Prevention Of Erectile Dysfunction Research Articles

Propionyl-L-carnitine, L-arginine and niacin in sexual medicine: a nutraceutical approach to erectile dysfunction

The application of nutraceuticals in the field of male sexual function -in particular for erectile dysfunction (ED)--remains relatively underexplored. In a group of 54 unselected men (35-75 years), consecutively presenting to our ED clinic and naive to other ED treatments, we carried out a single-blind, one-arm study to evaluate the effects of a 3-month supplementation with propionyl-L-carnitine, L-arginine and niacin on their sexual performance. All patients had the short-international index of erectile function (IIEF) questionnaire, global assessment questions (GAQs) and routine laboratory testing, at baseline and 3 months afterward. 51 (92%) patients of 54 completed the entire study period. After 3 months of treatment, a small, but statistically significant improvement in total and single items of the IIEF was found (Δ = 5.7 ± 4.1 P < 0.01). Analyses on GAQs revealed that treatment improved erections in 40% of cases, with a partial response occurring in up to 77% of subjects enrolled. These preliminary findings indicate that the favourable cardiovascular effects of nutraceuticals might also reflect on male sexual function with possible implication in the treatment and prevention of ED. This study documents a considerable patient's interest toward nutritional supplementation--as first-line or adjunctive treatment to PDE5 inhibitors--that goes beyond the measurable increment in penile rigidity.

Leaf morphometric and genetic variation of Butea superba in Thailand

Red kwao krua, Butea superba Roxb., is a herbal leguminous plant endemic in Thailand whose tuberous roots are used for male rejuvenation and the prevention of erectile dysfunction. Different populations from different provinces vary in their bioactivities, raising the need to evaluate the causes prior to optimal population selection and growth. Morphometric analysis of leaves collected from 34 populations from 24 provinces throughout Thailand using nine parameters for factor and cluster analyses were correlated with latitude and longitude revealing a clinal pattern. From the North to the South, leaf length increased in size in factor 1 but decreased in size in factor 2. Genetic analysis on the same samples, using DNA sequence analysis from the chloroplast rbcL, trnLF-cd, and trnLF-cf regions and maximum parsimony and neighbour- joining phylogenetic analysis, revealed essentially no genetic variation in the rbcL region, as expected. However, some between-population genetic variation was revealed by trnLF-cd and trnLF-cf sequences, suggesting potentially considerable genetic polymorphism. This was supported by preliminary RAPD analyses using five primers which indicated high genetic variation within and between populations.

Relative contributions of modifiable risk factors to erectile dysfunction: Results from the Boston Area Community Health (BACH) Survey

Objectives The objective of this study was to determine the relative contribution of modifiable risk factors (physical activity, smoking, and alcohol consumption) to inter-subject variation in erectile dysfunction (ED). Methods The Boston Area Community Health (BACH) Survey used a multistage stratified random sample to recruit 2301 men age 30–79 years from the city of Boston between 2002 and 2005. ED was assessed using the 5-item International Index of Erectile Function (IIEF-5). Multiple linear regression models and R 2 were used to determine the proportion of the variance explained by modifiable risk factors. Results In unadjusted analyses, lifestyle factors accounted for 12.2% of the inter-subject variability in IIEF-5 scores, comparable to the proportion explained by comorbid conditions (14.7%) and socioeconomic status (9%). Lifestyle factors were also significantly associated with age, comorbid conditions and socioeconomic status (SES). A multivariate model including all covariates associated with ED explained 29% of the variance, with lifestyle factors accounting for 0.9% over and above all other covariates in the model. Analyses repeated in a subgroup of 1215 men without comorbid conditions show lifestyle factors accounting for 2.5% of the variance after accounting for all other variables in the model. Conclusions Results of the present study demonstrate the contribution of modifiable lifestyle factors to the prevalence of ED. These results suggest a role for behavior modification in the prevention of ED.

A review of current progress in gene and stem cell therapy for erectile dysfunction

Background: Current gene-based strategies for treatment of erectile dysfunction (ED) are based on the nitric oxide (NO)/cGMP system; although growth factors, calcium sensitization, and potassium channel expression have been studied. Initial investigations of stem-cell-based therapy have attracted attention. Results of the first gene transfer clinical trial for treatment of ED with maxi-K channels are positive. Moreover, there is progress in gene and stem-cell therapy for the treatment of cardiovascular (CV) diseases. Objective: To improve understanding of gene and stem-cell therapy for CV disease, with emphasis on ED. Methods: Review of current literature. Results/conclusion: Treatment and prevention of ED can be improved by the application of CVD gene/cell-based therapy. New discoveries based on gene- and cell-based therapy will lead to new advances in the treatment of ED.

Pharmacoangiographic Evidence of the Presence and Anatomical Dominance of Accessory Pudendal Artery(s)

Potency preservation is one of the principal concerns surrounding newer developments in the management of organ confined carcinoma prostate. Nerve sparing techniques may not solely preserve erectile function and it is known that vascular factors may be an etiology of the dysfunction. The role of accessory pudendal arteries in the etiology and prevention of erectile dysfunction after radical prostatectomy is at present unclear. We reviewed pudendal angiograms in patients with erectile dysfunction to evaluate the prevalence and importance of these vessels. Selective pudendal pharmacoangiograms were obtained in 79 consecutive patients with a history of erectile dysfunction. The aim was to identify accessory pudendal arteries, their origin and their significance relative to all identifiable pudendal arteries and the dorsal penile artery with respect to penile arterial inflow. An accessory pudendal artery was identified in 28 (35%) of the patients. The most common origin was the obturator artery. In 15 of the 28 men (54%) in whom an accessory artery was identified it appeared angiographically to be the dominant penile artery. In 3 patients it was apparently the only major arterial inflow to the penis. Accessory pudendal arteries may be identifiable with pharmacoangiograms in approximately a third of all men. Because they may be the dominant source of blood supply to the penis in some cases, their preservation during radical prostatectomy could be critical to erectile function following radical prostatectomy.

Erectile dysfunction following radiotherapy and brachytherapy for prostate cancer: pathophysiology, prevention and treatment

Although detrimental impact on sexual function following radiotherapy (RT) and brachytherapy decreases the quality of life of prostate cancer survivors, the etiology, pathophysiology, prophylaxis and treatment of this condition has not yet been fully clarified. We reviewed the published literature in terms of etiology, treatment and possible prevention of erectile dysfunction (ED) following RT and/or brachytherapy. We have reviewed the literature through a MEDLINE search. Prostate cancer, erectile dysfunction, radiotherapy, brachytherapy, treatment and quality of life were used as keywords. Both RT and brachytherapy result in high rates of ED. Although arterial damage seems to be the main cause of ED after RT, exposure of neurovascular bundle to high levels of radiation dose has been also implicated in some studies with brachytherapy. The radiation dose received by the corpora cavernosa at the crurae of the penis may also be important in the etiology of ED. The most important predictive factor of ED following RT is the treatment modality. Intensity-modulated radiotherapy and vessel-sparing prostate radiotherapy are new techniques but those treatments may not guarantee complete preservation of the erectile function. Patients need to be correctly informed on the possible sequela of radiation-based treatments on their sexual well-being while planning their treatment. Patients should also be informed about the possible treatment modalities for ED, which may develop in due course.

Erectile dysfunction and treatment of carcinoma of the prostate

Prostate cancer is the leading malignancy in men in the United States and causes more than 60,000 deaths annually. Treatment of prostate cancer, whether it be with surgery, radiation therapy, cryotherapy, or medical treatment, is associated with significant life-altering morbidity. Incontinence and erectile dysfunction (ED) too often are sequelae of these treatment alternatives. ED can be a significant complication and can alter the life of the patient with prostate cancer and his partner. Newer modifications of the radical prostatectomy with nerve-sparing techniques are the cornerstone of erection preservation. Time following radical prostatectomy has been shown to increase erectile function such that more patients have functional erections at 3 years than 1 year after surgery. With the advent of phosphodiesterase-5 (PDE-5) inhibitors, many men can have improved functional erections and return to active coitus. Prevention of ED also is an important management technique. Evidence is gathering that prophylaxis with regular vasoactive injection or daily PDE-5 agents may be an integral part of preservation of corpus cavernosum smooth muscle function. Combination medical therapy and surgical penile prosthesis implantation also are options for patients who do not respond to oral PDE-5 inhibitors.

Role of Early Prophylaxis in the Prevention of Erectile Dysfunction Following Radical Prostatectomy

Patients who undergo radical prostatectomy (RP) usually report absence of spontaneous erection during the early postoperative period. The cause of this erectile dysfunction (ED) is mainly neurogenic - it stems from the failure to preserve the cavernous nerves or the nerves are preserved but are sometimes physiologically injured despite the best efforts of the surgeon. The latter often results in a period of neuropraxia. This has encouraged clinicians to use “early penile rehabilitation” to maintain the vascular and cellular integrity of the penis after RP.

The relationship between lipid profile and erectile dysfunction

The objective of this study is to investigate the relation between serum lipids (cholesterol, LDL, HDL, triglyceride (TG)) and erectile dysfunction (ED). The experimental methods involved comparison of 100 patients with organic ED (mean age of 43.59+/-10.51 y), with 100 healthy individuals (mean age of 43.72+/-9.76 y) regarding their lipid profile from January 2000 to June 2003 (cholesterol, TG, HDL, LDL). The results showed that there was a significant difference between mean plasma cholesterol and LDL levels in the individuals suffering from ED and the control group (P=0.04 and 0.02, respectively). The TG and HDL mean plasma level differences were not significant (P=0.583 and 0.299, respectively). Odds ratios for high plasma cholesterol level (>240 mg/dl) and high plasma LDL level (>160 mg/dl) were 1.74 and 1.97. The R2 was 0.04 for both cholesterol and LDL. Applying linear regression, the coefficient for cholesterol and LDL reduced the International Index of Erectile Function questionnaire scores by -0.036 and -0.035. In conclusion, this study, the correlation of cholesterol and LDL levels with ED strongly supports the role of hyperlipidemia treatment in both the prevention and management of ED.

1053: Effects of Antioxidants (A-Lipoic Acid and Selenium) in Prevention of Erectile Dysfunction in Streptozotocin-Induced Diabetic Rats

You have accessJournal of UrologyDiscussed Poster, Tuesday, May 24,2005, 8:00 am - 12:00 pm1 Apr 20051053: Effects of Antioxidants (A-Lipoic Acid and Selenium) in Prevention of Erectile Dysfunction in Streptozotocin-Induced Diabetic Rats Gurdal Inal, Evette Beshay, and Serge Carrier Gurdal InalGurdal Inal More articles by this author , Evette BeshayEvette Beshay More articles by this author , and Serge CarrierSerge Carrier More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35209-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1053: Effects of Antioxidants (A-Lipoic Acid and Selenium) in Prevention of Erectile Dysfunction in Streptozotocin-Induced Diabetic Rats." The Journal of Urology, 173(4S), pp. 285–286 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 285-286 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Gurdal Inal More articles by this author Evette Beshay More articles by this author Serge Carrier More articles by this author Expand All Advertisement PDF downloadLoading ...

Erectile dysfunction after fracture of the pelvis

Male sexual dysfunction after fracture of the pelvis is more common than previously supposed with rates as high as 30% reported when the complaint is specifically sought. With the increase in survival from major injuries, the long-term consequences of trauma are being seen with increasing frequency

The Relationship between Lipid Profile and Erectile Dysfunction

To evaluate the relationship between serum lipids including cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride and erectile dysfunction (ED). From January 2000 to June 2003, 100 patients with organic ED, who were referred to our center, were selected and their lipid profile (Cholesterol, Triglyceride, HDL, LDL) were assessed. The results were compared with those in 100 healthy individuals. Mean age of men in the study and control groups were 43.72 +/- 9.76 and 43.59 +/- 10.51 years, respectively. Mean plasma cholesterol and LDL levels in individuals suffering from erectile dysfunction were significantly higher than controls (P = 0.04 and P = 0.02, respectively). However, no difference in the mean plasma triglyceride and HDL levels was seen. Odds Ratios for high plasma cholesterol level (>240 mg/dl) and high plasma LDL level (>160 mg/dl) were 1.74 and 1.97, respectively (r2 = 0.04 and r2 = 0.04). Using linear regression analysis, the regression coefficient for cholesterol and LDL versus the International Index of Erectile Dysfunction Questionnaire (IIEF) score were -0.036 and -0.035, respectively (95% confidence interval: 0.98 - 2.5 for cholesterol and 1.13 - 2.81 for LDL). The impact of total cholesterol and particularly LDL on men's erectile function underlines the role of hyperlipidemia treatment in prevention of ED and emerges a holistic management in ED patients.

Pathophysiology of Erectile Dysfunction

Multiple regulatory systems are involved in normal erectile function. Disruption of psychological, neurological, hormonal, vascular, and cavernosal factors, individually, or in combination, can induced erectile dysfunction (ED). The contribution of neurogenic, vascular, and cavernosal factors was thoroughly reviewed by our committee, while psychological and hormonal factors contributing to ED were evaluated by other committees. To provide state of the art knowledge on the physiology of ED. An international consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five different continents developed in a process over a 2-year period. Concerning the pathophysiology of ED committee, there were seven experts from five different countries. Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. The epidemiology and classification of neurogenic ED was reviewed. The evidence for the association between vascular ED and atherosclerosis/hypercholesterolemia, hypertension and diabetes was evaluated. In addition, the pathophysiological mechanisms implicated in vascular ED were defined, including: arterial remodeling, increased vasoconstriction, impaired neurogenic vasodilatation, and impaired endothelium-dependent vasodilatation. The possible mechanisms underlying the association between chronic renal failure and ED were also evaluated as well as the evidence supporting the association of ED with various classes of medications. A better understanding of how diseases interfere with the physiological mechanisms that regulate penile erection has been achieved over the last few years, which helps establish a strategy for the prevention and treatment of ED.

Heavy smoking is an important risk factor for erectile dysfunction in young men

Clinical and basic science studies provide strong indirect evidence that smoking may affect penile erection. The objective of this retrospective research was to investigate the role of smoking for erectile dysfunction (ED) in order to obtain some insight into the prevention of ED. We reviewed the data from 860 male patients aged between 18 and 44 visited during the period January 1999 to December 2002. The patients were divided into three groups: smokers, never smokers and former smokers. All patients were submitted of medical history, such as, IIEF 5 Questionnaire, physical examination, serum levels of glucose, cholesterol, prolactin and free testosterone. Our data were compared with ISTAT (Italian Institute of Statistics) and data on the Italian population of smokers. We have stratified the data by age and area of residence. The 860 patients, mean age 32.4 y old (range 18-44), are distributed into three groups: smokers 460 (53.5%), never smokers 320 (37.2%) and former smokers 80 (9.3%). Current smokers in our series are 460 (53.5%) in comparison to 34.7% of male current smokers in Italy, in the same range (18-44). Out of 860, 337 are patients who smoked more than 20 cigarettes per/day (39.2%) and these data are extremely interesting; while comparing the same aged men through ISTAT, it is found that only 4% are heavy smokers. On analysing the incidence of heavy smoking in middle-aged patients affected by ED with the whole Italian population by means of ISTAT, taking into account males with the same age range and area of residence, it was shown that the data of our population (sample) compared all Italian middle-aged patients are 39.2 vs 4%; this explains the need for education within a comprehensive smoking cessation programme, and should be reserved especially for young smokers, in order to be aware and informed of the effect of tobacco on erectile function.

Are subjects with erectile dysfunction aware of their condition? Results from a retrospective study based on an Italian free-call information service

The aim of the study was to analyse the socio-demographic and epidemiological characteristics of the Italian male population affected by sexual disturbances. Men complaining of erectile dysfunction (ED) who called the Pfizer program "Man and Woman in Health" between April 18th 2001 and May 27th 2002 and asked for information about their medical condition, were interviewed by trained doctors using a computer-assisted questionnaire. 16007 out of 25018 calls were considered for statistical analysis. Mean age of callers was 48.8+/-14.2 yr, reporting ED in 83% of cases. In the majority of men ED was severe (58%) and lasting more than 3 yr (25%). Multivariate analysis revealed that diabetes, depression, prostate surgery, heart disease, neurological disorders, liver and renal diseases were all significant and independent contributors to the degree of erectile impairment adjusted for age (p<0.001). The principal concomitant medications were anti-hypertensive (23%), antidiabetic (9%) and cardiovascular agents (6%). Cigarette smoking was present in 24%. On directed questioning of the caller, anxiety and distress were perceived as the most frequent causes of ED (42%) across all age groups, followed by the presence of concomitant disease/s (26%) especially in aging men. Also, a large number of men (41 %) with severe ED waited for more than 3 yr before looking for medical referral. Interestingly, only 19% had ever tried any specific medication for ED. These data indicate that 5 yr after worldwide approval and release of sildenafil, ED is still largely undiagnosed and under-treated, possibly because it is still perceived as a condition mainly due to distress or advancing age and therefore not deserving medical referral. Effective prevention of ED commences with better awareness of the pathological causes by the population and modification of risk factors by the doctors.

Erectile function after radical prostatectomy: a review.

Although the high rate of erectile dysfunction (ED) following prostatectomy is well recognised, the aetiology and pathophysiology have not yet been fully elucidated. We examined the current literature as to aetiology, treatment and possible prevention of ED following prostatectomy. Review of the literature by a Medline search. The most important predictors of erectile function are pre-operative erectile function and the nerve sparing nature of the procedure. The former is determined by age and vascular risk-factors whereas the latter is decided by the stage of the tumour and the skill of the surgeon. The value of intraoperative nerve mapping seems limited and the importance of nerve grafting is uncertain. Natural recovery of erection can take as long as 24 months. Patients complain about a lack of professional support. Symptomatic therapy may be applied according to the current general standards of treatment in men with ED.

Association of type and duration of diabetes with erectile dysfunction in a large cohort of men.

Differences in risk of erectile dysfunction (ED) by characteristics of diabetes among older men are not well understood. We examined the association of type and duration of diabetes with erectile function in men >50 years of age in a large prospective cohort study. Subjects included 31,027 men aged 53-90 years in the Health Professionals Follow-Up Study cohort. On a questionnaire mailed in 2000, participants rated their ability (without treatment) in the past 5 years to have and maintain an erection sufficient for intercourse. Men who reported poor or very poor function were considered to have ED. Diabetes information was ascertained via self-report and documented with supplementary medical data. Men with diabetes had an age-adjusted relative risk (RR) of 1.32 (95% CI 1.3-1.4) for having ED compared with men without diabetes. In multivariable regression analyses, men with type 1 and type 2 diabetes were at a significantly higher risk for ED (type 1 diabetes RR = 3.0, 95% CI 1.5-5.9; type 2 diabetes RR = 1.3, 1.1-1.5) than nondiabetic men. Men with type 2 diabetes had an increasingly greater risk of ED with increased duration since diagnosis (trend test P value <0.0001) (RR = 1.7, 95% CI 1.1-2.7, for men diagnosed >20 years previously). For men over age 50 years, increasing duration of diabetes was positively associated with increased risk of ED relative to nondiabetic subjects. This association persisted despite the higher prevalence of other comorbid conditions. ED prevention and diabetes management efforts are likely to go hand-in-hand.

Aging and erectile dysfunction: the role of aging and concomitant chronic illness.

Erectile dysfunction (ED) can have a strong negative effect on the well-being and quality of life of the sufferer. Many factors may contribute to the development of this disorder; age in particular and also concomitant chronic illnesses including neurological, hormonal, arterial and cavernosal factors. An understanding of the prevalence and characteristics of risk factors for ED is required, in order to establish effective therapeutic strategies. However, the prevalence of ED depends on the definitions used and the use of an internationally established scale for the assessment of male sexual function is necessary to facilitate the comparison of data between different countries. Further epidemiologic research and analysis of individual risk factors is required. Such studies will clarify the interactive effects of organic factors and their probable etiology with the general physical, sociocultural and psychologic status of patients. These efforts will make it possible to design more effective future strategies for the treatment and prevention of ED.

Age-related prevalence of erectile dysfunction in Japan: assessment by the International Index of Erectile Function.

The effects of age and concomitant chronic illness on male sexual function were investigated to obtain insight into the prevention of erectile dysfunction (ED). A questionnaire from the International Index of Erectile Function (IIEF) was given to 2311 non-institutionalized men aged 23-79 years along with a survey of health status. The study sample consisted of 1517 men who provided complete responses to the questionnaire. For statistical analysis, ANOVA was conducted to evaluate the effect of aging on the sexual functions and a logistic regression model was used to identify significant independent risk factors for ED. There was a significant correlation between age and the scores for erectile function, orgasmic function, sexual desire and intercourse satisfaction. The prevalence of moderate and severe cases of ED were 1.8% and 0% for ages 23-29; 2.6% and 0% for ages 30-39; 7.6% and 1.0% for ages 40-49; 14.0% and 6.0% for ages 50-59; 25.9% and 15.9% for ages 60-69; and 27.9% and 36.4% for ages 70-79 years, respectively. Hypertension, diabetes mellitus, heart disease, chronic hepatitis, disc herniation and cerebral infarction under treatment with anticoagulants were significant independent risk factors for ED. The results obtained indicated a significant association between aging and chronic diseases and erectile function. Further epidemiologic research and analysis of individual risk factors are required to allow more effective future strategies for the treatment and prevention of ED.

Pathophysiology of erectile dysfunction: the contributions of trabecular structure to function and the role of functional antagonism.

Erectile dysfunction (ED) is estimated to impact more than 150 million men this year worldwide. An understanding of the pathophysiology of ED both furthers the basic scientific knowledge of disease processes and provides a rational design of pharmacotherapy. At present, there are two major views regarding the pathophysiology of ED. In the first hypothesis, the oxygen tension-dependent changes in the penis during erection are proposed to impact corpus cavernosum structure by inducing various cytokines, vasoactive factors and growth factors at the two different oxygen tensions (flaccidity and erection) which, in turn, alter smooth muscle metabolism and connective tissue synthesis. Decreases in the corpus cavernosum smooth muscle/connective tissue ratio have been correlated with an increased likelihood of diffuse venous leak and a failure of the veno-occlusive mechanism in prospective patient studies. Evidence for such a hypothesis incorporates nocturnal penile tumescence and circadian changes in oxygenation as important in maintaining erectile health. The alternate hypothesis proposes that ED is the result of a metabolic imbalance between relaxatory and contractile processes within the trabecular smooth muscle such that contractile processes predominate. Based on this hypothesis, therapy can be accomplished via drugs which shift this balance towards vasodilatation, or by gene therapy approaches to supplement the deficient components favoring smooth muscle relaxation. Both of these hypotheses predict a management strategy for ED that impacts pharmacotherapeutics. In this review of the pathophysiology of ED, each hypothesis will be examined and a synthesis devised incorporating both views. The future of research in this area as well as pharmacotherapy in ED in terms of pathophysiology is discussed including the merits and drawbacks of prophylaxis and prevention of ED. International Journal of Impotence Research (2000) 12, Suppl 4, S39-S46.