Subsequent Erectile Dysfunction Research Articles

Abstract 12049: The Association of Subclinical Vascular Disease and Erectile Dysfunction at 9-Year Assessment: The Multi-Ethnic Study of Atherosclerosis (MESA)

Background: In cross sectional studies, erectile dysfunction (ED) and overt clinical cardiovascular disease commonly coexist. However, the temporal relationship between subclinical vascular disease and subsequent identification of ED remains unclear. Methods: After excluding participants taking ED medications at baseline, we studied 1,862 asymptomatic men from the Multi-Ethnic Study of Atherosclerosis (MESA) with complete baseline multi-modality subclinical disease phenotyping who underwent ED assessment at MESA visit 5 (9.4 years after baseline). ED was defined by self-report per the single question self-assessment in the Massachusetts Male Aging Study. Using multivariable logistic regression (see figure legend for adjustments), we assessed the relationship between three different categories of baseline subclinical vascular disease with subsequent self-identification of ED. Subclinical vascular disease measures tested were: atherosclerosis: coronary artery calcium [CAC], carotid intima-media thickness [CIMT]; vascular stiffness: aortic distensibility, distensibility coefficient; vascular dysfunction: ankle-brachial index [ABI], flow-mediated dilation [FMD]. Results: A total of 839 men (45%) self-reported ED 9.4 ± 0.5 years after baseline. The mean age for the study population was 63.9 ± 8.9. There was a graded association between number and severity of subclinical disease abnormalities and ED. Measures of atherosclerosis were most closely associated with ED (see figure). Of the specific subclinical disease measurements, only presence of CAC and CAC>100 retained significance in a fully adjusted model (OR 1.5, 1.2 - 1.9; OR 1.4, 1.1 - 1.9). Conclusions: Multiple vascular disease abnormalities tend to cluster in men who later self-report ED. Of the tested subclinical vascular disease domains, markers of subclinical atherosclerosis, in particular CAC, are most closely associated with subsequent ED nearly 10 years after baseline.

Commentary to ‘Priapism in children: A comprehensive review and clinical guideline’

The review article on priapism in the paediatric population is timely and comprehensive. It summarises current knowledge of the condition. Although meant for paediatricians, this is, in fact, relevant to those treating adults also. This review should be read by all paediatric urologists, and should be available in all paediatric emergency departments. There are several interesting findings. Firstly, the quality of the evidence is poor, with only one known published randomised controlled trial, which was performed in the adult population. Secondly, much of the pathophysiology and treatments come from the adult world. Extrapolating this to younger males may be risky. Their recommendation of performing Doppler ultrasound on all cases is very sensible rather than first aspirating—as the converse tends to be the practice in adult medicine. Aspiration can cloud the issue and there have been reported cases of low-flow priapism being converted to a high-flow state by the passage of a needle. It is important for the Doppler study to survey the whole length of the copora cavernosa as there may be differences in flow proximally and distally. Patients who report a history of prolonged priapism several years prior can still have segmental woody feeling corpora when examined in the flaccid state. These patients also describe erectile dysfunction, which can be more marked in the fibrous-feeling segment. While this is typically distal, it can also be proximal. Hence, the needs to be thorough in the Doppler study on initial presentation. The review also discusses the pros and cons of giving a general anaesthetic prior to any aspiration/injection. General anaesthetic is important for psychological/psychosexual reasons. I would also recommend a dorsal penile/caudal block once anaesthetised. I have seen adults who were treated without any form of anaesthesia develop symptoms of post-traumatic stress disorder, which add to the complexity of managing any subsequent erectile dysfunction. Another benefit of performing any aspiration under general anaesthesia is that the anaesthetic team may be able to expedite blood gas analysis, for example in the nearby intensive care unit. An animal study from University College Hospital London [[1]Muneer A. Cellek S. Dogan A. Kell P.D. Ralph D.J. Minhas S. Investigation of cavernosal smooth muscle dysfunction in low flow priapism using an in vitro model.Int J Impot Res. 2005; 17: 10-18Crossref PubMed Scopus (51) Google Scholar] demonstrated that measuring glucose (often available as part of the blood gas analysis) was helpful in giving a prognosis of reversibility of the condition. A low glucose implies consumption of substrate and predicts smooth muscle damage. This was in a unit treating adults who may have a penile prosthesis placed acutely [[2]Ralph D.J. Garaffa G. Muneer A. Freeman A. Rees R. Christopher A.N. et al.The immediate insertion of a penile prosthesis for acute ischaemic priapism.Eur Urol. 2009; 56: 1033-1038Abstract Full Text Full Text PDF PubMed Scopus (117) Google Scholar]. This is probably not appropriate in paediatric cases, although in severe cases in mature teenagers it may be considered. All urology units should have rapid access to phenylephrine, not waiting for dispensing from the pharmacy at unsociable hours. Remember time is smooth muscle, so consider low-flow priapism like a “myocardial infarct of the penis”. Patients at risk of priapism should be prompted not to wait for the arbitrary 4-h cut-off for the definition of priapism. They should be instructed to keep fasting, attend the emergency department urgently, and prompt staff to get them seen immediately by a urologist/paediatric urologist. The man's long-term sex life depends on prompt identification and treatment of priapism. Hopefully, the quality of evidence will improve so more progress can be made in our understanding and management of this condition. Priapism in children: a comprehensive review and clinical guidelineJournal of Pediatric UrologyVol. 10Issue 1PreviewWe review the English literature between 1980 and 2013 and summarize the clinical classification, aetiology, physiology, and pathophysiology of paediatric priapism. We propose a clinical guideline for the management of priapism in children. Full-Text PDF Response to Commentary to ‘Priapism in children: A comprehensive review and clinical guideline’Journal of Pediatric UrologyVol. 10Issue 1PreviewThe article “Priapism in children: a comprehensive review and clinical guideline” [1] was conceived to act as a reference to all urologists. We feel this topic is complex enough to warrant specialist input, although we hope it will also be useful for paediatricians, emergency physicians, and, haematologists/paediatric haematologists. We feel that paediatric priapism is best managed jointly by a paediatric urologist and an andrologist. Full-Text PDF

Increased risk of erectile dysfunction among males with central serous chorioretinopathy - a retrospective cohort study

Central serous chorioretinopathy (CSCR) mostly affects middle-aged men and has been associated with stress and hypercortisolism. We hypothesized that some factors prone to inducing CSCR could also have a harmful effect on erectile function. This study aimed to investigate the risk of subsequent erectile dysfunction after CSCR using Taiwan National Health Insurance Research Database. The study cohort (n = 1220) consisted of newly diagnosed CSCR men aged 19-64 years between 1999 and 2007, and men matched for age, monthly income and time of enrolment were randomly selected as the control group (n = 10870). Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of clinically diagnosed erectile dysfunction (including organic origin and/or psychogenic origin) for the two groups. Erectile dysfunction-free survival analysis was assessed using a Kaplan-Meier method. Twenty-five patients (2.0%) from the CSCR cohort and 103 (0.9%) from the control group were diagnosed erectile dysfunction clinically during a mean observation period of 4.3 years. Patients with CSCR had a significantly higher incidence of erectile dysfunction diagnosis than those without CSCR (p < 0.001). After adjusting for age, geographic location, chronic comorbidities and medication habits, patients with CSCR were found to have a 2.22-fold [95% confidence interval (CI), 1.42-3.46] higher hazard ratio of a subsequent erectile dysfunction diagnosis than the matched controls. The adjusted HR for organic and psychogenic erectile dysfunction were 2.14 (95% CI: 1.34-3.44) and 3.83 (95% CI: 1.47-10.01), respectively. Central serous chorioretinopathy was independently associated with an increased risk of being diagnosed with erectile dysfunction.

V1557 SURGICAL TREATMENT OF PEYRONIE'S DISEASE BY INCISION AND GRAFTING

You have accessJournal of UrologyInfertility, Infection, Erectile Dysfunction & Trauma1 Apr 2011V1557 SURGICAL TREATMENT OF PEYRONIE'S DISEASE BY INCISION AND GRAFTING Niels Johnsen, Brian Richardson, Limin Ma, and Wayne Hellstrom Niels JohnsenNiels Johnsen New Orleans, LA More articles by this author , Brian RichardsonBrian Richardson New Orleans, LA More articles by this author , Limin MaLimin Ma New Orleans, LA More articles by this author , and Wayne HellstromWayne Hellstrom New Orleans, LA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1580AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Peyronie's disease is an idiopathic connective tissue disorder of the penis. Growth of fibrous plaques can result in abnormal penile curvature and subsequent erectile dysfunction. While medical and intralesional injection therapies are used, surgical management remains the gold standard. A number of different surgical techniques have been used in the treatment of Peyronie's disease, such as wedge resection, incision and grafting, and placement of a penile prosthesis with additional ancillary procedures. In this video, we review our technique of incision and grafting for the treatment of severe Peyronie's disease. METHODS The surgical technique of incision and grafting for Peyronie's disease is examined in its entirety. A history of Peyronie's disease is discussed, followed by explanation of pathophysiology and subsequent erectile dysfunction. Selection of potential candidates is examined in relation to degree of curvature and adequacy of cavernosal arterial inflow. Strategic aspects of this surgical procedure are shown with a careful description of techniques employed and materials used. In this particular video, we examine the use of human cadaveric pericardial grafts or porcine small intestine submucosal grafts for the grafting of tunical defects after incision or excision of the plaque. Post-operative management, including use of phosphodiesterase type 5 inhibitors and penile stretching devices, is discussed briefly. RESULTS The use of the incision and grafting technique for the treatment of severe Peyronie's disease has shown functional and anatomical benefits in properly selected patients. Patients are discharged for outpatient follow-up and report manageable postoperative discomfort. Post-operative artificially induced erections in the majority of patients show absence of penile curvature and most patients report a return of spontaneous erections within a few weeks, with resumption of sexual intercourse in an average of 6 weeks. CONCLUSIONS Though technically demanding, surgical incision and grafting procedures provide excellent results with minimal complications for the treatment of severe Peyronie's disease. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e625 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niels Johnsen New Orleans, LA More articles by this author Brian Richardson New Orleans, LA More articles by this author Limin Ma New Orleans, LA More articles by this author Wayne Hellstrom New Orleans, LA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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

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

Early intervention with phosphodiesterase‐5 inhibitors after prostate brachytherapy improves subsequent erectile function

To examine the early use of phosphodiesterase-5 inhibitor (PDE-5i; sildenafil citrate) in preventing subsequent erectile dysfunction (ED) after (monotherapy) prostate brachytherapy (PB, an accepted option for Gleason 6 or low-volume Gleason 7 prostate cancer), as PB is currently being offered more frequently in younger patients, and ED can be a side-effect often within the first 12 months after treatment. We examined a single-surgeon series of 69 patients who had been treated with PB from 2002 to 2005. All patients had a follow-up of ≥ 1 year; prospectively, and patients had baseline, 6- and 12-month assessments using the Sexual Health Inventory for Men (SHIM) and International Index of Erectile Function (IIEF)-6 scores. The 69 patients were divided into early treatment with PDE-5i (31) and not treated with PDE-5i (38), and their SHIM and IIEF-6 scores were compared at baseline, 6 and 12 months. Daily sildenafil (25-50 mg) was given immediately after PB for 12 months. Overall, for the entire group, the mean prostate-specific antigen (PSA) level was 6.8 ng/mL; 78% had Gleason 6 cancer and 20% had Gleason 7 (3 + 4) cancer. The mean age in the early PDE-5i group was 64.8 years, and was 66.0 years in the no-PDE-5i group. The mean radiation dose in the early PDE-5i group was 50.2 Gy, and 43.9 Gy in the other group (P= 0.08). In the no-PDE-5i group, the mean baseline SHIM score of 17.1 decreased rapidly to 9.1 at 6 months (P= 0.01) and stayed at 9.3 at 12 months (P= 0.01). In the early PDE-5i group, the mean baseline SHIM score of 21.8 decreased slightly to 17.6 at 6 months (P= 0.2), and was maintained at 17.9 at 12 months (P= 0.2). Using the Wilcoxon rank-sum test, the 6- and 12-month SHIM scores in the two groups (P < 0.001). The IIEF-6 questionnaire confirmed the SHIM analysis. After PB patients had a significant decline in SHIM/IIEF-6 scores at 6 and 12 months. Our results indicate a 50% decrease in the quality of their erections. This provides an opportunity to initiate early intervention with PDE-5i or perhaps vacuum constriction devices or intraurethral alprostadil. In this study, the early use of PDE-5i after PB maintained erectile function at both 6 and 12 months.

Evaluation and management of priapism: 2009 update

Priapism is defined as a persistent penile erection (typically 4 h or longer) that is unrelated to sexual stimulation. Priapism can be classified as either ischemic or nonischemic. Ischemic priapism, the most common subtype, is typically accompanied by pain and is associated with a substantial risk of subsequent erectile dysfunction. Prompt medical attention is indicated in cases of ischemic priapism. The initial management of choice is corporal aspiration with injection of sympathomimetic agents. If medical management fails, a cavernosal shunt procedure is indicated. Stuttering (recurrent) ischemic priapism is a challenging and poorly understood condition; new management strategies currently under investigation may improve our ability to care for men with this condition. Nonischemic priapism occurs more rarely than ischemic priapism, and is most often the result of trauma. This subtype of priapism, which is generally not painful, is usually initially managed with conservative treatment.

Adenosine Signaling, Priapism and Novel Therapies

Priapism is defined as abnormal prolonged penile erection lasting at least for 4 hours occurring without sexual interest. Forty percent of sickle cell disease (SCD) patients display priapism. The disorder is dangerous and urgent given its association with ischemia-mediated erectile tissue damage and subsequent erectile dysfunction. Current strategies to manage the disorder are poor due to lack of fundamental understanding of the molecular mechanisms of priapism. Adenosine is a signaling nucleoside that elicits many pathophysiological effects by engaging membrane receptors. Recent evidence shows that adenosine may play an important role in priapism via adenosine receptor. To summarize the recent findings on the importance of adenosine signaling in the pathogenesis of priapism. Evidence in the literature on the association between adenosine signaling and the development of priapism. This article reviews the literature that relates to the contributory role of adenosine signaling in priapism in multiple animal models and humans. Excessive adenosine accumulation in the penis, coupled with increased A(2B)R signaling, contributes to priapism in two independent lines of mutant mice. One is adenosine deaminase (ADA)-deficient mice, the only animal displaying spontaneously prolonged penile erection, and the other is SCD transgenic mice, a well-accepted priapic animal model. Both polyethylene glycol-modified ADA (PEG-ADA) enzyme therapy and A(2B)R antagonists are capable of inhibiting potent corpus cavernosal vascular relaxation associated with priapic-like activity seen in both ADA-deficient mice and SCD transgenic mice, indicating that PEG-ADA enzyme therapy is likely to be a novel therapy for such a dangerous urological disorder. Overall, the research reviewed here raises the intriguing possibility that elevated adenosine signaling contributes to priapism in general and that this signaling pathway represents a potentially important therapeutic target for the treatment of priapism.

Risk Factors for Erectile Dysfunction in Patients with Urethral Strictures Secondary to Blunt Trauma

Erectile dysfunction (ED) is a well-known consequence of pelvic fracture, particularly in cases involving urethral injury. There are several risk factors that may be related to ED. However, no systemic approach is used to assess erectile function secondary to urethral trauma. To investigate ED associated with urethral injury secondary to pelvic fracture and perineal trauma. Forty patients with traumatic urethral strictures secondary to blunt traumatic impact episode to the pelvis or perineum were included in our study. Pelvic fractures and urethral strictures were categorized according to injury types and radiological findings. All patients underwent nocturnal penile tumescence (NPT) monitoring, dynamic color-duplex Doppler ultrasonography (D-CDDU) before surgery. NPT monitoring was conducted again after surgery. The events of NPT and D-CDDU were recorded. In all patients, 11 had organic ED demonstrated by NPT. Vascular pathology was identified in three of 11 patients (27%). The peak systolic velocity of cavernosal artery was lower in patients with pubic diastasis in comparison to those without diastasis (P < 0.05). Significant changes in penile length and circumference were noted in posterior urethral injury compared with anterior urethral injury during erection (P < 0.05). The erectile duration time has a similar statistical difference in two groups mentioned above. However, no significant difference could be observed in the end-to-end anatomosis procedure before and after surgery (P > 0.05). The pelvic fracture type, especially pubic diastasis, is a risk factor for ED following urethral injury. Location of the stricture is also a risk factor for subsequent erectile dysfunction.

Clinical course linkage among different priapism subtypes: Dilemma in the management strategies

Priapism is a rare condition whose management differs according to the etiology. We report the clinical course of three forms of priapism to assess the feasibility and safety of recent management strategies. The study included eight patients complaining of persistent erection for >/=4 h who were treated in our institution between January 1996 and July 2007. Overall, we categorized 12 cases of priapism in eight patients divided as follows: five cases of ischemic priapism (IP), three of stuttering priapism (SP), and four of non-ischemic priapism (NIP). Two of five IP patients needed a shunt procedure, which led to the subsequent erectile dysfunction. The other three were treated successfully with a corporal injection of sympathomimetic agents and subsequently suffered from SP. One of the three SP patients suffered from mimicked NIP with increased arterial blood flow during the initial treatment for IP. Four of the NIP patients including the mimicked one achieved complete detumescence, through arterial embolization in two and conservative management in two. Current management seems effective and safe in the short-term. However, the long-term outcome of the treatment for IP is still disappointing. Careful long-term observation is needed for an appropriate management.

Early Intervention with PDE-5 Inhibitors Following Prostate Brachytherapy Improves Subsequent Erectile Function

Prostate mono brachytherapy (PMB) is an accepted option for Gleason 6, low-volume Gleason 7 prostate cancers, and is being offered more frequently in younger patients. Unfortunately, erectile dysfunction can be a side effect from PMB, occurring frequently in the first 12 months following treatment. This study examines the use of early PDE-5 inhibitors (sildenafil citrate) in preventing subsequent erectile dysfunction following prostate brachytherapy.

Excess adenosine in murine penile erectile tissues contributes to priapism via A2B adenosine receptor signaling

Priapism, abnormally prolonged penile erection in the absence of sexual excitation, is associated with ischemia-mediated erectile tissue damage and subsequent erectile dysfunction. It is common among males with sickle cell disease (SCD), and SCD transgenic mice are an accepted model of the disorder. Current strategies to manage priapism suffer from a poor fundamental understanding of the molecular mechanisms underlying the disorder. Here we report that mice lacking adenosine deaminase (ADA), an enzyme necessary for the breakdown of adenosine, displayed unexpected priapic activity. ADA enzyme therapy successfully corrected the priapic activity both in vivo and in vitro, suggesting that it was dependent on elevated adenosine levels. Further genetic and pharmacologic evidence demonstrated that A2B adenosine receptor-mediated (A2BR-mediated) cAMP and cGMP induction was required for elevated adenosine-induced prolonged penile erection. Finally, priapic activity in SCD transgenic mice was also caused by elevated adenosine levels and A2BR activation. Thus, we have shown that excessive adenosine accumulation in the penis contributes to priapism through increased A2BR signaling in both Ada -/- and SCD transgenic mice. These findings provide insight regarding the molecular basis of priapism and suggest that strategies to either reduce adenosine or block A2BR activation may prove beneficial in the treatment of this disorder.

Combined Angiopoietin-1 and vascular endothelial growth factor gene transfer restores cavernous angiogenesis and erectile function in a rat model of hypercholesterolemia

Hypercholesterolemia-related endothelial cell dysfunction and decreased endothelium-derived nitric oxide formation may account for impaired angiogenesis and subsequent erectile dysfunction. Angiopoietin-1 (Ang1) is a critical angiogenic factor for vascular maturation and enhances vascular endothelial growth factor (VEGF)-induced angiogenesis in a complementary manner. We hypothesized that combined adenovirus-delivered human Ang1 (ad-Ang1) and VEGF165 (ad-VEGF165) gene transfer might promote angiogenesis cooperatively in a rat model of hypercholesterolemic erectile dysfunction and result in a recovery of erectile function. Ad-Ang1 and ad-VEGF165 were injected either alone or in combination into the corpus cavernosum of the penis. Combined gene transfer of both ad-Ang1 and ad-VEGF165 significantly increased cavernous angiogenesis, eNOS phosphorylation, and cGMP expression compared with that in the groups treated with either therapy alone. Erectile function, as evaluated by electrical stimulation of the cavernous nerve 2 and 8 weeks after treatment, was completely restored in the combined treatment group, whereas intracavernous injection of either ad-Ang1 or ad-VEGF165 alone elicited partial improvement. The results indicate that combined application of angiogenic factors may enhance cavernous angiogenesis cooperatively by reinforcing the endothelium both structurally and functionally, which results in an additive effect on erectile function in hypercholesterolemic rats.

Use of combined intracorporal injection and a phosphodiesterase‐5 inhibitor therapy for men with a suboptimal response to sildenafil and/or vardenafil monotherapy after radical retropubic prostatectomy

To report experience with combined therapy using intracorporal injection (ICI) of alprostadil and oral phosphodiesterase 5 (PDE-5) inhibitors for the minimally invasive treatment of erectile dysfunction (ED) after radical prostatectomy (RP), as PDE-5 inhibitors are effective but a few patients may have a suboptimal response. In a retrospective study, 34 men (aged 46-66 years) had a nerve-sparing retropubic RP and subsequent ED. Patients were titrated on sildenafil citrate or vardenafil to maximum doses. All had a suboptimal response after a maximum of eight doses of oral therapy and were then treated with ICI therapy using 15 or 20 microg alprostadil. Erectile function was assessed with the Sexual Health Inventory for Men (SHIM). Of the 32 patients who continued combined therapy, 22 (68%) had an improvement in erectile function after ICI therapy, as assessed by the SHIM score. On follow-up, 36% of these patients used ICI therapy only intermittently, instead of regularly, as they felt that this was adequate enough for good results. PDE-5 oral pharmacotherapy is the most commonly used effective therapy for ED but may not be as effective in patients who have radical surgery; the addition of testosterone patches may have side-effects or be considered a risk in patients with a history of prostate cancer. The use of ICI therapy as an adjunct or maintenance therapy to their oral medication may be another alternative in these patients.

Erectile Dysfunction and Coronary Risk Factors: Prospective Results from the Massachusetts Male Aging Study

Background. Erectile dysfunction (ED), a wide spread and troublesome condition among middle-aged men, is partly vascular in origin. In the Massachusetts Male Aging Study, a random-sample cohort study, we investigated the relationship between baseline risk factors for coronary heart disease and subsequent ED, on the premise that subclinical arterial insufficiency might be manifested as ED.Methods. Men ages 40–70, selected from state census lists, were interviewed in 1987–1989 and reinterviewed in 1995–1997. Data were collected and blood was drawn in participants' homes. ED was assessed from responses to a privately self-administered questionnaire. Analysis was restricted to 513 men with no ED at baseline and no diabetes, heart disease, or related medications at either time.Results. Cigarette smoking at baseline almost doubled the likelihood of moderate or complete ED at followup (24% vs 14%, adjusted for age and covariates, P = 0.01). Cigar smoking and passive exposure to cigarette smoke also significantly predicted incident ED, as did overweight (body-mass index ≥ 28 kg/m2) and a composite coronary risk score. Weaker prospective associations were seen for hypertension and dietary intake of cholesterol and unsaturated fat.Conclusions. Erectile dysfunction and coronary heart disease share some behaviorally modifiable determinants in men who, like our sample, are free of manifest ED or predisposing illness. Open questions include whether modification of coronary risk factors can prevent ED and whether ED may serve as a sentinel event for coronary disease.

Post-vasectomy erectile dysfunction

We investigated two groups of men with regard to vasectomy acceptance, and subsequent erectile dysfunction. Group I was a group of 45 men chosen at random from 254 vasectomized patients. Group II was a group of 18 men who, out of 180 patients treated for erectile dysfunction, attributed their dysfunction to previous vasectomy. We analyzed the social background, motivation for vasectomy and postoperative changes of sexual life or behaviour of the partners. The partnership constellation, particularly the role of a predominant female partner seems to be an important feature for vasectomy acceptance. Low acceptance might cause erectile dysfunction.