Presence Of Erectile Dysfunction Research Articles

Predictors of elaborated perineal or a combined abdominoperineal approach during repair for pelvic fracture urethral injury.

A step-based anastomotic urethroplasty is a standard technique for repairing the posterior urethra in patients with pelvic fracture urethral injury (PFUI). We aim to identify pre-operative factors, including results of conventional radiological imaging, for prediction of elaborated perineal or a combined abdominoperineal procedure. Retrospective observational study on 114 consecutive patients undergoing urethroplasty for PFUI between January 2020 and December 2022 was conducted. Surgical procedures were categorized according to the Webster classification into two groups: steps 1-2 (group 1) and steps 3-4 or a combined abdominoperineal repair (group 2). Pre-operative pattern results of RGU/VCUG were categorized regarding the relation between the proximal urethral stump with the pubic symphysis: posterior urethral stump below (pattern 1) or above (pattern 2) the lower margin of the pubic symphysis. Patient demographics were assessed. Univariate and multivariate logistic regression analyses were utilized. Overall, 102 patients were enrolled in the study for data analysis. On the multivariate logistic regression analysis, the presence of erectile dysfunction (OR 4.5; p = 0.014), prior combined treatment (endoscopic and urethroplasty) (OR 6.4; p = 0.018) and RGU/VCUG pattern 2 (OR 66; p < 0.001) significantly increased the likelihood of the need of step 3 or higher. The need of step 3 or higher during urethroplasty for PFUI can be predicted pre-operatively with conventional imaging (RGU/VCUG). Patients with proximal urethral stump above the lower margin of pubic symphysis were about 66 times more likely to need step 3 or higher during urethroplasty.

Антеградная экстраперитонеоскопическая реваскуляризация полового члена в лечении васкулогенной эректильной дисфункции.

Introduction. Erectile dysfunction (ED) is a multifaceted and widely prevalent problem in modern medicine. The problem of erectile dysfunction has not only medical but also social significance – the presence of erectile dysfunction in men has a deleterious effect on their quality of life. One of the few pathophysiologically substantiated surgical methods of treatment for vasculogenic erectile dysfunction is penile revascularization. Objective. To evaluate the effectiveness of antegrade extraperitoneoscopic penile revascularization in patients with vasculogenic erectile dysfunction, to develop an algorithm for selecting patients with vasculogenic ED suitable for penile revascularization surgery. Materials and methods. From 2015 to 2022, 65 penile revascularizations were performed in patients with vasculogenic ED. All patients were divided into 2 groups. In the main group, antegrade extraperitoneoscopic penile revascularization was performed in 34 patients, while in the control group, penile revascularization was performed in 31 patients according to the Virag-Kovalev method. To assess the results of the treatment, we used the scales and questionnaires IIEF-5, QoL, and the evaluation of penile rigidity on the Erection Hardness Score (EHS) scale. We also compared the duration of surgery and length of hospital stay. Results. The duration of surgery in the main group was significantly shorter (p &lt;0.01) than in the control group. Additionally, the length of postoperative hospital stay was significantly shorter (p &lt;0.05) in the main group. When comparing patients, there was a significant statistical difference in IIEF-5, EHS, and QoL scores. Conclusions. Penile revascularization, particularly the antegrade revascularization method, is an effective method for treating ED. The proposed methodology, based on the shortcomings of previous methods, is the most effective and least invasive of all the presented options. The success of penile revascularization surgery directly depends on careful patient selection and surgeon experience.

(523) Changes in Testosterone Levels in Patients with Erectile Function

Abstract Introduction Erectile dysfunction (ED) is a disease that affects approximately 20% of adult men. Androgen deficiency is one of the organic etiologies described for this sexual dysfunction. Objective To estimate the frequency of alterations in the sex hormone binding globuline (SHBG), total testosterone (TT), calculated free (FT) and bioavailable testosterone (BT) in Spanish men with a clinical diagnosis of erectile dysfunction in Madrid, Spain. Patients and methods Cross-sectional study. Men over 18 years of age with a clinical diagnosis of erectile dysfunction and a score in the international index of erectile function (IIEF-EF) &amp;lt; 26 were included. Serum levels of SHBG, TT, TL and TB were evaluated and the proportion of men was estimated. with hormonal alterations defined as: a) serum levels &amp;lt;2.49 ng/mL of TT in men under 50 years and &amp;lt;1.93 ng/mL in men of 50 years or older; b) TL for calculated value &amp;lt;2% of total testosterone; c) TB for calculated value &amp;lt;40% of total testosterone; d) serum SHBG levels &amp;gt;54.1 nmol/L in men younger than 50 years and &amp;gt;76.7 nmol/L in men 50 years and older. Results 30 subjects participated in the study. The mean age was 50.6 years (+/− 13.2), the median scores for IIEF-EF, Erection Hardness Score (EHS) and Aging Male Symptoms Score (AMS) were 15 (range 1-24), 2 (range 1-3) and 29.5 (range 11-62) respectively. 6 patients (20%) had severe erectile dysfunction, 13 (43.3%) moderate, 8 (26.7%) mild to moderate, and 3 (10%) mild erectile dysfunction. The mean TT was 4.94 ng/mL (+/− 1.91), FT 1.94% (+/− 0.605), BT 45.6% (+/− 14.2), and SHBG 33.3 nmol/L ( +/− 14.5). Only 6.7% of the patients (n=2) presented alterations of the TT, while in 60% (n=18) an alteration of the FT was found, in 36.7% (n=11) an alteration of the BT and in 3.3% (n=1) SHBG alterations, alterations being more frequent in men with moderate ED. Conclusions Our study found alterations in total testosterone in a small percentage of patients with ED, however the alterations in Free Testosterone calculated turned out to be much higher. This study suggests that future research should be carried out to identify a relationship between changes in calculated free testosterone levels and the presence of erectile dysfunction. Disclosure No

(276) Sexual Health of Transfeminine Individuals: A Chance to Educate Medical Providers

Abstract Introduction Providers may be unfamiliar with the sexual health needs of transgender patients. This hinders chances to provide comprehensive care, as many patients require prompting to discuss sensitive sexual issues. To increase awareness of these issues, we developed a questionnaire which assessed the sexual health of transfeminine individuals. Objective We sought to describe the sexual experiences and preferences of transfeminine individuals, and to categorize sexual health needs in this population. Methods IRB approval was obtained to develop (with transgender community feedback) a questionnaire assessing urinary and sexual health. Sexual preferences, symptoms, and quality of life (QOL) responses were compared among vaginoplasty (VP) and non-vaginoplasty (NVP) groups. NVP respondents were evaluated based on the International Index of Erectile Function (IIEF) categories: erectile function (EF), orgasmic function (OF), and sexual desire (SD). Results 53 transfeminine individuals (11 vaginoplasty, 10 orchiectomy, 32 no procedure) with mean age of 40 years (range 21-80) participated. Sexual QOL was similar for both groups (Table 1). There was an association between self-reported sexual activity and VP/NVP status, where a higher proportion of NVP respondents reported sexual activity with others and penetrative anal sex (p&amp;lt;0.05). Among NVP respondents, 38 (90.4%) of whom were undergoing hormone therapy, 23 (55%) indicated penile function was important to them. NVP IIEF EF, OF, and SD categories mean scores were 13.3, 5.8, and 5.6, respectively, compared to 25.8, 9.8, and 7.0 from the cis-gender controls in the initial IIEF study. 5 (11.9%) individuals used oral medications for erectile assistance, while 1 (2.3%) had a prosthesis. Conclusions When comparing VP and NVP respondents, we found similarities in sexual QOL while noticing differences in sexual preference, highlighting the diversity of this population. While many NVP respondents reported importance of penile function and presence of erectile dysfunction, only a minority were on treatment. This highlights an opportunity for providers to discuss sexual health with transfeminine patients and offer appropriate treatments. Disclosure No

Sex and gender-specific aspects in prediabetes and diabetes mellitus-clinical recommendations (Update 2023)

Metabolic diseases dramatically affect the life of men and women from infancy up to old age in different and manifold ways and are amajor challenge for the healthcare system. The treating physicians are confronted with the different needs of women and men in the clinical routine. Gender-specific differences affect pathophysiology, screening, diagnostic and treatment strategies of diseases as well as the development of complications and mortality rates. Impairments in glucose and lipid metabolism, regulation of energy balance and body fat distribution and therefore the associated cardiovascular diseases, are greatly influenced by steroidal and sex hormones. Furthermore, education, income and psychosocial factors play an important role in the development of obesity and diabetes differently in men and women. Males appear to be at greater risk of diabetes at ayounger age and at alower body mass index (BMI) compared to women but women feature adramatic increase in the risk of diabetes-associated cardiovascular diseases after the menopause. The estimated future years of life lost owing to diabetes is somewhat higher in women than men, with ahigher increase in vascular complications in women but ahigher increase of cancer deaths in men. In women prediabetes or diabetes are more distinctly associated with ahigher number of vascular risk factors, such as inflammatory parameters, unfavourable changes in coagulation and higher blood pressure. Women with prediabetes and diabetes have amuch higher relative risk for vascular diseases. Women are more often morbidly obese and less physically active but may have an even greater benefit in health and life expectation from increased physical activity than men. In weight loss studies men often showed ahigher weight loss than women; however, diabetes prevention is similarly effective in men and women with prediabetes with arisk reduction of nearly 40%. Nevertheless, along-term reduction in all cause and cardiovascular mortality was so far only observed in women. Men predominantly feature increased fasting blood glucose levels, women often show impaired glucose tolerance. Ahistory of gestational diabetes or polycystic ovary syndrome (PCOS) as well as increased androgen levels and decreased estrogen levels in women and the presence of erectile dysfunction or decreased testosterone levels in men are important sex-specific risk factors for the development of diabetes. Many studies showed that women with diabetes reach their target values for HbA1c, blood pressure and low-density lipoprotein (LDL)-cholesterol less often than their male counterparts, although the reasons are unclear. Furthermore, sex differences in the effects, pharmacokinetics and side effects of pharmacological treatment should be taken more into consideration.

Repair of Traumatic Urethral Strictures: La Paz University Hospital Experience

The management of traumatic urethral strictures remains a challenge for urologists. Alteration of the pelvic anatomy and the significant fibrosis generated by the trauma make surgical repair complex. In most cases, the existing defect between the urethral ends is small, and the ideal treatment is end-to-end perineal urethroplasty. Cases of extensive strictures that are left with long gap defects may require the use of different sequential maneuvers to achieve a tension-free anastomosis. To describe the experience at our center with urethral strictures induced by closed perineal trauma. A retrospective analysis of 116 patients who underwent urethroplasty for urethral stricture after blunt perineal trauma at our center between 1965 and 2020 was conducted. Demographic data, date, mechanism of action of the trauma, emergency management, previous urethral interventions, surgical technique carried out in our center, complications, presence of erectile dysfunction, and urinary incontinence were collected. 82 patients (70.7%) presented with pelvic fractures. The most frequent etiology of trauma was traffic accidents (68%), followed by crushing injuries (24%). Suprapubic cystostomy was placed in 50.2% of patients, and urethral realignment was performed in 25.3%. The mean stricture length was 2.2 cm, affecting mostly the membranous urethra (67%). During surgery, it was necessary to perform crural separation in 61.5% and partial pubectomy in 18.8% of the cases. Erectile dysfunction developed after trauma in 40.5% of cases, while new erectile dysfunction was noted in 4.3% of patients after surgery. Surgery was successful in 91.3% of cases, with a median follow-up of 16 (6-47) months. Delayed anastomotic urethroplasty offers a high success rate in traumatic urethral strictures.

Urethral rupture concomitant with penile fracture does not adversely affect functional outcomes.

The aim of this study was to identify possible risk factors for urethral rupture and to evaluate the effect of urethral rupture repair on long-term functional outcomes and complications. The medical records of consecutive penile fracture patients were retrospectively reviewed. Penile fracture patients with and without urethral rupture were compared according to demographics, clinical and intraoperative findings. Comparisons of postoperative functional results of the groups were performed using the 5-item version of the International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS). Finally, among them, long-term penile complications including penile curvature, painful erection, palpable nodule, and paresthesia were assessed. Fifty-three patients participated. Patients with urethral rupture (n = 8) were older (44.50 ± 10.69, 36.58 ± 10.33 years, p = 0.052). There was no significant difference in fracture etiology (p = 0.64). Urethral bleeding was present only in patients with urethral rupture (p < 0.001). Although no bilateral corpus cavernosum rupture was encountered in penile fracture patients without urethral rupture, this rate was significantly higher in those with urethral rupture at a rate of 62.5% (p < 0.001). The time from surgical repair to sexual activity was similar in both groups (p = 0.66). There was no significant difference in IPSS and IIEF-5 scores, the presence of erectile dysfunction and complication rates (p > 0.05). Older age is a possible risk factor for a concomitant urethral rupture with penile fracture and it seems to be associated with urethral bleeding and bilateral corpus cavernosum involvement. Additionally, urethral rupture repair neither adversely affected functional outcomes nor increased penile complication rates.

Usefulness of routine assessment of free testosterone for the diagnosis of functional male hypogonadism

Objective To investigate whether routine assessment of free testosterone improves the diagnostic accuracy of functional hypogonadism. Methods Total and free testosterone (calculated on SHBG levels) were determined in 188 patients with sexual symptoms and 184 with infertility. Results Hypogonadism (calculated free testosterone <63 pg/ml) was found in 47/188 (25.0%) patients with sexual symptoms and in 21/184 (11.4%) with infertility. Total testosterone determination misdiagnosed hypogonadism in 8.4% (12/143) of men with sexual symptoms and in 2% (3/152) with infertility. In subjects with borderline total testosterone, only 24.7% (19/77) had hypogonadism confirmed by free testosterone levels. Free testosterone levels significantly correlated with age, haematocrit, gonadotropins, gynecomastia, BMI, and number of co-morbidities, whereas total testosterone associated only with the latter two. Furthermore, age, haematocrit, BMI, and the presence of erectile dysfunction and of low libido were significantly different between men with normal and low free testosterone, whereas only BMI and low libido were significantly different between patients with normal and low total testosterone. Conclusion Routine assessment of free testosterone allows a more accurate diagnosis of functional hypogonadism, especially in men with sexual symptoms. Free testosterone levels associate with clinical and biochemical parameters of androgen deficiency better than total testosterone levels.

Sexual Function in Men Living With a Fontan Circulation.

Introduction: It is unknown if the Fontan circulation has an impact on sexual health in men. This study assessed self-reported sexual health and fertility in men with a Fontan circulation.Aims: In this prospective, cross-sectional study, Australian men ≥18 years enrolled in the Fontan Registry of Australia and New Zealand were invited to complete the International Index of Erectile Function (IIEF), alongside questions assessing fertility. These data were compared to historical, age-matched controls.Results: Of 227 eligible men, 54 completed the survey; of those 37 were sexually active and included in the final analysis. Mean age was 28 ± 3 years, age at Fontan was 5 ± 3 years. Fontan type was extra-cardiac conduit in 15 (41%), lateral tunnel in 12 (32%), and atriopulmonary connection (APC) in 10 (27%). Ventricular function was normal in 24 (83%), and all were New York Heart Association Class I (23 patients, 79%) and II (six patients, 21%). Nine participants (24%) had erectile dysfunction (IIEF-EF score ≤25). The severity was mild (IIEF 22–24) in six (16%), mild–moderate (IIEF 17–21) in two (5%), and moderate (IIEF 11–16) in one (3%). Baseline characteristics and current medication usage were similar in those with and without erectile dysfunction. Compared with historical control values, erectile function was not significantly impaired in the Fontan population (p =0.76). Men with a Fontan circulation had decreased levels of sexual desire and overall satisfaction (p < 0.001). There was no correlation between the presence of erectile dysfunction and any assessed parameter. Eleven (30%) of the cohort reported a pregnancy with a prior partner.Conclusion: In our cohort, overall erectile function was comparable between men with a Fontan circulation and historical controls, however sexual desire and overall satisfaction were reduced. There was no correlation between study parameters and the presence of erectile dysfunction. The proportion of the cohort who had a prior pregnancy was congruent with population data.

Liquid chromatography-high-resolution mass spectrometry analysis of erectile dysfunction drugs and their analogues in food products

The presence of erectile dysfunction (ED) drugs in adulterated dietary supplements, mainly in pharmaceutical dosage forms, is frequently addressed in the literature. Little attention is given to food products despite their increasing adulteration trend. To address this knowledge gap targeted, suspected-target, and non-targeted strategies were utilised to analyse ED drugs and their analogues in powdered drink mix (PDM), honey, jelly, hard candy, and sugar-coated chewing gum using liquid chromatography-high-resolution mass spectrometry (LC-HRMS). The method was optimised and validated using 23 target analytes, representing different ED drugs with structural similarities. The modified quick, easy, cheap, effective, rugged, and safe (QuEChERS) extraction exhibited insignificant matrix effect (ME) within − 9.2–8.8% and provided complete coverage of target analytes with acceptable extraction recovery (RE) within 75.5–123.9%, except for carbodenafil in the PDM matrix. Based on the ME and RE performance, the analytical method was validated to analyse 25 food samples that claimed to enhance male sexual performance. The method exhibited good specificity and linearity with a limit of detection within 10–70 ng/mL and limit of quantification of 80 ng/mL. Similarly, the accuracy and precision were satisfactory within 77.4–122.0% and< 16.7%RSD, respectively. The LC-HRMS targeted analysis, together with suspected-target and non-targeted screenings, identified and detected ten ED drugs from 24 food samples. The modified QuEChERS extraction with LC-HRMS-based method was demonstrated to be universally applicable to various food products, covering an extensive range of known and potentially novel ED drugs, which is valuable for routine casework.

Mellituslu Erkek Hastalarda Akut-Kronik Glisemik Oran ile Erektil Disfonksiyon Arasındaki İlişkinin Değerlendirilmesi: Retrospektif, Olgu-Kontrol Çalışması

Objective: The aim of this study was to investigate the possible association between the acute to chronic (A/C) glycemic ratio and the presence of erectile dysfunction (ED) in diabetic men. Material and Methods: A total of 104 diabetic men, 45 of whom had ED while 59 did not, were retrospectively enrolled in this study. Clinical examination and laboratory analyses including A/C glycemic ratio, serum fasting glucose, hemoglobin A1c, lipid profile, and total testosterone were analyzed. Results: The total testosterone levels were lower in the diabetic ED patients compared to the non-ED diabetic participants (4.49 ng/dL vs 4.80 ng/dL, respectively). However, the difference was not statistically significant (p=0.093). Mean high-density lipoprotein cholesterol levels were significantly lower in the diabetic ED patients than in the controls (40±9 mg/dL vs 44±10 mg/dL; respectively; p=0.030). Although the median A/C glycemic ratios were higher in the diabetic ED patients (1.28±0.23 vs. 1.18±0.32), no statistical significant differences were noted between the two groups (p=0.054) Conclusion: The strong relationship between diabetes mellitus (DM) and ED demands caution since DM is a common disease in the population. We believe that developing biomarkers for the early diagnosis of ED will help provide treatment and improve the life quality of patients. Although we could not find a statistical relationship between the A/C glycemic ratio and ED in our study results, we think that further welldesigned prospective studies are needed in this area.

Erectile Dysfunction among Nigerian Men with Diabetes: A Systematic Review

Background Diabetes mellitus is a chronic metabolic disorder with multiple microvascular and macrovascular complications. Some of the complications of diabetes such as erectile dysfunction is a result of an interplay of both microvascular and macrovascular complications. Erectile dysfunction is the inability to achieve or sustain erection adequate for satisfactory sexual activity. Erectile dysfunction is relatively common in men with diabetes yet there is paucity of information on erectile dysfunction among Nigerian men with diabetes. Methods Twelve studies on erectile dysfunction in Nigerian men with diabetes with a total sample size of 1777 fulfilled the eligibility criteria and were recruited into the systematic review. The International Index of Erectile Function (IIEF) questionnaire was used to assess for erectile dysfunction in all the studies. Results The prevalence of erectile dysfunction among Nigerian men with diabetes is 48.4-98.0%. The factors significantly associated with the presence of erectile dysfunction among Nigerian men with diabetes are longer duration of diabetes, poor glycaemic control, older age, peripheral arterial disease, autonomic neuropathy and obesity. Conclusion There is scanty literature on erectile dysfunction among Nigerian men with diabetes mellitus hence the need to have a systematic review to provide composite information on the topic. The few studies on erectile dysfunction among Nigerian men with diabetes were done across different geopolitical zones but more studies were done in Southern Nigeria. Therefore, there is a need to conduct more studies across all zones and more especially in the Northern part of the country. The prevalence of erectile dysfunction among Nigerian men with diabetes is 48.4-98.0%. The wide range reflects differences in demographics and research designs. The main predictors of erectile dysfunction among Nigerian men with diabetes are longer duration of diabetes, poor glycaemic control, older age, peripheral arterial disease, autonomic neuropathy and obesity.

Erectile Dysfunction among Nigerian Men with Diabetes: a Systematic Review

Background Diabetes mellitus is a chronic metabolic disorder with multiple microvascular and macrovascular complications. Some of the complications of diabetes such as erectile dysfunction are a result of an interplay of both microvascular and macrovascular complications. Erectile dysfunction is the inability to achieve or sustain an erection adequate for satisfactory sexual activity. Erectile dysfunction is relatively common in men with diabetes yet there is a paucity of information on erectile dysfunction among Nigerian men with diabetes. Materials and Methods: Twelve studies on erectile dysfunction in Nigerian men with diabetes with a total sample size of 1777 fulfilled the eligibility criteria and were recruited into the systematic review. The International Index of Erectile Function (IIEF) questionnaire was used to assess erectile dysfunction in all the studies. Results: The prevalence of erectile dysfunction among Nigerian men with diabetes is 48.4-98.0%. The factors significantly associated with the presence of erectile dysfunction among Nigerian men with diabetes are longer duration of diabetes, poor glycaemic control, older age, peripheral arterial disease, autonomic neuropathy and obesity. Conclusion: The prevalence of erectile dysfunction among Nigerian men with diabetes is high. Close attention needs to be paid to glycaemic control in these patients to reduce the complications.

Peyroni cerrahisinde hasta memnuniyetine etki eden faktörler.

Özet Amaç: Penil eğriliğin en sık nedeni olan peyroni hastalığı için hala en etkili tedavi yöntemini cerrrahi müdahaleler oluşturmaktadır. Fonksiyonel ve kozmetik sonuçları olan peyroni cerrahisinde hasta memnuniyetine etki eden faktörleri araştırmayı amaçladık. Gereç ve yöntem: 2012-2019 yılları arasında peyroni hstalığı tanısı konulmuş ve peyroni cerrahisi önerilmiş hastaların kayıtları retrospektif olarak incelendi. 1. Yıl kontrollerinde hastaların erektil kapasite, rezidüel / tekrarlayan penil deformite, penil uzunluk ve potansiyel komplikasyonlar açısından preoperatif kayıtları ile birlikte değerlendirildi ve memnuniyet düzeyleri ölçülerek etki eden faktörler araştırıldı. Bulgular: Plikasyon cerrahisi (Grup 1) geçiren 27 hasta, İnsizyon safen ven greft cerrahisi (Grup 2) geçiren 21 hasta saptandı. Grup 1'de hasta memnuniyet %83,33, grup 2'de %67,14 saptandı. Grup 2’de penil kısalma miktarı (2,71±1,41 cm) grup 1’e (1,14±0,91 cm) göre daha fazla gözlendi. Hastaların memnuniyetine etki eden parametreler incelendiğinde; penis boyu kısalmasıyla ( p =0,036), cerrahi öncesi erektil disfonksiyon varlığını belirtmekle (rho-,375, p =0,009), plak varlığıyla ( p =0,002), eşlik eden komorbid hastalık varlığıyla ( p <0,001), şikayet tekrarı varlığıyla ( p =0,006) hasta memnuniyeti arasında negatif korelasyon saptandı. Sonuç: Peyroni hastalığında cerrahi yöntemler en etkili tedavi yöntemleri olarak önerilmektedir. Hastaların postoperatif penil kısalma ve kurvatür rekürrensi açısından preoperatif iyi bir bilgilendirme yapılması hasta memnuniyetlerini arttırabilir.

Testicular function and sexuality in adult patients with anorectal malformation

PurposeTo collect data on sexual and fertility issues in adult male patients with history of anorectal malformations (ARM). Materials and methodsThirty adult males born with ARM, cared for at the Pediatric Surgery of Treviso and Padua Hospitals, were enrolled and interviewed about sexual habits and relationships. Testicular ultrasound, evaluation of male sex hormones and semen analysis were performed to assess testicular function and compare data with 15 fertile controls. Presence of erectile dysfunction was evaluated with IIEF-5 questionnaire. ResultsCryptorchidism and recurrent orchiepididymitis were reported in 33% and 40% of patients, respectively. Average testicular volume resulted significantly lower than fertile controls (11.1 vs 14.3 mL, p = 0.002) and 53.5% presented testicular hypotrophy (<10 mL).Erectile dysfunction was reported by a single patient and ejaculatory anomalies by 46.5%.Thirteen patients were azoospermic/cryptozoospermic; 6 of them presented a reduced peripheral sensitivity to androgens (ASI > 139). Coital debut resulted delayed at 18 years old (vs 15 years in the control group). Overall 63.5% reported their condition did not affect their sexual sphere. ConclusionsEvaluation of testicular function is recommended in ARM patients to detect and treat possible infertility disorders, to recognize the clinical conditions which could affect the spermatogenesis since childhood, and to guarantee psychological support. Level of evidence ratingPrognosis study.Level III (case–control study).

Study of the prevalence and patterns of phosphodiesterase type 5 inhibitor use among sexually active Egyptian males: A National Cross-sectional Survey.

A cross-sectional survey was conducted in Egypt from November 2015 to June 2016. Sexually active adult men were interviewed by a questionnaire designed by the authors. All the participants were evaluated by the abridged 5-item version of the International Index of Erectile Function (IIEF). A total of 3,000 sexually active Egyptian males participated in this study, 946 (31.53%) reported using PDE5Is at least once, and 2054 (68.47%) have never used them. The majority of those who used PDE5Is obtained them for recreational purposes mainly for pleasure (58.35%) and to increase duration/frequency of the intercourse (15.6%). Only 26.05% used PDE5Is to treat ED. The main source of obtaining PDE5Is was friends, relatives and colleagues (62.79%); 25.16% of users obtained the drug by themselves, and 6.66% were prescribed the drug by a pharmacist. Only 5.39% of users obtained the drug after a specialist physician consultation. Sildenafil was the most commonly used PDE5I (90.6%), and most of the users (88.05%) used them in an occasional manner even in the presence of erectile dysfunction, while 11.95% used the drug in a regular manner for every intercourse. PDE5Is are frequently used by the Egyptian male population, and most of them seemed to take them as recreational medications.

Testosterone Levels Are Not Associated With Magnitude of Deformity in Men With Peyronie’s Disease

IntroductionThere are some data suggesting that there is a relationship between the magnitude of Peyronie’s disease (PD)–associated penile curvature and low serum testosterone. AimTo evaluate the relationship between PD associated penile deformity and total testosterone (TT) and free testosterone (FT) levels. MethodsWe identified patients diagnosed with PD who had early morning TT measurements. Because laboratories have different reference values, we analyzed testosterone values 2 ways, as raw values and as standardized values (TT and FT values converted into z-scores for each laboratory). Deformity assessment was conducted during an intracavernosal injection–induced rigid erection. The association between T levels and magnitude of penile curvature was analyzed in a number of ways. First, an independent measure t-test tested differences in curvature degree by TT groups (low T: <300 ng/dL; normal T: ≥300 ng/dL). Second, an association was sought between T levels based on quartiles of the normal range (<300, 300–450, 450–600, and >600 ng/dL). These analyses were conducted for both TT and FT levels and using both raw and standardized T values. Third, multivariable analysis using multiple linear regression was performed in an attempt to define predictors of the degree of penile curvature. Factors entered into the model included: TT level, FT level, patient age, race (white vs other), number of co-morbidities, body mass index, presence of erectile dysfunction, duration of PD, and prostatectomy (yes vs no). Main Outcome MeasuresThe relationship between T levels and the magnitude of penile curvature. Results184 subjects met all study criteria. Average age was 54 ± 12 years. Mean TT level was 425 ± 176 ng/dL, and mean curvature magnitude was 35° ± 19°. The percent of subjects in the first through fourth TT quartiles was 26%, 34%, 24%, and 16%. As a continuous variable, there was no association between TT levels (r = −0.01, P = .95) or FT levels (r = −0.08, P = .30) and the curvature magnitude. When examining TT groups, there was no difference in mean curvature between the low TT group and the normal TT group (35.4° ± 17° vs 34° ± 20°, P = .70). When analyzing the TT and FT levels standardized into z-scores, there was no association between degree of curvature and TT z-scores (r = −0.003, P = .95) and FT z-scores (r = −0.08, P = .43). There was also no association between testosterone levels and degree of curvature in the multivariable model. ConclusionsThere does not appear to be any association between testosterone levels and the magnitude of PD-associated penile deformity.Mulhall JP, Matsushita K, Nelson CJ. Testosterone Levels Are Not Associated With Magnitude of Deformity in Men With Peyronie’s Disease. J Sex Med 2019;16:1283–1289.

SEXUAL DISORDERS BY HYPERTONIC PATIENTS LIKE A PREDICTORS OF CARDIOVASCULAR DISEASE PROGNOSIS

Objective: Objective of this work is to explore the relationship of erectile dysfunction (as an expression of endothelial damage) and modifiable lifestyle risk factors in hypertensive patients with or without cardiovascular organic changes. Design and method: Method: The presence and severity of sexual disorders in the group of 200 hypertensive patients, aged 40–70 years, were studied in the beginning and after one year. With half of the enrolled patients was performed repeated targeted nursing intervention, focused on respect of the life style principles. Questionnaire method was used for data collection at the beginning and at the end of the annual reporting period. Questionnaires were focused on antropometric dates, lifestyle, QoL and presence of erectile dysfunction (IIEF5). Results: The research results showed that by hypertensive patients with organic cardiovascular changes is a higher incidence of moderate and severe erectile dysfunction than in hypertensive patients without organ changes. At the same time it showed a higher incidence in the group of patients with organic complications than without them. In groups without nursing intervention was an increase in the number of patients with erectile dysfunction by 18% (group without organic complications), respectively 37% (with organic complications). The severity of erectile dysfunction by groups without intervention increased also. The differences have been statistically significant. Conclusions: The results confirmed the assumption of a positive effect of targeted and repeated nursing interventions aimed at compliance with healthy lifestyle and quality of life on erectile dysfunction by hypertensive patients. In the end, paper makes recommendations regarding the highlighting of motivational factors affecting the adoption of healthy lifestyle and explains the role of nurses in applying the principles of secondary prevention of cardiovascular disease in practice.

Sex and gender-specific aspects in prediabetes and diabetes mellitus-clinical recommendations (Update 2019)

Metabolic diseases dramatically affect the life of men and women from infancy up to old age in different and manifold ways and are amajor challenge for the healthcare system. The treating physicians are confronted with the different needs of women and men in the clinical routine. Gender-specific differences affect screening, diagnostic and treatment strategies as well as the development of complications and mortality rates. Impairments in glucose and lipid metabolism, regulation of energy balance and body fat distribution and therefore the associated cardiovascular diseases, are greatly influenced by steroidal and sex hormones. Furthermore, education, income and psychosocial factors play an important role in the development of obesity and diabetes differently in men and women. Males appear to be at greater risk of diabetes at a younger age and at a lower body mass index (BMI) compared to women but women feature adramatic increase in the risk of diabetes-associated cardiovascular diseases after the menopause. The estimated future years of life lost owing to diabetes is somewhat higher in women than men, with a higher increase in vascular complications in women but a higher increase of cancer deaths in men. In women prediabetes or diabetes are more distinctly associated with ahigher number of vascular risk factors, such as inflammatory parameters, unfavorable changes in coagulation and higher blood pressure. Women with prediabetes and diabetes have a much higher relative risk for vascular diseases. Women are more often morbidly obese and less physically active but may have an even greater benefit in health and life expectation from increased physical activity than men. In weight loss studies men often showed a higher weight loss than women; however, diabetes prevention is similarly effective in men and women with prediabetes with arisk reduction of nearly 40%. Nevertheless, along-term reduction in all cause and cardiovascular mortality was so far only observed in women. Men predominantly feature increased fasting blood glucose levels, women often show impaired glucose tolerance. Ahistory of gestational diabetes or polycystic ovary syndrome (PCOS) as well as increased androgen levels in women and the presence of erectile dysfunction or decreased testosterone levels in men are important sex-specific risk factors for the development of diabetes. Many studies showed that women with diabetes reach their target values for HbA1c, blood pressure and low-density lipoprotein (LDL)-cholesterol less often than their male counterparts, although the reasons are unclear. Furthermore, sex differences in the effects, pharmacokinetics and side effects of pharmacological treatment should be taken more into consideration.

A Study of hypogonadism in type 2 Diabetes Mellitus male patients attending Shebin ElKoum Teaching Hospital- Egypt

Objective To the objective of this article is to evaluate serum-free testosterone levels as an indicator of hypogonadism in male patients with type 2 diabetes mellitus (DM). Background DM is considered to be one of the most common chronic diseases. Male hypogonadism is characterized by low levels of serum testosterone and is closely linked to the development of diabetes. Patients and methods This study included 80 individuals recruited from the Internal Medicine Department of Shebin El-Kom Teaching Hospital, Menoufia, Egypt. They were classified into: a case group which included 40 patients of type 2 DM in the age group of 30–65 years and a control group which included 40 healthy control persons matched for age and sex. After providing written informed consent, all patients were clinically evaluated, had routine laboratory investigations and assessment of glycated hemoglobin% (HbA1c%) and free testosterone and those who had low levels of free testosterone underwent assessment of the circulating levels of the follicle-stimulating hormone and luteinizing hormone. Results There was significant difference between the two groups regarding the presence of erectile dysfunction and hypogonadism as their percentages were increased in the case group. A comparison between diabetic patients with hypogonadism and diabetic patients with eugonadism regarding HbA1c has shown that diabetic patients with hypogonadism had significant elevated levels of HbA1c. Conclusion This study demonstrates the presence of a significant relationship between type 2 DM and presence of hypogonadism and erectile dysfunction in men.