Penile Hemodynamics Research Articles

DISCREPANCY BETWEEN PATIENT VERSUS PROVIDER ASSESSMENT OF ERECTION QUALITY

ObjectiveTo characterize the discrepancy between patients’ and providers’ assessments of erection rigidity and its association with patient characteristics and penile ultrasound parameters. MethodsPatients presenting for penile doppler ultrasound between July 2022 and October 2023 were reviewed retrospectively. After intracavernosal injection, patients and providers independently rated erection rigidity from 1 to 10 prior to ultrasound. We defined discrepancy as a difference of 2 out of 10 or greater between the two assessments. Chi-squared and Mann Whitney U tests were used for hypothesis testing. Results65/297 (22%) of patients demonstrated a discrepancy in perceived erection quality. 58/65 (89%) of these patients rated their erections lower than their providers. There was a higher incidence of ED as the primary diagnosis in the discrepant group as compared to the concordant group (p=0.01). The discrepant group also showed a higher resistive index on penile ultrasound (p=0.04), with no difference in peak systolic velocity, end diastolic velocity, or other clinical variables between the two groups. ConclusionDiscrepancy in perceived erection rigidity was mainly driven by lower patient perception, although these patients had noninferior penile hemodynamics to their peers. These findings underscore the influence of subjective perception of virility on sexual function. It is critical for clinicians to identify patients with poor perception of erectile function out of proportion to physiologic abnormalities. Thoughtful counseling about treatment goals and expectations, emphasizing functional outcomes, and adjunctive treatments such as sex therapy or psychotherapy are critical to therapeutic success in this population.

The role of Doppler ultrasound in the evaluation of penile haemodynamics—A sonographer's guide to the documentation of vasculogenic erectile dysfunction

AbstractVasculogenic erectile dysfunction (ED) is the most common form of ED affecting the male population. Once the first line investigation for erectile dysfunction, penile Doppler ultrasound examinations have reduced in number following the introduction of oral phosphodiesterase inhibitors as a treatment method. As such, skilled professionals versed in the performance of these examinations are dwindling. This skill deficit is compounded by the lack of standardisation that exists in the performance and interpretation of penile haemodynamics relative to impotence of vascular origin. Despite the success of pharmacological agents in the treatment of vasculogenic dysfunction, penile Doppler examinations are still relevant in the assessment of ED in non‐responders, and those patients in which pelvic surgery or trauma has altered the normal erectile mechanism. Growing evidence in the literature also suggests that vasculogenic ED may be an early indicator of systemic vascular disease and therefore prognostic of future cardiovascular events. Considering this, the relevance of Doppler assessment of penile haemodynamics with ultrasound should not be underestimated. This article will introduce the sonographer to advanced vascular anatomy of the penis, pathophysiology of erectile function and the principles of normal and pathological penile haemodynamic patterns. It also aims to suggest a standardised protocol for the performance of penile Doppler ultrasound relative to primary vasculogenic ED and reduce the amount of variability that exits between operators. As such the sonographer can make a significant contribution to patient management pathways.

(234) How Age and Obesity Influence Erectile Dysfunction: Evaluation Based Upon Penile Color Duplex Doppler Ultrasound

Abstract Introduction Color duplex Doppler ultrasound (CDDU) is an objective and reliable diagnostic tool for documenting penile hemodynamics. Objective vascular testing provides a physiologic diagnosis of erectile dysfunction (ED) and helps direct appropriate therapy even in this age of ED management including oral drugs. Although age and diabetes are known to be the major etiological factors in development of ED, it is not clear whether obesity as such also plays any role or not. Objective The main objective of this study is to retrospectively assess the penile CDDU hemodynamic parameters of obese men with ED in comparison to non-obese ED men in relation to age. Methods A total of 271 men including obese and non-obese who were diagnosed with ED visiting our Andrology clinic were included in this study. Initial ED was determined by using the International Index of Erectile Function (IIEF) score. Penile CDDU data was retrospectively collected from these ED patients, and parameters mainly peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were used for analysis. RI (=PSV-EDV/PSV) was calculated, and different types of penile vascular status were established based on our previously published SOP guidelines for standardization of penile CDDU parameters. Statistical analysis was performed using MedCalc statistical software version 22.009 (MedCalc Software bv, Ostend, Belgium). Results Our study results revealed that with advancement of age the occurrence of vascular changes in obese men were higher in comparison to non-obese men with ED. Table 1 summarizes the influence of obesity on the prevalence of penile vascular status in different age groups of obese and non-obese men with ED. Surprisingly, higher number of obese men showed non-vascular, venous and mixed vascular components compared to non-obese ED patients. Among these obese groups of all ages, the venous leakage was prevalent than arterial or mixed components. Conclusions Our current analysis indicates that besides age, obesity is also one of the major risk factors in altering the penile hemodynamics with increased incidence of veno-occlusive dysfunction (VOD) in ED patients. In addition, this demonstrates the utility of performing CDDU and diagnosing the presence of VOD in further understanding the pathophysiology of obesity associated ED, and an important determining factor in such patient care. Disclosure No.

(321) Penile Doppler Ultrasound (PDUS) Procedure Anxiety and Its Impact on the Erection Hardness (EH) and Corporo-venocclusive Dysfunction (CVOD) Diagnosis

Abstract Introduction Procedure anxiety is an excessive fear of medical, dental, or surgical procedures that result in acute distress or interference with completing necessary procedures. Previous work has shown that anxiety affects penile hemodynamics. Objective This study aims to examine the impact of PDUS procedure anxiety on the erection hardness (EH) achieved during and after PDUS and the diagnosis of CVOD. Methods The patient population included (i) men with poor response to erectogenic agents or (ii) who need curvature assessment due to Peyronie’s disease (PD), (iii) who underwent PDUS, (iv) using ICI vasoactive agent redosing schedule. We performed a descriptive assessment of demographics and comorbidities. We reported EH reached before and 30 minutes after PDUS, which was evaluated by a sexual medicine-trained physician for each case. EH was measured on a 0 (no erection) to 10 (erection hard as a rock). We also described the number of injections, the dose, and PDUS hemodynamic parameters, including peak systolic velocity (PSV) and end-diastolic velocity (EDV). Arterial insufficiency (AI) diagnosis was made with PSV values ≤30 cm/sec bilaterally, and CVOD diagnosis with EDV values ≥5 cm/sec bilaterally. A visual analog scale (VAS) evaluated the anxiety related to the procedure using a single question: “How anxious are you about your PDUS procedure?” This was measured on a 0 (not at all anxious) to 10 (extremely anxious) Likert scale. 7 or higher was defined as high anxiety, 4 to 6 as moderate anxiety, 1 to 3 as mild anxiety, 0 was no anxiety. We compared the EH pre and post-PDUS and the prevalence of CVOD based on the procedure anxiety category (high vs. no high anxiety). Predictors of persistent EH (6/10 or higher) after PDUS was analyzed using a logistic regression model. Factors entered into the model included: patient age, PD, and procedure high anxiety. A p-value ≤0.05 was considered statistically significant. Results 162 individuals were included. The median age of 65 (59,72) years. 19% had diabetes, 19% reported ≥ 3 comorbidities, 10% had a history of depression, and 11% had a history of anxiety. 72% had prostate cancer, 6% had bladder cancer, 3% had other cancer, and 19% had no cancer history. 35% reported PD. The VAS procedure anxiety median was 3 (1, 5), on which 22% reported no anxiety, 34% mild, 26% moderate, and 18% high anxiety. For men with high anxiety procedure, the median EH before and after PDUS was 6 (4, 8) and 5 (2, 8), respectively; 62% had CVOD diagnosis, 48% remained with an EH 6 or greater after PDUS, and 45% needed a reversal injection. No significant differences were observed compared to men without high anxiety procedures. In the MVA, only age significantly predicted EH 6 or greater after PDUS (Table 1). Conclusions High PDUS Procedure Anxiety does not affect EH pre and post-PDUS, CVOD diagnosis, or reversal rate after PDUS. Only younger age significantly predicted persistent EH 6 or greater after PDUS. Disclosure No.

Investigating the risk factors of penile arterial insufficiency and veno-occlusive dysfunction in patients with erectile dysfunction.

To investigate the risk factors for penile arterial insufficiency (PAI), which is a known cause of erectile dysfunction (ED). Patients who attended our urology clinic complaining of ED for more than 6 months were prospectively enrolled in this study over 1-year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie's disease (PD) and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile and glycated haemoglobin (HA1c). A penile duplex ultrasound study (PDU) was done for all patients after intracavernosal injection (ICI) with alprostadil. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured after 15 min. Statistical analysis was done using SPSS. A total of 440 patients were enrolled in this analysis. The mean age was 48(23-81), and the mean BMI was 30 (18-51). Older patients had lower PSV (r= -0.361, P= 0.000) and higher EDV (r= 0.174, P= 0.001), and both correlations were highly statistically significant. Diabetics had lower PSV (r= -0.318, P= 0.000) and higher EDV (r= 0.139, P= 0.008), which were also highly statistically significant. Smokers had lower PSV (r= -0.140, P= 0.008) and higher EDV (r= 0.178, P= 0.001), which were highly statistically significant. Men with larger penises measured skin to tip had lower EDV (r= -0.119, P= 0.024), which was less significant. Interestingly, there was neither a significant correlation between BMI and PSV (0.16, P= 0.745) nor a significant correlation between testosterone and PSV (0.029, P= 0.552). Also, there was no correlation between PSV and both dyslipidaemia and penile PD. Ageing, tobacco consumption, DM and hypertension seem to have a negative impact on penile haemodynamics, which was statistically significant. In our patients, there was no statistically significant effect on penile haemodynamics in patients with increased BMI, low testosterone or PD or according to the size of the penis.

(124) Investigating the Risk Factors of Penile Arterial Insufficiency and Veno-occlusive Dysfunction In Patients with Erectile Dysfunction

Abstract Introduction It was reported that a more generalized peripheral atherosclerotic process is associated with a severer penile arterial insufficiency (PAI), and this in turn was correlated well with decreased blood supply in more important arteries like the coronary and carotid arteries. Objective We investigated the risk factors for PAI which is a known cause of erectile dysfunction (ED Methods Patients who attended our urology clinic complaining of ED for more than 6 months, were prospectively enrolled in this study in one year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie’s disease (PD) and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile, and glycated haemoglobin (HbA1c). Penile duplex ultrasound study (PDU) was done for all patients after intra-cavernosal injection (ICI) with Alprostadil. peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured after 15 minutes. Statistical analysis was done using SPSS. Results A total of 440 patients were enrolled in this analysis. The mean age was 48 (23-81), and the mean BMI was 30 (18-51). Older patients had lower PSV (r=-0.361, P=0.000) and higher EDV (r=0.174, P=0.001) and both correlations were highly statistically significant. Diabetics had lower PSV (r=-0.318, P=0.000) and higher EDV (r=0.139, P=0.008) which were also highly statistically significant. Hypertensive patients had lower PSV (r=-0.296, P=0.000) which was highly statistically significant. Smokers had lower PSV (r=-0.140, P=0.008) and higher EDV (r=0.178, P=0.001) which were highly statistically significant. Men with larger penises measured skin to tip, had lower EDV (r=-0.119, P=0.024) which was less significant. Interestingly there was neither significant correlation between BMI and PSV (0.16, p=0.745) nor significant correlation between testosterone and PSV (0.029, p=0.552). Also, there was no correlation between PSV and both dyslipidaemia and penile PD. Conclusions Our study highlights key risk factors - Increased age, tobacco consumption, DM and hypertension - are factors that have a statistically significant negative impact on penile haemodynamics. Of these, tobacco consumption, good diabetic control and hypertension are potentially modifiable and should form part of any treatment plan for erectile dysfunction. Other risk factors – increased BMI, low testosterone, PD and penile size – had no statistically significant impact on penile hemodynamics. This allows for targeted advice that can be given to patients who present with this very common problem. Ultimately, good vascular health goes hand in hand with good erectile function. Disclosure No

(357) Nocturnal Penile Tumescence Test in Patients with Erectile Dysfunction Associates With Penile and Systemic Vascular Disease

Abstract Introduction Erectile dysfunction (ED) is the most frequent male sexual dysfunction along with premature ejaculation. Moreover, its prevalence is increasing worldwide due to ageing of the population and spreading of risk factors like obesity, diabetes, hypercholesterolemia, hypertension, etc. Also, it represents an important cardiovascular risk marker because of its demonstrated tight association with cardiovascular disease (CVD). We dispose of many diagnostic tools to assess ED and a proper workup includes the anamnesis, a physical exploration, blood tests for hormonal and metabolic evaluation, and ED grading through validated questionnaires such as the International Index of Erectile Function (IIEF). One of the instrumental tests we may indicate is the nocturnal penile tumescence (NPT) test or “Rigiscan”. This test measures the spontaneous erections overnight and helps discriminating between organic and psychological ED. However, this is a highly specific but low sensitive test since a positive (normal) result can roll out an organic ED and suggest a psychological etiology while a negative result cannot confirm or exclude an organic condition. Objectives In this context the aim of this study is to investigate the predictive role of Rigiscan in discriminating patients with an organic ED and the presence of vascular disease in patients with ED. Methods We conducted a prospective study in patient 25 patient who underwent a Rigiscan test as part of ED assessment. Each patient had blood tests for hormonal and metabolic analysis, a measurement of the carotid intima-media thickness (cIMT), a brachial flow-mediated vasodilation test (FMD), and a penile color doppler ultrasound (PCDU) to assess penile hemodynamics. Results Our patients had a mean age of 47.9 ± 13.7 years, with a mean IIEF score of 9.0 ± 6.5. Among them 13 (54.2%) were active smokers, 5 (20.8%) were diabetics, 8 (32%) had dyslipidemia, and 4 (16.7%) had hypertension. Eleven patients (44%) had a normal Rigiscan while 14(56%) had a pathological result. We found that patient with a pathological Rigiscan presented with a cluster of impaired vascular function at different levels. In particular, they had statistically lower peak systolic velocity (PSV) in the PCDU (52.5 vs 80.2 cm/s p=0.014) and a higher prevalence of arterial insufficiency (42.9% vs 0.0% p=0.020). Moreover, in patients with negative Rigiscan, there was a higher cIMT (0.9 vs 0.7 mm) and lower response to FMD (7.7% vs 9.6%) with a more frequent diagnose of impaired FMD (63.6% vs 46.2%) but without reaching a statistically significance. Conclusion We can conclude that a negative Rigiscan is indicative of altered penile hemodynamics and may suggests the presence of systemic vascular disease. Therefore, while a positive Rigiscan excludes organic ED, a negative Rigiscan should be considered a cardiovascular risk marker and induce the clinician to address the cardiovascular risk in that patient. More studies with larger population are warranted to confirm and further investigated these findings. Disclosure No

(358) Responder Analysis from a Multicentered Survey of Men’s Perception who underwent Low Intensity Extracorpeal Shock Wave Therapy (LIESWT), as a Novel and Experimental Intervention for the Treatment of Erectile Dysfunction (ED)

Abstract Introduction Low-intensity extracorporeal shock wave therapy (LI-ESWT) is an experimental, non-FDA approved yet novel treatment modality that has recently been developed for treating erectile dysfunction (ED). The basic science hypothesis concerning the mechanism of action is that LI-ESWT causes microtrauma at the cellular level which may stimulate the release of angiogenic factors, and cause neovascularization of the treated tissue. Completed research report improvement in erectile functioning, decreased reliance on phosphodiesterase inhibitor medication as well as the regained ability to attain and maintain natural or spontaneous erections. We report here a preliminary responder analysis of men who had LIESWT as part of their erectile dysfunction treatment paradigm. Objective We report here the preliminary responder analysis results of an internet based, random retrospective survey on past users of this novel technology for the treatment of ED. Methods A random survey was sent to a convenience sample from 10 national centers (Hawaii, Washington (2), Portland, Utah, Oklahoma (2), Arizona, California, Oregon) to men who had completed 6 sessions of LIESWT for the treatment of ED. The internet-based survey examined patient perception and experience of this intervention. We present the responders analysis ( n=47). All procedures were performed by sexual medicine health care professionals after a detailed and comprehensive history, physical examination, and laboratory/hormonal assessment. Results Surveys were completed anonymously over the course of a 2-week period by men who had undergone 6 sessions of LIESWT. 28% of participants were aged 50-59; whereas 63 percent were over the age of 60. Other adjunctive treatments included erectile dysfunction (ED) medication, testosterone replacement therapy (TRT), previous plasma rich protein injections and Intracavernosal injections. 83% of those who got the procedure noticed an improvement within the first 5 weeks. 89% of responders noticed an improvement in erection firmness whereas 81% noticed an improvement in quality of erections. 77% of responders noticed an improvement in their level of sexual satisfaction and 72% noticed an improvement in sexual pleasure. 60% noticed an improvement in the overall quality of the orgasm. Overall, the procedure was well tolerated with <0.5% (3/670 procedures) adverse events reported (1 pain in penis, 1 “knot in penis” and 1 pain in the head) reported. Overall, 65% of LIESWT users would recommend this procedure to a friend. Conclusions LIESWT is a novel and experimental intervention for the treatment of ED. While it shows excellent promise, most data contain some shortcomings, including: small numbers, limited follow-p, and various non-standardized protocols. Results from a double-blind, randomized, control trial confirm that LI-ESWT may result in significant clinical improvement of erectile function and a shift towards improvement in penile hemodynamics without any adverse effects. Our participant responder analysis demonstrates that LIESWT improves erectile function and other sexuality parameters. Further larger, randomized sham-controlled, and comparative clinical trials are warranted before LI-ESWT may be considered new standard of care for men with vasculogenic ED. Disclosure No

MP45-02 INVESTIGATING THE RISK FACTORS OF PENILE ARTERIAL INSUFFICIENCY AND VENO-OCCLUSIVE DYSFUNCTION IN PATIENTS WITH ERECTILE DYSFUNCTION

You have accessJournal of UrologyCME1 Apr 2023MP45-02 INVESTIGATING THE RISK FACTORS OF PENILE ARTERIAL INSUFFICIENCY AND VENO-OCCLUSIVE DYSFUNCTION IN PATIENTS WITH ERECTILE DYSFUNCTION Mohamad Habous, Ahmed Khattak, Mohammed Nassar, Saleh Binsaleh, and Gordon Muir Mohamad HabousMohamad Habous More articles by this author , Ahmed KhattakAhmed Khattak More articles by this author , Mohammed NassarMohammed Nassar More articles by this author , Saleh BinsalehSaleh Binsaleh More articles by this author , and Gordon MuirGordon Muir More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It was reported that a more generalized peripheral atherosclerotic process is associated with a severer penile arterial insufficiency(PAI), and this in turn was correlated well with decreased blood supply in more important arteries like the coronary and carotid arteries.Aim We investigated the risk factors for penile arterial insufficiency (PAI), which is a known cause of erectile dysfunction (ED). METHODS: Patients who attended our urology clinic complaining of ED for more than 6 months, were prospectively enrolled in this study in one year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie’s disease (PD)and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile, and glycated haemoglobin (HbA1c). Penile duplex ultrasound study (PDU) was done for all patients after intra-cavernosal injection (ICI) with Alprostadil. peak systolic velocity (PSV)and end diastolic velocity (EDV) were measured after 15 minutes. Statistical analysis was done using SPSS. RESULTS: A total of 440 patients were enrolled in this analysis. The mean age was 48(23-81), and the mean BMI was 30(18-51). Older patients had lower PSV (r=-0.361, p=0.000) and higher EDV (r=0.174, p=0.001) and both correlations were highly statistically significant. Diabetics had lower PSV (r=-0.318, p=0.000) and higher EDV (r=0.139, p=0.008) which were also highly statistically significant. Smokers had lower PSV (r=-0.140, p=0.008) and higher EDV (r=0.178, p=0.001) which were highly statistically significant. Men with longer penises measured skin to tip, had lower EDV (r=-0.119, p=0.024) which was also significant. Interestingly there was neither significant correlation between BMI and PSV (0.16, p=0.745) nor significant correlation between testosterone and PSV (0.029, p=0.552). Also, there was no correlation between PSV and either dyslipidaemia or Peyronie’s disease. CONCLUSIONS: Our study highlights key risk factors - Increased age, tobacco consumption, DM and hypertension - are factors that have a statistically significant negative impact on penile haemodynamics. Of these, tobacco consumption, good diabetic control and hypertension are potentially modifiable and should form part of any treatment plan for erectile dysfunction.Other risk factors – increased BMI, low testosterone, PD and penile size – had no statistically significant impact on penile hemodynamics. This allows for targeted advice that can be given to patients who present with this very common problem. Ultimately, good vascular health goes hand in hand with good erectile function. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e621 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamad Habous More articles by this author Ahmed Khattak More articles by this author Mohammed Nassar More articles by this author Saleh Binsaleh More articles by this author Gordon Muir More articles by this author Expand All Advertisement PDF downloadLoading ...

MP27-08 RADIAL TYPE LOW-INTENSITY EXTRACORPOREAL SHOCKWAVE THERAPY (LI-ESWT) AS NOVEL THERAPY TO ENHANCE MICROCIRCULATION IN AGING RAT PENIS

You have accessJournal of UrologyCME1 Apr 2023MP27-08 RADIAL TYPE LOW-INTENSITY EXTRACORPOREAL SHOCKWAVE THERAPY (LI-ESWT) AS NOVEL THERAPY TO ENHANCE MICROCIRCULATION IN AGING RAT PENIS Saager Chawla, Yong Sun Choi, Bae Woongjin, Samuel Sorkhi, Jae Hak Jeong, Tung-Chin Hsieh, and M. Raj Rajasekaran Saager ChawlaSaager Chawla More articles by this author , Yong Sun ChoiYong Sun Choi More articles by this author , Bae WoongjinBae Woongjin More articles by this author , Samuel SorkhiSamuel Sorkhi More articles by this author , Jae Hak JeongJae Hak Jeong More articles by this author , Tung-Chin HsiehTung-Chin Hsieh More articles by this author , and M. Raj RajasekaranM. Raj Rajasekaran More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003255.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Physiological aging is associated with the impairment of microvascular function in several organs, including the penis. Low-intensity extracorporeal shock-wave therapy (Li-ESWT) is a non-invasive intervention for the restoration of the pathological alterations of penile tissue. However, the effect of ESWT on penile microvascular function is still unclear. In addition, most previous studies have employed focused ESWT, which is known to target deeper organs, while radial ESWT is more superficial. Thus, our objective is to evaluate the effect of radial type Li-ESWT (targeting superficial penile tissue) on microvascular perfusion (MVP) in an aging rat model and elucidate a possible mechanism of action. METHODS: We anesthetized male rats (n=5; age 15-18 months) and subjected them to radial type Li-ESWT (Fig A-C) while monitoring penile hemodynamics via Laser Speckle Contrast imaging techniques immediately before and after Li-ESWT. The penile shaft was positioned beneath the ESWT applicator (HNT MEDICAL Co., Ltd, Seoul, Korea; Fig B). A level 1 intensity (L1i) (0.12 mJ/mm2) ESWT session for 500 counts at 120 HZ (Fig C) was chosen to increase blood penile microvascular perfusion (PMP). Baseline and peak PMP was assessed by the PeriCam PSI system (Perimed AB, Järfälla, Sweden). This technique quantifies PMP in arbitrary perfusion units (AU) and displays a real-time perfusion image. To assess the involvement of the nitric oxide (NO) pathway, an intracavernosal injection of L-NAME (NO synthase inhibitor) was given [200 µg/kg], and the response to ESWT was recorded again after 15 minutes. RESULTS: ESWT produced a 2-fold increase in PMP (mean±SEM) from baseline (68.456±9.021 AU) to max (163.742±11.787 AU). In addition, the L-NAME injection (n=4) resulted in a ∼40-50% decrease (from 185.293±20.604 AU to 101.008±13.077 AU) in ESWT-induced MVP response. CONCLUSIONS: Our results suggest ESWT is a novel, non-invasive intervention to improve penile circulation and treat erectile and sexual dysfunction following cancer treatment, possibly by improving penile hemodynamics and preventing penile hypoxia and fibrosis. Our findings suggest that the Li-ESWT-induced increase in MVP is mediated by the NO pathway, and future studies are warranted to confirm its efficacy in human subjects. Source of Funding: UCSD Academic Senate © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e365 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Saager Chawla More articles by this author Yong Sun Choi More articles by this author Bae Woongjin More articles by this author Samuel Sorkhi More articles by this author Jae Hak Jeong More articles by this author Tung-Chin Hsieh More articles by this author M. Raj Rajasekaran More articles by this author Expand All Advertisement PDF downloadLoading ...

Changes in the penile microcirculation in the treatment of mixed erectile dysfunction on the background of arterial hypentension in locomotive team workers

BACKGROUND: Railway workers constantly experience stress in the workplace, associated with the need to maintain high attention and be ready for emergency action, which provokes a persistent increase in blood pressure. A significant number of such patients have erectile dysfunction. Most patients require complex therapy for stress-induced arterial hypertension and erectile dysfunction.
 AIM: To evaluate the dynamics of penile microcirculation indicators in the treatment of erectile dysfunction against the background of arterial hypotension in locomotive team workers.
 MATERIALS AND METHODS: A comprehensive examination and treatment of 65 young and middle-aged men from 30 to 55 years old (mean age 48.1 0.7 years), working as machinists or assistant machinists, was carried out. All observed patients complained of erectile dysfunction of varying severity and were registered with a general practitioner and (or) a cardiologist for controlled hypertension stage III. The patients were divided into three groups. Patients of the 1st group (n = 20) were prescribed basic treatment with antihypertensive drugs, as well as the drug Afalasa sublingually, 2 tablets 2 times a day. Patients of the 2nd group (n = 25) also received basic antihypertensive therapy, Afalasa (2 tablets 2 times a day sublingually) and the 5-PDE inhibitor tadalafil 5 mg once a day. Group 3 included 20 patients receiving basic antihypertensive therapy. The course of treatment for patients in each group was 4 months. The control 4th group consisted of 20 healthy men. In all patients before and after treatment and representatives of the control group, the state of microcirculation of the penis was assessed by laser Doppler flowmetry.
 RESULTS: According to the Doppler flowmetry technique, microcirculatory disorders of varying severity were detected in the penis before treatment. The most pronounced positive dynamic at 4 months after the start of treatment was noted in patients of the 2nd group who received complex treatment, which included antihypertensive therapy, a 5-PDE inhibitor, and Afalasa. In patients, the index of microcirculation significantly increased, the index of hypoxia and tissue ischemia decreased, an increase in the inert mechanism of blood flow regulation was noted, which was expressed in an increase in the index of microcirculation efficiency from 0.79 0.08 to 2.01 0.29 c.u. (p 0.05) and an increase in the bypass rate from 0.69 0.13 to 1.06 0.33 c.u. (p 0.05). The improvement in microcirculation was accompanied by an improvement in erectile function, most pronounced in patients of the 2nd group.
 CONCLUSIONS: Locomotive team workers with arterial hypertension have a mixed form of erectile dysfunction caused by a psychogenic factor and disruption of the vascular endothelium. The monitoring revealed significant violations of the penile microcirculation. The most pronounced improvement in penile hemodynamics and erectile function was noted with complex treatment, including basic antihypertensive therapy, a NO synthase activator, and a 5-PDE inhibitor.

Erektil disfonksiyon ve Peyronie hastalığında ESWT başarısı

Treatment of Erectile Dysfunction (ED) should be started with the elimination of correctable factors such as diabetes, cardiovascular causes, and drug use that cause ED, and lifestyle changes. Currently ED treatment mostly depends on phosphodiesterase type 5 inhibitors, which fail for some ED patients. Surgical and nonsurgical treatments in Peyronie’s disease related ED are frequently difficult to achieve satisfactory results. Recent studies indicate that extracorporeal shock wave therapy induces neoangiogenesis and positively affects on penile hemodynamics. In this review the evidence of clinical efficacy of extracorporeal shock wave therapy for the treatment of erectile dysfunction and Peyronie’s disease. Keywords: erectile dysfunction, Peyronie’s disease, extracorporeal shockwave therapy

Tumor Necrosis Factor- α (TNF-α) and Rho-Associated Kinase 2 (ROCK2) Inhibitors Improve Erectile Function in a Bilateral Cavernous Nerve Injury Rat Model

ABSTRACT Introduction Prior studies suggest Rho-kinase (ROCK) upregulation and pro-inflammatory cytokines such as Tumor Necrosis Factor-α as causative factors of axonal degeneration, neuropathy, and penile fibrosis following peripheral cavernous nerve (CN) injury. We hypothesize, the combination therapy using inhibitors/antagonists of ROCK and TNF-α may prevent end-organ damage and neuroinflammation in the penis. The current study was designed to investigate selective inhibition of ROCK2 (SAR407899) and TNF-α (Infliximab) in a pre-clinical model of post-radical prostatectomy ED to prevent penile neuroinflammation, fibrosis, and preserve penile hemodynamics. Objective This study investigates the effect of FDA approved TNF- α inhibitor (Infliximab) in combination with ROCK2 selective inhibitor (SAR407899) on erectile function restoration in the bilateral crush nerve injury (BCNI) rat model. Methods Sprague Dawley rats were randomized to undergo either sham (6) or BCNI (28). The BCNI rats were further randomly stratified to receive saline (6), Infliximab (5 mg/kg once weekly) (6), low dose of SAR407899 (1.5 mg/kg QD) (5), high dose of SAR407899 (3 mg/kg QD) (5), or combination treatment SAR407899 (1.5 mg/kg QD) + Infliximab (5 mg/kg once weekly) (6). At 14 days after injury rats underwent cavernous nerve stimulation to determine erectile function. Penes were collected and immune infiltrate analyses were performed using multicolor flow-cytometry. Results Erectile response studies demonstrated that rodents treated with combination of Infliximab and SAR407899 had significantly improved (p<0.05) erectile function (ICP/MAP) at all voltages compared to BCNI alone (2V: 0.243 vs 0.051, 4V: 0.321 vs 0.0782, 6V: 0.456 vs 0.091, p <0.05). Peak ICP and total ICP were also significantly (p<0.05) improved compared to BCNI rats. Combination therapy, however, did not show a significant change compared to each treatment alone. Likewise, there was no significant difference between low and high dose SAR407899. Flow cytometry showed that Infliximab and SAR407899 significantly (p<0.05) decreased % of CD11b+ CD45+ monocytes in the penis. While combination therapy had no effect. The percent of CD11b+ MHCII+ CD45+ macrophages were increased (p<0.05) in the penes of rats treated with Infliximab and SAR407899 while combination therapy decreased penile macrophage population. We found no change in TNF- α+ monocytes and macrophages compared in penes from all groups investigated. Conclusions Our study suggests that treatment with commercially available TNF-α and ROCK2 inhibitors result in mitigation of erectile dysfunction in a BCNI rat model when administered at the time of nerve injury. The mechanism of the beneficial effects may involve reduction in macrophage population in the penis. Disclosure No

Transpelvic Magnetic Stimulation Enhances Penile Microvascular Perfusion in a Rat Model: A Novel Interventional Strategy to Prevent Penile Fibrosis after Cavernosal Nerve Injury.

PurposePenile microvascular dysfunction is a known contributor to erectile dysfunction (ED) and penile fibrosis has been shown to impair microvascular perfusion (MVP). Our objectives were to: (i) determine beneficial effects of TPMS to modulate penile MVP, (ii) determine its mechanism, (iii) evaluate impact of cavernosal nerve injury (CNI) on penile MVP, and (iv) determine time-course of cavernosal tissue elastin changes after CNI in rats.Materials and MethodsAdult male rats (n=5) were anesthetized and subjected to TPMS (13%, 15%, and 17%) and MVP changes were recorded using laser speckle contrast imaging (LSCI). Another group of male rats were subjected to either bilateral cavernosal nerve injury (CNI; n=7) or sham surgery (n=7). After recovery, animals were monitored for MVP using LSCI before and after TPMS. Rat penile tissues were harvested and analyzed for fibrosis using a marker for elastin.ResultsRat TPMS resulted in a stimulus dependent increase in MVP; maximal perfusion was observed at 17%. L-N(G)-Nitroarginine methyl ester (L-NAME) resulted in a marked decrease in TPMS induced MVP increase (393.33 AU vs. 210.67 AU). CNI resulted in 40% to 50% decrease in MVP. CNI produced a remarkable increase in elastin deposits that are noticeable throughout the cavernosal tissues post injury.ConclusionsTPMS is a novel and non-invasive intervention to improve penile MVP after CNI. Potential application includes treatment of ED and sexual function preservation following cancer treatment, possibly through improved penile hemodynamics that might help prevent penile hypoxia and fibrosis.

Low-intensity shockwave treatment (LISWT) improves penile rigidity in eugonadal subjects with erectile dysfunction: a pilot study.

Since low-intensity shockwave treatment (LISWT) has putative effects on penile hemodynamics remodeling, the aim of this study was to evaluate any improvement of penile vascular flows after LISWT treatment in patients with erectile dysfunction (ED) and poor response to PDE5i. Twenty-one eugonadal patients with different ED severity underwent 6 weekly LISWT sessions (1500-4000 pulses) after 2 weeks withdrawal from PDE5i assumption. Once daily Tadalafil (2.5 mg daily) was reintroduced 4 weeks apart from LISWT termination and patients were evaluated at 1, 2 and 6 months follow-up (T1, T2, T6) by the International Index of Erectile Function-15 items questionnaire (IIEF-15) erectile function (EF) domain, Erection Hardness Score (EHS) and Global Assessment Questionnaires (GAQ). Basal Penile Color-Doppler Ultrasound parameters in the flaccid state (B-PCDU) were evaluated before, during and after interventional protocol. Mean EHS score improved in 35% of patients at T1, and in up to 50% of patients at T2 and T6 follow-up visits (P<0.05). We found 25% improvement of EF scores at T1 session, 43.75% at T2 and 62.5% at T6, respectively (P<0.05). No statistically significant differences in flow parameters, EF-domain and testosterone levels were found when baseline and last observation carried forward (LOCF) parameters were compared. The GAQ questionnaire scored higher satisfaction rates either at the end of the treatment (100%), or at LOCF (92.5%). Despite the study limitations with respect to B-PCDU in this setting, our results confirm a trend toward improvement of erectile questionnaire scores after LISWT with higher overall satisfaction rates among patients with ED. We conclude that LISWT may be an effective option in some difficult-to-treat patients with ED by improving the erectile response to PDE5i.

Application of the complex Edelim in pathogenetic management of patients with erectile dysfunction

AIM: To assess the degree of changes in complaints, dynamics of biochemical parameters of lipid metabolism, penile hemodynamics in patients with ED during therapy with EDELIM in comparison with PDE-5 inhibitors. Assess the tolerability of the drug based on the analysis of reported adverse events.&#x0D; MATERIALS AND METHODS: The study was prospective comparative observational cohort. The study included 60 patients over 18 years old with complaints of persistent, at least 1 month, erectile dysfunction. The patients were divided into 2 groups: group 1 patients with ED received Edelim on a regular basis, one capsule 2 times daily for 3 months; group 2 patients with ED received generic tadalafil 5 mg daily for 1 month, then 1 month break, then 5 mg per day for 1 month.&#x0D; RESULTS: The mean age of the patients was 38.4 9.2 years. In group 1, significant differences were noted in the all hemodynamic and biochemical indicators, except for HDL levels (2.2 0.4 vs. 2.3 0.4 mmol/L; p = 0.067). In group 2, significant differences were noted in the dynamics of the IIEF-5 scale, the level of HDL, and the blood flow velocity in the right and left cavernous arteries. There were no significant differences in blood flow in the left and right dorsal arteries, levels of total cholesterol, LDL, triglycerides, glucose, HbA1c, systolic blood pressure. In the 1st group of patients, there were no adverse events, in the 2nd group, in 3 patients mild side effects.&#x0D; CONCLUSIONS: The improvement in the quality of erection in the group of patients taking Edelim is associated with decrease in the lipid profile, glucose, glycated hemoglobin, which can be regarded as a variant of pathogenetic conservative treatment of ED.

Эректильная дисфункция: взаимосвязь показателей гемодинамики полового члена и диастолической функции левого желудочка

Introduction. Erectile dysfunction (ED) is one of the most common male urological complaints. At the same time, ED is pathogenetically closely associated with many life-threatening diseases (coronary heart disease, cerebrovascular diseases). Purpose. Based on Doppler data, determine the relationship between the blood flow in the cavernous arteries and intracardiac hemodynamics. Materials and methods. There are 246 men aged 40-65 years with complaints of erectile dysfunction was evaluated. The examination included anthropometry, questionnaires (IIEF-5, AMS), biochemical, hormonal blood tests and a comprehensive instrumental study: (Penile Doppler ultrasound, Holter ECG monitoring, Treadmill test, EchoCG). Results. Patients with arteriogenic ED have a significantly different risk factor profile. These patients have worse indicators of intracardiac hemodynamics compared to ED of other etiology - a higher ratio of the maximum rate of early and late left ventricular filling (E / A), lower rates of slowing down of early diastolic left ventricular filling and the time of isovolumic relaxation of the left ventricle. A significant correlation was found between the peak systolic blood flow velocity in the cavernous bodies of the penis, the resistance index in the cavernous arteries, and the E/A ratio. Discussion. Arteriogenic ED may be a sign of left ventricular diastolic myocardial dysfunction in men without symptoms of cardiovascular disease and may be a criterion for the formation of a group of high cardiovascular risk. Conclusions. Penile hemodynamics can be used as a predictive marker for early forms of cardiovascular disease.

Application and Value of Dynamic Volume CT Multiparameter Imaging in the Diagnosis of Traumatic High-Flow Penile Abnormal Erection

Objective. To explore the clinical application of dynamic volume CT multiparameter imaging in the observation of penile hemodynamics in patients with abnormal vascular erections. Methods. 90 patients with suspected vascular abnormal erections treated in our hospital from January 2016 to January 2020 were included in the study, and 40 patients with psychologically abnormal erections were selected for the control. The corpus cavernosum injection vasoactive drug test (ICI) and dynamic volume CT and Doppler ultrasound were used to test the hemodynamics of the corpus cavernosum of all selected patients and to analyze the changes of penile length, circumference, systolic peak flow rate, diastolic peak flow rate, and blood flow resistance index in different types of penile erection disorder patients before and after ICI test. Results. Among the 90 patients with suspected vascular abnormal erection, 34 patients had arterial abnormal erection, 25 patients had venous abnormal erection, and 31 patients had mixed vascular abnormal erection. In patients with arterial abnormal erection and mixed vascular abnormal erection, penile cavernous body diameter, PSV, and abnormal erection V are smaller than those in patients with venous abnormal erection and psychological abnormal erection, while arterial abnormal erection and psychological abnormal erection are obviously higher in RI than venous abnormal erection and mixed vascular abnormal erection, and the difference is statistically significant ( P &lt; 0.05 ). Before the ICI test, there was no significant difference in the penis circumference and length between the four groups of patients with arterial abnormal erection, venous abnormal erection, mixed vascular abnormal erection, and psychological abnormal erection ( P &gt; 0.05 ); after the ICI test, patients with arterial abnormal erections had significantly shorter penis perimeter and penis length than those with venous abnormal erections, mixed vascular abnormal erections, and psychological abnormal erections ( P &lt; 0.05 ). Conclusion. Dynamic volume CT can clearly reflect the penile hemodynamic state of patients with vascular abnormal erections, provide a powerful diagnostic basis for accurately and effectively determining the classification of vascular abnormal erections, and be worthy of popularization and clinical use.

Smoking status and the baseline international index of erectile function score can predict satisfactory response to platelet-rich plasma in patients with erectile dysfunction: A prospective pilot study.

Erectile dysfunction (ED) is a common condition with a significant impact on the quality of life. Regenerative medicine maladies are intended to repair or replace damaged tissues and organs through different therapeutic mechanisms. Our aim was to study the effect of intra-corporeal injection (ICI) of platelet-rich plasma (PRP) in ED patients. Thirty-four patients' erectile function was evaluated by filling up an abridged form of the international index of erectile function (IIEF-5) before and after PRP therapy. ICI of PRP was done once per week for 2months. All patients were prescribed PDE5Is for one month after PRP therapy. Penile haemodynamics was assessed using 20µg of PGE1 before and 3months after initiating PRP therapy. Interestingly, our study had shown that there was a statistically significant difference in the IIEF-5 score after ICI of PRP (-5.5, ±5.2, p=<0.001). Furthermore, in multiple logistic regression model for PRP responsiveness, smoking and IIEF score before PRP were the only significant independent variables (p=.040, p=.023 respectively). PRP injection for ED patients may be a promising modality as well as baseline IIEF-5, and smoking status can be used as predictors for a satisfactory response to PRP in such patients.

Probing penile hemodynamics by using photoplethysmography as objective indicators for male erection quality and sexual function

Erectile dysfunction (ED) is mostly due to the lack of blood flow into the penis. In the past 20 years, near-infrared spectroscopy (NIRS) was used in measuring the concentrations and temporal dynamics of different hemoglobin types. However, the dynamics of the light absorption (photoplethysmography; PPG) have not been applied to survey penile hemodynamics and erection quality. This paper compared the use of photoplethysmography (PPG) to study vascular ED with standard penile Doppler ultrasonography. Men diagnosed with vascular ED for at least 6 months and nominated for penile ultrasonography were included. PPG signals were collected during the ultrasound examination. All beat-to-beat PPG waveforms were aligned with the peak and averaged to one representative template waveform for feature analysis, including amplitude differences (APD) index, reflection time index (RTI), augmentation index (AI), and perfusion index (PI). An inverse correlation was found between end-erection amplitude and both erection hardness score (EHS) and resistive index (RI). APD index and EHS as well as the international index of erectile function-5 (IIEF) and RI were positively correlated. RTI and AI were inversely correlated to IIEF and RI. PI was positively correlated to RI. PPG may therefore be useful as a noninvasive, convenient, technique for sexual function evaluation.