Risk Factors For Erectile Dysfunction Research Articles

Impact of infertility duration on male sexual function and mental health.

This study aimed to explore whether infertility duration has an impact on the sexual function and mental health of men from infertile couples. We conducted a case-control study of 558 men from infertile couples, and the participants were divided into four groups based on their infertility duration: group I: ≤ 2years; group II: 2-5years; group III: 5-8years; and group IV: > 8years. Sexual function and mental disorders were measured using the International Index of Erectile Function-15 (IIEF-15), Premature Ejaculation Diagnostic Tool (PEDT), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire (PHQ-9) separately. As the years of infertility duration increase, the total IIEF-15 score and four domains (sexual desire, orgasmic function, erectile function, and intercourse satisfaction) significantly decrease (p < 0.05). The PEDT score gradually increases significantly (p < 0.05). Increased infertility duration is an independent risk factor for erectile dysfunction and premature ejaculation (p < 0.05). However, increased infertility duration is not a risk factor for depression and anxiety (p > 0.05). Our study is the first time to use the infertility duration as an independent variable and group this variable to analyze its impact on the sexual function and mental health of men from infertile couples comprehensively and systematically. The increased infertility duration is an independent risk factor for the occurrence of sexual dysfunction but not for mental disorders. In the process of infertility treatment, sexual health and mental health cannot be ignored, especially for patients with prolonged infertility.

Primary organic versus primary psychogenic erectile dysfunction: Findings from a real-life cross-sectional study.

Erectile dysfunction aetiology has been historically identified as organic, psychogenic and mixed. To stratify and compare a cohort of patients seeking medical help for erectile dysfunction for the first time according to the newly proposed binary classification of the European Association of Urology guidelines: 'primary organic' versus 'primary psychogenic'. Complete data from 2009 consecutive patients presenting for erectile dysfunction were analysed. All patients completed the International Index of Erectile Function at baseline. According to the presence of erectile dysfunction-related risk factors indexed by the European Association of Urology Guidelines on Sexual and Reproductive Health, patients were categorised as having primary organic (≥1 risk factor) or primary psychogenic (0 risk factor) erectile dysfunction. Descriptive statistics compared the two groups. Linear regression analysis tested the association between the number of risk factors and erectile dysfunction severity. Locally estimated scatterplot smoothing method graphically explored the relationship between the number of risk factors for erectile dysfunction and the International Index of Erectile Function domain scores. Median (interquartile range) age at first presentation was 50 (39-61) years. Of all, 1632 (86.2%) and 377 (13.8%) were identified as having primary organic and primary psychogenic erectile dysfunction, respectively. Overall, 1488 (74.1%) patients were >40 years of age; in this subgroup, the most frequent risk factors were age, hypertension (29%), active smoking (42%) and alcohol intake (25.1%). Median (interquartile range) International Index of Erectile Function-erectile function score was 15 (7-22). Primary organic erectile dysfunction patients depicted lower International Index of Erectile Function-sexual desire and International Index of Erectile Function-orgasmic function scores (all p≤0.02), whilst groups did not differ in terms of International Index of Erectile Function-erectile function, International Index of Erectile Function-intercourse satisfaction and International Index of Erectile Function-overall satisfaction scores. One out of nine patients complaining of erectile dysfunction depict criteria for primary psychogenic erectile dysfunction. Erectile function severity could be as severe as patients with organic erectile dysfunction. The single-centre-based cross-sectional nature of the study, raising the possibility of selection biases, is our main limitation. One out of nine patients presenting for erectile dysfunction depict criteria suggestive for primary psychogenic erectile dysfunction in the real-life setting. Patients with primary psychogenic and primary organic erectile dysfunction have comparable erectile dysfunction severity, thus outlining the importance of a comprehensive and tailored management work-up in every patient seeking medical help for the first time.

Novel predictive risk factor for erectile dysfunction: Serum high-sensitivity C-reactive protein.

C-reactive protein (CRP), as a marker of inflammation, may be closely related to erectile dysfunction (ED), however, there is no meta-analysis exists for it. We aimed to verify the relationship between CRP and erectile dysfunction and to explore the changes of CRP levels in ED patients after first-line treatment. We searched databases including the Cochrane Library, PubMed, and MEDLINE to identify studies up to January 1, 2022. We performed a comprehensive analysis of the included studies by STATA software and calculated standardized mean differences (SMDs) and their corresponding 95% confidence intervals. A total of 12 studies were included and the analysis showed that CRP levels were higher significantly in patients with erectile dysfunction than the healthy controls (p<0.001) and decreased by a mean of 0.38mg/L after first-line PDE5i drug treatment (p=0.001). This novel meta-analysis suggests that CRP is statistically significantly associated with erectile dysfunction and may be a predictor or risk factor for the assessment of ED. However, further original studies with large sample sizes are needed to validate this.

Erectile Dysfunction in Multiple Sclerosis: A Prevalence Meta-Analysis and Systematic Review

A connection between multiple sclerosis (MS) and erectile dysfunction (ED) has been debatable. To assess the pooled prevalence of ED among men with MS and whether MS was a risk factor for ED. A systematic review of the literature was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library to find relevant English-language studies published up to February 2022 that assessed the prevalence of ED in MS patients. Two authors independently evaluated the full text of the enrolled studies to determine eligibility, and if there was disagreement, the decision was made by a third author after discussion. Assessment tools adapted for prevalence studies were used to evaluate the quality of cross-sectional studies, and the quality of case-control studies was assessed by Newcastle-Ottawa scale. The relative risk (RR) and its 95% confidence interval (CI) were used to assess the strength of association between MS and the risk of ED. The sources of heterogeneity were investigated by subgroup analysis. Sensitivity analysis was conducted to evaluate the stability of the results. The pooled prevalence of ED in MS patients as well as 95% CIs were estimated, and the RR and its 95% CI were used to assess the strength of association between MS and the risk of ED. Sixteen studies included collectively gave information about ED in 2,760 MS men, resulting in a pooled prevalence of 49% (95% CI=42-56%) for ED with a large heterogeneity. Synthesis of results revealed that MS was significantly associated with an increased risk of ED (RR=3.17, 95% CI=2.31-4.36, P < .001; heterogeneity: I2=0.0%, P=.716). The pooled prevalence estimates of ED were 55, 63, and 57% in the age >40, IIEF diagnostic tool, and mean disease duration >10 years subgroups, respectively. The present meta-analysis indicates that MS patients had a significantly increased risk of ED, which should raise awareness of the potential association between MS and ED by clinicians. This is the first meta-analysis to provide the global prevalence of ED in MS patients and to demonstrate that MS is a risk factor for ED. However, all enrolled studies were observational in design, which may reduce the robustness of this evidence. Results of this meta-analysis showed that ED was highly prevalent in adult men with MS and MS was a potential risk factor for ED development. Wu X, Zhang Y, Zhang W, etal. Erectile Dysfunction in Multiple Sclerosis: A Prevalence Meta-Analysis and Systematic Review. J Sex Med 2022;19:1255-1268.

86-OR: Erectile Dysfunction in Men with Prediabetes and Type 2 Diabetes: The Diabetes Prevention Program Outcomes Study (DPPOS)

Introduction: Erectile dysfunction (ED) is more common and less responsive to pharmacotherapy in men with T2D. Data in men with prediabetes (PreD) and risk profiles in those with T2D, are lacking. We determined the burden and risk factors for ED in men with PreD and with T2D enrolled in the DPPOS. Methods: Between 1996-1999, 3,234 adults with PreD were randomized to intensive lifestyle intervention, metformin, or placebo in the DPP. In 2001, metformin was continued for those originally randomized with modified lifestyle intervention offered to all. In 2016-2017, 568 (88%) of 648 male participants completed the International Index of Erectile Function (IIEF) . ED was defined as having low or very low confidence getting and keeping an erection and/or ED medication use. Backwards selection multivariable logistic regression models including DPP treatment estimated odds of ED for covariates significant in bivariate analysis in men with persistent PreD and T2D. Results: Overall, 218 (38%) men met ED criteria. Prevalence of ED was similar in men with PreD (41%) and T2D (37%) (p=0.4) . In all men, older age (p&amp;lt;0.001) , non-white race (p&amp;lt;0.001) and depression (defined by Beck Depression Inventory or antidepressant use) (p&amp;lt;0.01) were associated with ED. Among men with PreD, those assigned to intensive lifestyle intervention, but not metformin, had decreased odds of ED compared with the placebo group (OR=0.26, 95%CI=0.09, 0.77) . Among men with T2D, metabolic syndrome (MetS) , defined by NCEP ATP III criteria, was associated with increased odds of ED (OR=1.72, 95%CI=1.05, 2.83) . Conclusions: ED is highly prevalent in men with PreD and with T2D. In addition to demonstrated factors typically observed in the general population such as younger age and absence of depression, intensive lifestyle intervention was protective in men at increased risk for T2D. In men with T2D, ED was associated with MetS. Our findings suggest metabolic mechanisms contribute to the pathogenesis of ED in T2D. Disclosure Y.Blair: None. L.Doherty: None. M.Temprosa: None. H.Wessells: None. R.Pop-busui: Advisory Panel; Averitas Pharma, Inc., Boehringer Ingelheim International GmbH, Nevro Corp., Novo Nordisk, Reata Pharmaceuticals, Inc., Regenacy Pharmaceuticals, Inc. K.M.Gadde: Research Support; AstraZeneca, BioKier, Inc. P.Singh: None. A.V.Sarma: None. D.Research group: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (UDK048489, UDK048339, UDK048377, UDK048349, UDK048381, UDK048468, UDK048434, UDK048485, UDK048375, UDK048514, UDK048437, UDK048413, UDK048411, UDK048406, UDK048380, UDK048397, UDK048412, UDK048404, UDK048387, UDK048407, UDK048443, and UDK048400)

Associations between exposure to different heavy metals and self-reported erectile dysfunction: a population-based study using data from the 2001-2004 National Health and Nutrition Examination Survey.

Heavy metals are ubiquitous and nonbiodegradable pollutants that are widely distributed in the environment. Heavy metal exposure can damage various biological tissues and cause several diseases. This study aimed to investigate the association between blood and urinary cadmium, lead, and mercury levels and erectile dysfunction (ED) based on data from the 2001-2004 National Health and Nutrition Examination Survey. In total, 3681 participants were included in the analysis. Results showed that participants with ED had high blood cadmium, mercury, creatinine, urinary lead, cadmium levels, low blood lead, serum cotinine, and urinary mercury levels. Multivariate logistic regression analysis showed that only blood cadmium level was an independent risk factor of ED (tertile [T]2 vs T1: odds ratio = 1.495, 95% confidence interval: 1.181-1.892, p = 0.001; T3 vs T1: odds ratio = 2.089, 95% confidence interval: 1.554-2.809, p < 0.001). The dose-response curve showed a positive nonlinear association between blood cadmium and lead levels and ED and a negative nonlinear association between blood and urinary mercury levels and ED after propensity score matching. In conclusion, heavy metal exposure is closely correlated with the development of ED, and a high blood cadmium level is an independent risk factor of ED.

Erectile Dysfunction and Obstructive Sleep Apnea: A Review.

Erectile dysfunction (ED) is a disease with a wide scope of etiologies. Obstructive sleep apnea (OSA) is considered one of the risk factors for ED and is less studied. A growing lot of evidence show an association between OSA and ED. This study provides an updated review of the relationship between ED and OSA and the possible physiological mechanisms of ED in patients with OSA based on the current evidence. In clinical interviews, patients with ED may benefit from a sleep evaluation. However, further clinical investigations and more basic research are needed to illustrate the relationship between ED and OSA.

Study of erectile dysfunction in patients of type 2 diabetes mellitus and its association with cardiovascular risk

Background: Diabetes is a chronic metabolic disorder that is characterized by high level of blood glucose levels, which over a period of time can lead to micro-vascular or macro-vascular complications. Erectile dysfunction (ED) is common not much discussed and distressing complication of diabetes. ED in type 2 may be independent marker of coronary artery disease (CAD). Aim and objectives were to assess the ED in subject of type 2 diabetes mellitus (DM). Assessment of correlation of ED with CAD. Methods: The present cross-sectional study consisted total 180 diabetic patients. On basis of international index of erectile function (IIEF) questionnaire ED patients were assessed.Result: Out of 180 diabetic patients 36.11% had varying degree of ED. Out of 65 ED patients, maximum frequency of moderate ED (47.69%) was found then severe ED (32.30%), mild to moderate ED (12.30%) and mild ED (7.69%). Most of the patients were in the age group of 40-50 years 35 (53.84%), 50-60 years 22 (33.4%), &lt;40 years (9.23%) and 60-70 years 2 (3.07%) showed ED. Fasting blood sugar and postprandial blood sugar showed significant (p&lt;0.05) relation with ED. HbA1c show an insignificant correlation (p&gt;0.05) with ED. In patient with ED was having more value of atherosclerotic cardiovascular disease (ASCVD) (9.11±4.84) than patient without ED (8.82±5.72). There was no significant (p&gt;0.05) difference in term of ASCVD risk score in ED patient’s ED and without ED patients.Conclusions: Poor glycemic control was a strongest risk factor for ED.

Exploring the relationship between socioeconomic status and erectile dysfunction: an analysis of the National Health and Nutrition Examination Survey.

The aim of this study was to investigate the association between socioeconomic status and erectile dysfunction. Data were obtained from the National Health and Nutrition Examination Survey, a nationally representative survey of the United States population. Socioeconomic status was estimated using the poverty income ratio, a ratio of family income to established poverty levels. Erectile function was assessed from a single survey question and was divided into two groups: normal (always and usually able to maintain an erection) and erectile dysfunction (sometimes or never able to maintain an erection). Multivariable logistic regression, using a multi-model approach, was used to characterize the interplay between well-established risk factors for erectile dysfunction and socioeconomic status. Our final cohort included 3679 respondents, representative of 81,255,155 subjects with a mean age of 44.4 [SE, 0.365]. Multivariable logistic regression showed that low-income respondents were significantly more likely to report erectile dysfunction [adjusted odds ratio (AOR) = 1.95, 95% CI 1.28-2.96; p = 0.003] compared to higher-income respondents. This study suggests that low socioeconomic status may be associated with erectile dysfunction in a large, nationally representative sample.

PD47-01 LOW SOCIOECONOMIC STATUS IS A RISK FACTOR FOR ERECTILE DYSFUNCTION: AN ANALYSIS OF NHANES DATA

You have accessJournal of UrologyCME1 May 2022PD47-01 LOW SOCIOECONOMIC STATUS IS A RISK FACTOR FOR ERECTILE DYSFUNCTION: AN ANALYSIS OF NHANES DATA Eric Macdonald, Joseph Kim, and Darius A. Paduch Eric MacdonaldEric Macdonald More articles by this author , Joseph KimJoseph Kim More articles by this author , and Darius A. PaduchDarius A. Paduch More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002615.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Socioeconomic status (SES) plays a critical role in an individual’s overall health. However, little is known about the relationship between SES and erectile dysfunction (ED), a condition that affects millions of men in the United States. We analyzed nationally representative survey data to determine the effect of SES on ED. METHODS: Data was obtained from the National Health and Nutrition Examination Survey (NHANES). Demographic, medical, laboratory, and social factors were collected. Age matching was performed due to significantly different mean ages among men of different races. SES was estimated using the poverty income ratio (PIR), a ratio of family income to established poverty levels. Low SES was defined by PIR <2. Erectile function was assessed from a single survey question: “How would you describe your ability to get and keep an erection adequate for satisfactory sexual intercourse?” Responses were divided into two groups: normal (always and usually able to maintain an erection) and ED (sometimes or never able to maintain an erection). Weighted prevalence comparisons were performed using Chi-squared and t-tests at p=0.05. Multivariate logistic regression was subsequently used to characterize the interplay between well-established risk factors for ED and SES. RESULTS: 3,898 men responded to the ED survey question. After age matching, 3,679 men (mean age 48.14±17.41) were included. 975 men (26.5%) reported ED. Weighted prevalence comparisons are reported in Table 1 with many factors showing a significant association (p <05) with ED. Multivariate logistic regression showed that patients with a low income (PIR <2) were significantly more likely to report ED; AOR=2.02 (1.33-3.07; p <0.001). Only diabetes had a similar AOR of 2.52 (1.57-4.05, p <0.001). Other social factors, such as private insurance coverage and education level, did not maintain significance during multivariate regression analysis. CONCLUSIONS: This study provides strong evidence that low SES is an independent risk factor for ED. Physicians must consider SES when evaluating patients with ED and forming a treatment plan. Our data suggest that future urological outcome studies must include SES as an important modifying factor to ensure accurate analysis. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e793 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Macdonald More articles by this author Joseph Kim More articles by this author Darius A. Paduch More articles by this author Expand All Advertisement PDF DownloadLoading ...

Standardizing sonographic descriptors of Peyronie's plaques

ABSTRACT Introduction Peyronie's Disease (PD) is characterized by a fibrous scar of the tunica albuginea. PD is typically imaged with 2D ultrasound. We propose a classification system of these ultrasound findings in the evaluation of PD. Objective The purpose of this study is to establish a functional, reproducible sonographic classification system for evaluating PD and to examine the relationship between PD grading and curvature, duration of PD, and vascular erectile status. Methods In our study, 395 patients with PD underwent intracavernous injection with an erectile agent (ICI) followed by Color Doppler Duplex Ultrasound (CDDU). All CDDU studies were performed by a single examiner and all PD grading was done by two independent reviewers using saved images. CCDU findings including peak systolic velocities (PSV) and resistive indices (RIs) were recorded. PD grades of 2D images were classified into three grades: Grade 1 acoustic shadowing without calcification; Grade 2 focal microcalcifications of the tunica, pillars, or septal fibers; Grade 3 confluent calcification of the dorsal, septal, ventral tunica albuginea. Results There were 250 patients classified with Grade 1 (63%) sonographic changes, 75 with Grade 2 (19%), and 70 with Grade 3 (18%). Neither median age nor body mass index (BMI) of the cohorts were significantly different: Grade 1 (59.3 yr), Grade 2 (59 yr) and Grade 3 (60.3 yr), p = 0.711; BMI 27.6, 28.2, 27.7, p = 0.813. Medical risk factors for erectile dysfunction, including hypertension, heart disease, diabetes mellitus, hyperlipidemia, smoking history, and history of prostate surgery were not statistically different for the three cohorts. Most patients had previously used PDE5-Inhibitors (293/395). History and or physical findings of Dupuytren's palmar contracture was noted in 30/395 (7.6%) of men. The median duration of PD was not significantly different in the three cohorts (12, 12, 14 months p = 0.639). Neither CDDU diagnoses (Table 1) nor curvature varied by sonographic grades (Table 2). Conclusions The scar resulting from PD seals together the outer longitudinal and inner circular layers of the tunica albuginea causing deformity of the erect shaft. PD plaques are usually palpable and associated with focal thickening of the tunica. On 2D ultrasound, the typical appearance is an acoustic shadow. Most of our patients presented with Grade I acoustic shadowing and no calcifications 250/395 (63%); on the other hand, 19% had acoustic plaque shadowing and additional findings of focal tunica or deep microcalcifications and 18% had confluent calcification of the dorsal, septal or ventral tunica. We propose a unique and reproducible classification system. This grading system based on grayscale ultrasound of Peyronie's plaques may serve as a paradigm for diagnosis, didactics and integrated research. Disclosure Work supported by industry: no, by N/A.

A study of erectile dysfunction in men 40 years of age or younger

ABSTRACT In recent years, awareness of erectile dysfunction and the demand for treatment have been increasing even among young men. We investigated the status of young patients 40 years of age or younger with erectile dysfunction. The subjects were 208 patients who visited the urology departments of Showa University Fujigaoka Hospital and affiliated hospitals with a chief complaint of erectile dysfunction. The erectile function was assessed with the Sexual Health Inventory for Men (SHIM), diary questions on sexual intercourse from the Sexual Encounter Profile, and the Erection Hardness Score, which measures the hardness of erection. The treatment was monotherapy with sildenafil (25 or 50 mg), vardenafil (10 or 20 mg), or tadalafil (10 or 20 mg) or a combination of multiple phosphodiesterase 5 (PDE5) inhibitors. To investigate the cause, blood tests including free testosterone and the Self-rating Depression Scale questionnaire were conducted, and Pulse Wave Velocity (PWV) was measured. The median age of the patients was 36 years. As for the cause of erectile dysfunction, psychogenic erectile dysfunction was observed in 141 patients, accounting for 67.7% of the patients. However, 82.1% of patients who underwent PWV measurement showed measurements suggestive of organic changes. The efficacy rates of PDE5 inhibitors were 77% for sildenafil, 73% for vardenafil, and 85% for tadalafil. This study showed that psychogenic erectile dysfunction was common in young patients, and that PDE5 inhibitors were effective for them. In addition, the study suggested the presence of organic changes as a risk factor for erectile dysfunction even in young patients. Disclosure Work supported by industry: no.

The Prevalence and Associated Risk Factors of Erectile Dysfunction in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Erectile dysfunction (ED) may be common in patients with inflammatory bowel disease (IBD), but its prevalence and risk factors still remain debatable. To evaluate the prevalence of ED in the IBD population and the potential role of risk factors in the development of ED. An extensive search in the PubMed, Cochrane Library, and Web of Science was performed to identify relevant English-language articles published up to December 2021 that evaluated the prevalence of ED on IBD patients. The included studies were evaluated by 2 independent reviewers for eligibility. We used an adapted Assessment Tool for Prevalence Studies to evaluate the quality of enrolled studies. Data were analyzed and graphed using the STATA software (version 16.0; Stata Corporation, College Station, TX, USA). The ORs with 95% CIs were pooled using a fixed or random-effects model according to heterogeneity. Subgroup analysis was performed to explore the source of heterogeneity. Sensitivity analysis was conducted to evaluate the stability of the results. The pooled prevalence of ED in IBD patients was calculated, and the OR value and 95% CIs were used to assess the strength of the association between IBD-related risk factors and ED. Fourteen studies included 32,858 individuals totally were enrolled for this meta-analysis. The overall pooled prevalence estimate of ED in IBD patients was 27% (95% CI: 20-34%). Operation (OR 1.28; 95% CI: 1.17-1.39; P < .00001; I2 = 0.0%), disease activity (OR 2.06; 95% CI: 1.07-3.05; P < .00001), and depression (crude OR 3.31; 95% CI: 1.08-5.54; P = .004; I2 = 0.0%) significantly increase the risk of ED in people with IBD. The association of depression and ED was further confirmed by calculating the pooled estimates of adjusted OR (1.58; 95% CI: 0.05-3.12; P < .05; I2 = 0.0%). The pooled prevalence estimates of ED were 30, 33, and 17% in the age <40, IIEF diagnostic tool, and IPAA surgery subgroups, respectively. IBD patients had a significantly increased prevalence of ED, indicating that erectile function in men with IBD should be concerned by clinicians. The strength of this study is that this is the first meta-analysis to assess the global prevalence and risk factors of ED in IBD patients. A limitation is that the results after pooling the included articles showed significant heterogeneity. The results of our meta-analysis and systematic review provide evidence of the high prevalence and risk factors of ED in IBD patients.

Prevalence and Associated Factors of Sexual Dysfunction in Patients With Inflammatory Bowel Disease.

BackgroundSexual dysfunction (SD) in patients who suffer from inflammatory bowel disease (IBD) has not attracted widespread attention, and thus research studies are scarce.ObjectiveThis study aims to evaluate the rates of SD in IBD compared with healthy individuals and elucidate the associated factors.MethodsIn this cross-sectional study, the Female Sexual Function Index (FSFI) and the simplified version of the International Index of Erectile Function (IIEF-5) were filled by IBD patients, as well as healthy control individuals.ResultsA total of 208 IBD patients, including 133 with Crohn’s disease (CD) and 75 with ulcerative colitis (UC), and 190 healthy individuals filled out the questionnaires. In women, SD rates were 61.9% in the patients with IBD vs. 24.4% in the healthy controls (p < 0.01). In men, the rates of erectile dysfunction (ED) were 43.5% in the patients with IBD vs. 12.5% in the healthy controls (p < 0.01). Anxiety (OR, 3.092; 95%CI: 1.033-9.252, p = 0.044) and active perianal disease (OR, 4.481; 95%CI: 1.055-19.029, p = 0.042) were independent risk factors for SD in female IBD patients. age (OR, 1.050; 95%CI: 1.007-1.095, p = 0.022), depression (OR, 5.763; 95%CI: 1.864-17.821, p = 0.002) and active perianal disease (OR, 7.117; 95%CI: 1.747-28.983, p = 0.006) were independent risk factors for ED in male patients.ConclusionsIn the IBD patients, 62% of women reported having SD, and 44% of men reported having ED. These higher rates, as compared to the healthy controls, are mostly driven by active perianal disease and psychological factors.

Standardizing Sonographic Descriptors of Peyronie's Plaques

ABSTRACT Introduction Peyronie's Disease (PD) is characterized by a fibrous scar of the tunica albuginea. PD is typically imaged with 2D ultrasound. We propose a classification system of these ultrasound findings in the evaluation of PD. Objective The purpose of this study is to establish a functional, reproducible sonographic classification system for evaluating PD and to examine the relationship between PD grading and curvature, duration of PD, and vascular erectile status. Methods In our study, 395 patients with PD underwent intracavernous injection with an erectile agent (ICI) followed by Color Doppler Duplex Ultrasound (CDDU). All CDDU studies were performed by a single examiner and all PD grading was done by two independent reviewers using saved images. CCDU findings including peak systolic velocities (PSV) and resistive indices (RIs) were recorded. PD grades of 2D images were classified into three grades: Grade 1 acoustic shadowing without calcification; Grade 2 focal microcalcifications of the tunica, pillars, or septal fibers; Grade 3 confluent calcification of the dorsal, septal, ventral tunica albuginea. Results There were 250 patients classified with Grade 1 (63%) sonographic changes, 75 with Grade 2 (19%), and 70 with Grade 3 (18%). Neither median age nor body mass index (BMI) of the cohorts were significantly different: Grade 1 (59.3 yr), Grade 2 (59 yr) and Grade 3 (60.3 yr), p = 0.711; BMI 27.6, 28.2, 27.7, p = 0.813. Medical risk factors for erectile dysfunction, including hypertension, heart disease, diabetes mellitus, hyperlipidemia, smoking history, and history of prostate surgery were not statistically different for the three cohorts. Most patients had previously used PDE5-Inhibitors (293/395). History and or physical findings of Dupuytren's palmar contracture was noted in 30/395 (7.6%) of men. The median duration of PD was not significantly different in the three cohorts (12, 12, 14 months p = 0.639). Neither CDDU diagnoses (Table 1) nor curvature varied by sonographic grades (Table 2). Conclusions The scar resulting from PD seals together the outer longitudinal and inner circular layers of the tunica albuginea causing deformity of the erect shaft. PD plaques are usually palpable and associated with focal thickening of the tunica. On 2D ultrasound, the typical appearance is an acoustic shadow. Most of our patients presented with Grade I acoustic shadowing and no calcifications 250/395 (63%); on the other hand, 19% had acoustic plaque shadowing and additional findings of focal tunica or deep microcalcifications and 18% had confluent calcification of the dorsal, septal or ventral tunica. We propose a unique and reproducible classification system. This grading system based on grayscale ultrasound of Peyronie's plaques may serve as a paradigm for diagnosis, didactics and integrated research. Disclosure No

Caprini Risk Score is Shockingly High in Penile Prosthesis Surgery Patients

ABSTRACT Introduction The significant overlap of risk factors for erectile dysfunction and venous thromboembolism (VTE) may disproportionally increase the risk of VTE in men undergoing inflatable penile prosthesis (IPP) surgery. Owing to the absence of available literature, AUA and EAU perioperative VTE guidelines do not address VTE risk with IPP surgery and generally recommend against pharmacologic prophylaxis with outpatient surgery. The Caprini Score is a validated scoring system to estimate VTE risk in the perioperative period. Objective We sought to assess the risk of VTE by calculating Caprini Scores in men undergoing IPP surgery. Methods We retrospectively reviewed and calculated Caprini Scores for patients undergoing IPP surgery at our institution between July 2017 and June 2019. Results 215 patients undergoing IPP surgery were identified with a mean and median Caprini score of 5.96 (SD, 1.63) and 6 (IQR 5,7), respectively. 84% of the cohort was classified as high or highest risk for VTE (Figure 1). This is in part due to our cohort's mean age of 64, mean BMI of 31 and history of prostate cancer treatment as the cause of ED. Prior history of VTE (deep vein thrombosis(DVT) or pulmonary embolism (PE)was identified in 17 (8%) patients with 5 (2%) have a history of both DVT and PE. Conclusions Men undergoing IPP surgery are high risk for VTE based on Caprini score assessment. VTE prophylaxis should be considered in men undergoing penile implant surgery. Before widespread application, long-term data is necessary to assess safety and efficacy of VTE prophylaxis in the IPP surgery population. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Senior author consultant for Coloplast

Long term complications of penile fracture repair: Erectile dysfunction and penile curvature

ObjectiveTo determine the factors that cause erectile dysfunction and penile curvature after repair of penile fracture (PF). MethodsData from 25 patients who underwent PF repair was retrospectively analyzed. PF was diagnosed by examining patients’ medical histories and performing physical examinations. All patients underwent immediate PF repair. All patients filled out the International Index of Erectile Function (IIEF-5) form and penile curvature was examined. ResultsThe median age of patients at the time of surgery and the median follow-up duration were 46 years (22–60 years) and 95 months (12–156 months), respectively. Two of the patients had concomitant urethral injury. At the final follow up, erectile dysfunction (ED) was present in 13 patients (52%). Among these patients, 9 patients (36%) had mild ED and 4 patients (16%) had moderate ED. With a univariate analysis, age and penile curvature were significantly associated with ED (p=0.008 and p=0.039, respectively). With a multivariate analysis, age was independently associated with ED (p=0.048, odds ratio=1.104, 95% confidence interval 1.000–1.218). The IIEF-5 scores correlated with age (p=0.009, r=0.510). Seven patients (28%) had penile curvature and one patient underwent penile plication surgery. ConclusionAfter PF repair, age is the only risk factor for ED and penile curvature rarely requires surgical treatment.

Prevalence, Comorbidities, and Risk Factors of Erectile Dysfunction: Results from a Prospective Real-World Study in the United Kingdom.

Objectives Assessment of erectile dysfunction (ED) burden could improve health outcomes associated with underlying cardiometabolic and psychological causes of ED. This study provided updated real-world evidence (RWE) on ED epidemiology and quantified healthcare resource utilization (HCRU) and health-related quality of life (HRQoL) burden among men with ED in the UK. Methods This cross-sectional, prospective real-world evidence study was conducted via a self-reported Internet survey in 2018 in the UK general population. Prevalence of ED was estimated; HCRU and HRQoL were compared between men with ED versus without ED via bivariate analysis. Results Of 12,490 men included, 41.5% reported ED; 7.5% of men reported severe ED; ED was most prevalent in Wales (44.3%). Men with ED were older (54.1 ± 14.5 vs. 46.8 ± 14.1 years) and often reported modifiable lifestyle risk factors, including smoking (32.8% vs. 26.3%), drinking alcohol (76.1% vs. 71.0%), not exercising (21.7% vs. 19.4%), and being overweight or obese (64.9% vs. 54.6%). Additionally, men with ED more often reported ≥1 comorbid chronic conditions (73.7% vs. 47.7%), including hypertension (31.8% vs. 16.3%), hyperlipidemia (27.6% vs. 14.0%), depression (24.3% vs. 14.6%), anxiety (23.3% vs. 16.6%), and diabetes (15.9% vs. 6.1%) versus men without ED (all, p < 0.001). Nearly half of men with ED (45.3%) were not undergoing treatment for cardiometabolic or psychological comorbidities. Furthermore, men with ED more often reported ≥1 visit to physicians/nurse practitioners and pharmacists in the past year and had significantly lower SEAR total and domain scores than men without ED (all, p < 0.001). Conclusion ED was highly prevalent in the UK affecting over a quarter of younger men. Cardiometabolic and psychological conditions were common among men with ED and often remained untreated. Higher proportions of modifiable lifestyle risk factors observed among men with ED present an opportunity for healthcare providers to help mitigate the risk of cardiometabolic diseases and incidence of ED.

Psychosocial risk factors of erectile dysfunction among heterosexual men living with HIV

ABSTRACT The risk of erectile dysfunction (ED) is significantly higher in men living with HIV (MLWH). Despite the adverse effects of ED on quality of life for MLWH, there is a lack of research on the psychosocial factors that may influence ED, especially among heterosexual MLWH. According to a recent systematic review, findings on the psychosocial risk factors of ED in past studies have been largely conflicting or inconclusive. To bridge this gap, we analyzed psychosocial and other correlates of ED among a sample of 317 primarily Black and Latino heterosexual adult MLWH in New York City. Data collection involved quantitative surveys administered using a combination of computer-assisted personal interview and audio computer-assisted self-interview techniques. After adjusting for age and general health, the relative risk of ED among heterosexual men living with HIV was associated with higher HIV-related stigma, anxiety, depression, and negative HIV-coping; greater social support was associated with a lower risk of ED. In addition, the data were consistent with the potential effects of childhood emotional, physical, and sexual abuse and structural discrimination on the risk of ED. Overall, our research findings help provide a better understanding of the psychosocial factors associated with ED among heterosexual MLWH.

Hyperuricaemia is an important risk factor of the erectile dysfunction: A systematic review and meta-analysis.

Serum uric acid can affect endothelial function, and hyperuricaemia-induced endothelial dysfunction is involved in the pathogenesis of cardiovascular diseases. As endothelial dysfunction is also a main pathogenic mechanism of erectile dysfunction (ED), the present study aims to evaluate the relationship between hyperuricaemia and ED via systemic review and meta-analysis. Five cohort studies and six cross-sectional studies on hyperuricaemia and ED, including a total of 454,510 participants, were recruited. Odds ratio (OR) and the 95% confidence intervals (CI) were adopted to estimate the relationship between hyperuricaemia and ED. Overall risk on effects of urate-lowering therapy (ULT) were analysed. In addition, subgroup analyses on study design, populations, age stratification and the object were conducted. In the patients with hyperuricaemia, the risk of ED was 1.59-fold higher than (pooled OR=1.59, 95% CI [1.29, 1.97]) the non-hyperuricaemia counterparts. Urate-lowing therapy (ULT) in these hyperuricaemia patients reduced the risk of ED by 27% (OR=1.27, 95% CI [1.14, 1.41]). After subgroup analysis, the association between hyperuricaemia and ED remained significant apart from the >60years subgroup. Hyperuricaemia is an important risk factor of ED, while ULT can reduce the risk of ED in hyperuricaemia. This study suggests that hyperuricaemia-associated endothelial dysfunction may also underlie the pathogenesis of ED in these patients.