 25) and 18 (minimum: 15, maximum: 25), respectively. In patients who reported new onset erectile dysfunction (ED) 6 months after surgery, the mean follicle-stimulating hormone and luteinizing hormone levels increased from 21 +/- 2 to 38 +/- 3 IU/L (P <.001), and from 11 +/- 2 to 14 +/- 2 IU/L (P >.05), respectively. The mean total testosterone level decreased from 7.83 +/- 2 to 2.8 +/- 2 ng/mL (P <.001). The Hospital Anxiety and Depression Scale revealed that patients who reported new onset ED also reported both depression and anxiety. Unsuccessful TESE procedures might have a negative effect on erectile function because of hormonal and psychological reasons. The andrologist should treat the ED of the patients and refer them to the psychiatrist for anxiety and depression assessment.

Erectile Dysfunction (ED) is a Shared Sexual Concern of Couples II: Association of Female Partner Characteristics with Male Partner ED Treatment Seeking and Phosphodiesterase Type 5 Inhibitor Utilization

Erectile dysfunction (ED) is a prevalent condition that impacts on both patients and their female partners. ED may therefore be regarded as a shared sexual concern for couples. The current analysis of the Female Experience of Men's Attitudes to Life Events and Sexuality (FEMALES) study data addresses women's perceptions, beliefs, and attitudes concerning their partner's ED, and whether these are associated with the likelihood of the male partner seeking medical advice and utilizing phosphodiesterase type 5 inhibitors. The current research sought to explore the association of female partners' perceptions of male partners' ED and male partners' medical consultation and treatment seeking for ED. Questionnaires were sent to partners of men who participated in the Men's Attitudes to Life Events and Sexuality (MALES) 2004 study, and who consented to their partner's involvement. A modified version of the questionnaire used in the MALES study was developed for the FEMALES study, reflecting the female partner's perspective. A 65-item questionnaire assessing women's perceptions, beliefs, and attitudes regarding various aspects of ED. Women's perceptions of the nature and causes of their partner's ED were significantly associated with men's treatment seeking and utilization. Significant associations were observed between women's level of satisfaction with the relationship before ED onset; perceptions of the impact of ED on quality of life; desire to deal with ED; attitudes to ED treatment; and the treatment-seeking behavior of the male partner. Multivariate regression analyses identified a mixture of female and male partner perceptions and attitudes that uniquely accounted for >30% of the variance in men's ED treatment-seeking behavior and treatment utilization. This study illustrates the importance of the female partner's attitudes to ED in men's ED treatment-seeking behavior. These findings strongly support the potential benefits of partner integration into ED consultation and treatment strategies.

T-786C Polymorphism in Promoter of eNOS Gene as Genetic Risk Factor in Patients With Erectile Dysfunction in Turkish Population

To investigate the effect of 2 endothelial nitric oxide synthase gene polymorphisms, namely, variable number of 27-bp tandem repeats in intron 4 and T-786C in the promoter region, on the susceptibility to erectile dysfunction (ED) in Turkish population. A total of 72 patients with ED (mean age 54.3 +/- 9.2 years) diagnosed by Doppler ultrasonography and 71 healthy controls (mean age 55.4 +/- 8.2 years) were analyzed. Genotypes were determined through polymerase chain reaction with or without restriction endonuclease digestions. Genotype distribution for CC genotype of T-786C polymorphism in promoter was significantly different between patients with ED and controls, the genotype frequency being 31.9% and 12.7%, respectively (P = .019). The univariate odds ratio (OR) associated with CC alleles revealed 3 times increased risk for ED (OR = 3.2; 95% confidence interval [CI], 1.4-7.6; P = .006). The risk also holds when excluding patients with hypertension and diabetes mellitus (P = .012, OR = 3.1; 95% CI, 1.2-7.7) as well as obesity (P = .05, OR = 4; 95% CI, 1.05-15.3). Patients with CC genotype of promoter present earlier symptoms of ED (51.7%) compared with controls (10.7%) (P <.001). No significant correlation was observed with variable number of tandem repeats in intron 4 and with the type of vascular insufficiency. The CC genotype of T-786C polymorphism in the promoter of eNOS gene is associated with increased risk of ED in Turkish population. Earlier onset of ED with CC genotype suggests that CC allele is an independent risk factor for endothelial dysfunction in the absence of other risk factors (hypertension, diabetes mellitus, obesity). An impaired NO production because of CC alleles may account for pathophysiology of ED.

Statins and Erectile Dysfunction

HMG-CoA reductase inhibitors, more commonly called statins, are widely used in the pharmacological management of hyperlipidaemias. The most common adverse drug reactions (ADRs) of statins are muscular. Other reported ADRs of statins along with other lipid-lowering drugs, namely fibrates, include erectile dysfunction (ED). The relationship between ED and exposure to statins has not clearly been established even though a number of significant case reports have associated ED with exposure to statins. To investigate the association between exposure to statins and the occurrence of ED on the French Pharmacovigilance System Database. Within the French Pharmacovigilance System Database, the case/non-case method was used to measure the disproportionality of combination between a statin and ED. Cases are defined as those reports corresponding to the ADR of interest (i.e. ED) and non-cases are all reports of ADRs other than that being studied. The study period was from 1 January 1985 to 31 December 2006, limited to males aged 13-80 years. We estimated the association between ED and statins by calculating a reporting odds ratio (ROR) of exposure to each drug, with its 95% confidence interval (CI). Among the total of spontaneous reports selected (110 685), exposure to statins was identified in 4471 cases (4%), of which 51 reports (1.1%) concerned ED, whereas 431 (0.4%) cases of ED were found in the 106 214 reports without exposure to statins (p < 0.0001). The mean delay of onset of ED after starting statins, known for 19 cases, was 62 days (median 29 days). In 56.9% of cases, recovery occurred after withdrawal of statin, and rechallenge was positive in five cases. The association was statistically significant for all statins (adjusted ROR [aROR] = 2.4; 95% CI 1.8, 3.3), simvastatin (aROR = 2.6; 1.6, 4.1), atorvastatin (aROR = 3.4; 2.1, 5.4) and rosuvastatin (aROR = 7.1; 2.6, 19.4) [p < 0.001 for all] but not for pravastatin and fluvastatin. We did not find any relationship between the occurrence of ED and the daily dose or the duration of exposure to statins (data not shown). Assessment of the association between drugs other than statins known to be at risk of ED confirmed a significant association for finasteride (aROR = 14.5; 95% CI 8.3, 25.4), fibrates (aROR = 3.6; 2.6, 5.1), beta-adrenergic receptor antagonists (aROR = 1.5; 1.01, 2.1) and tricyclic antidepressants (aROR = 2.0; 1.2, 3.4) [all p < 0.05]. Despite some methodological limitations, the present study suggests that statins may induce or worsen ED in accordance with other data. Further pharmacoepidemiological studies are necessary to confirm this conclusion and to improve the precision of the prevalence and/or the risk factors of this ADR.

Predictors of Response to Sildenafil Citrate Following Radiation Therapy for Prostate Cancer

Phosphodiesterase type 5 inhibitor (PDE5) use is a treatment strategy for prostate cancer patients with post-radiation therapy (RT) erectile dysfunction (ED). To define the predictors of sildenafil response in men treated with RT for prostate cancer. International Index of Erectile Function (IIEF). Patients were enrolled prospectively if they met the following criteria: (i) either a three-dimensional conformal external beam (EBRT) or brachytherapy (BT) with or without androgen deprivation (AD) for prostate cancer; (ii) self-reported ability to have sexual intercourse prior to RT; (iii) experienced onset of ED following RT; (iv) candidates for sildenafil citrate use; (v) followed-up periodically; and (vi) completed the IIEF at least 12 months after RT. Failure to respond to sildenafil was defined as IIEF-erectile function (EF) domain score of <22. One hundred fifty-two patients met all the criteria: 110 in the EBRT group and 42 in the BT group. Mean age was 62 years. The mean follow-up was 38 months. Mean radiation dose for EBRT was 78 Gy and for BT was 101 Gy. Thirty-five patients received AD, 25% of EBRT, and 62% of BT patients. Sixty-one percent of the patients receiving AD had exposure only pre-RT, whereas 39% had pre- and post-RT AD exposure. The mean duration of AD was 4.6 months. Post-RT IIEF-EF domain score at >24 months was 17. Successful response to sildenafil occurred in 68% of men at 12 months after RT, 50% at 24 months, and 36% at 36 months. On multivariable analysis, predictors of failure to respond to sildenafil were: older age, longer time after RT, AD > 4 months duration, and RT dose > 85 Gy. Modality of radiation delivery was not predictive of sildenafil failure. A steady decrease in sildenafil response was seen with increasing duration after RT. Several factors were predictive of sildenafil failure.

Prevention of cardiovascular disease by the early identification of erectile dysfunction

Both erectile dysfunction (ED) and vascular disease share the same risk factors and the two conditions often coexist, with endothelial dysfunction being the common underlying pathophysiology. Up to two-thirds of all patients with clinically evident coronary artery disease (CAD) have ED. Because of their smaller size, the same degree of lipid plaque burden has a greater effect on the penile arteries compared with the coronary arteries. As a result, the clinical consequences of penile vascular disease (ED) frequently manifest 2-3 years before the consequences of coronary atherosclerosis. This phenomenon has led to the widespread view that ED is a silent marker of vascular disease, particularly CAD, in otherwise asymptomatic men. The Second Princeton Consensus Guidelines reflect this by stating that a man with ED and no cardiac symptoms should be considered a cardiac (or vascular) patient until proven otherwise. For most men with no cardiac symptoms, we therefore have 2-3 years from ED onset to reduce the risk of a cardiovascular event. This article discusses the rationale for the link between ED and CAD, with reference to endothelial dysfunction, and the role of ED as an important means of identifying men at risk of vascular disease.

There Is No Correlation Between Erectile Dysfunction and Dose to Penile Bulb and Neurovascular Bundles Following Real-Time Low-Dose-Rate Prostate Brachytherapy

We evaluated the relationship between the onset of erectile dysfunction and dose to the penile bulb and neurovascular bundles (NVBs) after real-time ultrasound-guided prostate brachytherapy. One hundred forty-seven patients who underwent prostate brachytherapy met the following eligibility criteria: (1) treatment with 125I brachytherapy to a prescribed dose of 160 Gy with or without hormones without supplemental external beam radiation therapy, (2) identification as potent before the time of implantation based on a score of 2 or higher on the physician-assigned Mount Sinai Erectile Function Score and a score of 16 or higher on the abbreviated International Index of Erectile Function patient assessment, and (3) minimum follow-up of 12 months. Median follow-up was 25.7 months (range, 12-47 months). The 3-year actuarial rate of impotence was 23% (34 of 147 patients). An additional 43% of potent patients (49 of 113 patients) were using a potency aid at last follow-up. The penile bulb volume receiving 100% of the prescription dose (V(100)) ranged from 0-0.05 cc (median, 0 cc), with a dose to the hottest 5% (D(5)) range of 12.5-97.9 Gy (median, 40.8 Gy). There was no correlation between penile bulb D(5) or V(100) and postimplantation impotency on actuarial analysis. For the combined right and left NVB structures, V(100) range was 0.3-5.1 cc (median, 1.8 cc), and V(150) range was 0-1.5 cc (median, 0.31 cc). There was no association between NVB V(100) or V(150) and postimplantation impotency on actuarial analysis. Penile bulb doses are low after real-time ultrasound-guided prostate brachytherapy. We found no correlation between dose to either the penile bulb or NVBs and the development of postimplantation impotency.

Surgical Correction of Peyronie's Disease via Tunica Albuginea Plication or Partial Plaque Excision with Pericardial Graft: Long Term Follow‐Up: An Editorial Comment

This is an excellent article on two surgical techniques to straighten the penis in Peyronie’s disease. As with other series it is evident that grafting, be it autologous or extracellular matrix grafts, is associated with a significant risk of erectile dysfunction (ED) and a risk of some penile shortening [1,2]. In this article, 32% had worsening erections and 21% new onset of ED after a grafting procedure. There was an objective loss of length in 33% in the grafting group with 22% wishing that they had not had the operation. It is clear, however, that patients who request a grafting technique usually have more severe PD with a more significant curvature and are more concerned about length loss. It is, therefore, not surprising that satisfaction is less than in the plication group. As patients with PD have significant risk factors for “de novo” ED at presentation, there is a significant risk that this may get worse when a grafting technique is performed [3]. The article highlights that in advanced and severe disease it may therefore be better to insert a penile prosthesis that straightens the penis and corrects any ED while minimizing loss of length. Informed consent is therefore imperative so that patients can have real expectations and then hopefully satisfaction improved.

Does Educational Status Affect a Patient's Behavior Toward Erectile Dysfunction?

Educational status has been investigated rarely as a potential factor affecting the behavior of patients with new onset erectile dysfunction (ED) toward seeking first medical help and subsequent compliance with prescribed phosphodiesterase type 5 inhibitor (PDE5) therapy. To test whether the educational status of patients with new onset ED and naïve to PDE5 therapy may have a significant impact on the delay before seeking first medical help (DSH) and compliance with the suggested PDE5. Assessing DSH and compliance with PDE5 in new onset ED patients according to their educational status by means of detailed logistic regression analyses. Data from 302 consecutive patients with new onset ED and naïve to PDE5s were comprehensively analyzed. Patients were segregated according to their educational status into low (elementary and/or secondary school education) and high (high school and/or university degrees) educational levels. Complete data were available for 231 assessable patients. Univariate (UVA) and multivariate (MVA) logistic regression analyses addressed the association between educational status and DSH after adjusting for age, relationship status, and Sexual Health Inventory for Men score. Likewise, UVA and MVA were performed to test the association between educational status and patient compliance with PDE5 at the 9-month median follow-up. Median DSH was 24 months (range 1-350; mean 38.1 +/- 42.8). The lower the educational status, the shorter the DSH (P = 0.03). In contrast, a significantly (P < 0.0001) greater proportion of patients with a higher educational status showed compliance with the suggested PDE5 at the 9-month follow-up. Overall, educational status was not an independent predictor of either DSH or patient compliance with PDE5 therapy. After adjusting for other variables, our findings suggest that in new onset ED patients, educational status does not independently affect the DSH and patient compliance with PDE5 therapy.

ASSOCIATION STUDY OF ENDOTHELIAL NITRIC OXIDE SYNTHASE (NOS3) GENE POLYMORPHISMS AND SCHIZOPHRENIA

To investigate the effect of 2 endothelial nitric oxide synthase gene polymorphisms, namely, variable number of 27-bp tandem repeats in intron 4 and T-786C in the promoter region, on the susceptibility to erectile dysfunction (ED) in Turkish population.A total of 72 patients with ED (mean age 54.3 ± 9.2 years) diagnosed by Doppler ultrasonography and 71 healthy controls (mean age 55.4 ± 8.2 years) were analyzed. Genotypes were determined through polymerase chain reaction with or without restriction endonuclease digestions.Genotype distribution for CC genotype of T-786C polymorphism in promoter was significantly different between patients with ED and controls, the genotype frequency being 31.9% and 12.7%, respectively (P = .019). The univariate odds ratio (OR) associated with CC alleles revealed 3 times increased risk for ED (OR = 3.2; 95% confidence interval [CI], 1.4-7.6; P = .006). The risk also holds when excluding patients with hypertension and diabetes mellitus (P = .012, OR = 3.1; 95% CI, 1.2-7.7) as well as obesity (P = .05, OR = 4; 95% CI, 1.05-15.3). Patients with CC genotype of promoter present earlier symptoms of ED (51.7%) compared with controls (10.7%) (P <.001). No significant correlation was observed with variable number of tandem repeats in intron 4 and with the type of vascular insufficiency.The CC genotype of T-786C polymorphism in the promoter of eNOS gene is associated with increased risk of ED in Turkish population. Earlier onset of ED with CC genotype suggests that CC allele is an independent risk factor for endothelial dysfunction in the absence of other risk factors (hypertension, diabetes mellitus, obesity). An impaired NO production because of CC alleles may account for pathophysiology of ED.

Does regular consumption of green tea influence expression of vascular endothelial growth factor and its receptor in aged rat erectile tissue? Possible implications for vasculogenic erectile dysfunction progression

Erectile dysfunction (ED) is a highly prevalent disease affecting millions of men worldwide with a tendency for widespread increase. ED is now considered an early manifestation of atherosclerosis and, consequently, a precursor of systemic vascular disease. Atherosclerosis and ED share potentially modifiable risk factors, as smoking or high-fat food intake, but it is unclear how regular consumption of anti-oxidant rich drinks, which exhibit recognised anti-atherosclerotic features, affects ED progression. The objective of this study was to evaluate the modulating effects of chronic consumption of catechin-rich beverages on the vascular structure of the rat corpus cavernosum, and how this could contribute to delay or prevention of the onset of ED. Male Wistar rats aged 12 months were treated with green tea (GT) or a green tea extract solution (GTE) as the only liquid source for 6 months. Consumption of GT and GTE led to decreased plasma androgen levels without any significant change in plasma lipid levels. A reduction in corpus cavernosum intracellular storage of lipids, associated with decreased expression of vascular endothelial growth factor (VEGF) and its receptor VEGFR2 in endothelial cells, was observed. Taken together, these results suggest diminished atherosclerotic progression in cavernous tissue. However, functional studies will be necessary to elucidate if catechin-rich beverages are useful compounds in the prevention of deleterious vascular events associated with ED. It was also demonstrated that regular consumption of catechins reduces atherosclerotic progression and mortality due to cardiovascular disease. The results reported here suggest diminished atherosclerotic progression in cavernous tissue in aged rats following chronic ingestion of catechin-rich beverages.

T09-P-09 Artery size hypothesis, does it exist?

Introduction Erectile dysfunction (ED) is related to atherosclerosis risk factors. Of clinical importance is the potential link between ED and coronary artery disease (CAD). Montoresi and his collegues 2004 proposed a pathophysiological mechanism termed the ‘artery-size hypothesis’ to explain the link between ED and CAD. They also postulated that if this hypothesis holds true, the chance of a patient with proved CAD having concomitant erectile dysfunction should be high. Moreover symptoms of ED should come before CAD symptoms. We evaluated this theory by detecting the distribution of ED in CAD patients and the onset of ED in relation to the occurrence of the first cardiac attack. Methods The present study included 100 patients with established ischemic heart disease. The patients were evaluated by abridged form of International Index of Erectile Function questionnaire (IIEF-5), Pharmaco-Penile Duplex Ultrasound. Results The results of the IIEF-5 questionnaire demonstrated 20/100 patients showed normal results while 80/100 patients showed ED. Among patients with ED (57.5%) reported the onset of ED before the occurrence of the first cardiac attack by a period of time ranging from 3 months to 10 years while (42.5%) experienced ED after the first cardiac attack in a period of 15 days to one year. Penile duplex results showed significantly higher incidence of arteriogenic factor (57 patients) compared to either venocclusive dysfunction (17 patients) or normal duplex results ( 6 patients) (p Conclusion We conclude that “artery size hypothesis” could explain the relation between the ED and the CAD.

T05-O-04 Association between erectile dysfunction and coronary artery disease

1- To investigate the prevalence of erectile dysfunction (ED) in patients with coronary artery disease (CAD). 2- To evaluate the relationship between the severity of ED and the extent of coronary vessel involvement. 3-To register the first symptom(DE or CAD) and the mean time interval between them. Erectile dysfunction was evaluated using the International Index of Erectile Dysfunction. 264 patients with angiographically documented CAD were registered. ED prevalence was 81%. There was low ED in 18% of the patients (47 / 264), medium ED in 23% (62/ 264) and severe ED in 40% (104/264). All the patients with severe DE had angiographic findings of 2-3 vessel disease. ED onset occurred before the ischemic heart disease in 78% of the patients (166/213) and the mean time interval was more than 24 months. Early diagnosis of ED, cardiovascular assessment and aggressive treatment of cardio vascular risk factors might have contributed to prevent the acute events of this patient. Patients should be systematically screened for ED after his 40s, as part of periodic examination programs. This would lead to early detection of modifiable vascular risk factors, or already existing vascular disease and to prevent ED and vascular disease progression through pharmacological and life style modifications.

PREDICTORS OF RESPONSE TO SILDENAFIL CITRATE FOLLOWING RADIATION THERAPY FOR PROSTATE CANCER

Introduction. Phosphodiesterase type 5 inhibitor (PDE5) use is a treatment strategy for prostate cancer patients with post-radiation therapy (RT) erectile dysfunction (ED). Aim. To define the predictors of sildenafil response in men treated with RT for prostate cancer. Main Outcome Measures. International Index of Erectile Function (IIEF). Methods. Patients were enrolled prospectively if they met the following criteria: (i) either a three-dimensional conformal external beam (EBRT) or brachytherapy (BT) with or without androgen deprivation (AD) for prostate cancer; (ii) self-reported ability to have sexual intercourse prior to RT; (iii) experienced onset of ED following RT; (iv) candidates for sildenafil citrate use; (v) followed-up periodically; and (vi) completed the IIEF at least 12 months after RT. Failure to respond to sildenafil was defined as IIEF-erectile function (EF) domain score of 24 months was 17. Successful response to sildenafil occurred in 68% of men at 12 months after RT, 50% at 24 months, and 36% at 36 months. Onmultivariable analysis, predictors of failure to respond to sildenafil were: older age, longer time after RT, AD > 4 months duration, and RT dose > 85 Gy. Modality of radiation delivery was not predictive of sildenafil failure. Conclusions. A steady decrease in sildenafil response was seen with increasing duration after RT. Several factors were predictive of sildenafil failure. Teloken PE, Parker M, Mohideen N, and Mulhall JP. Predictors of response to sildenafil citrate following radiation therapy for prostate cancer. J Sex Med 2009;6:1135–1140.

Variations of the internal pudendal artery as a congenital contributing factor to age at onset of erectile dysfunction in Japanese

To investigate the relationship between variations of the pelvic artery arrangement and the age at erectile dysfunction (ED) onset, as some men develop ED while relatively young, while others maintain erectile function into old age despite having cardiovascular diseases, thus congenital factors might be involved. We examined 290 units of internal iliac arteries (IIA) in 145 patients showing repeated incomplete erectile response to intracavernosal injections with prostaglandin E(1). Patients with cardiovascular risk factors, neurological disease or pelvic injury were excluded. The pelvic artery arrangement, evaluated by three-dimensional computed tomographic angiography, was classified anatomically into five types: Type 1 (normal or basic type), in which the internal pudendal artery (IPA) originates from the anterior trunk at the level between the linea terminalis and the major ischial notch; Type 2, the IPA originates from the anterior trunk of the IIA at the level of the major ischial notch or more distally; Type 3, the IPA originates directly from the IIA at a level proximal to the linea terminalis; Type 4, the IPA originates together with the superior and inferior gluteal artery within 1 cm of each other; and Type 5, the penile blood supply is dependent on arteries other than the IPA, such as the obturator artery. Among the 290 units, eight could not be classified due to poor image quality. There were no statistically significant differences in blood flow parameters among the types of IIAs, but there was a statistically significant difference in the IPA type at the age of onset of ED. Type 1 (153 units or 53%) anatomy, was more common in patients who developed ED at an advanced age. Types 2, 3 and 4 were more common in patients with onset of ED at an early age (log-rank test P < 0.001, P = 0.044, P < 0.001, respectively). Compared with patients with the common type of IIAs bilaterally, patients with any of the variations bilaterally are at risk of early onset of ED (log-rank test: P = 0.002). In these anatomical studies, nearly half of all internal artery units are variations in type. Congenital factors might contribute to the development of ED. If a man has bilateral variation from the common type (Type 1), he might develop ED approximately 10 years earlier than those who are identical in every way except for their IPA (Type 1) arrangements.