Treatment Of Erectile Dysfunction Research Articles

Role of Nutraceuticals in Treating Erectile Dysfunction via Inhibition of Phosphodiesterase-5 Enzyme: A Mini Review.

Erectile Dysfunction (ED) is a prevalent sexual health condition affecting a significant portion of the male population worldwide. The conventional therapeutic approaches for ED often involve the use of pharmaceutical agents targeting the phosphodiesterase-5 (PDE5) enzyme. Currently, treatment with PDE-5 inhibitors is the standard approach for ED, and four PDE-5 inhibitors, namely sildenafil, vardenafil, tadalafil, and avanafil, are in use. However, these pharmaceutical interventions may be associated with adverse effects and limitations. As a result, there has been a growing interest in exploring alternative and complementary treatment options for ED, such as nutraceuticals, which are bioactive compounds derived from natural sources. Nutraceuticals, which include vitamins, minerals, herbs, and other dietary supplements, have gained popularity for their potential health benefits. Certain nutraceuticals have demonstrated the ability to modulate various physiological pathways, including those involved in erectile function. A notable mechanism of action is the inhibition of the PDE5 enzyme, which plays a pivotal role in the regulation of cGMP levels. By inhibiting PDE5, nutraceuticals can promote the accumulation of cGMP, leading to enhanced penile blood flow and improved erectile function. A comprehensive analysis of the literature showcases various nutraceutical agents, including plant-derived compounds like flavonoids, polyphenols, and amino acids which have exhibited PDE5 inhibitory effects. Mechanistic insights into their action involve modulation of NO release, cGMP elevation, and relaxation of penile smooth muscles, all critical factors for achieving and sustaining erections. This review focuses on elucidating the role of nutraceuticals in treating erectile dysfunction through the inhibition of the PDE5 enzyme.

A Novel Multi-compartment Rotating Bioreactor for Improving ADSC-Spheroid Formation and its Application in Neurogenic Erectile Dysfunction.

The aim of this study was to construct a multicompartment synchronous rotating bioreactor (MCSRB) for batch-production of homogenized adipose-derived stem cell (ADSC) microspheres and treat neurogenic erectile dysfunction (ED). Firstly, an MCSRB was constructed using a centrifugal device and hinged trays. Secondly, influence factors (density, rotational speed) on the formation of ADSC-spheroids were explored. Finally, a neurogenic ED model was established to verify the effectiveness and safety of ADSC-spheroids for ED treatment. An MCSRB promoted ADSCs to gather microspheres, most of which were 90-130 μm in diameter. Supernatant from three-dimensional culture led to a significant increase in cytokine expression in ADSCs and migration rate in human umbilical vein endothelial cells (HUVECs) compared to control groups. The erectile function and pathological changes of the penis were improved in the ADSC-spheroids treatment group compared to the traditional ADSCs treatment group (p < 0.01). Efficient, batch, controlled and homogenized production of ADSC stem cell microspheres, and effective improvement of erectile dysfunction in neurogenic rats can be achieved using the MCSRB device.

The versatility of using platelet-enriched autoplasm in medical practice

The search for highly effective and safe methods in regenerative medicine has always been and remains an urgent problem. There are many drugs on the pharmacological market, but they cannot be considered to meet the requirements. One of the potential compounds capable of solving this problem is platelet-enriched autoplasm, which is economical and obtained directly from human blood with further centrifugation and platelet activation. An impressive number of studies are presented in the domestic and foreign literature, which confirm its effectiveness in assessing the area of a wound defect, the rate of regeneration and the absence of side effects. This is ensured by the content of a large number of growth factors and various biologically active compounds. In modern surgical practice, platelet-enriched autoplasm has found extensive use in the treatment of chronic wounds of various etiologies, prone to long-term course and frequent relapses; in cosmetology and aesthetic medicine in the issue of improving the appearance of scars; in urology in the treatment of erectile dysfunction; in obstetric and gynecological practice in improving pregnancy and pregnancy outcomes, reducing recurrence of adhesions, correcting functional sexual dysfunction and a favorable course of in vitro fertilization.

Determining the Severity of Benign Urologic Health States in Men Using Utilities Measures

ObjectivesTo assess a population level perceived health status of common reconstructive urologic conditions using health utilities. MethodsHealth utilities are generic quality of life measures that can help describe overall health status and can quantitatively compare different disease states and the perceived benefits of various interventions. An a priori determined, representative sample of adult men were recruited by Qualtrics™ to review standardized scenarios describing typical patients with reconstructive urologic conditions, surgeries to treat conditions, and control conditions (e.g. blindness, osteoarthritis). Condition-specific health status was measured using four tools: visual analog scale, standard gamble, time-trade off and willingness-to-pay and reported in Quality-adjusted Life Years (QALY; range 0.0 (death) to 1.0 (perfect health)). ResultsWe analyzed 562 completed surveys from condition-naive participants. Condition-specific health status ranged from a mean of 0.52 QALY to 0.66 QALY, with all reconstructive conditions perceived to be worse than osteoarthritis and monocular blindness (QALY 0.68). Health status was lowest for adult acquired buried penis (0.52 QALY) and pelvic radiation disease (0.53 QALY), comparable to binocular blindness (QALY 0.52). Treatment of erectile dysfunction with inflatable penile prosthesis (∆QALY +0.02; p<0.001) and stress urinary incontinence with artificial urinary sphincter (∆QALY +0.04; p<0.001) offered only nominal perceived gain in health status. ConclusionsHealth utilities may improve the ability to discriminate between heterogeneous reconstructive urologic disease states. For non-oncologic disease states in which mortality is not measured, health utilities could improve the ability to measure societal impact and justification for clinical and research investment.

Influence of personality disorders on sexual behaviours and response to treatment of psychogenic erectile dysfunction in phosphodiesterase 5 inhibitor non-responders

BackgroundPersonality disorders may influence sexual behaviours and sexual dysfunction.AimOur main objective was to analyse the influence of personality disorders (PDs) in patients with erectile dysfunction (ED) of psychological origin that fail to respond to andrological treatment with Phosphodiesterase-5 inhibitors (IPDE5), assessing whether there are differences in sexual behaviours and response to psychosexual treatment.MethodsThe research is designed as an ex post facto retrospective study with two groups. A control group of 23 men with ED without personality disorders and a group of 51 men with both ED and PDs.ResultsIn the case sample, 34.30% of the participants presented more than one personality disorder. No significant differences were found in sexual behaviours except for heteromasturbation (men without PDs masturbated their partners more to satisfy them than men with PDs), and men with PDs considered themselves less premature ejaculators than the control group. Finally, 82.14% of the control group did well with psychosexual therapy compared to 53.85% of the PDs group.ConclusionPsychosexual treatment of ED has a worse outcome if the men also have PDs. Strengths and Limitations: from a clinical standpoint, it is important to assess the presence of personality disorders in men with ED and to implement psychosexual strategies to improve the response to treatment in these cases. Confirmation of the results with a much larger sample becomes necessary.

An efficient enhanced stacked auto encoder assisted optimized deep neural network for forecasting Dry Eye Disease

Meibomian Gland Dysfunction (MGD) and Dry Eye Disease (DED) comprise two of the most significant eye diseases, impacting millions of sufferers worldwide. Several etiological factors influence the early symptoms of DED. Early diagnosis and treatment of erectile dysfunction may significantly improve the Quality of Life (QoL) for people. The current study introduces the ESAE-ODNN, an improved stacked autoencoder-aided optimised deep neural network, as a new way to predict DED using feature selection (FS), feature extraction (FE), and classification. The approach described here is novel because it merges chaotic maps into FS, employs SLSTM-STSA for improved classification accuracy (CA), and optimizes with the adaptive quantum rotation of the Enhanced Quantum Bacterial Foraging Optimisation Algorithm (EQBFOA). The present study enhances prediction functions by extracting MGD-related features and complicated relationships from the DED dataset. To ensure essential feature identification, the ESAE minimizes irrelevant and redundant features. To predict the DED, the ESAE first applies FE and then implements an ODNN classifier. This method fine-tunes the ODNN framework to enhance the effectiveness of the classification. The proposed ESAE-ODNN classification system efficiently assists in the early diagnosis of DED. Combining advanced Deep Learning (DL) methods with optimization can help us understand MGD features better and sort the data with the best accuracy (96.34%). The experimental evaluation with relevant performance metrics indicates that the proposed method is efficient in diverse aspects: accurate identification, reduced complexity, and fine-tuned performance. The ESAE-ODNN’s robustness in handling intricate feature indications and high-dimensional data outperforms the existing state-of-the-art techniques.

Exploring You-gui Pill for the Treatment of Diabetic Erectile Dysfunction: Data Mining Analysis, Network Pharmacology and Experiments In Vitro.

The You-gui pill (YGP) is a classical compound used for treating antidiabetic erectile dysfunction (DMED). However, the specific active ingredients responsible for its effects on DMED and their mechanisms remain unclear. In this paper, we used data mining techniques to analyze high-frequency herbs and herb combinations used in Chinese medicine for the treatment of DMED based on existing literature. Using network pharmacology to study the active components and mechanism of action of YGP against DMED, molecular docking was used to analyze the interactions of the active components with major structural proteins, nonstructural proteins, and mutants. Also, the therapeutic effect of YGP on hyperglycemic modelling and its underlying mechanisms were experimentally validated in CCEC cells by analyzing the expression of its relevant target mRNAs. Network pharmacological analysis identified the three core components of YGP as quercetin, kaempferol, and β-sitosterol, and constructed a PPI network map of common targets of YGP and DMED, which included HIF-1α, ALB, Bcl-2, INS, IL-1β, IL-6, TNF-α, CASP3, and TP53. Combined with molecular docking results, these targets had a strong binding affinity between them and the active ingredient compounds, with the highest affinity for HIF-1α and TNF-α. During the in vitro cellular assay validation, the HIF-1α, ALB, Bcl-2, TNF-α, and IL-6 mRNA in CCECs cells showed positive regulation after YGP intervention. The combination of "data mining - network pharmacology - molecular docking - experimental validation" provides a powerful methodological basis for the study of the main active components and mechanism of action of YGP against DMED, as well as the development and application of the drug.

The Emerging Role of Phosphodiesterase 5 Inhibition in Neurological Disorders: The State of the Art.

Growing evidence suggests that neuroinflammation is not just a consequence of neurodegeneration in pathologies such as Alzheimer's disease, Parkinson's disease, Huntington's disease or Amyotrophic lateral sclerosis, but it is rather a determinant factor, which plays a pivotal role in the onset and progression of these disorders. Neuroinflammation can affect cells and processes in the central nervous system (CNS) as well as immune cells, and might precede protein aggregation, which is a hallmark of the neurodegenerative process. Standard treatment methods are far from being able to counteract inflammation and delay neurodegeneration. Remarkably, phosphodiesterase 5 inhibitors (PDE5is), which represent potent vasoactive drugs used as a first-line treatment for erectile dysfunction (ED), display important anti-inflammatory effects through cyclic guanosine monophosphate (cGMP) level stabilization. Since PDE5 hydrolyzes cGMP, several studies positioned PDE5 as a therapeutic target, and more specifically, PDE5is as potential alternative strategies for the treatment of a variety of neurological disorders. Indeed, PDE5is can limit neuroinflammation and enhance synaptic plasticity, with beneficial effects on cognitive function and memory. The aim of this review is to provide an overview of some of the main processes underlying neuroinflammation and neurodegeneration which may be potential targets for PDE5is, focusing on sildenafil, the most extensively studied. Current strategies using PDEis for the treatment of neurodegenerative diseases will be summarized.

The Relationship between Erectile Dysfunction, Self-Esteem, and Depression in Post-Myocardial Infarction Patients.

Background: The interplay between the physical and mental health of patients recovering from myocardial infarction (MI) is crucial. Erectile dysfunction (ED) is a common sexual issue, particularly among patients who have had a myocardial infarction and arterial diseases, and it significantly affects self-esteem and overall psychological well-being. Despite significant advances in cardiac rehabilitation, the psychosocial aspects, especially those related to sexual health, remain underexplored. Objectives: The objective of this study was to examine the relationship between ED, self-esteem, and depression in male patients post-MI, and to assess how ED treatment affects patients' psychological health. Methods: This cross-sectional study involved 80 male patients with a confirmed MI within the last six months, aged between 35 and 77 years. The Beck Depression Inventory-II (BDI-II) and Rosenberg Self-Esteem Scale (SES) were used to assess psychological well-being, while the International Index of Erectile Function-5 (IIEF-5) was employed specifically to evaluate ED. Results: This study demonstrates a strong interdependence between mental and physical health in post-myocardial infarction (MI) patients, with ED being a key factor affecting self-esteem. There is a significant negative correlation between self-esteem and depression, highlighting the importance of psychological resilience in post-MI rehabilitation. Elevated self-esteem helps mitigate depressive symptoms, contributing to improved mental health and rehabilitation outcomes. Conclusions: Older patients tend to have lower self-esteem, likely due to the presence of multiple comorbidities and a longer, more challenging recovery period post-MI. Age was a significant factor in predicting lower self-esteem, but other demographic characteristics did not have a strong influence on self-esteem, depression, or ED.

Intranasal nanocrystals of tadalafil: in vitro characterisation and in vivo pharmacokinetic study

Tadalafil (TDA) is a class II drug of the biopharmaceuticals classification system (BCS), with limited aqueous solubility and high permeability. This study aims to improve the bioavailability of poorly soluble tadalafil by developing intranasal nanocrystals (NCs) of TDA. TDANCs that were stabilised by polyvinyl alcohol (PVA) had the lowest size and the best solubility. F11 had a 196 nm in size with PDI and zeta potential of 0.21 and -11.20, respectively, which shows 5.5 and 1.6-fold higher in solubility (9.37 ± 0.36 μg/mL) and dissolution (50.11 ± 1.69%) than pure tadalafil, respectively. An in vivo animal study demonstrated that the maximum plasma concentration (Cmax) and total area under the curve (AUC0∞) achieved in the TDANCs group were 352.77 ± 35.17 ng/mL and 3377 ± 558 ng.h/mL, respectively, and were significantly higher than the pure TDA group after intranasal administration. In conclusion, TDANCs were successfully prepared by the sonoprecipitation technique, with significant enhancement in in vitro and in vivo properties. Therefore, intranasal administration of TDA nanocrystals was a good model for the treatment of erectile dysfunction.

Developing a sensitive electrochemical platform constructed with nanoparticles of dysprosium supported on graphene nanoplatelets for the determination of yohimbine

Yohimbine, an α2-adrenoceptor antagonist, is used in the treatment of erectile dysfunction. However, it has various side effects such as tachycardia, arrhythmias, hypertension, dizziness, and poisoning. Some of its side effects are also manifested as anxiety, headaches and increased urinary output. Considering the consumption of yohimbine with dietary supplements and its side effects on the human system, the development of a novel, simple and sensitive method for the determination of yohimbine is significant. For this purpose, an electrochemical method was developed on a glassy carbon electrode (GCE) modified with dysprosium oxide (Dy2O3) and graphene nanoplatelets (GRNP). The electrochemical platform (GCE/GRNP@Dy2O3) possessed high electro-active surface area and lower value of charge transfer resistance (Rct). Yohimbine undergoes irreversible oxidation through a diffusion-controlled process. The observation of improved voltammetric behavior and enhanced peak response for yohimbine at GCE/GRNP@Dy2O3 could be attributed to the high synergistic effect between Dy2O3 and GRNP in addition to the increased surface area and electrocatalytic activity. The expected sensing mechanism of GCE/GRNP@Dy2O3 towards yohimbine might be attributed to the surface oxygen vacancies of Dy2O3 which are available on the surface of the nanocomposite. The oxygen atoms can interact with the functional groups of yohimbine and facilitate the oxidation of yohimbine. The peak response and concentration were found to be correlated over a range of 8.0 × 10−9–7.8 × 10−7 M. The GCE/GRNP@Dy2O3 system exhibited a detection limit (LOD) of 5.7 × 10−9 M for yohimbine. Average recovery values of 98.0 %–104.9 % with lower RSD values in yohimbine supplements and 101.0 %–103.0 % in artificial urine confirmed that GCE/GRNP@Dy2O3 provides reliable results for the determination of yohimbine.

Safety and efficacy of platelet-rich plasma injection for treatment of erectile dysfunction: a prospective randomized controlled study

BackgroundAffected sexual relationships affect both the quality of life of men and women. Platelet-derived therapies are becoming increasingly popular in various medical and surgical fields because of their ability to aid in tissue healing and vascular remodeling. This study aimed to assess the safety and effectiveness of platelet-rich plasma (PRP) injections in treating patients with erectile dysfunction (ED).ResultsFifty-two participants with mild to moderate ED were divided into two groups: group A, who received three PRP penile injections, and group B, who received three saline injections (5 ml for each injection site). The International Index of Erectile Function (IIEF) was used to evaluate all participants. A month after the last injection, the PRP group's IIEF was 16.12 ± 1.25, while the placebo group's was 15.99 ± 1.21 (p = 0.683). Following a 3-month period, the IIEF for the PRP group was 16.44 ± 1.17, while the placebo group's was 16.31 ± 1.06 (p value = 0.653). Following a 6-month period, the IIEF for the PRP group was 16.35 ± 1.45, while that for the placebo group's was 16.23 ± 1.19 (p = 0.727). In terms of IIEF, there was no significant difference between the two groups after one, three, and six months of treatment.ConclusionIn brief, our research revealed no data to support the application of PRP injections in the management of mild-to-moderate ED.

Assessing Attitudes and Confidence in Managing Erectile Dysfunction Among Urology, Internal Medicine, and Family Medicine Providers

ObjectiveTo assess and contrast attitudes and confidence regarding erectile dysfunction (ED) treatment among urologists (GU) and primary care providers (PCPs), identifying areas for collaboration, practice improvement, and additional training to enhance men's healthcare (MH) quality and access. MethodsAn anonymous survey with 25 questions on ED treatment, rated on a 5-point Likert scale, was conducted among our institution's providers in GU, internal medicine (IM), and family medicine (FM). Data were analyzed using descriptive statistics and Fisher’s exact test. Results138 providers responded, including 58 IM, 47 FM, and 33 GU. FM and IM responses generally overlapped with some differences. IM were more positive regarding vacuum erection device (VED) and inflatable penile prosthesis (IPP) satisfaction and risk.Comparing GU to FM + IM, GU displayed greater confidence and knowledge about ED. Notably, 63% of GU used the validated International Index of Erectile Function (IIEF) compared to 3% of FM + IM. Additionally, 100% of GU strongly/agreed that good options remained after pills failed vs 83% of FM + IM.Significant differences in GU vs FM + IM perspectives on IPP included patient willingness to undergo surgery for ED (67% vs. 12%), patient satisfaction (91% vs. 28%), partner satisfaction (79% vs. 26%) and willingness to recommend/repeat surgery (82% vs. 17%). Notably, 82% of GU vs 10% of FM + IM were aware that Medicare covered implants. ConclusionThis survey reveals significant knowledge gaps in ED treatment between GU and PCPs. Targeted provider education, particularly about penile prostheses, could optimize patient care.

202 - Erectile dysfunction treatment by platelet-rich plasma and extracorporeal shock wave therapy

202 - Erectile dysfunction treatment by platelet-rich plasma and extracorporeal shock wave therapy

Pharmacological evaluation of a new nanoformulation in the erectile tissue of rabbits and humans

The failure of achieving a penile erection for satisfactory sexual intercourse is known as erectile dysfunction (ED). The primary mediator for penile erection is nitric oxide (NO). ED is often associated with endothelial/nitrergic dysfunction characterized by a reduction of the bioavailability of NO. Phosphodiesterase-5 inhibitors (PDE-5Is) clinical efficacy in the treatment of ED depends on the integrity of the NO-sGC-PKG pathway. In the present study, we probed the effect of sodium nitroprusside incorporated into mesoporous silica nanoparticles (MPSi-NP), which traps cyanide and slowly releases NO. MPSi-NP induced a maximal relaxation of 92.8 ± 5.2% in rabbit corpora cavernosa (RbCC), blunted by a soluble guanylate cyclase (sGC) inhibitor and blockers of calcium-dependent potassium channels. MPSi-NP abolished spontaneous contractions of human corpora cavernosa (HCC) strips. In addition, MPSi-NP induced maximal relaxation of phenylephrine precontracted HCC by 118.6 ± 3.6%, and in comparison, tadalafil induced a maximal relaxation of HCC by 98.3 ± 1.2%. Similarly, the sGC inhibitor blocked the MPSi-NP relaxation. MPSi-NP potentiated the relaxation induced by tadalafil. MPSi-NP increased cGMP levels in HCC strips by 2.6-fold and increased by 3.5-fold the phosphorylation level of the VASP protein, which is a downstream target to PKG. MPSi-NP effectively relaxes RbCC and HCC by activating the sGC-PKG pathway and potentiates the tadalafil response. MPSi-NP could be helpful in conditions where nitric oxide availability is decreased. A topical gel formulation of MPSi-NP could be used as a rescue therapy to treat true non-responders of PDE5Is drugs.

Investigation of the effects of tadalafil on the myocardium via electrical and isometric contractions and cardiac markers in Wistar rats

Purpose: Tadalafil, a long-acting phosphodiesterase-5 (PDE-5) inhibitor, is commonly used in the treatment of erectile dysfunction. This study investigates the contribution of tadalafil in cardiac function by measuring isometric and electrical contractions of myocardium in rats. Materials and Methods: Thirty rats were divided into five groups. Basal electrical contractions were recorded via electrocardiogram (ECG) for intervals PR (ms), QRS (ms), QT (ms), Tp (ms), Te (ms), pathological Q and heart beats/min. Then group 1 received saline for 7 days (control); group 2 received tadalafil 1 mg/kg; group 3 received tadalafil 10 mg/kg; group 4 received tadalafil 1 mg/kg for 7 days; group 5 received tadalafil 10 mg/kg for 7 days. After treatments, electrical contractions were re-performed to analyze the differences in ECG. For isometric contractions, hearts were connected to isometric power transducer to determine myocardial contractile forces (g), durations (ms) and frequencies (Hz). Serum samples were collected for cardiac creatine kinase (CK-MB) and cardiac troponin I via ELISA. Results: We found a significant decrease in CK-MB in Group 2 (395.56±124.38 pg/ml) and 3 (377.81±79.61 pg/ml), compared to Group 1 (575.32±83.54 pg/ml). The differences in cardiac contractile forces, contraction durations or frequencies were not statistically significant. Conclusion: Tadalafil did not exert obvious distruption on myocardial electrical or isometrical contractions. It is noteworthy that tadalafil 1 and 10 mg/kg reduced serum CK-MB. Shortening in QT and decrease in heart rate may have important implications on myocardial functions.

Urologist communication is a primary factor leading to erectile dysfunction treatment postprostatectomy.

Studies have shown insufficient utilization of care for patients with erectile dysfunction (ED) after radical prostatectomy (RP). The aim of this study was to evaluate variables associated with barriers to seeking and receiving ED treatment. In this multicenter prospective cross-sectional study, the functional outcomes of 936 patients were assessed 10 to 15years after RP. A total of 525 patients with ED or incontinence were asked about their treatment experiences or lack thereof. The data were analyzed using the chi-square test, t test, and multivariate logistic analyses. Patients answered validated questionnaires regarding information sources, communication with their partner and urologist, and barriers to ED treatment. Of the 525 patients, 80 were not available to survey. A total of 304 patients answered the survey (response: 68.0%). A total of 246 patients had ED and were included in this study. The mean age at surgery was 64.4 ± 6.1years, and the mean age at the time of this survey was 77.1 ± 6.2years. The mean follow-up duration was 12.7 ± 1.5years. Forty-six percent (n = 114 of 246) of the patients had never received ED treatment. The most important conversation partners regarding the ED were the partner (69% [n = 169 of 246]) and the urologist (48% [n = 118 of 246]). Patients who never received ED treatment were less likely to have conversations with their urologist (34% vs 60%; P < .001), had less support (51% vs 68%; P = .01), and had less interest in sex from their partner (20% vs 40%; P = .001). Communication with other groups (general practitioners, other physicians, family, friends, and the Internet) had no influence on ED treatment utilization. The most relevant barrier to receiving ED treatment was the belief that treatment would not help (65%). No interest in sex from their partner (odds ratio, 3.9) and no conversation with their urologist about ED (odds ratio, 2.9) were found to be independent predictors of not receiving ED treatment. Urologists should have enhanced awareness of how to approach patients directly about their ED and actively offer them treatment options. These results should be further validated in a multicenter, prospective study. Response bias may have affected the results. Furthermore, the current cohort was relatively old. This study revealed that no interest in sex from one's partner and insufficient communication with a urologist were relevant barriers to insufficient utilization of ED treatment after RP.

Attitudes and preferences towards erectile dysfunction treatment among men with fertility needs: insights from a clinical study.

Erectile dysfunction (ED) is prevalent among males experiencing fertility challenges, yet attitudes towards actively treating ED in this group are under-researched. From a cohort of 1256 men with reproductive needs, 303 were identified with ED. The survey encompassed 296 respondents who correctly completed the second questionnaire, revealing that 50.3% sought ED treatment, with higher ED severity increasing the likelihood of seeking treatment. Infertile men were more likely to seek treatment than those with pregnancy loss (OR 3.18, 95% CI 1.74-5.83). Men with normal semen parameters were more open to ED therapy (OR 3.02, 95% CI 1.69-5.36), whereas those undergoing Assisted Reproduction Treatment were less inclined (OR 0.32, 95% CI 0.18-0.58). PDE-5 inhibitors (PDE-5Is) were preferred by 51.0% of those seeking treatment, with 29.7% of men with pregnancy loss and 60.1% of infertile men choosing PDE-5Is as their first option. Concerns included potential adverse effects of PDE-5Is on fetal health (78.7% of men with pregnancy loss) and on sperm quality (44.2% of infertile men). In conclusion, the different fertility requirements, semen parameters, and whether received ART are significant factors influencing the acceptance of treatment, PDE-5Is utilization among individuals in men with couple pregnancy loss is notably limited.

NLRP3 inhibitor combined with Yimusake improves erectile dysfunction in rats with diabetes mellitus through the attenuation of pyroptosis

Erectile dysfunction (ED) is a prevalent complication associated with diabetes mellitus (DM), yet pharmacological treatments for diabetes-related erectile dysfunction (DMED) continue to be inadequate in clinical settings. Our previous studies have indicated that there is a close correlation between ED and pyroptosis, but the specific mechanism remains unclear. In this study, we sought to explore the therapeutic effects of DMED through the modulation of NLRP3, aiming to elucidate its potential molecular mechanisms. The DMED rat model was established via intraperitoneal injection of streptozotocin. The rats were randomly assigned to the control group, the DMED group, the Yimusake group, the MCC950 (NLRP3 inhibitor) group, and the MCC950+Yimusake group. Erectile function of rats was observed by measuring intracavernosal pressure (ICP) and mean arterial pressure (MAP). HE staining was performed to observe the histopathological changes in penile; immunofluorescence was performed to measure the level of CD31 (Platelet endothelial cell adhesion molecule-1) in penile. Besides, immunohistochemistry, RT-qPCR and Western blot were performed to demonstrate the expression of NLRP3, caspase-1, IL-1β and eNOS. After treatment with the MCC950 and Yimusake, the number of blood sinusoids and small vessels significantly reduced in penile tissue; NLRP3, caspase-1, IL-1β proteins and mRNA expression decreased, eNOS protein and mRNA expression increased. Compare with the Y group and the MCC950 group, MCC950+Yimusake group had a more significant effect. MCC950 and Yimusake might potentially suppress pyroptosis in the penile tissue of DMED rats by modulating the NLRP3/caspase-1 pathway, thus enhancing erectile function. This discovery could offer a promising therapeutic approach for individuals with DMED.

Research progress on the therapeutic application of extracellular vesicles in erectile dysfunction.

Erectile dysfunction (ED) is one of the most common male sexual dysfunctions and is related to many pathogenic factors. However, first-line treatment, represented by phosphodiesterase 5 inhibitors, is unable to maintain long-term efficacy. Extracellular vesicles (EVs) have recently attracted the attention of researchers in the fields of cardiovascular disease, neurologic disease, and regenerative medicine and may become a treatment for ED. This article reviews recent applications of EVs in the treatment of ED from the aspects of the source, the therapeutic mechanism, and the strategies to enhance therapeutic efficacy. These research advances lay the foundation for further research and provide references for in-depth understanding of the therapeutic mechanism and possible clinical application of EVs in ED.