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Sulistiawati S, Kristina Enggi C, Wiyulanda Iskandar I, Rachmad Saputra R, Sartini S, Rifai Y, Rahman L, Aswad M, Dian Permana A. Bioavailability enhancement of sildenafil citrate via hydrogel-forming microneedle strategy in combination with cyclodextrin complexation. Int J Pharm 2024; 655:124053. [PMID: 38537922 DOI: 10.1016/j.ijpharm.2024.124053] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/03/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024]
Abstract
Sildenafil citrate (SIL) as a first-line treatment for erectile dysfunction is currently reported to have poor solubility and bioavailability. Moreover, SIL undergoes first-pass metabolism when taken orally and its injection can lead to discomfort. In this study, we introduce a novel transdermal delivery system that integrates hydrogel-forming microneedles with the inclusion complex tablet reservoir. The hydrogel-forming microneedle was prepared from a mixture of polymers and crosslinkers through a crosslinking process. Importantly, the formulations showed high swelling capacity (>400 %) and exhibited adequate mechanical and penetration properties (needle height reduction < 10 %), penetrating up to five layers of Parafilm® M (assessed to reach the dermis layer). Furthermore, to improve the solubility of SIL in the reservoir, the SIL was pre-complexed with β-cyclodextrin. Molecular docking analysis showed that SIL was successfully encapsulated into the β-cyclodextrin cavity and was the most suitable conformation compared to other CD derivatives. Moreover, to maximize SIL delivery, sodium starch glycolate was also added to the reservoir formulation. As a proof of concept, in vivo studies demonstrated the effectiveness of this concept, resulting in a significant increase in AUC (area under the curve) compared to that obtained after administration of pure SIL oral suspension, inclusion complex, and Viagra® with relative bioavailability > 100 %. Therefore, the approach developed in this study could potentially increase the efficacy of SIL in treating erectile dysfunction by being non-invasive, safe, avoiding first-pass metabolism, and increasing drug bioavailability.
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Affiliation(s)
| | | | | | - Rizki Rachmad Saputra
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, University of Palangka Raya, Central Kalimantan 73111, Indonesia
| | - Sartini Sartini
- Faculty of Pharmacy, Hasanuddin University, Makassar 90245, Indonesia
| | - Yusnita Rifai
- Faculty of Pharmacy, Hasanuddin University, Makassar 90245, Indonesia
| | - Latifah Rahman
- Faculty of Pharmacy, Hasanuddin University, Makassar 90245, Indonesia
| | - Muhammad Aswad
- Faculty of Pharmacy, Hasanuddin University, Makassar 90245, Indonesia
| | - Andi Dian Permana
- Faculty of Pharmacy, Hasanuddin University, Makassar 90245, Indonesia.
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Dilixiati D, Kadier K, Laihaiti D, Lu JD, Azhati B, Rexiati M. Association between leucocyte telomere length and erectile dysfunction in US adults: a secondary study based on 2001-2002 NHANES data. BMJ Open 2024; 14:e077808. [PMID: 38643009 PMCID: PMC11033652 DOI: 10.1136/bmjopen-2023-077808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 03/04/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVE We aimed to explore the association between the leucocyte telomere length (LTL) and erectile dysfunction (ED) among a nationally representative sample of US adults. DESIGN Secondary population-based study. SETTING The National Health and Nutrition Examination Survey (NHANES) (2001-2002). PARTICIPANTS A total of 1694 male participants were extracted from the NHANES database for 2001-2002. PRIMARY AND SECONDARY OUTCOME MEASURES The primary focus of the study was to determine the association between the LTL and ED, using multivariate logistic regression and restricted cubic spline models for examination. The secondary outcome measures involved conducting stratified subgroup analyses to exclude interactions of different variables with the LTL. RESULTS Participants with ED had shorter LTLs than those without ED (p<0.05). After adjusting for confounding factors, compared with the reference lowest LTL quartile, the ORs and 95% CIs for the second, third and fourth LTL quartiles were (OR 1.51; 95% CI 1.01 to 2.26), (OR 1.79; 95% CI 1.24 to 2.58) and (OR 1.25; 95% CI 0.74 to 2.11), respectively. In addition, restricted cubic splines showed an inverted J-curve relationship between the LTL and ED. At an LTL of 1.037, the curve showed an inflection point. The ORs (95% CI) of ED on the left and right sides of the inflection point were (OR 1.99; 95% CI 0.39 to 10.20; p=0.385) and (OR 0.17; 95% CI 0.03 to 0.90; p=0.039). CONCLUSION Our results demonstrated an inverted J-curve relationship between the LTL and ED. When the LTL was ≥1.037, the incidence of ED decreased with increasing LTL.
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Affiliation(s)
- Diliyaer Dilixiati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Kaisaierjiang Kadier
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Duolikun Laihaiti
- Department of Joint Surgery, Changji Branch of First Affiliated Hospital of Xinjiang Medical University, Changji, China
| | - Jian-De Lu
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Baihetiya Azhati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Mulati Rexiati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Li L, Zhang Y, Ma M, Liu F, Shang Y, Yuan Q, Li X, Ju B. Does erectile dysfunction predict cardiovascular risk? A cross-sectional study of clinical characteristics in patients with erectile dysfunction combined with coronary heart disease. Front Cardiovasc Med 2024; 11:1341819. [PMID: 38562188 PMCID: PMC10984325 DOI: 10.3389/fcvm.2024.1341819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
Background Erectile Dysfunction (ED) is a common sexual dysfunction in men who are unable to consistently obtain and maintain sufficient penile erection to accomplish a satisfactory sexual life. ED is currently considered to be a predictor of cardiovascular disease (CVD), but few studies have observed the association between ED and clinical features of coronary heart disease (CHD). An investigation of the association between ED and clinical characteristics of CHD was carried out using a cross-sectional study design. Methods This cross-sectional single-center study was conducted in the Department of Cardiology and included 248 patients. Associations between patients' general information, underlying disease information, coronary heart disease information, and ED severity were statistically and analytically analyzed using SPSS 26.0 software. Patients with comparable clinical characteristics were grouped together using K-means clustering. Finally, ordered logistic regression analysis was performed for general and underlying disease information. Results In the comparison of general data, age, education, and weekly exercise were associated with the distribution of ED severity. In the comparison of underlying disease information, the number of underlying diseases, hypertension, diabetes, hyperlipidemia, anxiety state, and depressive state were associated with the distribution of ED severity. In the comparison of CHD information, the degree of ED severity was associated with CHD subtypes, lesion sites, number of stenoses, degree of stenosis, and interventional interventions. The time from ED to CHD onset was associated with the subtypes of CHD and the number of stenoses. We clustered the main characteristics of low-risk and high-risk patients and ordered logistic regression analysis found that BMI, smoking, alcoholism, number of underlying diseases, diabetes, anxiety state, and depression state were all risk factors for CHD severity (P < 0.05); the higher the value of the above factors, the more severe the degree of CHD. Age was a protective factor for CHD severity; the younger the patient, the lower the likelihood of myocardial infarction. Conclusion ED severity and the time from ED to CHD onset may be predictive of coronary heart disease severity. Reducing smoking and alcohol consumption, maintaining a healthy body weight, and regular physical activity are important in preventing CVD in ED patients.
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Affiliation(s)
- Luyu Li
- The First School of Clinical Medicine, The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yongtao Zhang
- The First School of Clinical Medicine, The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Miaomiao Ma
- The First School of Clinical Medicine, The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Feng Liu
- The First School of Clinical Medicine, The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yihan Shang
- The First School of Clinical Medicine, The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Quan Yuan
- The First School of Clinical Medicine, The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Xiao Li
- Department of Andrology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Baojun Ju
- Department of Andrology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
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Liu Z, Wu T, Ma S, Wang L, Jiang X, Xue W, Tang Q, Zhang K, Liu S, Xu C, Chen Y, Zhou Y, Ma J. More Efficient Approach: Independent Diagnostic Value of Audiovisual Sexual Stimulation for Psychogenic Erectile Dysfunction. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1107-1114. [PMID: 38167989 PMCID: PMC10920448 DOI: 10.1007/s10508-023-02763-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024]
Abstract
The diagnostic value of audiovisual sexual stimulation (AVSS) for psychogenic erectile dysfunction (ED) is still unclear. We investigated the independent diagnostic value and optimal cut-off parameter of AVSS for psychogenic ED. All participants had received the AVSS test and nocturnal penile tumescence and rigidity (NPTR) monitoring at least twice. ED patients were divided into psychogenic ED and organic ED according to NPTR examination. The diagnostic accuracy of AVSS parameters was evaluated with the receiver operating characteristic (ROC) curve, and the Youden index was employed to determine the optimal diagnostic cut-off values. A total of 346 patients with ED and 60 healthy men were included in this study, among which 162 and 184 cases of psychogenic and organic ED were identified based on NPTR, respectively. When comparing the two ED groups, the area under the curve (AUC) of AVSS parameters was 0.85-0.89. Six-selected AVSS parameters could precisely diagnose psychogenic ED, exhibiting increased diagnostic specificity compared with corresponding sensitivity. When comparing psychogenic ED with the control group, the AUC of the tumescence of the tip was superior to the AUC other parameters (0.81 vs. 0.58, 0.66, 0.59, 0.53, 0.68), and the best determined diagnostic cut-off value was the tumescence of the tip < 29.87%. Independent AVSS could diagnose psychogenic ED objectively and effectively, and its diagnostic value was highest when 1.50% ≤ tumescence of the tip < 29.87%.
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Affiliation(s)
- Zhiwei Liu
- Department of Urology, Tangdu Hospital, Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, 710038, China
| | - Tao Wu
- Department of Urology, Tangdu Hospital, Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, 710038, China
| | - Shanjin Ma
- Department of Urology, Tangdu Hospital, Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, 710038, China
| | - Lei Wang
- Department of Urology, Tangdu Hospital, Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, 710038, China
| | - Xiaoye Jiang
- Department of Urology, Tangdu Hospital, Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, 710038, China
| | - Wei Xue
- Department of Urology, Tangdu Hospital, Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, 710038, China
| | - Qisheng Tang
- Department of Urology, Tangdu Hospital, Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, 710038, China
| | - Keying Zhang
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Shaojie Liu
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Chao Xu
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Yurui Chen
- Department of Urology, Air Force Medical Center of PLA, Beijing, China
| | - Yenong Zhou
- Department of Nursing, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jianjun Ma
- Department of Urology, Tangdu Hospital, Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, 710038, China.
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Deng CY, Ke XP, Guo XG. Dietary calcium, phosphorus, and potassium intake associated with erectile dysfunction in the National Health and Nutrition Examination Survey (NHANES) 2001 to 2004. PLoS One 2024; 19:e0297129. [PMID: 38381721 PMCID: PMC10880986 DOI: 10.1371/journal.pone.0297129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/28/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Erectile dysfunction is now a common disorder of sexual function, and its relationship to dietary calcium, phosphorus, and potassium has not been well studied. We set out to determine if dietary intakes of calcium, phosphorus, and potassium are related to erectile dysfunction in U.S. men. METHODS For this cross-sectional investigation, we used data from NHANES 2001-2004. To investigate the connection of dietary calcium, phosphorus, and potassium intake with erectile dysfunction, we employed multivariate logistic regression, smoothed curve fitting, and subgroup analysis. RESULTS This cross-sectional study comprised 3,556 eligible male subjects in total, with a weighted mean age of 49.93±18.13 years. After controlling for race and age, the greatest tertile of calcium consumption was found to have a 34% lower risk of erectile dysfunction than the lowest tertile (OR = 0.66; 95% CI = 0.52-0.84; p = 0.0006). The risk of erectile dysfunction was found to be reduced by 33% (OR = 0.67; 95% CI = 0.52-0.87; p = 0.0024) for the highest tertile of phosphorus intake compared to the lowest tertile of phosphorus intake and by 35% (OR = 0.65; 95% CI = 0.50-0.83; p = 0.0006) for the highest tertile of potassium intake compared to the lowest tertile of potassium intake in the fully adjusted model. CONCLUSION Erectile dysfunction and dietary consumption of calcium, phosphorus, and potassium are inversely associated with the U.S. population. To confirm the accuracy of our findings, additional prospective studies are necessary. Furthermore, it is imperative to do further fundamental research at the molecular level to gain a deeper understanding of the underlying mechanisms.
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Affiliation(s)
- Chen-Yuan Deng
- Department of Clinical Laboratory Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Xin-Peng Ke
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Xu-Guang Guo
- Department of Clinical Laboratory Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
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Dilixiati D, Kadier K, Lu JD, Xie S, Azhati B, Xilifu R, Rexiati M. Causal associations between prostate diseases, renal diseases, renal function, and erectile dysfunction risk: a 2-sample Mendelian randomization study. Sex Med 2024; 12:qfae002. [PMID: 38348104 PMCID: PMC10859556 DOI: 10.1093/sexmed/qfae002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/17/2023] [Accepted: 12/28/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Previous observational studies have found a potential link between prostate disease, particularly prostate cancer (PCa), and kidney disease, specifically chronic renal disease (CKD), in relation to erectile dysfunction (ED), yet the causal relationship between these factors remains uncertain. AIM The study sought to explore the potential causal association between prostate diseases, renal diseases, renal function, and risk of ED. METHODS In this study, 5 analytical approaches were employed to explore the causal relationships between various prostate diseases (PCa and benign prostatic hyperplasia), renal diseases (CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, and kidney ureter calculi), as well as 8 renal function parameters, with regard to ED. All data pertaining to exposure and outcome factors were acquired from publicly accessible genome-wide association studies. The methods used encompassed inverse variance weighting, MR-Egger, weighted median, simple mode, and weighted mode residual sum and outlier techniques. The MR-Egger intercept test was utilized to assess pleiotropy, while Cochran's Q statistic was employed to measure heterogeneity. OUTCOMES We employed inverse variance weighting MR as the primary statistical method to assess the causal relationship between exposure factors and ED. RESULTS Genetically predicted PCa demonstrated a causal association with an elevated risk of ED (odds ratio, 1.125; 95% confidence interval, 1.066-1.186; P < .0001). However, no compelling evidence was found to support associations between genetically determined benign prostatic hyperplasia, CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, kidney ureter calculi, and the renal function parameters investigated, and the risk of ED. CLINICAL IMPLICATIONS The risk of ED is considerably amplified in patients diagnosed with PCa, thereby highlighting the importance of addressing ED as a significant concern for clinicians treating individuals with PCa. STRENGTHS AND LIMITATIONS This study's strength lies in validating the PCa-ED association using genetic analysis, while its limitation is the heterogeneity in study results. CONCLUSION The results of this study suggest a potential link between PCa and a higher risk of ED.
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Affiliation(s)
- Diliyaer Dilixiati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Kaisaierjiang Kadier
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Jian-De Lu
- Department of General Surgery, Children's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830010, China
| | - Shiping Xie
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Baihetiya Azhati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Reyihan Xilifu
- Department of Nephrology, Children's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830054, China
| | - Mulati Rexiati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
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Liu G, Zhang Y, Zhang W, Wu X, Jiang H, Zhang X. Validation of the relationship between rapid eye movement sleep and sleep-related erections in healthy adults by a feasible instrument Fitbit Charge2. Andrology 2024; 12:365-373. [PMID: 37300476 DOI: 10.1111/andr.13478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/30/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sleep, particularly rapid eye movement sleep, has been found to be associated with sleep-related erections. While RigiScan is currently a more accurate method for monitoring nocturnal erectile events, the Fitbit, a smart wearable device, shows great potential for sleep monitoring. OBJECTIVES To analyze the relationship between sleep-related erections and sleep by recruiting sexually active, healthy men for simultaneous monitoring of sleep and nocturnal penile tumescence and rigidity. PATIENTS AND METHODS Using Fitbit Charge2 and RigiScan, we simultaneously monitored nocturnal sleep and erections in 43 healthy male volunteers, and analyzed the relationship between sleep periods and erectile events with the Statistical Package for Social Sciences. RESULTS Among all erectile events, 89.8% were related to rapid eye movement, and 79.2% of all rapid eye movement periods were associated with erectile events. Moreover, a statistical correlation was shown between the duration of rapid eye movement and the time of total erectile events (first night: 𝜌 = 0.316, p = 0.039; second night: 𝜌 = 0.370, p = 0.015). DISCUSSION AND CONCLUSION Our study shows a potential link between sleep-related erections and rapid eye movement sleep, which has implications for the current examination of sleep-related erections and further research into the mechanisms of erectile function. Meanwhile, the wearable device Fitbit has shown a potential promise for sleep monitoring in patients with erectile dysfunction. The results provide an alternative approach for further research on the relationship between erectile function and sleep with large sample sizes in the future.
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Affiliation(s)
- Guodong Liu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China
| | - Yuyang Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China
| | - Wei Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China
| | - Xu Wu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China
| | - Hui Jiang
- Department of Urology, Peking University First Hospital Institute of Urology, Peking University Andrology Center, Beijing, China
| | - Xiansheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China
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Üzel A, Ebik B, Bucaktepe GE, Yolaçan R, Karabulut Ü, Uçmak F. Do oral antiviral drugs used in the treatment of chronic hepatitis B cause erectile dysfunction? Eur J Gastroenterol Hepatol 2024; 36:184-189. [PMID: 37942730 DOI: 10.1097/meg.0000000000002672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE The effect of antiviral drugs on the erectile dysfunction (ED) problem expressed by some patients using antiviral drugs due to chronic hepatitis B infection (HBV) was investigated. METHODS A total of 102 male patients receiving antiviral therapy for HBVinfection without any known non-cirrhotic and comorbid disease that may cause ED and whodon't use any drugs with an ED formation potential were analyzed through the InternationalIndex of Erectile Function test. RESULTS Among the patients admitted to the study, anxiety disorder was detected as 24.5% (n = 25) and depression as 46.1% (n = 47). 70.6% (n = 72) of the patients suffered ED. Severe ED was only detected in 3 (n = 2.9%) patients. ED was detected in 70.6% of the entecavir, 64.2% of tenofovir, and 80% of Tenofovir alafenamide users ( P = 0.287). On the other hand, the logistics regression analysis revealed that the most important factors that increase the risk of ED are age (>55 age; RR: 2.66; P < 0.001), and anxiety disorder (RR: 2.30; P < 0.0001). The cumulative effect of antiviral drugs on ED was 5.7% (RR: 0.8; P = 0.156). CONCLUSION We could not find any mounting evidence relating to the effect ofcommonly used antiviral drugs for hepatitis B causing ED. The incidence rate of ED on ourpatients was at a similar rate with population studies in the literature based on society. It is notappropriate to terminate antiviral therapy in hepatitis B for this reason.
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Affiliation(s)
- Ali Üzel
- Division of Gastroenterology, Diyarbakir Gazi Yasargil Education and Research Hospital, University of Health Sciences
| | - Berat Ebik
- Division of Gastroenterology, Diyarbakir Gazi Yasargil Education and Research Hospital, University of Health Sciences
| | | | - Ramazan Yolaçan
- Department of Gastroenterology, Bingöl Government Hospital, Bingöl
| | - Ümit Karabulut
- Department of Gastroenterology, Dicle University School of Medicine
| | - Feyzullah Uçmak
- Department of Gastroenterology, Dicle University School of Medicine, Diyarbakir, Turkey
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Xi YJ, Feng YG, Bai YQ, Wen R, Zhang HY, Su QY, Guo Q, Li CY, Wang ZX, Pei L, Zhang SX, Wang JQ. Genetic prediction of modifiable lifestyle factors for erectile dysfunction. Sex Med 2024; 12:qfae010. [PMID: 38505341 PMCID: PMC10949036 DOI: 10.1093/sexmed/qfae010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/28/2024] [Accepted: 02/08/2024] [Indexed: 03/21/2024] Open
Abstract
Background The causal relationship between certain lifestyle factors and erectile dysfunction (ED) is still uncertain. Aim The study sought to investigate the causal effect of 9 life factors on ED through 2-sample single-variable Mendelian randomization (SVMR) and multivariable Mendelian randomization (MVMR). Methods Genetic instruments to proxy 9 risk factors were identified by genome-wide association studies. The genome-wide association studies estimated the connection of these genetic variants with ED risk (n = 223 805). We conducted SVMR, inverse variance-weighting, Cochran's Q, weighted median, MR-Egger, MR-PRESSO (Mendelian Randomization Pleiotropy RESidual Sum and Outlier), and MVMR analyses to explore the total and direct relationship between life factors and ED. Outcomes The primary outcome was defined as self or physician-reported ED, or using oral ED medication, or a history of surgery related to ED. Results In SVMR analyses, suggestive associations with increased the risk of ED were noted for ever smoked (odds ratio [OR], 5.894; 95% confidence interval [CI], 0.469 to 3.079; P = .008), alcohol consumption (OR, 1.495; 95% CI, 0.044 to 0.760; P = .028) and body mass index (BMI) (OR, 1.177; 95% CI, 0.057 to 0.268; P = .003). Earlier age at first intercourse was significantly related to reduced ED risk (OR, 0.659; 95% CI, -0.592 to -0.244; P = 2.5 × 10-6). No strong evidence was found for the effect of coffee intake, time spent driving, physical activity, and leisure sedentary behaviors on the incidence of ED (All P > .05). The result of MVMR analysis for BMI (OR, 1.13; 95% CI, 1.01 to 1.25; P = .045) and earlier age at first intercourse (OR, 0.77; 95% CI, 0.56 to 0.99; P = .018) provided suggestive evidence for the direct impact on ED, while no causal factor was detected for alcoholic drinks per week and ever smoked. Clinical implications This study provides evidence for the impact of certain modifiable lifestyle factors on the development of ED. Strengths and limitations We performed both SVMR and MVMR to strengthen the causal relationship between exposures and outcomes. However, the population in this study was limited to European ancestry. Conclusion Ever smoked, alcoholic drinks per week, BMI, and age first had sexual intercourse were causally related to ED, while the potential connection between coffee intake, physical activity, recreational sedentary habits, and increased risk of ED needs to be further confirmed.
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Affiliation(s)
- Yu-Jia Xi
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, China
- Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi Province 030001, China
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, Shanxi Province 030001, China
| | - Yi-Ge Feng
- Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi Province 030001, China
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, Shanxi Province 030001, China
| | - Ya-Qi Bai
- Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi Province 030001, China
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, Shanxi Province 030001, China
| | - Rui Wen
- Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi Province 030001, China
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, Shanxi Province 030001, China
| | - He-Yi Zhang
- Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi Province 030001, China
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, Shanxi Province 030001, China
| | - Qin-Yi Su
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, China
- Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi Province 030001, China
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, Shanxi Province 030001, China
| | - Qiang Guo
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Cheng-Yong Li
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Zhen-Xing Wang
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Liang Pei
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Sheng-Xiao Zhang
- Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi Province 030001, China
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, Shanxi Province 030001, China
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Jing-Qi Wang
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, China
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Podlasek CA. Nanotechnology in sexual medicine. J Sex Med 2024; 21:81-83. [PMID: 38314625 PMCID: PMC10839571 DOI: 10.1093/jsxmed/qdad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 02/06/2024]
Abstract
Statement of Significance: There is significant potential for improvement in erectile function and prevention of erectile dysfunction if these diverse and novel nanotherapies can be translated to the clinic.
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Affiliation(s)
- Carol A Podlasek
- Departments of Urology, Physiology, Bioengineering, and Biochemistry, University of Illinois at Chicago, Chicago, IL 60612, United States
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Chen D, Zhou C, Luo Q, Chen C, Liu G. A Mendelian randomization study on causal effects of inflammatory bowel disease on the risk of erectile dysfunction. Sci Rep 2024; 14:2137. [PMID: 38272986 PMCID: PMC10811225 DOI: 10.1038/s41598-024-52712-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/23/2024] [Indexed: 01/27/2024] Open
Abstract
This study aimed to evaluate the causal effects of inflammatory bowel disease (IBD) and erectile dysfunction (ED) using Mendelian randomization (MR). All datasets were obtained from the public genome-wide association study database. In the exposure group, 12,882 IBD patients and 21,770 controls were included. A total of 1154 ED patients and 94,024 controls were included in the outcome group. Two-sample MR was conducted to estimate the causal effect of IBD on ED. Furthermore, Crohn's disease (CD) and ulcerative colitis (UC) were exposure factors in subgroup analyses. Weighted median, MR-egger, Inverse-variant weighted (IVW), weighted mode, and simple mode methods were used in MR analysis. Horizontal pleiotropy test, heterogeneity test, and leave-one-out method were utilized to evaluate the sensitivity and stability of results. After analysis, 62, 52, and 36 single nucleotide polymorphisms (SNPs) that IBD-ED, CD-ED, and UC-ED were included, respectively. The incidence of ED was increased by IBD (IVW: OR = 1.110, 95% CI = 1.017-1.211, P = 0.019; P-heterogeneity > 0.05) and, in addition, ED was affected by CD (IVW: OR = 1.085, 95% CI = 1.015-1.160, P = 0.016; P-heterogeneity > 0.05). However, there was no causal effect of UC on ED (IVW: OR = 1.018, 95% CI = 0.917-1.129, P = 0.743; P-heterogeneity < 0.05). All SNPs showed no significant horizontal pleiotropy (P > 0.05). These results indicate that IBD and CD can cause ED; However, UC did not cause ED. Additional research was required to determine causality and potential mechanisms further.
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Affiliation(s)
- Di Chen
- Department of Urology, The Frist Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chao Zhou
- Department of Assisted Reproduction, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Quanhai Luo
- Department of Urology, Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Changsheng Chen
- Department of Urology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Gang Liu
- Department of Urology, Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
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Gao Y, Liu C, Lu X, Lu K, Zhang L, Mao W, Pan K, Liang Z, Sun C, Chen M. Lycopene intake and the risk of erectile dysfunction in US adults: NHANES 2001-2004. Andrology 2024; 12:45-55. [PMID: 37038051 DOI: 10.1111/andr.13439] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Erectile dysfunction is a condition with a high incidence among adult men. Lycopene has been shown to lower blood glucose and reduce weight in diabetic patients because of its antioxidant and anti-inflammatory properties. However, the association between lycopene and the incidence of erectile dysfunction is unclear. OBJECTIVE The aim of this study was to examine the dietary lycopene intake and its association with erectile dysfunction risk in the US population. MATERIALS AND METHODS We investigated the lycopene intake of adult participants with complete information on clinical variables from the National Health and Nutrition Examination Survey between 2001 and 2004. Dose-response curve analysis was applied to explore the association between lycopene intake and erectile dysfunction. Logistic regression models were used to adjust for confounders. Different ethnicities, body mass index level, hypertension status, diabetes status, and smoking status were analyzed as subgroups. Propensity score matching was employed to eliminate the effects of potential confounders to confirm the reliability of the results. RESULTS A total of 3265 participants with lycopene consumption data were included in our study, including 931 individuals with erectile dysfunction and 2334 without erectile dysfunction during National Health and Nutrition Examination Survey 2001-2004. We found more consumption of lycopene in the non-erectile dysfunction group than in the erectile dysfunction group. Dose-response curve analysis revealed a significant negative association between lycopene intake and erectile dysfunction prevalence. After adjusting for age, race, cigarette smoking, body mass index, annual family income, education, physical activity, hypertension, diabetes, depression, and testosterone level, we found that increased lycopene intake reduced the odds ratio of erectile dysfunction. Low lycopene intake was positively related to erectile dysfunction in almost all subgroups, especially in Mexican American, non-Hispanic white, body mass index <25, hypertension positive, diabetes mellitus negative, and smoke negative. Furthermore, the results were confirmed in the 1:1 matched group. CONCLUSION Our national data suggest that lower dietary lycopene intake is positively associated with an increased risk of erectile dysfunction in US men.
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Affiliation(s)
- Yue Gao
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, China
| | - Chunhui Liu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Xun Lu
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, China
| | - Kai Lu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Lei Zhang
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Weipu Mao
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Kehao Pan
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, China
| | - Zichun Liang
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, China
| | - Chao Sun
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
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Wang H, Lei X, Ma D, Zhao Z, Wang A, Du G, Zhang J, Wang F, Guo J. Efficacy of acupuncture for psychogenic erectile dysfunction: a randomized, sham-controlled trial. Basic Clin Androl 2023; 33:40. [PMID: 38124064 PMCID: PMC10734192 DOI: 10.1186/s12610-023-00215-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Psychogenic erectile dysfunction (pED) is a common sexual dysfunction often accompanied by psychosomatic factors. Its treatment includes oral medications, psychotherapy, and behavioral therapy. Acupuncture's effect on erectile function in pED patients remains to be investigated. This randomized study evaluated the effects of acupuncture and sham acupuncture in pED patients. Altogether, 66 men with pED were randomized to the acupuncture (n = 33) or sham acupuncture group (n = 33). Both groups have a 6-week treatment with 18 sessions. Primary outcome was the International Index of Erectile Function-5 (IIEF-5) at 6 weeks. Secondary outcomes were IIEF-5 (weeks 2, 4, and 10), erection hardness score (EHS), sexual encounter profile-2 (SEP-2), SEP-3, self-rating anxiety scale (SAS), and self-rating depression scale (SDS). RESULTS Among the 66 participants, 64 completed the outcome measurements at week 10. Both acupuncture and sham acupuncture groups had improved IIEF-5 and EHS and decreased SAS and SDS post-treatment (p < 0.05). The acupuncture group had significantly better improvement in IIEF-5, EHS, and SEP-3 and significantly reduced SAS and SDS than the sham acupuncture group (p < 0.05). The improvement in SEP-2 post-treatment was not significantly different between the two groups (p > 0.05). There were no serious adverse events. CONCLUSIONS The 6-week acupuncture treatment significantly improved the erectile capacity and psychosomatic status of pED patients. TRIAL REGISTRATION ChiCTR2200064345 (Chinese Clinical Trial Registry) ( https://www.chictr.org.cn/showproj.html?proj=174873 ).
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Affiliation(s)
- Hao Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Xulu Lei
- Department of Preventive Care Center, Beijing Fengtai Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Dongyue Ma
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Ziwei Zhao
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Anmin Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Guanchao Du
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiwei Zhang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Fu Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
| | - Jun Guo
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
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Su Q, Long Y, Luo Y, Jiang T, Zheng L, Wang K, Tang Q. Specific gut microbiota may increase the risk of erectile dysfunction: a two-sample Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1216746. [PMID: 38192423 PMCID: PMC10773840 DOI: 10.3389/fendo.2023.1216746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
Objective Studies have found that gut microbiota may be associated with the development of erectile dysfunction (ED); however, the exact link between the two remains unclear. This study aimed to elucidate the relationship between the gut microbiota and the risk of ED from a genetic perspective. Methods We investigated the relationship between the gut microflora and ED using two-sample Mendelian randomization. GWAS-pooled data for ED were obtained from 223805 participants in Europe. GWAS summary data for ED were obtained from 223805 subjects in Europe and that for the gut microbiota were obtained from 18340 participants in 24 cohorts. We used the inverse-variance weighted (IVW) estimator as the primary method for the preliminary analysis, and the MR-Egger, weighted median (WM), simple model, and weighted model as secondary methods. We used Cochrane's Q-test, to detect heterogeneity, MREgger to detect pleiotropy, and the leave-one-out method to test the stability of the MR results. Ultimately, we genetically predicted a causal relationship between 211 gut microbiota and ED. Results A total of 2818 SNPs associated with gut microflora were screened in the ED correlation analysis based on the assumption of instrumental variables. The results of MR analysis showed a causal relationship between the six gut microbes and ED occurrence. The results of the fixed effects IVW method revealed five gut microflora, including Lachnospiraceae (OR, 1.265; P = 0.008), Lachnospiraceae NC2004 group (OR, 1.188; P = 0.019), Oscillibacter (OR, 1.200; P = 0.015), Senegalimassilia (OR, 1.355; P = 0.002), Tyzzerella3 (OR, 1.133; P = 0.022), to be negatively associated with ED. In addition, the IVW method revealed Ruminococcaceae UCG-013 (OR, 0.827; P = 0.049) to be positively associated with ED. Quality control results showed no heterogeneity or horizontal pleiotropy in the MR analysis (P > 0.05). Conclusions Six gut microbes were genetically associated with ED; of which, Ruminococcaceae UCG-013 was causally associated with a reduced risk of ED development. Our findings provide a new direction for research on the prevention and treatment of ED; however, the mechanisms and details require further investigation.
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Affiliation(s)
- Quanxin Su
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yanxi Long
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yayin Luo
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Tao Jiang
- Department of Andrology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Lei Zheng
- Department of Andrology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Kenan Wang
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Qizhen Tang
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Zhu Q, Tan Y, Zou X, Lu L. Association of high LDL concentrations with erectile dysfunction from a Mendelian randomization study. Sci Rep 2023; 13:22252. [PMID: 38097781 PMCID: PMC10721885 DOI: 10.1038/s41598-023-49771-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
Lipid metabolism plays a key role in erectile dysfunction. Our purpose was to evaluate the influence of lipid-lowering drugs on erectile dysfunction employing a two-sample Mendelian randomization (MR) study. Genetic instruments were employed to represent the exposure of lipid-lowering drugs. Inverse variance-weighted MR (IVWMR) was employed to calculate the estimation of effects. IVW-MR analysis showed that the positive relationship between the expression of HMGCR and the risk of erectile dysfunction (odds ratio [OR] = 1.27, 95% confidence interval [CI] 1.03-1.57; p = 0.028). No significant relationship was detected between NPC1L1, PSK9 expression and erectile dysfunction. This MR study suggested that HMGCR inhibitors are a more desirable treatment modality for patients with ED.
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Affiliation(s)
- Quan Zhu
- Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yao Tan
- Department of Ophthalmology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Xuyan Zou
- The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Liqing Lu
- Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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Rezali MS, Mohamad Anuar MF, Abd Razak MA, Chong ZL, Shaharudin AB, Kassim MSA, Mohamed Daud MA, Ismail SB, Said ZM. Prevalence and associated factors of moderate to severe erectile dysfunction among adult men in Malaysia. Sci Rep 2023; 13:21483. [PMID: 38057375 PMCID: PMC10700487 DOI: 10.1038/s41598-023-48778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Abstract
Erectile dysfunction (ED) is a pervasive problem among men, often shrouded in silence and stigma. This manuscript analysed the National Health and Morbidity Survey 2019 data to identify the prevalence of moderate to severe ED among men aged 18 and above in Malaysia and describe its associated factors. Self-administered questionnaire on ED utilised a locally validated International Index of Erectile Function. Variables on sociodemographics, risky lifestyles and comorbidities were obtained via an interviewer-administered questionnaire. The prevalence was determined using complex sampling analysis, and logistic regression was used to determine the associated factors of ED. A sample of 2403 men aged ≥ 18 participated, with a moderate to severe ED prevalence was 31.6% (95% CI 28.8, 34.6). The mean (± SD) of the total score of IIEF-5 for overall respondents was 18.16 (± 4.13). Multiple logistic regression analysis revealed a significant association between moderate to severe ED among men aged 60 years and above, single or divorcee, men without formal, primary, and secondary education, non-government employees, unemployed, and retiree, as well as physically inactive men. Focused public health interventions are necessary to improve education in sexual health, increase health promotion programs, and promote healthy ageing across the population.
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Affiliation(s)
- Muhammad Solihin Rezali
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, No.1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
| | - Mohamad Fuad Mohamad Anuar
- Biostatistic and Repository Data, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Mohamad Aznuddin Abd Razak
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, No.1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Zhuo Lin Chong
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, No.1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Azli Baharudin Shaharudin
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, No.1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Mohd Shaiful Azlan Kassim
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, No.1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | | | - Shaiful Bahari Ismail
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Gelugor, Malaysia
| | - Zakiah Mohd Said
- Adult Health Sector, Family Health Development Division, Ministry of Health Malaysia, Shah Alam, Malaysia
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Suarez Arbelaez MC, Nackeeran S, Shah K, Blachman-Braun R, Bronson I, Towe M, Bhat A, Marcovich R, Ramasamy R, Shah HN. Association between body mass index, metabolic syndrome and common urologic conditions: a cross-sectional study using a large multi-institutional database from the United States. Ann Med 2023; 55:2197293. [PMID: 37036830 PMCID: PMC10088970 DOI: 10.1080/07853890.2023.2197293] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/25/2023] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION The study aims to determine whether body mass index (BMI), metabolic syndrome (MS) or its individual components (primary hypertension, type 2 diabetes mellitus and dyslipidemias) are risk factors for common urological diseases. MATERIALS AND METHODS Cross-sectional study with data collected on February 28, 2022 from the TriNetX Research Network. Patients were divided in cohorts according to their BMI, presence of MS (BMI > 30 kg/m2, type 2 diabetes mellitus, primary hypertension and disorders of lipoprotein metabolism) and its individual components and its association with common urological conditions was determined. For each analysis, odds ratio (OR) with 95% confidence intervals were calculated. Statistical significance was assessed at p < .05. RESULTS BMI > 30 kg/m2 was associated with increased risk of lithiasis, kidney cancer, overactive bladder, male hypogonadism, benign prostatic hyperplasia, and erectile dysfunction (p < .05). On the contrary, BMI was inversely associated with ureteral, bladder and prostate cancer (p < .05). In all urological diseases, MS was the strongest risk factor, with prostate cancer (OR = 2.53) showing the weakest and male hypogonadism the strongest (OR = 13.00) associations. CONCLUSIONS MS and its individual components were significant risk factors for common urological conditions. Hence holistic approaches with lifestyle modification might prevent common urological disease.Key messagesOverall, metabolic syndrome is the strongest risk factor for all the analysed urological diseases.Abnormally high body mass index can be a risk or protective factor depending on the threshold and urological disease that are being evaluated.Metabolic syndrome and increased BMI should be considered important factors associated to the prevalence of common urological diseases.
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Affiliation(s)
| | - Sirpi Nackeeran
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Khushi Shah
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Isaac Bronson
- UMass Chann Medical School, University of Massachusetts, Amherst, MA, USA
| | - Maxwell Towe
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Abhishek Bhat
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hemendra N. Shah
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Stefanac S, Smith L, Grabovac I, Jacob L, López Sánchez GF, Ilie PC, Koyanagi A, Schiffler T, Kostev K. Changes in frequency of urology clinic visits and diagnosis of erectile dysfunction in Germany before and during COVID-19. Rev Epidemiol Sante Publique 2023; 71:102181. [PMID: 37918041 DOI: 10.1016/j.respe.2023.102181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVES To explore and analyze [1] the differences in the total number of patients visiting urology practices in Germany, [2] explore and analyze any differences in the number of newly diagnosed erectile dysfunction (ED) patients as well as [3] the number of new drug prescription, before and during the COVID-19 pandemic in Germany (April 2019-March 2020 and April 2020-March 2021). METHODS This retrospective cross-sectional study used data from the Disease Analyzer database (IQVIA) and included all patients aged ≥18 years with at least one visit to one of 85 urology practices across Germany. Outcomes were the mean number of patients with [1] new diagnosis of ED and [2] new prescription of drugs for erectile dysfunction per practice, in pandemic (April 2020-March 2021) versus non-pandemic (April 2019-March 2020) time periods. Differences between the periods were assessed using Wilcoxon tests. RESULTS In the non-pandemic period, there were 195,895 men, and in the pandemic period, 192,659 men visiting urology practices in Germany. A total of 10,977 men were initially diagnosed with ED in non-pandemic and 12,213 (+11.26%) men in pandemic time periods. Although the differences of new ED diagnoses were not statistically significant, a non-significant increase of new ED diagnoses was observed across all age groups. Also, a non-significant increase in new ED prescription drugs was detected across all age groups. CONCLUSIONS Even though less urology practice-visits of men with ED were recorded during the COVID-19 pandemic, an increase of new ED diagnosis was observed across all age groups between April 2020 and March 2021.
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Affiliation(s)
- Sinisa Stefanac
- Centre for Medical Statistics, Informatics and Intelligent Systems, Institute for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK.
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain; Université Paris Cité, AP-HP, Lariboisière-Fernand Widal Hospital, Department of Physical Medicine and Rehabilitation, Paris, France
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain.
| | - Petre Cristian Ilie
- Research and Innovation Department, The Queen Elizabeth Hospital Foundation Trust, King's Lynn, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - Tobias Schiffler
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
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Cooley-Strickland M, Wyatt GE, Loeb TB, Nicholas LA, Smith-Clapham A, Hamman A, Abraham M, Scott EN, Albarran G. Need for Sexual, Reproductive, and Mental Health Promotion Among Diverse College Students in a COVID-19 Era. Clin Child Fam Psychol Rev 2023; 26:1077-1096. [PMID: 37934361 PMCID: PMC10640429 DOI: 10.1007/s10567-023-00460-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/08/2023]
Abstract
In 2020, the COVID-19 pandemic forced unprecedented disruptions in higher education operations. While the adverse mental health effects experienced by college students due to these changes are well documented, less is known about the impact on their sexual and reproductive health (SRH), and the reciprocal relationships between SRH and mental health among adolescents and emerging adults. This position paper reviews existing literature on the effects of the COVID-19 pandemic on SRH, sexual violence, unintended pregnancy, sexually transmitted illness and human immunodeficiency virus rates and highlights issues specific to college-aged males, females, racial/ethnic and sexual minorities, and individuals with disabilities. The need to conceptualize SRH as an integral component of normal development, overall health, and well-being in the context of COVID-19 is discussed. The need to prioritize the design and implementation of developmentally appropriate, evidence-based SRH interventions specifically targeting college students is identified. Furthermore, an intergenerational approach to SRH that includes parents/caregivers and/or college faculty and staff (e.g., coaches, trainers) could facilitate comprehensive SRH prevention programming that enhances sexual violence prevention training programs currently mandated by many colleges. Policies and programs designed to mitigate adverse pandemic-related exacerbations in negative SRH outcomes are urgently needed and should be included in mainstream clinical psychology, not only focused on preventing unwanted outcomes but also in promoting rewarding interpersonal relationships and overall well-being. Recommendations for clinical psychologists and mental health researchers are made.
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Affiliation(s)
- Michele Cooley-Strickland
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA.
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Gail E Wyatt
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Tamra Burns Loeb
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Lisa A Nicholas
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amber Smith-Clapham
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Amina Hamman
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Misha Abraham
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Enricka Norwood Scott
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Graciela Albarran
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
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Hudnall MT, Ambulkar SS, Lai JD, Pham MN, Fantus RJ, Keeter MK, Wren J, Bennett NE, Brannigan RE, Halpern JA. Characteristics of men who use direct-to-consumer men's health telemedicine services. Int J Impot Res 2023; 35:753-757. [PMID: 36310185 PMCID: PMC9618023 DOI: 10.1038/s41443-022-00635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022]
Abstract
The characteristics of men who use direct-to-consumer (DTC) men's health services are not well understood. We conducted an online survey of adult men via ResearchMatch, assessing sociodemographic data, health behaviors, and concern for low testosterone and infertility. Logistic regression estimated the association between participant characteristics and familiarity with and reported use of DTC services such as Hims® and Roman®. Among 1276 men surveyed, 62.2% were concerned about low testosterone. While almost half (48.5%) were familiar with men's DTC health services, only 37 (2.9%) reported using these services. On multivariable analysis, men who used DTC men's health services were more likely to be younger (age 18-39: odds ratio [OR] 2.94, 95% confidence interval [CI] 1.03-8.38, p = 0.04; age 40-59: OR 3.26, CI 1.17-9.10, p = 0.02; referent age ≥60), have annual income between $75k and $100k (OR 5.25, CI 1.39-19.87.45, p = 0.02), and be concerned about low testosterone (OR 3.81, CI 1.46-9.96, p = 0.01). In conclusion, younger men and those with mid-range incomes were more likely to use online DTC men's health services compared to older or wealthier men. Likewise, men with concerns about low testosterone were more likely to use DTC services, but other health-conscious behaviors and frequency of doctor visits did not predict use.
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Affiliation(s)
- Matthew T Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Siddhant S Ambulkar
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Jeremy D Lai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Minh N Pham
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | - Mary Kate Keeter
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - James Wren
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Nelson E Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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Xu RN, Ma JX, Zhang X, Liao ZD, Fu YJ, Lv BD. Efficacy of Chinese Herbal Medicine Formula in the Treatment of Mild to Moderate Erectile Dysfunction: Study Protocol for a Multi-Center, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial. Int J Gen Med 2023; 16:5501-5513. [PMID: 38034900 PMCID: PMC10683653 DOI: 10.2147/ijgm.s436347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Erectile dysfunction (ED) is a prevalent condition in urology, primarily managed with PDE5 inhibitors (PDE5Is). However, approximately 20% of patients do not experience improvement in overall sexual satisfaction (OS) after taking PDE5Is. Among these, traditional Chinese medicine (TCM) has emerged as a complementary approach, with formulas like Hongjing I granules (HJIG) showing promise in preliminary studies. This study aims to rigorously evaluate the effectiveness and safety of HJIG in mild to moderate ED cases, assessing improvement in both sexual function and TCM pattern alignment. Methods This study is a randomized, double-blind, placebo-controlled multicentre trial. Recruitment will be conducted from patients who have a strong willingness to try using only traditional Chinese medicine treatment (This is very common in traditional Chinese medicine hospitals.). A total of 100 patients diagnosed with mild to moderate ED caused by qi deficiency and blood stasis will be recruited and randomly assigned to receive one of two treatments: HJIG (N = 50) or placebo (N = 50). Patients will receive 8 weeks of treatment and a 16-week follow-up starting from the fourth week of treatment. Outcome measures, including the International Index of Erectile Function-Erectile Function domain (IIEF-EF) score, Sexual Encounter Profile (SEP), and Traditional Chinese Medicine symptom score, will be evaluated. Discussion The expected outcome of this trial is that the use of the herbal formula HIJG alone can improve overall sexual satisfaction (OS) in patients with mild to moderate ED, while also improving their traditional Chinese medicine symptom scores. This will provide evidence-based support for the use of Chinese medicine in the treatment of ED in China. Trial Registration Chinese Clinical Trial Registry, ChiCTR2000041127, Registered on 19 December 2020, https://www.chictr.org.cn/showproj.html?proj=46469. Trial Status Recruitment began in March 2021, therefore 80 patients have been recruited. It is expected to finish recruiting in December 2023.
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Affiliation(s)
- Run-Nan Xu
- The Second Affiliated Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Jian-Xiong Ma
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Xin Zhang
- The Second Affiliated Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Ze-Dong Liao
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yi-Jia Fu
- The Second Affiliated Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Bo-Dong Lv
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
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Arslan B, Kecebas AB, Ates A, Gurkan O, Cetin B, Kardas S, Ekinci S, Ozalevli M, Aydin M, Özdemir E. Predictive value of Prognostic Nutritional Index (PNI) for the severity of vasculogenic erectile dysfunction. Int Urol Nephrol 2023; 55:2773-2779. [PMID: 37486593 DOI: 10.1007/s11255-023-03716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE Our aim was to investigate the association of prognostic nutritional index (PNI) score with erectile dysfunction (ED), therefore, we prospectively evaluated the relationship between penile doppler ultrasonography (PDU) findings, PNI and Sexual Health Inventory for Men (SHIM) scores in patients with ED. METHODS A total of 414 patients' characteristics, laboratory findings, SHIM and PNI scores were recorded. The PNI is calculated using the formula: 10 × serum albumin + 0.005 × total lymphocyte count. PDU was performed in patients with a SHIM score of 17 and below, while patients with a SHIM score ≥ 18 were recruited for the control group. Correlation analysis was performed to evaluate the relationship between PNI, SHIM scores and PDU parameters. The predictive value of variables for severe ED was assessed with regression analysis. RESULTS A significant difference was demonstrated between the ED subgroups and control group for total cholesterol (p = 0.04), serum albumin (p = 0.03), total lymphocyte count (p = 0.02), BDI score (p < 0.001), and PNI score (p = 0.03). A strong positive correlation between PNI score and PSV (rho = 0.73; p = 0.001), a moderate negative correlation between PNI score and EDV (rho = - 0.54; p = 0.02), and a moderate positive correlation between PNI and SHIM scores (rho = 0.61; p = 0.02) were demonstrated. PNI score ≤ 40 (OR: 3.49; p = 0.01), age (OR: 2.15; p = 0.03) and total cholesterol (OR: 2.03; p = 0.04) were determined as significant predictors of severe ED in multivariate analysis. CONCLUSION Our results demonstrated that PNI score is significantly lower in patients with severe and moderate ED. It has been also revealed that the PNI score is an independent predictive factor for severe ED.
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Affiliation(s)
- Burak Arslan
- Department of Urology, University of Health Sciences Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey.
| | - Arif Burak Kecebas
- Department of Radiology, University of Health Sciences Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Alaaddin Ates
- Department of Radiology, University of Health Sciences Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Okan Gurkan
- Department of Radiology, University of Health Sciences Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Bugra Cetin
- Department of Urology, University of Health Sciences Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Sina Kardas
- Department of Urology, University of Health Sciences Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Suat Ekinci
- Department of Urology, University of Health Sciences Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ozalevli
- Department of Urology, University of Health Sciences Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Muammer Aydin
- Department of Urology, OTA-Jinemed Hospital, Istanbul, Turkey
| | - Enver Özdemir
- Department of Urology, University of Health Sciences Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
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Lin W, Wang H, Lin ME. Relationship Between Systemic Inflammatory Response Index and Erectile Dysfunction: A Cross-sectional Study. Urology 2023; 181:69-75. [PMID: 37673404 DOI: 10.1016/j.urology.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To explore the association between systemic inflammation response index (SIRI) and erectile dysfunction (ED) in American men. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2004 were used. Multivariate logistic regression and restricted cubic spline were used to evaluate the relationship between SIRI and ED. Interaction analysis was performed for subgroups to verify the results. Meanwhile, 1:1 propensity score matching was performed to adjust for potential confounding factors for data reanalysis to confirm the reliability of the results. RESULTS A total of 3543 US adults aged 20years or older were included in the study, of whom 955 participants were considered to have ED. After adjusting for potential confounding factors, we found that compared with the lowest tertiles, the highest tertiles of SIRI showed a positive association with ED, which odd ratio was 1.70 (95%CI: 1.16-2.50). Dose-response curve analysis showed a positive linear correlation between SIRI and ED prevalence. And in the subgroup analysis, the interaction analysis showed that the results were consistent. Meanwhile, the matching of propensity scores further confirmed the validity of the results. CONCLUSION In conclusion, in this cross-sectional study, we found a positive relationship between SIRI and the prevalence of ED. Further experimental studies are needed to explore the underlying mechanism in the future.
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Affiliation(s)
- Weilong Lin
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
| | - Haoxu Wang
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China
| | - Ming-En Lin
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, China.
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74
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Brown NB, Milani S, Jabs F, Kingstone A, Brotto LA. Exploring Women's State-Level Anxiety in Response to Virtual Reality Erotica. JOURNAL OF SEX & MARITAL THERAPY 2023; 50:137-151. [PMID: 37807833 DOI: 10.1080/0092623x.2023.2265924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Virtual Reality (VR)-based treatments for anxiety disorders are efficacious but there is a lack of research examining anxious responses to VR erotica, which could innovate treatments for sexual difficulties. We examined erotica features that elicited anxiety and sexual presence in women. Thirty-eight women viewed erotic videos from different modalities (2D, VR) and points of view (1st, 3rd person) and completed anxiety and sexual presence measures before and after each video. Women experienced greater anxiety for VR than 2D films and reported the most anxiety for VR 1st person films. Sexual presence was affected by modality and point of view.
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Affiliation(s)
- Natalie B Brown
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Sonia Milani
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Faith Jabs
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Alan Kingstone
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Lori A Brotto
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada
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75
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Feng S, Dong L, Yan B, Zheng S, Feng Z, Li K, Jia H, Ning Y. Altered White Matter Structural Network Connectivity Associated with Cognitive Declines in Psychogenic Erectile Dysfunction. Neuroscience 2023; 529:54-61. [PMID: 37595940 DOI: 10.1016/j.neuroscience.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/17/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023]
Abstract
It has been reported that individuals with psychogenic erectile dysfunction (pED) potentially suffer from cognitive declines. Despite that increasing neuroimaging studies have demonstrated abnormalities of cerebral structural changes in pED, the association between altered white matter (WM) structural network and cognitive impairments remains unclear. Hence, this study aimed to explore the relationship between WM structural network connectivity and cognitive performance in patients with pED. Forty pED patients and 33 healthy controls (HCs) were recruited to perform cognitive assessments, and diffusion tensor imaging scans. We firstly constructed the WM structural network and applied the machine learning method to identify the important features. Then, we examined group differences in cognitive assessments, WM structural network connectivity within the identified features, and associations between altered WM structural network connectivity and cognitive scores in pED patients. From 26,896 features of DTI data, 24 important features were identified by K-Nearest Neighbor classification with a satisfactory accuracy (78%). Compared with HCs, we found that pED patients showed higher fractional anisotropy (FA) values between left transverse temporal sulcus and left supramarginal gyrus, and lower FA values between left suborbital sulcus and left para-hippocampal part of the medial occipito-temporal gyrus in pED patients. Furthermore, the increased FA between left transverse temporal sulcus and left supramarginal gyrus was observed to be negatively associated with impaired delayed memory. Overall, our findings provide new insights into WM network alterations associated with impaired cognitive functions in pED, which may unravel the potential neural mechanisms underlying the cognitive impairments of pED patients.
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Affiliation(s)
- Sitong Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, 100088 Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100069 Beijing, China
| | - Linrui Dong
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, 100088 Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100069 Beijing, China
| | - Bin Yan
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, 100091 Beijng, China
| | - Sisi Zheng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, 100088 Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100069 Beijing, China
| | - Zhengtian Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, 100088 Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100069 Beijing, China
| | - Kuangshi Li
- Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700 Beijing, China.
| | - Hongxiao Jia
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, 100088 Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100069 Beijing, China.
| | - Yanzhe Ning
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, 100088 Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100069 Beijing, China.
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76
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Wu H, Gao Z, Dai D, Liu X, Fang Y, Chen X, Wang Q. Efficacy and safety assessment of traditional Chinese medicine for erectile dysfunction: A meta-analysis and trial sequential analysis. Andrology 2023; 11:1345-1367. [PMID: 36848898 DOI: 10.1111/andr.13420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/11/2023] [Accepted: 02/23/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Several patients with erectile dysfunction do not accept or benefit from conventional therapy with phosphodiesterase type 5 inhibitors; thus, alternative and complementary therapies are in need. Traditional Chinese medicine has been treating erectile dysfunction in China, but its clinical value is inconclusive. OBJECTIVE To systematically evaluate the efficacy and safety of traditional Chinese medicine in treating erectile dysfunction. METHODS Randomized controlled trials were retrieved from a comprehensive search in the literature published in the past decade from the Web of Science, PubMed, Embase, Cochrane Library, SinoMed, China National Knowledge Internet, WanFang, and VIP. We performed a meta-analysis of the International Index of Erectile Function 5 questionnaire scores, clinical recovery rates, and testosterone levels using Review Manager 5.4 software. The trial sequential analysis was conducted to check the results. RESULTS A total of 45 trials with 5016 patients were included. Meta-analysis results showed that traditional Chinese medicine effectively improved the International Index of Erectile Function 5 questionnaire scores (weighted mean difference = 3.78, 95% confidence interval: 3.12, 4.44; p < 0.001), clinical recovery rates (risk ratio = 1.57, 95% confidence interval: 1.38, 1.79; p < 0.001), testosterone levels (weighted mean difference = 2.42, 95% confidence interval: 1.59, 3.25; p < 0.001) compared with the controls. The single and add-on applications of traditional Chinese medicine could improve the International Index of Erectile Function 5 questionnaire score (p < 0.001). The trial sequential analysis confirmed the robustness of the analysis of the International Index of Erectile Function 5 questionnaire scores. A significant difference in the incidence of adverse effects between the treatment and control groups was not observed (risk ratio = 0.82, 95% confidence interval: 0.65, 1.05; p = 0.12). CONCLUSION Traditional Chinese medicine can gain better responses in improving the International Index of Erectile Function 5 questionnaire scores, clinical recovery rates, and testosterone levels as an alternative and complementary treatment, with no increase in side effects. However, more standardized, long-term, traditional Chinese medicine and integrative therapy clinical trials are needed to support the clinical application of traditional Chinese medicine.
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Affiliation(s)
- Haoran Wu
- National Institute of Traditional Chinese Medicine Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Zezheng Gao
- Institute of Metabolic Diseases, Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dan Dai
- Department of Dermatology, Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xing Liu
- National Institute of Traditional Chinese Medicine Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yini Fang
- National Institute of Traditional Chinese Medicine Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xuemei Chen
- National Institute of Traditional Chinese Medicine Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Qi Wang
- National Institute of Traditional Chinese Medicine Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China
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Musa Obadia P, Pyana Kitenge J, Carsi Kuhangana T, Kalenga Ilunga G, Billen J, Kayembe-Kitenge T, Haufroid V, Mukalay wa Mukalay A, Ris L, Banza Lubaba Nkulu C, Nemery B, Enzlin P. Erectile dysfunction in copper and cobalt miners: a cross-sectional study in the former Katanga province, Democratic Republic of the Congo. Sex Med 2023; 11:qfad052. [PMID: 37869070 PMCID: PMC10588613 DOI: 10.1093/sexmed/qfad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Background The African Copperbelt is a site of intense artisanal and industrial mining and refining of copper and cobalt. Aim We aimed to investigate factors that are possibly associated with erectile dysfunction (ED) in metal miners in the former Katanga province of the Democratic Republic of the Congo. Methods In a cross-sectional study of 138 miners and 139 controls (bakers), we administered questionnaires to obtain sociodemographic and occupational data and to assess male sexual function (International Index of Erectile Function [IIEF]) and marital relation quality (Revised Dyadic Adjustment Scale). Furthermore, we measured trace metals in blood and urine, as well as testosterone and thyroid hormones in serum. Outcomes Outcomes included the prevalence of questionnaire-derived ED and the relation of ED with individual characteristics, serum testosterone, and environmental factors. Results Miners were on average 4 years older than bakers (mean ± SD, 37.5 ± 6.9 vs 33.3 ± 5.7 years). Miners had significantly lower scores than bakers on the IIEF (median [IQR], 66 [49-73] vs 73 [66-74]) and the 3 domains of the Revised Dyadic Adjustment Scale (consensus, satisfaction, cohesion). Free testosterone was significantly lower in miners than bakers (ng/dL; 8.11 [6.90-10.10] vs 10.52 [8.83-12.58]; P ˂ .001). In miners, sex hormone-binding globulin correlated positively with blood Pb and urinary Cd. In a multivariable analysis, mild to moderate ED or moderate ED (IIEF-erectile function score ≤18) was significantly associated with having a mining-related job (adjusted odds ratio [aOR], 2.6; 95% CI, 1.3-5.3), work seniority ˃5 years (aOR, 2.3; 95% CI, 1.1-4.6), alcohol consumption (aOR, 2.8; 95% CI, 1.2-6.7), and aphrodisiacs use (aOR, 4.2; 95% CI, 2.2-8.0). Mediation analysis showed that marital relationship partially mediated the relation between work seniority >5 years in mining and ED. Clinical Implications The high prevalence of ED found in artisanal mine workers indicates that work-related factors should be considered as possibly contributing, directly or indirectly, to sexual dysfunction in men. Strengths and Limitations Strengths include being the first epidemiologic study documenting ED with validated questionnaires and its possible determinants, including exposure to toxic metals, among young artisanal miners vs a suitable control group. Limitations are the cross-sectional design with convenience sampling and absence of objective confirmation of ED. Conclusion As compared with controls, miners reported poorer sexual function and lower quality of their marital relationship, and they had lower free testosterone levels, which may be due to their high exposure to trace metals.
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Affiliation(s)
- Paul Musa Obadia
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
| | - Joseph Pyana Kitenge
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
- Unité de Santé au travail et Santé environnementale, Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
| | - Trésor Carsi Kuhangana
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
- Ecole de Santé Publique, Université de Kolwezi, 07301 Kolwezi, Democratic Republic of the Congo
| | - Georges Kalenga Ilunga
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
| | - Jaak Billen
- Department of Laboratory Medicine, Leuven University Hospitals, 3000 Leuven, Belgium
| | - Tony Kayembe-Kitenge
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
- Institut Supérieur des Techniques Médicales, 4748 Lubumbashi, Democratic Republic of the Congo
| | - Vincent Haufroid
- Toxicology and Applied Pharmacology, Université catholique de Louvain, 1200 Brussels, Belgium
| | - Abdon Mukalay wa Mukalay
- Unité d’Epidémiologie clinique et Pathologies tropicales, Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
| | - Laurence Ris
- Département de Neurosciences, Faculté de Médecine, Université de Mons, 7000 Mons, Belgium
| | - Célestin Banza Lubaba Nkulu
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
| | - Benoit Nemery
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
| | - Paul Enzlin
- Institute for Family and Sexuality Studies, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium
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Fazekas D, Campbell K, Ledesma B, Masterson T. Platelet-rich plasma for erectile dysfunction: a review of the current research landscape. Sex Med Rev 2023; 11:369-374. [PMID: 37786350 DOI: 10.1093/sxmrev/qead032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is the inability to achieve or maintain erection for satisfactory sexual performance. ED drastically reduces the quality of life for men and their partners and is commonly linked to comorbid conditions such as diabetes and cardiovascular disease. As a result, clinicians and researchers are working to improve treatments for ED. Current guideline-approved ED treatments include oral phosphodiesterase type 5 inhibitors, intraurethral alprostadil, penile intracavernosal injections, and penile prosthesis surgery. Today, there is increasing interest in restorative therapies such as intracavernosal platelet-rich plasma (PRP) for the management of ED. OBJECTIVES This narrative review describes the current trials investigating intracavernosal PRP for ED and proposes future directions to increase the strength of evidence to support use of PRP in this population. METHODS A comprehensive literature search of PubMed, Science Direct, and Scopus was performed to identify all randomized clinical trials using PRP for the treatment of ED. RESULTS We identified 4 randomized clinical trials investigating the safety and efficacy of PRP for ED. We found significant heterogeneity among study protocols, including collection of PRP, dosing of PRP, and follow-up. CONCLUSION While intracavernosal PRP is considered safe, its efficacy for the management of ED remains unknown due to variability among clinical trials.
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Affiliation(s)
- Dylan Fazekas
- Desai Sethi Urology Institute, University of Miami, Miami, FL 33136, United States
| | - Katherine Campbell
- Desai Sethi Urology Institute, University of Miami, Miami, FL 33136, United States
| | - Braian Ledesma
- Desai Sethi Urology Institute, University of Miami, Miami, FL 33136, United States
| | - Thomas Masterson
- Desai Sethi Urology Institute, University of Miami, Miami, FL 33136, United States
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Kumar R, Kumar U, Trivedi S. Comparison of Risk Factors for Erectile Dysfunction (ED) in Type 2 Diabetics and Nondiabetics: A Retrospective Observational Study. Cureus 2023; 15:e44576. [PMID: 37790032 PMCID: PMC10545003 DOI: 10.7759/cureus.44576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND AND AIMS We aim to compare the various risk factors for erectile dysfunction (ED) in type 2 diabetes mellitus (DM) and nondiabetic patients. MATERIALS AND METHODS We retrospectively collected and evaluated the data of 175 OPD patients with ED. We included 138 patients of ED from endocrinology and urology OPD after exclusion. ED was assessed by using a questionnaire adapted from the abridged five-item version of the International Index of Erectile Function (IIEF-5) score. RESULTS A total of 96 (69.56%) were diabetic, and 42 (30.43%) were nondiabetic. The majority of patients (62.31 %) were in the age group of 40-60 years. Thirty-nine (28.26%) were alcoholics, and 55 (40%) were smokers. The average duration of diabetes was 6.6±1.5 years. Hypertension was present in 49 (35.5%). Diabetic patients were significantly older (47.9±8.2 vs. 40.2±7.6 years, p=0.0001) and obese (BMI (kg/m2), 27.3±5.4 vs. 24.6±3.9, p=0.004). Waist circumference in diabetics was 95.3±10.9, as compared to nondiabetics, which was 89.6±9.2 cm (p=0.0037). The IIEF-5 score was significantly lower in diabetic subjects in comparison to nondiabetics (9.4±3.2 vs. 12.1±3.6 p=0.0001). Moderate-to-severe ED was more common in diabetic patients (76%) in comparison to nondiabetics (59.5%). The prevalence of mild and mild-to-moderate ED was 11.45 % and 12.5 % in diabetic patients in comparison to 16.7% and 23.5% in nondiabetics, respectively. The prevalence of hypertension and coronary artery was higher in diabetics in comparison with nondiabetics. Hypertension was significantly higher in diabetic patients with ED (42.7% vs. 19.04%, p=0.0075), but coronary artery disease was not statistically significant (8.3% vs. 2.3%, p=0.1925). LH (2.6±0.7 vs. 3.5±0, p=0.0001) and testosterone (312.1±110.7 vs. 367.8±115.1, p=0.0081) were significantly lower in diabetics in comparison to nondiabetics. CONCLUSIONS The IIEF-5 score was lower in diabetic cases as compared to those without diabetes. The factors that significantly contributed to ED in type 2 DM patients, as compared to nondiabetic patients, were age, BMI, waist circumference, hypertension, poor glycemic control, LH, and testosterone levels.
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Affiliation(s)
- Ritesh Kumar
- Department of Endocrinology, Diabetes and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Ujwal Kumar
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Sameer Trivedi
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
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Tucker J, Salas J, Secrest S, Scherrer JF. Erectile dysfunction associated with undiagnosed prediabetes and type 2 diabetes in young adult males: A retrospective cohort study. Prev Med 2023; 174:107646. [PMID: 37499919 DOI: 10.1016/j.ypmed.2023.107646] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/15/2023] [Accepted: 07/23/2023] [Indexed: 07/29/2023]
Abstract
Erectile dysfunction (ED) is a common comorbidity in type 2 diabetes (T2D). ED has been studied as an outcome in diabetes, but it is not known if ED is a risk factor for T2D. We determined if patients with ED have an increased risk for prediabetes and/or T2D and measured the duration between ED and prediabetes/T2D diagnosis. Retrospective cohort study using de-identified medical record data from a large mid-western health care system to measure ED, T2D and potential confounding factors. Patients were 18 to 40 years of age because we were interested in early onset pre-diabetes/T2D. Eligible patients had ED and were free of prediabetes, hyperglycemia and T2D at index. Entropy balancing controlled for confounding. Modified Poisson regression models with robust error variances calculated relative risk (RR) and 95% confidence intervals for the association of ED and pre-diabetes/T2D. Patients' mean age was 28.3 (±7.0) years, 81.7% were White and 14.0% were Black. After controlling for confounding, ED was associated with increased risk for prediabetes/T2D (RR = 1.34; 95%CI:1.16-1.55). This association was similar to that between ED and T2D alone (RR = 1.38; 95% CI: 1.10-1.74). About 30% had ED and prediabetes/T2D diagnosed on the same day and nearly 75% were diagnosed within a year of ED. ED is a marker for undiagnosed prediabetes/T2D and a risk factor for near term onset of prediabetes/T2D. ED may offer the opportunity for earlier detection and diagnoses of T2D, particularly in younger men. Younger patients presenting with ED should be screened for hyperglycemia.
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Affiliation(s)
- Jane Tucker
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4(th) Floor, St. Louis, MO 63104, USA
| | - Scott Secrest
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4(th) Floor, St. Louis, MO 63104, USA; Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd, St. Louis, MO 63104, USA.
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81
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Liu C, Gao Y, Ji J, Sun C, Chen M. Association between inflammatory indexes and erectile dysfunction in U.S. adults: National Health and Nutrition Examination Survey 2001-2004. Sex Med 2023; 11:qfad045. [PMID: 37577069 PMCID: PMC10413424 DOI: 10.1093/sexmed/qfad045] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Background The association of inflammatory biomarkers with erectile dysfunction (ED) is still largely unknown. Aim The study sought to explore the association of inflammatory biomarkers with ED in U.S. adults. Methods Participant data for this study were extracted from the National Health and Nutrition Examination Survey, and individuals that lacked information on clinical variables were excluded. Dose-response curve analysis was applied to explore the association of inflammatory biomarkers with ED prevalence. The confounders were adjusted for with weighted logistic regression analysis. We employed 1:1 propensity score matching to eliminate the effects of clinical variables to confirm the reliability of the results. Outcomes ED prevalence was investigated with potential risk factors. Results A total of 2331 men ≥20 years of age who participated in the National Health and Nutrition Examination Survey 2001-2004 were included in this study. Compared with individuals without ED, ED cohort displayed higher levels of neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammatory index, and systemic inflammation response index. Dose-response curve analysis indicated ED prevalence increased with the increase of platelet-to-lymphocyte ratio, systemic immune-inflammatory index, and systemic inflammation response index. Weighed logistic regression analysis revealed neutrophil-to-lymphocyte ratio was positively associated with ED. The reliability of the results was confirmed by 1:1 propensity score matching reanalysis. Clinical Implications Individuals with chronic inflammatory conditions should be alert for the development of ED. Strengths and Limitations It is a large controlled study to investigate the relationship between inflammatory indexes and ED. However, it is a cross-sectional study and it lacks an accurate assessment of the degree of ED. Conclusion Inflammatory biomarkers were associated with ED prevalence.
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Affiliation(s)
- Chunhui Liu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, China
| | - Yue Gao
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, 210009, China
| | - Jie Ji
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, 210009, China
| | - Chao Sun
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, China
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, China
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Warli SM, Steven S, Kadar DD, Prapiska FF, Siregar GP. The Efficacy and Safety of Avanafil During a Treatment of Male Erectile Dysfunction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ther Clin Risk Manag 2023; 19:629-644. [PMID: 37484697 PMCID: PMC10362898 DOI: 10.2147/tcrm.s419408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose Erectile dysfunction (ED) contributes to a large burden and impairs the quality of life among males. Avanafil appears to be a promising treatment for ED; however, its efficacy and safety profile remain unclear. This study aimed to evaluate the efficacy and safety of avanafil for the treatment of ED. Patients and Methods An extensive search of PubMed, ScienceDirect, Web of Science, and Embase databases with 11 publications was performed, with outcomes evaluated are International Index of Erectile Function - Erectile Function (IIEF-EF), Sexual Encounter Profile (SEP), and Treatment-Emergent Adverse Events (TEAE). Statistical parameter Mean Difference (MD) and Risk Ratio (RR) with 95% Confidence Interval (CI) were used to measure effect size. Results The pooled estimates demonstrated that changes in IIEF-EF function (MD=4.39, 95% CI [3.41, 5.37], p<0.001), SEP-2 (RR=3.43, 95% CI [2.79, 4.22], p<0.001), SEP-3 (RR=2.30, 95% CI [2.01, 2.62], p<0.001), and TEAE (RR=1.49, 95% CI [1.12, 1.96], p=0.005) were significantly higher in the avanafil group than in the placebo group. Moreover, 200 mg avanafil was superior to that mg 100 mg-avanafil, indicated by the IIEF-EF score (MD=-1.15, 95% CI [-1.40, -0.89], p<0.001). In contrary, there were no significant differences in SEP-2 (RR=0.90, 95% CI [0.75, 1.08], p=0.26), SEP-3 (RR=0.92, 95% CI [0.81, 1.05], p=0.21) and TEAE (RR=1.00, 95% CI [0.87, 1.15], p=0.99) for both 100 mg and 200 mg doses. Conclusion This review highlights the potential use of this drug in ED treatment. Further large-scale Randomized Controlled Trials investigations involving various racial groups are required to confirm these findings.
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Affiliation(s)
- Syah Mirsya Warli
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
- Department of Urology, Universitas Sumatera Utara Hospital, Universitas Sumatera Utara, Medan, Indonesia
| | - Steven Steven
- Department of Urology, Faculty of Medicine, Universitas Indonesia - Haji Adam Malik General Hospital, Medan, Indonesia
| | - Dhirajaya Dharma Kadar
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Fauriski Febrian Prapiska
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Ginanda Putra Siregar
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
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Zhang K, Zhou J, Li A, Chen M. Mendelian randomization study reveals the effect of idiopathic pulmonary fibrosis on the risk of erectile dysfunction. Front Med (Lausanne) 2023; 10:1162153. [PMID: 37502356 PMCID: PMC10370277 DOI: 10.3389/fmed.2023.1162153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
Background Several studies have found that erectile dysfunction (ED) is associated with interstitial lung disease. However, the causal relationship between idiopathic pulmonary fibrosis (IPF) and ED risk remains unclear. The present two-sample Mendelian randomization (MR) study aimed to reveal the causal effect of IPF on ED risk. Methods This study included two GWAS summary statistics of IPF (1,028 cases and 196,986 controls) and ED (6,175 cases and 217,630 controls) of European ancestry. The inverse-variance weighted (IVW) was applied as the primary method, and MR-Egger, weighted median, weighted mode, and simple mode were applied as complementary methods to estimate the causal impact of IPF on ED risk. The MR-PRESSO global test and MR-Egger regression were applied to evaluate the pleiotropy. The Cochran's Q test was applied to examine heterogeneity. The leave-one-out analysis ensured the robustness and reliability of the results. Results Twenty-one genetic variants were obtained as IPF instrumental variables without pleiotropy and heterogeneity. MR analysis using the IVW showed a potential causal relationship between IPF and increased ED risk (ORIVW = 1.046, 95% CI: 1.020-1.073, p = 0.001), and consistent results were obtained with MR-Egger, weighted median, and weighted mode. The leave-one-out analysis showed that no instrumental variables unduly influenced the results. Conclusion This study suggested that IPF may increase the ED risk of the European population.
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84
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Topak OZ, Sinik Z, Oguzhanoglu NK, Ugurlu TT. An Evaluation of Psychogenic Predictors of Non-Organic Erectile Dysfunction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1195. [PMID: 37512007 PMCID: PMC10385497 DOI: 10.3390/medicina59071195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/10/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Erectile dysfunction is a significant problem, which diminishes the quality of life. The aim of this study was to investigate the relationship of childhood trauma and attachment styles in the aetiology of psychogenic erectile dysfunction. Materials and Methods: The study included 80 participants (40 patients who presented with the complaint of erectile dysfunction, were not determined with an organic pathology, and were diagnosed with erectile dysfunction according to the DSM-5 criteria; and a control group of 40 healthy subjects.) The structured clinical interview form for DSM-5 (SCID-5) was applied to all the participants, together with the International Erectile Function Index (IIEF), the Childhood Trauma Questionnaire (CTQ), the Relationship Scale Questionnaire (RSQ), and the Beck Depression Inventory (BDI). Results: The emotional abuse (p = 0.002), physical abuse (p = 0.049), emotional neglect (p = 0.004), physical neglect (p = 0.002), and total scale points of the CTQ were determined to be significantly higher in the patient group than in the control group. Secure (p = 0.022) and dismissive (p = 0.009) attachment styles were found to be higher in the control group. As the time together with the current sexual partner increased, so the severity of erectile dysfunction increased, and sexual function, orgasmic function, sexual satisfaction, and general satisfaction decreased. As emotional abuse, sexual abuse, and physical neglect increased, the severity of erectile dysfunction increased. Childhood trauma (β = -0.275, t (73) = -2.704, p = 0.009) and the duration together with the partner (β = -0.249, t (73) = -2.512, p = 0.014) were found to be predictive of erectile dysfunction. Conclusions: The results of this study demonstrated that childhood trauma and the time elapsed without treatment are predictors of psychogenic erectile dysfunction severity, and secure attachment style and self-esteem play an important role in the aetiology of psychogenic erectile dysfunction.
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Affiliation(s)
- Osman Zulkif Topak
- Department of Psychiatry, School of Medicine, Pamukkale University, Denizli 20160, Turkey
| | - Zafer Sinik
- Department of Urology, Odak Hospital, Denizli 20100, Turkey
| | | | - Tugce Toker Ugurlu
- Department of Psychiatry, School of Medicine, Pamukkale University, Denizli 20160, Turkey
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85
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Liu X, Feng Z, Galling B, Qi N, Zhu XQ, Xiao L, Wang G. Gender specific sexual dysfunction in patients with depression. Front Psychiatry 2023; 14:1194228. [PMID: 37398603 PMCID: PMC10309026 DOI: 10.3389/fpsyt.2023.1194228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
Background This study aims to investigate the factors associated with sexual dysfunction (SD), with a particular focus on the influence of sex on the occurrence and severity of this condition in patients with major depressive disorder (MDD). Method Sociodemographic and clinical assessments were conducted on 273 patients with MDD (female = 174, male = 99), including the ASEX, QIDS-SR16, GAD-7, and PHQ-15. Univariate analyses, independent samples t-test, Chi-square test, and Fisher's exact test were used as appropriate, and logistic regression analysis was used to identify correlation factors for SD. Statistical analyses were performed using the Statistical Analysis System (SAS 9.4). Result SD was reported in 61.9% of the participants (ASEX score = 19.6 ± 5.5), and the prevalence of it in females (75.3%, ASEX score = 21.1 ± 5.4) was significantly higher than that in males (38.4%, ASEX score = 17.1 ± 4.6). Factors associated with SD included being female, being aged 45 years or above, having a low monthly income (≤750 USD), feeling more sluggish than usual (a QIDS-SR16 Item 15 score of 1 or above), and having somatic symptoms (evaluated with the total score of PHQ15). Limitation The use of antidepressants and antipsychotics might be a confounding factor affecting sexual function. Also, the lack of information in the clinical data regarding the number, duration, and time of onset of the episodes limits the richness of the results. Conclusion Our findings reveal the sex differences in the prevalence and severity of SD in patients with MDD. Evaluated with the ASEX score, female patients showed significantly worse sexual function than male patients. Being female, having a low monthly income, being aged 45 years or above, feeling sluggish, and having somatic symptoms may increase the risk of SD in patients with MDD.
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Affiliation(s)
- Xinyu Liu
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Zizhao Feng
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Britta Galling
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, School of Medicine, Kiel, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Na Qi
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xue-quan Zhu
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Le Xiao
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
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Liu X, Liu S, Liu T, Tang L, Ji M, Xu Y, Xiang Z, Zhou J, Chen Y, Chen J. Altered regional brain activity and functional connectivity in resting-state brain networks associated with psychological erectile dysfunction. Front Neurosci 2023; 17:1074327. [PMID: 37360175 PMCID: PMC10285100 DOI: 10.3389/fnins.2023.1074327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/14/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Erectile dysfunction (ED), especially psychological ED (pED), is usually accompanied with psychological factors, which are related to abnormal activity in brain regions involved in sexual behavior. However, the mechanisms underlying functional changes in the brain of pED are still unclear. The present study aimed to explore the abnormalities of brain function, as well as their relationships with sexual behavior and emotion in pED patients. Materials and methods Resting state functional magnetic resonance imaging (rs-fMRI) data were collected from 31 pED patients to 31 healthy controls (HCs). The values of amplitude of fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) were calculated and compared between groups. In addition, the associations between abnormal brain regions and clinical features were evaluated by Pearson correlation analyses. Results Compared to HCs, pED patients demonstrated decreased fALFF values in the left medial superior frontal gyrus (had decreased FC values with the left dorsolateral superior frontal gyrus), the left lingual gyrus (had decreased FC values with the left parahippocamal gyrus and insula), the left putamen (had decreased FC values with the right caudate) and the right putamen (had decreased FC values with the left putamen and the right caudate). The fALFF values of the left medial superior frontal gyrus were negatively correlated with the fifth item scores of International Index of Erectile Function (IIEF-5). Negative relationships were found between fALFF values of the left putamen and the second item scores of Arizona Sexual Scale (ASEX). FC values between the right putamen and caudate were negatively related to the state scores of State-Trait Anxiety Inventory (STAI-S). Conclusion Altered brain function were found in the medial superior frontal gyrus and caudate-putamen of pED patients, which were associated with sexual function and psychological condition. These findings provided new insights into the central pathological mechanisms of pED.
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Affiliation(s)
- Xue Liu
- Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shaowei Liu
- Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Tao Liu
- Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Liang Tang
- Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Mufan Ji
- Medical College of Nantong University, Nantong, China
| | - Yan Xu
- Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ziliang Xiang
- Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianwen Zhou
- Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yun Chen
- Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianhuai Chen
- Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Corona G, Cucinotta D, Di Lorenzo G, Ferlin A, Giagulli VA, Gnessi L, Isidori AM, Maiorino MI, Miserendino P, Murrone A, Pivonello R, Rochira V, Sangiorgi GM, Stagno G, Foresta C, Lenzi A, Maggi M, Jannini EA. The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction. J Endocrinol Invest 2023; 46:1241-1274. [PMID: 36698034 PMCID: PMC9876440 DOI: 10.1007/s40618-023-02015-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE Erectile dysfunction (ED) is one of the most prevalent male sexual dysfunctions. ED has been in the past mistakenly considered a purely psycho-sexological symptom by patients and doctors. However, an ever-growing body of evidence supporting the role of several organic factors in the pathophysiological mechanisms underlying ED has been recognized. METHODS The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving several other National Societies to provide an updated guideline on the diagnosis and management of ED. Derived recommendations were based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. RESULTS Several evidence-based statements were released providing the necessary up-to-date guidance in the context of ED with organic and psychosexual comorbidities. Many of them were related to incorrect lifestyle habits suggesting how to associate pharmacotherapies and counseling, in a couple-centered approach. Having the oral therapy with phosphodiesterase type 5 inhibitors as the gold standard along with several other medical and surgical therapies, new therapeutic or controversial options were also discussed. CONCLUSIONS These are the first guidelines based on a multidisciplinary approach that involves the most important Societies related to the field of sexual medicine. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving couple sexual satisfaction and overall general health.
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Affiliation(s)
- G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda Usl, Bologna, Italy
| | - D Cucinotta
- Chair of Internal Medicine, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - G Di Lorenzo
- Section of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - A Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padua, Italy
| | - V A Giagulli
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", Bari, Italy
- Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - L Gnessi
- Section of Food Science, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A M Isidori
- Section of Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M I Maiorino
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - P Miserendino
- Diabetology and Endocrinology Unit, ASP #, Caltanissetta, Italy
| | - A Murrone
- Cardiology Unit, Città di Castello and Gubbio-GualdoTadino Hospitals, Azienda Usl Umbria 1, Gubbio, Italy
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile, Università Federico II di Napoli, Naples, Italy
- Staff of UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - V Rochira
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - G M Sangiorgi
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
| | - G Stagno
- Diabetology Unit, ASP Reggio Calabria, Reggio Calabria, Italy
| | - C Foresta
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padua, Italy
| | - A Lenzi
- Section of Food Science, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - E A Jannini
- Chair of Endocrinology and Sexual Medicine (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, E Tower South Floor 4, Room E413, Via Montpellier 1, 00133, Rome, Italy.
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Perticarrara Ferezin L, Kayzuka C, Rondon Pereira VC, Ferreira de Andrade M, Molina CAF, Tucci S, Tanus-Santos JE, Lacchini R. The rs2682826 Polymorphism of the NOS1 Gene Is Associated with the Degree of Disability of Erectile Dysfunction. Life (Basel) 2023; 13:life13051082. [PMID: 37240727 DOI: 10.3390/life13051082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Erectile dysfunction (ED) is a common male disorder, often associated with cardiovascular disease and ageing. The Sildenafil, a PDE5 inhibitor, can improve the erectile function by prolonging the nitric oxide (NO) downstream effect. NO is a molecule of pivotal importance in erection physiology and is mainly produced by neuronal nitric oxide synthase (nNOS) and endothelial NO synthase (eNOS). While it has been shown that eNOS and nNOS genetic polymorphisms could be associated with Sildenafil responsiveness in ED, no study so far has assessed whether nNOS polymorphisms and PDE5A polymorphism could be associated with increased risk to ED or with intensity of symptoms. A total of 119 ED patients and 114 controls were studied, with evaluation of the clinical disability by the International Index for Erectile Function instrument, plasma assessment of nitrite levels and genomic DNA analysis regarding the rs41279104 and rs2682826 polymorphisms of the NOS1 gene and the rs2389866, rs3733526 and rs13124532 polymorphisms of the PDE5A gene. We have found a significant association of the rs2682826 with lower IIEF scores in the clinical ED group. While this result should be confirmed in other populations, it may be helpful in establishing a genetic panel to better assess disease risk and prognosis on ED therapy.
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Affiliation(s)
- Leticia Perticarrara Ferezin
- Department of Psychiatric Nursing and Human Sciences, Ribeirão Preto College of Nursing, University of Sao Paulo, Ribeirao Preto 14040-902, Brazil
| | - Cezar Kayzuka
- Department of Pharmacology, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto 14049-902, Brazil
| | - Vitória Carolina Rondon Pereira
- Department of Pharmacology, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto 14049-902, Brazil
| | - Murilo Ferreira de Andrade
- Department of Surgery and Anatomy, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo 05508-090, Brazil
| | | | - Silvio Tucci
- Department of Surgery and Anatomy, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo 05508-090, Brazil
| | - Jose Eduardo Tanus-Santos
- Department of Pharmacology, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto 14049-902, Brazil
| | - Riccardo Lacchini
- Department of Psychiatric Nursing and Human Sciences, Ribeirão Preto College of Nursing, University of Sao Paulo, Ribeirao Preto 14040-902, Brazil
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89
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Searl T, Ohlander S, McVary KT, Podlasek CA. Pathway analysis of microarray data from corpora cavernosal tissue of patients with a prostatectomy or Peyronie disease in comparison with a cavernous nerve-injured rat model of erectile dysfunction. J Sex Med 2023; 20:139-151. [PMID: 36763930 PMCID: PMC10226855 DOI: 10.1093/jsxmed/qdac019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/14/2022] [Accepted: 10/24/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Patients with a prostatectomy are at high risk of developing erectile dysfunction (ED) that is refractory to phosphodiesterase type 5 inhibitors. The cavernous nerve (CN) is frequently damaged during prostatectomy, causing loss of innervation to the penis. This initiates corpora cavernosal remodeling (apoptosis and fibrosis) and results in ED. AIM To aid in the development of novel ED therapies, the current aim was to obtain a global understanding of how signaling mechanisms alter in the corpora cavernosa with loss of CN innervation that results in ED. METHODS Microarray and pathway analysis were performed on the corpora cavernosal tissue of patients with a prostatectomy (n = 3) or Peyronie disease (control, n = 3). Results were compared with an analysis of a Sprague-Dawley rat CN injury model (n = 10). RNA was extracted by TRIzol, DNase treated, and purified by a Qiagen Mini Kit. Microarray was performed with the Human Gene 2.0 ST Array and the RU34 rat array. Differentially expressed genes were identified through several analytic tools (ShinyGO, Ingenuity, WebGestalt) and databases (GO, Reactome). A 2-fold change was used as the threshold for differential expression. OUTCOMES Pathways that were altered (up- or downregulated) in response to CN injury in the prostatectomy patients and a rat CN injury model were determined. RESULTS Microarray identified 197 differentially expressed protein-coding genes in the corpora cavernosa from the prostatectomy cohort, with 100 genes upregulated and 97 genes downregulated. Altered signaling pathways that were identified that affect tissue morphology included the following: neurologic disease, cell death and survival, tissue and cellular development, skeletal and muscle development and disorders, connective tissue development and function, tissue morphology, embryonic development, growth and proliferation, cell-to-cell signaling, and cell function and maintenance. These human pathways have high similarity to those observed in the CN-injured rat ED model. CLINICAL IMPLICATIONS Significant penile remodeling continues in patients long after the acute surgical injury to the CN takes place, offering the opportunity for clinical intervention to reverse penile remodeling and improve erectile function. STRENGTHS AND LIMITATIONS Understanding how signaling pathways change in response to CN injury and how these changes translate to altered morphology of the corpora cavernosa and ensuing ED is critical to identify strategic targets for therapy development. CONCLUSION Altered signaling in pathways that regulate tissue homeostasis, morphogenesis, and development was identified in penes of patients with a prostatectomy, and competitive forces of apoptosis and proliferation/regeneration were found to compete to establish dominance after CN injury. How these pathways interact to regulate penis tissue homeostasis is a complex process that requires further investigation.
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Affiliation(s)
- Tim Searl
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Samuel Ohlander
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Kevin T McVary
- Department of Urology, Loyola University Stritch School of Medicine, Maywood, IL 60153, United States
| | - Carol A Podlasek
- Departments of Urology, Physiology, Bioengineering, and Biochemistry, University of Illinois at Chicago, Chicago, IL 60612, United States
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El-Osta A, Kerr G, Alaa A, El Asmar ML, Karki M, Webber I, Riboli Sasco E, Blume G, Beecken WD, Mummery D. Investigating self-reported efficacy of lifestyle medicine approaches to tackle erectile dysfunction: a cross-sectional eSurvey based study. BMC Urol 2023; 23:15. [PMID: 36740686 PMCID: PMC9901095 DOI: 10.1186/s12894-023-01180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/27/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Erectile dysfunction (ED) is the most common sexual dysfunction in men. Some types of ED are amenable to treatment using lifestyle medicine approaches with or without pharmacotherapy. AIM Investigate self-reported efficacy of lifestyle medicine approaches to tackle ED. METHODS A cross-sectional online survey of 1177 community dwelling adults explored the prevalence and methods used to tackle ED in the community setting. We examined differences between participants with and without ED. Variables associated with ED in univariable analyses were included in a multivariable logistic regression to identify variables independently associated with the condition. OUTCOMES Self-reported measure: perceived effectiveness of lifestyle medicine interventions to tackle ED. RESULTS Most respondents (76.5%) had experienced ED, and this was associated with having a long-term condition, taking anti-hypertensive medication, hypercholesterolaemia and obesity. Medication was the most common management strategy overall (65.9%), followed by stress management (43.5%) and weight loss (40.4%). Over half (53.9%) did not use any lifestyle modification strategies to tackle ED. Only 7.0% of ED sufferers received a mental health assessment and 29.2% received other tests (e.g., blood test, medical imaging) by GPs. Cardiovascular training was identified as the best rated strategy by its users (37.8%). Supplements (35.1%) and weight training/physical activity (32.6%) were also positively rated. CLINICAL IMPLICATIONS Structured education to general practitioners and community dwelling adults about the impact of lifestyle behaviour modification and how this could influence the appearance or trajectory of ED could help improve personal choice when tackling ED. STRENGTHS AND LIMITATIONS To our knowledge, this is the first study to collect eSurvey responses from community dwelling adults to gauge their reliance and perceived effectiveness of lifestyle medicine approaches to tackle ED. The principal limitation was the lack of follow-up, and not recording other information including lifestyle factors such as nutrition, smoking, and the use of alcohol and recreational drugs, which may have enabled a fuller exploration of the factors that could influence the primary outcome measures examined. CONCLUSION Despite the high prevalence of ED, there is not enough awareness in the community setting about effective and low-cost lifestyle medicine strategies, including cardiovascular training and the use of supplements and weight training, to help tackle this common condition.
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Affiliation(s)
- Austen El-Osta
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
| | - Gabriele Kerr
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
| | - Aos Alaa
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
| | - Marie Line El Asmar
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
| | - Manisha Karki
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
| | - Iman Webber
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
| | - Eva Riboli Sasco
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
| | - Giordano Blume
- UroGate Praxisnetzwerk, Berliner Platz 2, 61476 Kronberg, Germany
| | - Wolf-D. Beecken
- UroGate Praxisnetzwerk, Berliner Platz 2, 61476 Kronberg, Germany
| | - David Mummery
- grid.7445.20000 0001 2113 8111Self-Care Academic Research Unit (SCARU), Department of Primary Care and Public Health, School of Public Health, Imperial College London, 323 Reynolds Building, Charing Cross Hospital, St Dunstan’s Road, London, W6 8RP UK
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91
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Xiao Y, Xie T, Peng J, Zhou X, Long J, Yang M, Zhu H, Yang J. Factors associated with anxiety and depression in patients with erectile dysfunction: a cross-sectional study. BMC Psychol 2023; 11:36. [PMID: 36739441 PMCID: PMC9899110 DOI: 10.1186/s40359-023-01074-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/02/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Few studies have investigated factors associated with anxiety and depression among patients with erectile dysfunction (ED). This study aimed to investigate associated factors and the prevalence of anxiety and depression in this special group in China. METHODS Data from 511 patients with ED aged 18-60 years were collected between July 2021 and April 2022. The 5-item International Index of Erectile Function (IIEF-5) questionnaire, self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate erectile function, anxiety and depression, respectively. Univariate analysis and multivariate linear regression analyses were used to explore the associated factors of depression and anxiety. RESULTS The prevalence of anxiety and depression among ED patients was 38.16% and 64.97%, respectively. The mean anxiety index score was 47.37 ± 6.69 points, and the mean depression index was 54.72 ± 9.10 points. Multiple linear regression analysis showed that worse ED, low education level, and smoking were positively associated with increased risk of anxiety and depression. In addition, younger age, longer onset time, and irregular sleep were positively associated with high risk of anxiety, and irregular exercise was associated with severe depression. CONCLUSIONS The prevalence of depression and anxiety in ED patients is high, and the severity of ED, age, education level, smoking, onset time, regular sleep, and exercise were associated with anxiety or depression. Reversible risk factors should be avoided and individualized psychological support services are necessary for ED patients.
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Affiliation(s)
- Yang Xiao
- grid.431010.7Department of Urology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Tongjin Xie
- grid.431010.7Department of Urology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jingxuan Peng
- grid.452223.00000 0004 1757 7615Department of Urology, Xiangya Hospital of Central South University, Changsha, China
| | - Xun Zhou
- grid.431010.7Department of Urology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jinsong Long
- grid.431010.7Department of Urology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Mohan Yang
- grid.431010.7Department of Urology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Haiyan Zhu
- grid.431010.7Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jianfu Yang
- grid.431010.7Department of Urology, The Third Xiangya Hospital of Central South University, Changsha, China
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Alonso-Isa M, García-Gómez B, González-Ginel I, García-Rayo-Encina C, Del Prado Caro-González M, Medina-Polo J, García-Rojo E, Romero-Otero J. Conservative Non-surgical Options for Erectile Dysfunction. Curr Urol Rep 2023; 24:75-104. [PMID: 36445614 DOI: 10.1007/s11934-022-01137-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW This study aimed to review recent evidence on conservative non-surgical options for erectile dysfunction (ED) in men. A narrative review of the literature was performed. A comprehensive search in the MEDLINE, Embase, and Cochrane databases was done. Papers in English language, published from May 2017 until May 2022, were included. Papers reporting basic research or animal research were excluded, as long as reviews or meta-analyses. Congress reports, clinical cases, or clinical trials protocols with no results were also excluded. RECENT FINDINGS We found a multitude of different treatment modalities for ED. We must take into account the type of patient, their comorbidities, the origin of their ED, and its severity in order to reproduce effective results using these therapies. Some of the treatments show good results with a good level of evidence (new IPDE5 formulations, intracavernous injections, shock wave therapy, hormonal theraphy, psycho-sexual theraphy). However, others (some new molecules, stem cell theraphy, platelet-rich plasma injections, oxygenation-based therapy, nutraceuticals), although some of them present promising results, require randomized studies with a larger number of patients and a longer follow-up time to be able to establish firm recommendations. Regarding the conservative treatment of erectile dysfunction, in recent years, some therapies have been consolidated as effective and safe for certain types of patients. On the other hand, other treatment modalities, although promising, still lack the evidence and the necessary follow-up to be recommended in daily practice.
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Affiliation(s)
- Manuel Alonso-Isa
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Madrid, Spain
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain
- ROC Clinic, Madrid, Spain
| | - Borja García-Gómez
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Madrid, Spain
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain
- ROC Clinic, Madrid, Spain
| | - Ignacio González-Ginel
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Madrid, Spain
| | - Clara García-Rayo-Encina
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Madrid, Spain
| | - María Del Prado Caro-González
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Madrid, Spain
| | - José Medina-Polo
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Madrid, Spain
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain
- ROC Clinic, Madrid, Spain
| | - Esther García-Rojo
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain
- ROC Clinic, Madrid, Spain
| | - Javier Romero-Otero
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain.
- ROC Clinic, Madrid, Spain.
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Rainer QC, Dubin JM, Balaji NC, Troesch V, Terry W, Monga V, Clifford L, Shoag J, Greer A, Nackeeran S, Rodriguez AA, Patel P, Paz L, Kava BR, Alperstein W, Pearlman AM, Ramasamy R. Sexual Dysfunction Among Adolescent and Young Adult Men Diagnosed with Cancer. J Adolesc Young Adult Oncol 2023; 12:93-100. [PMID: 35319264 DOI: 10.1089/jayao.2021.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Adolescent and young adult (AYA) cancer patients frequently demonstrate sexual dysfunction; however, there is a lack of data quantifying the severity and frequency. Methods: Males aged 18-39 years, diagnosed with cancer of any kind and who were scheduled to begin, were actively receiving, or had completed cancer treatment within 6 months, were offered validated surveys during their oncology appointment. These surveys included the International Index of Erectile Function (IIEF-6), Masturbation Erection Index (MEI), 36-Item Short Form Survey, and 5-point Likert scales to assess their desire and ability to engage in sex and masturbation. Results: Forty subjects completed the IIEF survey with a mean score of 17.7 ± 11, erectile dysfunction (ED) prevalence accordingly was 58%. Thirty-eight subjects completed the MEI with a mean score of 25.3 ± 5.3, ED prevalence was again 58%. Age and IIEF scores demonstrated a statistically significant (p < 0.05, n = 38) Pearson's correlation coefficient of 0.40, patients younger than 30 years had an ED prevalence of 72% (mean IIEF 13), whereas patients aged 30 years and older had an ED prevalence of 45% (mean IIEF 22). All treatment modalities had ED rates >30%: chemotherapy demonstrated the highest prevalence at 64% (mean IIEF 17), whereas radiation therapy had the lowest prevalence at 33% (mean IIEF 23). Conclusion: This study demonstrates that the prevalence of sexual dysfunction among male AYA patients undergoing treatment for cancer is high. AYA oncologists should discuss potential sexual health concerns when treating this population. The exact cause of ED (non-organic vs. organic) within this group should be explored further.
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Affiliation(s)
- Quinn Carroll Rainer
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Justin Michael Dubin
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA.,Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Victoria Troesch
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA.,Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - William Terry
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Varun Monga
- Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Lindsey Clifford
- Department of Oncology, The University of Iowa Holden Comprehensive Cancer Center, Iowa City, Iowa, USA
| | - Jamie Shoag
- Department of Pediatric Hematology and Oncology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Aubrey Greer
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Sirpi Nackeeran
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | | | - Premal Patel
- Department of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Paz
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Bruce Richard Kava
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Warren Alperstein
- Department of Pediatric Hematology and Oncology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Amy Marcia Pearlman
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Chen Y, Chang HC, Huang WJ, Wang CJ, Hwang TIS, Liao CH, Liu CC, Pang ST, Huang EYH, Tsao CW, Chen KC, Liu SP, Huang CY, Hsieh CH, Jiann BP. Consensus of Experts on the Treatment of Sexual Dysfunction after Surgery for Prostate Cancer in Taiwan. J Clin Med 2023; 12:jcm12030740. [PMID: 36769388 PMCID: PMC9917785 DOI: 10.3390/jcm12030740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
According to the Taiwan Cancer Report, in 2018, prostate cancer was one of the top five cancers reported in men. Each year, many patients with prostate cancer undergo radical prostatectomy (RP) therapy. One of the most common RP complications is erectile dysfunction (ED). Although consensus guidelines for the management of sexual dysfunction after prostate cancer surgery have been developed for many Western and Asian countries, no such clinical practice guidelines have been developed for Taiwan. The consensus opinions expressed in this article were discussed by numerous experienced physicians in Taiwan, based on both existing international guidelines and their individual experiences with clinical trials and providing advice to clinical physicians on how to inform patients of the risk of ED prior to surgery. This review also discusses how recovery and rehabilitation may be affected by socioeconomic status, the existence of an intimate relationship, comorbidities, or the need for cancer adjuvant therapy and how to determine rehabilitation goals and provide appropriate treatments to assist in the recovery of both short- and long-term sexual function.
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Affiliation(s)
- Yu Chen
- Department of Surgery, Division of Urology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Hong-Chiang Chang
- Department of Surgery, Division of Urology, Far-Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - William J. Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Chii-Jye Wang
- Department of Urology, E-Da Dachang Hospital, Kaohsiung 82446, Taiwan
| | - Thomas I-Sheng Hwang
- School of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan
- Department of Surgery, Shin Kong Memorial Hospital, New Taipei City 111045, Taiwan
| | - Chun-Hou Liao
- Department of Urology, Cardinal Tien Hospital, Fu-Jen Catholic University, New Taipei 362, Taiwan
| | - Chia-Chu Liu
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - See-Tong Pang
- Department of Surgery, Division of Urology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Eric Yi-Hsiu Huang
- Urology Division, Taipei Veterans General Hospital, Taipei City 112, Taiwan
| | - Chih-Wei Tsao
- Department of Surgery, Division of Urology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Kuo-Chiang Chen
- Cathay General Hospital, Fu Jen Catholic University, Taipei City 106, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 11031, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 11031, Taiwan
| | - Cheng-Hsing Hsieh
- Division of Urology, Buddhist Tzu-Chi General Hospital Taipei Branch, School of Medicine, Buddhist Tzu-Chi University, Hualien City 970, Taiwan
| | - Bang-Ping Jiann
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
- Correspondence:
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95
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Zang G, Sun X, Sun Y, Zhao Y, Dong Y, Pang K, Cheng P, Wang M, Zheng Y. Chronic liver diseases and erectile dysfunction. Front Public Health 2023; 10:1092353. [PMID: 36684968 PMCID: PMC9853559 DOI: 10.3389/fpubh.2022.1092353] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
Chronic liver diseases (CLDs) are characterized by progressive necrosis of hepatocytes, which leads to liver fibrosis and cirrhosis, and ultimately liver dysfunction. The statistics of 2020 shows that the number of patients with CLDs, including chronic hepatitis, fatty liver, and cirrhosis, may exceed 447 million in China. The liver is a crucial organ for the metabolism of various substances, including sex hormones and lipids. CLDs frequently result in abnormalities in the metabolism of sex hormones, glucose, and lipids, as well as mental and psychological illnesses, all of which are significant risk factors for erectile dysfunction (ED). It has been reported that the prevalence of ED in male patients with CLDs ranges from 24.6 to 85.0%. According to a survey of Caucasians, liver transplantation may improve the erectile function of CLDs patients with ED. This finding supports the link between CLDs and ED. In addition, ED is often a precursor to a variety of chronic diseases. Given this correlation and the significant prevalence of CLDs, it is important to evaluate the epidemiology, risk factors, etiology, and treatment outcomes of ED in male patients with CLDs, expecting to attract widespread attention.
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Affiliation(s)
- Guanghui Zang
- Department of Urology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Xv Sun
- Graduate School, Bengbu Medical College, Bengbu, Anhui, China
| | - Yufeng Sun
- Department of Urology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Yan Zhao
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Yang Dong
- Department of Urology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Kun Pang
- Department of Urology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Ping Cheng
- Graduate School, Bengbu Medical College, Bengbu, Anhui, China
| | - Meng Wang
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Yuli Zheng
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
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Xu J, Chen Y, Gu L, Liu X, Yang J, Li M, Rao K, Dong X, Yang S, Huang B, Jin L, Wang T, Liu J, Wang S, Bai J. Hypothalamic-pituitary-adrenal axis activity and its relationship to the autonomic nervous system in patients with psychogenic erectile dysfunction. Front Endocrinol (Lausanne) 2023; 14:1103621. [PMID: 36936153 PMCID: PMC10020360 DOI: 10.3389/fendo.2023.1103621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Psychological stress and its two stress response systems, the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS), are closely related to psychogenic erectile dysfunction (pED). However, the analyses of perceived stress and stress systems in pED patients need to be more in-depth, especially the interactions between them. METHODS Our study included 75 patients with pEDs and 75 healthy men. The International Index of Erectile Function-5 (IIEF-5) and the 10-item Perceived Stress Scale (PSS-10) were used for assessing the severity of ED and perceived stress. All participants collected saliva samples on three consecutive days at eight specific times with strict reference to the time of morning awakening for measuring cortisol parameters and wore electrocardiography for 24 h to derive heart rate variability (HRV). RESULTS The PSS-10 scores of pED patients were significantly higher than the control group (p<0.001). Although PSS-10 and IIEF-5 scores were negatively correlated in pED patients, there was no statistical significance between them (r=-0.049, p=0.677). Compared with the control group, the HRV parameters of pED patients were significantly increased in LF/HF ratio (p=0.014) but significantly decreased in LF, HF, and pNN50 (p<0.001). However, the two groups had no statistically significant differences in cortisol variables (all p>0.05). The interaction between sympathovagal modulation (HF, rMSSD) and cortisol awakening response (CAR AUCi) explained significantly greater variance in perceived stress than either stress system alone. Higher parasympathetic activity combined with a higher cortisol awakening response was associated with greater perceived stress. CONCLUSION Our results suggested that the interrelation between ANS and HPA axis activity might enhance our comprehension of how stress affected the physical and mental health of pED patients.
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Affiliation(s)
- Jinzhou Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yinwei Chen
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Longjie Gu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mingchao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ke Rao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiyuan Dong
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shulin Yang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bo Huang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jian Bai
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- *Correspondence: Jian Bai,
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97
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Yao J, Ju B, Li X, Ma M, Li L, Zhang Y. Clinical study of comprehensive TCM therapy in the treatment of damp and hot stasis erectile dysfunction. Medicine (Baltimore) 2022; 101:e30776. [PMID: 36316841 PMCID: PMC9622706 DOI: 10.1097/md.0000000000030776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The dilemma of male sexual dysfunction has been the focus of the whole society. Erectile dysfunction (ED) is one of the common sexual dysfunctions, and traditional Chinese medicine therapy has shown potential benefits in the treatment of ED. Comprehensive therapy of traditional Chinese medicine (CTTCM) is a comprehensive application of Chinese medicine therapy for auxiliary intervention. Through preliminary clinical observations, we found that CTTCM is simple, safe, and has good efficacy; however, there is a lack of rigorous clinical trials to support its application. Therefore, we designed a randomized controlled trial to evaluate the efficacy and safety of CTTCM for patients with ED of damp-heat stasis type, and to provide evidence for the clinical application of CTTCM and the construction of a traditional Chinese medicine andrology rehabilitation system. METHODS In this randomized controlled study, 108 eligible patients were assigned 1:1 to the CTTCM group or the tadalafil group. The treatment period was 8 weeks and the follow-up period was 8 weeks. The primary outcome will be the International Erectile Function Score and traditional Chinese medicine Syndrome Score. Secondary outcomes will include the Erection Quality Score, Patient Health Questionnaire-9, and the 7-item Generalized Anxiety Scale. Safety results will include electrocardiogram, blood tests (including blood, liver and kidney function), urine and stool. International Erectile Function Score-5, traditional Chinese medicine Syndrome Score, Erectile Quality Score, Patient Health Questionnaire-9, 7-item Generalized Anxiety Scale and all Safety outcomes will be conducted at baseline, 2th, 4th, 6th, and 8th week. Follow-up results will be assessed at 8th week after 8 weeks' treatment. DISCUSSION This study will provide preliminary evidence for the efficacy and safety of traditional Chinese medicine integrated therapy in the treatment of damp-heat stasis ED. In addition, it also provides a basis for the clinical application of Chinese medicine comprehensive therapy and the construction of Chinese medicine andrology rehabilitation system. TRIAL REGISTRATION Chinese clinical trial registration identifier, ChiCTR2200062016, registered on July 19, 2022.
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Affiliation(s)
- Junchao Yao
- Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Baojun Ju
- Henan University of Traditional Chinese Medicine, Zhengzhou, China
- * Correspondence: Xiao Li, Department of Andrology, The First Affiliated Hospital of Henan University of Chinese Medicine, No. 19, Renmin Road, Zhengzhou 450000, China (e-mail: )
| | - Xiao Li
- Department of Andrology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Miaomiao Ma
- Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Luyu Li
- Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Yongtao Zhang
- Henan University of Traditional Chinese Medicine, Zhengzhou, China
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98
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Song J, Wang J, Liu K, Xu W, Sun T, Liu J. The role of microRNAs in erectile dysfunction: From pathogenesis to therapeutic potential. Front Endocrinol (Lausanne) 2022; 13:1034043. [PMID: 36387873 PMCID: PMC9640492 DOI: 10.3389/fendo.2022.1034043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022] Open
Abstract
Erectile dysfunction (ED) is a common male sexual dysfunction disease, and it was predicted that the number of ED patients worldwide will reach 322 million by 2025. However, the pathogenesis of ED is complex and the current treatment options are still limited, so it is urgent to explore new treatment strategies. Recent studies have shown that microRNAs (miRNAs) play an important role in ED, and these single-stranded non-coding small RNA molecules are involved in key pathophysiological processes in the occurrence and development of ED. Therefore, miRNAs have remarkable potential as therapeutic targets in ED. Here, this review introduces the physiological basis of erectile function and the pathophysiological changes in ED and summarizes the current knowledge on the expression, biological functions, and molecular mechanisms of miRNAs in ED, especially the potential of miRNA-targeted therapies to improve ED. This review will provide a comprehensive view of the role of miRNAs in the pathogenesis of ED and the potential value of miRNAs in the treatment of ED.
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Affiliation(s)
- Jingyu Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaxin Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kang Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenchao Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Taotao Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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99
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Charoenmakpol N, Chiddaycha M, Wainipitapong S. The Arizona Sexual Experiences Scale-the Thai Translation (ASEX-Thai): Reliability and validity in Thai patients with mental disorders. F1000Res 2022; 11:503. [PMID: 36226038 PMCID: PMC9525992 DOI: 10.12688/f1000research.111051.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Sexual dysfunction is common among patients with mental disorders but receives less clinical attention, especially in Thailand and other Asian countries. The Arizona Sexual Experiences Scale-the Thai Translation (ASEX-Thai), a self-rated, brief, questionnaire is a potential tool for screening for sexual dysfunction in this population. Our study aimed to assess the reliability and validity of ASEX-Thai in Thai patients with mental disorders. Methods: We enrolled 202 patients from an outpatient psychiatric department at a tertiary hospital in Bangkok, Thailand. Demographic data, clinical data, and diagnosis of sexual dysfunction were assessed. ASEX-Thai was done, and we analyzed the test’s psychometric properties. Results: Most participants were diagnosed with major depressive disorder (48%). There was a positive correlation between the ASEX-Thai and sexual dysfunction diagnosis (r = 0.402, p < 0.001). The KMO coefficient was 0.77 and Barlett’s sphericity test was significant (χ
2 = 409.76, p<0.001). A score of ≥ 17 points of the ASEX-Thai was the most suitable for sexual dysfunction screening (sensitivity 77.23 %, and specificity 58.42 %). For reliability, the Cronbach’s alpha coefficient (0.831) showed good internal consistency. Conclusions: The ASEX-Thai is a valid and reliable self-rated questionnaire for screening for sexual dysfunction among Thai patients with mental disorders. The test could help clinicians to evaluate this undetected condition and deliver proper interventions.
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Affiliation(s)
- Natthaphon Charoenmakpol
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Mayteewat Chiddaycha
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Sorawit Wainipitapong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, 10330, Thailand
- Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
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100
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Hamzehnejadi M, Tavakoli MR, Homayouni F, Jahani Z, Rezaei M, Langarizadeh MA, Forootanfar H. Prostaglandins as a Topical Therapy for Erectile Dysfunction: A Comprehensive Review. Sex Med Rev 2022; 10:764-781. [PMID: 37051966 DOI: 10.1016/j.sxmr.2022.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a substantial cause of dissatisfaction among many men. This discontentment has led to the emergence of various drug treatment options for this problem. OBJECTIVES Unfortunately, due to various interactions, contraindications, and side effects, systemic therapies such as phosphodiesterase-5 inhibitors (including sildenafil, tadalafil, vardenafil, avanafil, etc.) are not welcomed in many patients. These problems have led researchers to look for other ways to reduce these complications. METHODS This article holistically reviews the efficacy of topical prostaglandins and their role in treating ED. We sought to provide a comprehensive overview of recent findings on the current topic by using the extensive literature search to identify the latest scientific reports on the topic. RESULTS In this regard, topical and transdermal treatments can be suitable alternatives. In diverse studies, prostaglandins, remarkably PGE1 (also known as alprostadil), have been suggested to be an acceptable candidate for topical treatment. CONCLUSION Numerous formulations of PGE1 have been used to treat patients so far. Still, in general, with the evolution of classical formulation methods toward modern techniques (such as using nanocarriers and skin permeability enhancers), the probability of treatment success also increases.
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Affiliation(s)
- Mohammadsadegh Hamzehnejadi
- Pharmaceutical Sciences and Cosmetic Products Research Center Kerman University of Medical Sciences, Kerman, Iran
| | | | - Fatemeh Homayouni
- Student Research Committee Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Jahani
- Student Research Committee Kerman University of Medical Sciences, Kerman, Iran
| | - Masoud Rezaei
- Faculty of Medicine Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Amin Langarizadeh
- Pharmaceutical Sciences and Cosmetic Products Research Center Kerman University of Medical Sciences, Kerman, Iran
- Department of Medicinal Chemistry Faculty of Pharmacy Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Forootanfar
- Pharmaceutical Sciences and Cosmetic Products Research Center Kerman University of Medical Sciences, Kerman, Iran
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