Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study

Patients' understanding and perception of erectile dysfunction: Hong Kong versus Europe

PURPOSE

To estimate the prevalence of Erectile dysfunction (ED) in a Hong Kong (HK) population, evaluate the understanding and perception of ED and compare results with the European Association of Urology (EAU) and The Urology Foundation Trust (TRTed-TUF) data.

METHODS

A survey-based study was conducted between Dec 2023 and Mar 2024. The EAU and TRTed-TUF surveys were used as a template to design the current survey to ensure consistent reporting. Questions on the understanding of ED, healthcare seeking behaviour and awareness of treatment options were included. The survey was distributed via an online link to students and staff from The Hong Kong University (HKU) and to patients attending outpatient clinics at HKU Queen Mary Hospital.

RESULTS

616 responses were received from men aged 18-81 years. The prevalence of ED in our population was 51.8%. 53.2% (EAU 33.6%) were incorrect about what ED is, 54.0% (EAU 56.5%) knew that ED could be treated and 26.4% (TRTed-TUF 22%) were aware that ED could be a sign of heart disease. 73.6% (EAU, 26.3%) do not talk with anyone about ED. 88.3% (TRTed-TUF 77%) would be more likely to seek help if they knew ED was a sign of heart disease. Up to 32.6% (EAU 17.2%) have heard of alternative therapies to oral phosphodiesterase-5 inhibitors.

CONCLUSIONS

ED awareness is low, and it is important to raise awareness possibly through charity campaigns, social media and education in primary care in order to detect underlying cardiovascular disease and reduce the impact of ED on psychosocial health.

Point-of-Care Ultrasound in Urologic Practice and Training

PURPOSE OF REVIEW

Review the current ways in which POCUS is currently being used and discuss current and future trends of POCUS training.

RECENT FINDINGS

Despite broad utilization in many urologic practices, POCUS training is not routinely provided during urologic residency. Several barriers, including cost of equipment procurement and lack of expertise, prevent standardized implementation of POCUS curricula. POCUS education is valued and beneficial at all levels of training and changes in healthcare may reinforce the need for formal instruction.

Proceedings of PRINCETON IV: PDE5 inhibitors and cardiac health symposium

INTRODUCTION

Prior consensus meetings have addressed the relationship between phosphodiesterase type 5 (PDE5) inhibition and cardiac health. Given significant accumulation of new data in the past decade, a fourth consensus conference on this topic was convened in Pasadena, California, on March 10 and 11, 2023.

OBJECTIVES

Our meeting aimed to update existing knowledge, assess current guidelines, and make recommendations for future research and practice in this area.

METHODS

An expert panel reviewed existing research and clinical practice guidelines.

RESULTS

Key findings and clinical recommendations are the following: First, erectile dysfunction (ED) is a risk marker and enhancer for cardiovascular (CV) disease. For men with ED and intermediate levels of CV risk, coronary artery calcium (CAC) computed tomography should be considered in addition to previous management algorithms. Second, sexual activity is generally safe for men with ED, although stress testing should still be considered for men with reduced exercise tolerance or ischemia. Third, the safety of PDE5 inhibitor use with concomitant medications was reviewed in depth, particularly concomitant use with nitrates or alpha-blockers. With rare exceptions, PDE5 inhibitors can be safely used in men being treated for hypertension, lower urinary tract symptoms and other common male disorders. Fourth, for men unresponsive to oral therapy or with absolute contraindications for PDE5 inhibitor administration, multiple treatment options can be selected. These were reviewed in depth with clinical recommendations. Fifth, evidence from retrospective studies points strongly toward cardioprotective effects of chronic PDE5-inhibitor use in men. Decreased rates of adverse cardiac outcomes in men taking PDE-5 inhibitors has been consistently reported from multiple studies. Sixth, recommendations were made regarding over-the-counter access and potential risks of dietary supplement adulteration. Seventh, although limited data exist in women, PDE5 inhibitors are generally safe and are being tested for use in multiple new indications.

CONCLUSION

Studies support the overall cardiovascular safety of the PDE5 inhibitors. New indications and applications were reviewed in depth.

Handgrip strength, and erectile dysfunction among men with metabolic syndrome attending an institutional primary care clinic in Malaysia: A cross-sectional study

Background

Erectile dysfunction (ED) is an independent predictor for cardiovascular diseases (CVD). The prevalence increases with age, but little is known about the relationship between handgrip strength (HGS) and ED, especially among men with a high risk of CVD. This study aimed to determine the prevalence of ED among men aged ≥40 years with metabolic syndrome (MetS) and its association with HGS.

Materials and Methods

A cross-sectional study at an institutional primary care clinic in Malaysia was conducted between June 2021 and October 2021. HGS and erectile function were assessed using a hand dynamometer and International Index of Erectile Function (IIEF-5) questionnaire, respectively. Multiple logistic regression analyses were performed to determine the association between sociodemographics, clinical characteristics, and HGS with ED.

Results

A total of 334 participants were recruited. The prevalence of ED was 79% (95% confidence interval [CI]: 0.75-0.84). ED was associated with elderly aged ≥60 years (odds ratio [OR] 3.27, 95%CI: 1.60-6.69), low HGS (OR 15.34, 95%CI: 5.64-41.81) and high total cholesterol (OR 0.36, 95%CI: 0.16-0.78).

Conclusion

In conclusion, age above 60 years and those with low HGS are at higher risk of ED. Thus, robust screening of ED among men with MetS and improving muscle strength and physical fitness may be warranted.

Association between the C-reactive protein-triglyceride glucose index and erectile dysfunction in US males: results from NHANES 2001-2004

The C-reactive protein-triglyceride glucose index (CTI) is emerging as a novel indicator for comprehensively assessing the severity of both inflammation and insulin resistance. However, the association between CTI and erectile dysfunction (ED) remains largely unexplored. Participant data for this study were sourced from NHANES 2001-2004, with exclusion criteria applied to those lacking information on clinical variables. The CTI was defined as 0.412*Ln (CRP) + ln [T.G. (mg/dL) × FPG (mg/dL)/2]. Weighted univariable and multivariable logistic regression models were utilized to examine the correlation between the CTI and ED, assessing the CTI as both a continuous and categorical variable (quartile). Moreover, subgroup analyses were conducted to pinpoint sensitive populations, and interaction analysis was performed to validate the findings. A total of 1502 participants were included in the final analysis, encompassing 302 with ED and 1200 without ED. After adjusting for potential confounders, the CTI was positively associated with ED incidence (OR = 1.56, 95% CI: 1.27-1.90, P = 0.002). The fourth quartile of the CTI significantly increased the incidence of ED (OR = 2.69, 95% CI: 1.07-6.74, P = 0.04), and the lowest quartile of CTI was used as the reference. The dose-response curve revealed a positive linear relationship between the CTI and the incidence of ED. Subgroup analysis confirmed the consistent positive relationship between the CTI and ED. The interaction test indicated no significant impact on this association. Finally, a sensitivity analysis was performed to verify the significant positive correlation between the CTI and severe ED (OR = 1.44, 95% CI: 1.19-1.76, P = 0.004). Our national data indicate that a greater CTI is positively linked to an increased risk of ED in US men, suggesting its potential for use in clinical practice for ED prevention or early intervention. Additional large-scale prospective studies are warranted to substantiate the causative relationship between CTI and ED.

Testicular protective effects of hesperidin against chemical and biological toxicants

Toxic agents can adversely impact the male reproductive system mainly via activating oxidative stress affecting the seminiferous epithelia, spermatogenesis, sperms, and the testis. Toxic agents lead to the excessive generation of reactive oxygen species (ROS), such as hydroxyl radicals, hydrogen peroxide, and superoxide anions. ROS exert a cytotoxic effect and oxidative damage to nucleic acids, proteins, and membrane lipids. Hesperidin is a pharmacologically active phytoflavone abundantly occurring in citrus fruits, such as oranges and lemons. It has shown various pharmacological properties such as antioxidant, anti-inflammatory, anti-carcinogenic, analgesic, antiviral, anti-coagulant, hypolipidemic, and hypoglycemic effects. Hesperidin has been found to exert protective effects against natural and chemical toxins-induced organ toxicity. Considerable evidence has implicated the testicular protective effects of hesperidin against the toxicological properties of pharmaceutical drugs as well as biological and chemical agents, and in the present review, we discussed, for the first time, the reported studies. The resultant data indicate that hesperidin can exert testicular protective effects through antioxidant properties.

Higher oxidative balance score was associated with decreased risk of erectile dysfunction: a population-based study

BACKGROUND

Erectile dysfunction (ED) is a prevalent condition that is thought to be significantly impacted by oxidative stress. The oxidative balance score (OBS) has been built to characterize the state of antioxidant/pro-oxidant balance. There is less known regarding the relationship of OBS with ED.

METHODS

This study conducted cross-sectional analyses on 1860 males who participated in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004. OBS was constructed by the 16 dietary components and 4 lifestyle factors. Self-reported ED was defined as men who indicated that they "never" or "sometimes" could achieve or keeping an erection adequate for satisfactory intercourse. Multivariate logistic regression models were applied to examine the association between OBS and the risk of ED.

RESULTS

Among 1860 participants, the median OBS was 20 (IQR 15-26), and OBS was lower in males with ED vs. those without ED (P = 0.001). The results of our analyses indicated a negative correlation between OBS and ED among male subjects. Specifically, each one-unit increase in the continuous OBS was relate to 3% reduction in the odds of ED after full adjustment. Moreover, when extreme OBS quartiles were compared, the adjusted odds ratio (95% confidence interval) for the 4th OBS category was 0.53 (0.32 to 0.88) after full adjustment (P for trend < 0.05). There was also statistical significance in the relationships between dietary/lifestyle OBS with ED, and the association between lifestyle OBS and ED may be even tighter. For each unit increase in lifestyle OBS, the odds of ED decreased by 11% after full adjustment.

CONCLUSION

Higher OBS was associated with reduced risk of ED in U.S. males. These findings suggested that adopting an antioxidant-rich diet and engaging in antioxidant-promoting lifestyle behaviors may contribute to a lower incidence of ED. These results provided recommendations for a comprehensive dietary and lifestyle antioxidants for ED patients.

A healthy lifestyle can support future sexual satisfaction: results from a 9-year longitudinal survey

BACKGROUND

Previous follow-up studies have demonstrated the association between good health behavior and good sexual functioning for men, but the longitudinal relationship between multiple health behaviors and satisfaction with sex life remains understudied.

AIM

The aim of the study was to explore whether good health behavior associates with improved satisfaction with sex life for men and women in a follow-up of 9 years.

METHODS

This cohort study utilized survey data from the population-based Health and Social Support study. It includes responses from 10 671 working-aged Finns. Using linear regression models, we examined a composite sum score representing 4 health behaviors (range, 0-4) in 2003 as a predictor of satisfaction with sex life in 2012. The analyses adjusted for various covariates in 2003, including satisfaction with sex life, living status, age, gender, education, number of diseases, and importance of sex life in 2012.

OUTCOMES

The outcome in the study was satisfaction with sex life in the year 2012.

RESULTS

Participants who exhibited better health behavior at baseline demonstrated improved satisfaction with sex life when compared with those with poorer health behavior (β = -0.046, P = .009), even when controlling for the aforementioned covariates. The positive effect of reporting all beneficial health behaviors vs none of them was greater than having none vs 3 chronic conditions. Furthermore, this was almost half the effect of how satisfaction with sex life in 2003 predicted its level in 2012. These findings were supported by an analysis of the congruence of health behavior in the observation period from 2003 to 2012 predicting changes in satisfaction with sex life.

CLINICAL IMPLICATIONS

The results could serve as a motivator for a healthy lifestyle.

STRENGTHS AND LIMITATIONS

The current study used a longitudinal large sample and a consistent survey procedure, and it explored the personal experience of satisfaction instead of sexual function. However, the study is limited in representing today's diversity of gender, since the options for gender at the time of survey were only male and female.

CONCLUSION

These findings indicate that engaging in healthy behaviors contributes to the maintenance and enhancement of satisfaction with sex life over time.

Infertility Improvement after Medical Weight Loss in Women and Men: A Review of the Literature

Infertility is a modern health problem. Obesity is another expanding health issue associated with chronic diseases among which infertility is also included. This review will focus on the effects of weight loss by medical therapy on fertility regarding reproductive hormonal profile, ovulation rates, time to pregnancy, implantation rates, pregnancy rates, normal embryo development, and live birth rates. We comprised medicine already used for weight loss, such as orlistat and metformin, and emerging medical treatments, such as Glucagon-Like Peptide-1 receptor agonists (GLP-1 RA). Their use is not recommended during a planned pregnancy, and they should be discontinued in such cases. The main outcomes of this literature review are the following: modest weight loss after medication and the duration of the treatment are important factors for fertility improvement. The fecundity outcomes upon which medical-induced weight loss provides significant results are the female reproductive hormonal profile, menstrual cyclicity, ovulation and conception rates, and pregnancy rates. Regarding the male reproductive system, the fertility outcomes that feature significant alterations after medically induced weight loss are as follows: the male reproductive hormonal profile, sperm motility, movement and morphology, weight of reproductive organs, and sexual function. The newer promising GLP-1 RAs show expectations regarding fertility improvement, as they have evidenced encouraging effects on improving ovulation rates and regulating the menstrual cycle. However, more human studies are needed to confirm this. Future research should aim to provide answers about whether medical weight loss therapies affect fertility indirectly through weight loss or by a possible direct action on the reproductive system.

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

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.

Sexual Function and Satisfaction in the Context of Obesity

PURPOSE OF REVIEW

Sexual dysfunction is commonly associated with overweight/obesity, but the underlying physiological and psychosocial mechanisms are not fully understood. This review contextualizes the obesity-sexual (dys)function relationship, describes recent insights from the medical and social science literature, and suggests opportunities for continued research.

RECENT FINDINGS

Although sexual dysfunction has been historically evaluated as a consequence/outcome of obesity, it is increasingly considered as a harbinger of future metabolic comorbidities, including type 2 diabetes and cardiovascular disease. Body image dissatisfaction is a consistent predictor for lower sexual satisfaction across BMI categories, likely mediated by cognitive distraction during partnered sex. To fully capture the relationship between obesity and sexual dysfunction, multidisciplinary research approaches are warranted. While clinically significant weight loss tends to improve sexual functioning for women and men, higher body image satisfaction may independently promote sexual function and satisfaction without concomitant weight loss.

Unlocking Potentially Therapeutic Phytochemicals in Capadulla (Doliocarpus dentatus) from Guyana Using Untargeted Mass Spectrometry-Based Metabolomics

Doliocarpus dentatus is thought to have a wide variety of therapeutic phytochemicals that allegedly improve libido and cure impotence. Although a few biomarkers have been identified with potential antinociceptive and cytotoxic properties, an untargeted mass spectrometry-based metabolomics approach has never been undertaken to identify therapeutic biofingerprints for conditions, such as erectile dysfunction, in men. This study executes a preliminary phytochemical screening of the woody vine of two ecotypes of D. dentatus with renowned differences in therapeutic potential for erectile dysfunction. Liquid chromatography-mass spectrometry-based metabolomics was used to screen for flavonoids, terpenoids, and other chemical classes found to contrast between red and white ecotypes. Among the metabolite chemodiversity found in the ecotype screens, using a combination of GNPS, MS-DIAL, and SIRIUS, approximately 847 compounds were annotated at levels 2 to 4, with the majority of compounds falling under lipid and lipid-like molecules, benzenoids and phenylpropanoids, and polyketides, indicative of the contributions of the flavonoid, shikimic acid, and terpenoid biosynthesis pathways. Despite the extensive annotation, we report on 138 tentative compound identifications of potentially therapeutic compounds, with 55 selected compounds at a level-2 annotation, and 22 statistically significant therapeutic biomarkers, the majority of which were polyphenols. Epicatechin methyl gallate, catechin gallate, and proanthocyanidin A2 had the greatest significant differences and were also relatively abundant among the red and white ecotypes. These putatively identified compounds reportedly act as antioxidants, neutralizing damaging free radicals, and lowering cell oxidative stress, thus aiding in potentially preventing cellular damage and promoting overall well-being, especially for treating erectile dysfunction (ED).

Ameliorative effect of hesperidin against high dose sildenafil-induced liver and testicular oxidative stress and altered gene expression in male rats

BACKGROUND

The clinical use of sildenafil citrate (Viagra), a drug used to treat erectile dysfunction, is limited because of its many side effects on tissues. In this context, we aimed to investigate the protective effects of hesperidin, a citrus flavonoid, on hepatic and testicular damage induced by a high dose of sildenafil citrate in male rats. Rats were randomly divided into four groups. The first group was used as the control group. The second group was orally administered sildenafil citrate at a high dose of 75 mg/kg thrice a week. In the third group, hesperidin was administered orally at a dose of 50 mg/kg/day. The fourth group was administered 75 mg/kg sildenafil citrate three times a week with 50 mg/kg hesperidin daily. The experiment lasted for 28 days.

RESULTS

In the sildenafil-treated groups, blood indices were altered, liver function tests were deranged, and serum testosterone levels were reduced. In the liver and testicular tissue, sildenafil citrate treatment resulted in significant reductions in catalase and total antioxidant capacity; as well as increased malondialdehyde, reactive oxygen species, and nitrous oxide levels. In addition, sildenafil citrate treatment caused abnormal histopathological patterns in both the liver and the testes. Liver vascular endothelial growth factor and testicular steroidogenic acute regulatory protein gene expression were upregulated.

CONCLUSIONS

Hesperidin attenuated the harmful effects of intensive sildenafil citrate treatment on liver and testicular functions, alleviated oxidative stress and normalized blood indices. Therefore, hesperidin could be protective against sildenafil citrate-induced oxidative damage that may develop over the long term.

Comparison of Risk Factors for Erectile Dysfunction (ED) in Type 2 Diabetics and Nondiabetics: A Retrospective Observational Study

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.

Obesity and male infertility

The worldwide prevalence of obesity is increasing among both sexes, with associated impacts on chronic health and medical comorbidities. Similarly, the effects of obesity on reproductive health are increasingly being recognized. Adiposity is associated with reduced fertility in men, with a complex and multifactorial etiology. The reported effects of obesity on semen parameters and impaired fertility are contrasting, with some studies showing a clear reduction in reproductive outcomes associated with increased body mass index, while others do not show such impacts. These controversies may be due to the complex pathophysiology and interplay between gonadotropins and end organs, as well as genetic and epigenetic changes and oxidative stress on male fertility and function. These different aspects have led to heterogeneous participants in studies and varying implications for assisted reproductive outcomes as well as offspring health. Treatment modalities to manage obesity include lifestyle, medical, and surgical options, with emerging and effective medical treatments showing promise in reproductive outcomes.

Is Continuous Positive Airway Pressure a Valid Alternative to Sildenafil in Treating Sexual Dysfunction among OSA Patients? A Systematic Review and Meta-Analysis

Background and Objectives: This study aimed to assess the comparative effectiveness of continuous positive airway pressure (CPAP) therapy and sildenafil pharmacological therapy in improving sexual function among patients with obstructive sleep apnea (OSA) and erectile dysfunction (ED). Materials and methods: Population: Patients affected by OSA and ED; Intervention: CPAP therapy vs. Comparison: Sildenafil pharmacological therapy; Outcomes: Improvement in erectile function, as measured by the International Index of Erectile Function 5 (IIEF-5) scoring system; Time: A systematic review of the literature from the past 20 years; Study Design: Observational studies comparing erectile function improvements after OSA treatment. Results: A total of eight papers were included in the qualitative summary, involving four hundred fifty-seven patients with ED and OSA. Erectile function improvements were observed in both treatment groups. After sildenafil and CPAP treatment, the mean IIEF-5 domain scores were 37.7 and 27.3, respectively (p < 0.001). Sildenafil 100 mg demonstrated a higher therapeutic impact compared to CPAP treatment. Conclusions: CPAP therapy significantly improved sexual parameters in most studies for OSA patients with ED. The findings suggest that CPAP therapy effectively alleviates erectile dysfunction symptoms, resulting in improved sexual performance in OSA patients. The comparison of the two treatments indicates that sildenafil has a more substantial therapeutic impact on erectile function than CPAP therapy; however, a combined treatment will provide a cumulative effect.

Association between neutrophil to lymphocyte ratio and erectile dysfunction among US males: a population-based cross-sectional study

Objective

The purpose of the study was to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR) and erectile dysfunction (ED) in adult American males using a large database.

Methods

We adopted a series of statistical analyses of the relationship between NLR indices and ED prevalence among participants in the 2001-2004 National Health and Nutrition Examination Survey (NHANES) database using the R software.

Results

The study included a total of 3012 participants, of whom 570 (18.9%) presented with ED. NLR levels were 2.13 (95% CI: 2.08,2.17) in those without ED and 2.36 (95% CI: 2.27,2.45) in those with ED. After adjusting for confounding variables, NLR levels were higher in patients with ED, (β, 1.21, 95% CI, 1.09-1.34, P < 0.001). In addition, a U-shaped relationship between NLR and ED was observed after controlling for all confounders. A more significant correlation (β, 1.35, 95% CI, 1.19 to 1.53, P < 0.001) existed to the right of the inflection point (1.52).

Conclusion

The results of the large cross-sectional study showed a statistically significant association between the occurrence of ED and NLR, a simple, inexpensive, and readily available parameter of inflammation, in US adults. Further studies are still needed in the future to validate and replicate our findings and to investigate the specific mechanisms involved.

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

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.

Evaluation of the sexual function of men in Kazakhstan during 2021-2022: A cross-sectional study

Background and Aims

Assessing male sexual function is an important public health issue in every country. In Kazakhstan, there are currently no reliable statistics on male sexual function. The study aimed at the assessment of sexual function in men in Kazakhstan.

Methods

Men between the ages of 18 and 69 from Astana, Almaty, and Shymkent, three of Kazakhstan's biggest cities, were included in the cross-sectional study in 2021-2022. A standardized and modified Brief Sexual Function Inventory (BSFI) tool was used for participants' interviews. The World Health Organization STEPS questionnaire was employed to gather sociodemographic information, including smoking and alcohol use.

Results

Respondents from three cities: n = 283 from Almaty, n = 254 from Astana, and n = 232 from Shymkent were interviewed. All participants' average age was 39.2 ± 13.4. Kazakhs made up 79.5% of the respondents by nationality; 19.1% who answered questions on physical activity verified that they were involved in high-intensity labor. According to the BSFI questionnaire, the respondents from Shymkent had an average total score of 2.82 ± 0.92, (p ≤ 0.05), which was higher than the total scores of respondents from Almaty (2.69 ± 0.87) and Astana (2.69 ± 0.95). A relationship was found between sexual dysfunction and age indicators over 55 years. Participants with overweight had a relationship with sexual dysfunction with an odds ratio (OR): 1.84 (p = 0.01). According to the smoking factor, in study participants with sexual dysfunction, a relationship was also determined, OR: 1.42; 95% confidence interval (CI): 0.79-1.97 (p = 0.001). The presence of high-intensity activity (OR: 1.58; 95% CI: 0.04-1.91), and physical inactivity (OR: 1.49; 95% CI: 0.89-1.97) were associated with the presence of sexual dysfunction, p ≤ 0.05.

Conclusions

Our research indicates that men over 50 who smoke, are overweight, and are physically inactive are at risk for sexual dysfunction. Early health promotion may be the most effective method to reduce the negative effects of sexual dysfunction on the health and wellbeing of men over 50.

Cigarette smoking and erectile dysfunction: an updated review with a focus on pathophysiology, e-cigarettes, and smoking cessation

Introduction

Cigarette smoking has major health implications and causes substantial damage to all organ systems. Approximately one-third of men are active smokers worldwide, and most men are unaware that cigarette smoking can contribute to erectile dysfunction (ED).

Objectives

This article aims to provide a comprehensive overview of research conducted on cigarette smoking and ED, with a particular focus on pathophysiology, electronic cigarettes (e-cigarettes), and smoking cessation.

Methods

A manual literature search was conducted on all research conducted on cigarette smoking and ED up to October 2022.

Results

Substantial evidence is now available showing that past and current cigarette smoking has dose-dependent associations with ED in studies controlling for age and important health comorbidities. Cigarette smoke contains nicotine, carbon monoxide, oxidant chemicals, and metals that can damage the endothelium and disrupt erectile processes. For current smokers, smoking abstinence can strengthen the endothelium and reverse diminished erectile function. The effect of e-cigarettes on endothelial damage and ED remains largely untested. E-cigarettes expose users to fine and ultrafine particles and toxins that can increase risk of cardiovascular injury, but these acute effects appear less potent than conventional cigarettes (long-term cardiovascular effects are still unknown). E-cigarettes are therefore likely to have less harmful effects on ED than conventional cigarettes.

Conclusions

Smoking cessation programs that focus on nicotine replacement therapy (transdermal patches, gum, or inhalers), behavioral counseling, social support, and education programs can be effective approaches to ED treatment in active smokers. Temporarily transferring from regular cigarettes to e-cigarettes—which transmit some of the same carcinogens as conventional cigarettes and are likely to have some long-term cardiovascular effects that disrupt erectile function—might also be useful for long-term smoking cessation and treatment of ED.

Endothelial Dysfunction, Erectile Deficit and Cardiovascular Disease: An Overview of the Pathogenetic Links

Erectile dysfunction (ED) is a condition with multifactorial pathogenesis, quite common among men, especially those above 60 years old. A vascular etiology is the most common cause. The interaction between chronic inflammation, androgens, and cardiovascular risk factors determines macroscopically invisible alterations such as endothelial dysfunction and subsequent atherosclerosis and flow-limiting stenosis that affects both penile and coronary arteries. Thus, ED and cardiovascular disease (CVD) should be considered two different manifestations of the same systemic disorder, with a shared aetiological factor being endothelial dysfunction. Moreover, the penile arteries have a smaller size compared with coronary arteries; thus, for the same level of arteriopathy, a more significant blood flow reduction will occur in erectile tissue compared with coronary circulation. As a result, ED often precedes CVD by 2–5 years, and its diagnosis offers a time window for cardiovascular risk mitigation. Growing evidence suggests, in fact, that patients presenting with ED should be investigated for CVD even if they have no symptoms. Early detection could facilitate prompt intervention and a reduction in long-term complications. In this review, we provide an overview of the pathogenetic mechanisms behind arteriogenic ED and CVD, focusing on the role of endothelial dysfunction as the common denominator of the two disorders. Developed algorithms that may help identify those patients complaining of ED who should undergo detailed cardiologic assessment and receive intensive treatment for risk factors are also analyzed.

The impact of smoking on sexual function

OBJECTIVES

To evaluate the hypothesis that there is an improvement in sexual function following smoking cessation (as smoking is a well-established risk factor for sexual dysfunction), we analysed the association between cigarette smoking and smoking cessation with sexual function among participants of the REduction by DUtasteride of prostate Cancer Events (REDUCE) study.

SUBJECTS AND METHODS

We analysed baseline data of 6754 men, aged 50-75 years divided into: lifelong non-smokers, former smokers, and current smokers. We examined total testosterone (TT, normal range ≥10 nmol/L) and sexual function variables: self-reported sexual activity, low libido, and erectile dysfunction (ED). Differences between current vs non-smokers and former vs current smokers were analysed using the chi-square test, linear and logistic regressions.

RESULTS

A total of 3069 (45.4%) men were non-smokers, 2673 (39.6%) former smokers, and 1012 (15%) current smokers. Current smokers were significantly younger than former and non-smokers (mean age 61.6, 63.2, and 62.7 years, respectively), leaner (mean body mass index 27.0, 27.7, and 27.2 kg/m2 , respectively), and had less hypertension (32.4%, 41.6%, and 36.8%, respectively; all P < 0.01). In uni- and multivariable analysis, current smokers had higher mean TT than non-smokers (485.4 vs 451.2 nmol/L, P < 0.001), higher prevalence of low libido (25.6% vs 21.0%, P = 0.002) and ED (31.6% vs 26.0%, P < 0.001) with comparable sexual activity (81.7% vs 82.8%, P = 0.420). In multivariable analysis, former smokers had statistically significantly less prevalence of low libido (odds ratio [OR] 0.8, P = 0.013) and ED (OR 0.8, P = 0.006) compared to current smokers.

CONCLUSION

Cigarette smoking was associated with worse sexual health compared to non-smokers, while former smokers had better erectile function and libido than current smokers. Smoking cessation may improve male sexual health and counselling on smoking cessation may be considered at the time of sexual health evaluations.

An objective correlation of specific haematological parameters with ED severity

This study aims to investigate the role of nocturnal penile tumescence and rigidity (NPTR) and laboratory features in patients with mild, moderate and severe ED and then explored the correlation between ED severity with certain blood count parameters such as WBC and NLR. A total of 86 ED patients (age 29.8 ± 7.09 years) were enrolled. Classification of ED severity according to IIEF-5 scores was as follows: mild ED, 43.02% (37/86); moderate ED, 27.91% (24/86) and severe ED, 29.07% (25/86). Patients with moderate and severe ED had declined IIEF-5 scores and increased GAD-7 and PHQ-9 scores compared with mild ED. The mean NLR value of the mild, moderate and severe ED groups was 1.43 ± 0.39, 1.74 ± 0.45 and 2.0 ± 0.58, respectively. Stratification analysis according to NPTR results indicated that there was a significant difference in WBC and NLR between the two groups. Patients with abnormal NPTR had increased WBC and NLR levels compared with the normal groups. Multivariate logistic regression analysis suggested that severe ED (OR [95% CI]: 5.736 [1.248-26.354]), WBC (OR [95% CI]: 1.676 [1.094-2.567]) and NLR (OR [95% CI]: 5.595 [1.478-21.178]) were identified as independent risk factors for severe ED (abnormal NPTR results). In conclusion, this study indicates a significant difference in NLR, PLR, PDW, MPV and HDL between the mild, moderate and severe ED groups. The WBC and NLR are significantly increased in patients with severe ED (abnormal NPTR results) and it can be available as a quick, easy and cheap investigation compared with the RigiScan to evaluate the severity of ED with good sensitivity and specificity, which is important for the diagnosis and evaluation of ED.

Prevalence and Pattern of Sexual Dysfunction in Male Patients with Alcohol Dependence

Background

Alcohol is a potent substance that causes both acute and chronic changes in almost all neurochemical systems, with the result that heavy drinking can produce serious psychological symptoms including depression, anxiety, and psychoses. It also affects sexual health adversely and causes sexual dysfunction.

Methods

This study aimed to find the prevalence and pattern of sexual dysfunction in male patients with alcohol dependence. This cross-sectional study included 100 patients attending psychiatry out patient department (OPD) at a tertiary care center in west India. Informed written consent was taken for collecting socio-demographic and clinical data in a uniform and standard manner. Sexual dysfunction was assessed using a sexual dysfunction checklist, constructed by Arackal and Benegal at the national institute of mental health and neuroscience, Bangalore containing 12 items from the diagnostic criteria for research and ICD-10 classification of mental and behavioral disorders. The Leeds dependence questionnaire was used to assess the severity of alcohol dependence.

Findings

Sexual dysfunction was present in 62% of the patients. Among the patients, 36% had difficulty achieving an erection, 34% had difficulty maintaining an erection, 37% reported premature ejaculation, 7% had delayed ejaculation, 14% reported anorgasmia, 1% had ejaculation with a flaccid penis, 2% had pain during intercourse, 6% were dissatisfied with the frequency of intercourse, 4% were dissatisfied with their sexual partner, and 7% were dissatisfied with their performance.

Conclusion

Sexual dysfunction is significantly and positively associated with duration, amount of alcohol consumed per day, and severity of alcohol dependence.

Perspectives on sexual history taking in routine primary care consultations in North West, South Africa: Disconnect between patients and doctors

Background: Sexual history is rarely taken in routine consultations and research reported on common barriers that doctors experience, such as gender, age and cultural differences. This article focuses on how patients and doctors view sexual history taking during a consultation and their perspectives on barriers to and facilitators of sexual history taking.Aim: This study aimed to explore doctors’ and patients’ perspectives on sexual history taking during routine primary care consultations with patients at risk of sexual dysfunction.Setting: The research was conducted in primary care facilities in the Dr Kenneth Kaunda Health District, North West province.Methods: This was part of grounded theory research, involving 151 adult patients living with hypertension and diabetes and 21 doctors they consulted. Following recording of routine consultations, open-ended questions on the demographic questionnaire and brief interactions with patients and doctors were documented and analysed using open inductive coding. The code matrix and relations browsers in MaxQDA software were used.Results: There was a disconnect between patients and doctors regarding their expectations on initiating the discussion on sexual challenges and relational and clinical priorities in the consultation. Patients wanted a doctor who listens. Doctors wanted patients to tell them about sexual dysfunction. Other minor barriers included gender, age and cultural differences and time constraints.Conclusion: A disconnect between patients and doctors caused by the doctors’ perceived clinical priorities and screening expectations inhibited sexual history taking in a routine consultation in primary care.

Cardiovascular/Stroke Risk Assessment in Patients with Erectile Dysfunction-A Role of Carotid Wall Arterial Imaging and Plaque Tissue Characterization Using Artificial Intelligence Paradigm: A Narrative Review

PURPOSE

The role of erectile dysfunction (ED) has recently shown an association with the risk of stroke and coronary heart disease (CHD) via the atherosclerotic pathway. Cardiovascular disease (CVD)/stroke risk has been widely understood with the help of carotid artery disease (CTAD), a surrogate biomarker for CHD. The proposed study emphasizes artificial intelligence-based frameworks such as machine learning (ML) and deep learning (DL) that can accurately predict the severity of CVD/stroke risk using carotid wall arterial imaging in ED patients.

METHODS

Using the PRISMA model, 231 of the best studies were selected. The proposed study mainly consists of two components: (i) the pathophysiology of ED and its link with coronary artery disease (COAD) and CHD in the ED framework and (ii) the ultrasonic-image morphological changes in the carotid arterial walls by quantifying the wall parameters and the characterization of the wall tissue by adapting the ML/DL-based methods, both for the prediction of the severity of CVD risk. The proposed study analyzes the hypothesis that ML/DL can lead to an accurate and early diagnosis of the CVD/stroke risk in ED patients. Our finding suggests that the routine ED patient practice can be amended for ML/DL-based CVD/stroke risk assessment using carotid wall arterial imaging leading to fast, reliable, and accurate CVD/stroke risk stratification.

SUMMARY

We conclude that ML and DL methods are very powerful tools for the characterization of CVD/stroke in patients with varying ED conditions. We anticipate a rapid growth of these tools for early and better CVD/stroke risk management in ED patients.

Homocysteine levels correlate with velocimetric parameters in patients with erectile dysfunction undergoing penile duplex ultrasound

INTRODUCTION

Hyperhomocysteinemia may contribute to the development of endothelial dysfunction and, consequently, atherosclerosis, a systemic disease involving the vessels that may affect the cavernous arteries leading to vasculogenic erectile dysfunction. Our study aims therefore to explore the relationship between homocysteine levels and velocimetric parameters detected by basal penile duplex ultrasound such as peak systolic velocity and flaccid penile acceleration in patients with erectile dysfunction.

METHODS

A cross-sectional study was conducted collecting clinical, metabolic, hormonal, and instrumental (basal penile duplex ultrasound) data in patients affected by vasculogenic erectile dysfunction.

RESULTS

Data of 126 subjects affected by erectile dysfunction were collected. Mean age was 52.1 ± 12.6 years, whereas mean body mass index was 25.6 ± 4.0 kg/m² . Basal penile duplex ultrasound showed peak systolic velocity values of 13.1 ± 2.9 cm/s and mean flaccid penile acceleration of 2.28 ± 0.70 m/s² , with a strong correlation among these two parameters (r = 0.690; p < 0.001). Frankly pathological values of peak systolic velocity and flaccid penile acceleration were detected in 39.7% and 4.8% of the subjects examined, respectively. Mean homocysteine levels were 14.9 ± 9.5 μmol/l. Homocysteine values >15 μmol/l were found in 26% of the subjects with erectile dysfunction. Peak systolic velocity values and homocysteine levels showed an inverse correlation (r = -0.213; p = 0.03). Similarly, flaccid penile acceleration values were inversely correlated to homocysteine levels (r = -0.199; p = 0.05). In addition, an inverse correlation was found between both peak systolic velocity and flaccid penile acceleration and body mass index, atherogenic lipid pattern, and age. Homocysteine and metabolic parameters showed no significant correlations.

CONCLUSION

Hyperhomocysteinemia is highly prevalent in erectile dysfunction patients. The results of our study show that homocysteine levels correlate with velocimetric parameters assessed by basal penile duplex ultrasound, confirming the role of hyperhomocysteinemia in the genesis of erectile dysfunction of arterial origin.

Contemporary cost-analysis comparison of direct-to-consumer vs. traditional prescriptions of phosphodiesterase-5 inhibitors

After a focused telehealth visit, patients can now access phosphodiesterase-5 inhibitor (PDE5 inhibitor) prescriptions through online direct-to-consumer (DTC) healthcare companies. This study seeks to quantify the cost of DTC PDE5 inhibitor treatment compared to a traditional physician visit and local pharmacy prescription. Two DTC companies, two compounding pharmacies with national reach, three online Canadian pharmacies, and sixteen American pharmacy chains were queried for prices of 90-day regimens of common PDE5 inhibitors. Prices for chains were determined using their publicly available price on GoodRx^® with coupon. Cost of physician visit was determined using 2020 Center for Medicare and Medicaid Services reimbursement for a level 3 new patient visit. For sildenafil 20 mg, a physician visit and local prescription cost a low of $125.45 compared to $144.35 for compounding, $169.34 for Canadian, and $195.00 for DTC. For sildenafil 100 mg, a physician visit and local prescription cost a low of $137.16 compared to $289.35 for compounding, $200.36 for Canadian, and $900.00 for DTC. For tadalafil 5 mg, a physician visit and local prescription cost a low of $125.80 compared to $169.35 for compounding, $195.34 for Canadian, and $720.00 for DTC. For tadalafil 20 mg, a physician visit and local prescription cost a low of $161.00 compared to $289.35 for compounding, $229.00 for Canadian, and $2880.00 for DTC. Thus, local pharmacies, in conjunction with online coupons, consistently provide a markedly less-expensive option for fulfillment of PDE5 inhibitor prescriptions than online DTC services.

Diabetes associated with hypertension exacerbated oxidative stress-mediated inflammation, apoptosis and autophagy leading to erectile dysfunction in rats

BACKGROUND

Diabetes or hypertension contributes to erectile dysfunction (ED). We hypothesized that excess reactive oxygen species (ROS) production evoked by diabetes combined with hypertension may further suppress endothelial nitric oxide (NO) expression/activity and promote oxidative stress in the ED penis.

METHODS

Twenty-four adult male Wistar Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) were divided into four groups: normal WKY, diabetic WKY, normal SHR and diabetic SHR. Intraperitoneal streptozotocin (65 mg/kg) was applied to induce type I diabetes. After 4-week diabetes and/or hypertension induction, we determined the intra-cavernous pressure (ICP) using electrical stimulation of cavernous nerves, intra-cavernosum NO amount using an electrochemical NO probe, and blood ROS using an ultrasensitive chemiluminescence-amplified analyzer. Western blot analysis and immunohistochemistry were used to explore the pathophysiologic mechanisms of inflammation, apoptosis and autophagy in the penis. A novel NO donor, CysaCysd Lu-5 (CCL5, (RCH2CH2S)(R'R"CHCH2S)Fe(NO)2, 1-4 µg), was intravenously administered to these ED rats for evaluating their ICP responses.

RESULTS

In the baseline status, the lucigenin- and luminol-amplified blood ROS were significantly enhanced in the diabetic SHR rats vs normal WKY rats. Significantly decreased ICP, eNOS expression and NO amount were found in the normal SHR, diabetic WKY, and diabetic SHR vs normal WKY rats. Intravenous NO donor L-Arginine markedly increased ICP and NO amount, whereas eNOS inhibitor, Nω-Nitro-L-Arginine methyl ester hydrochloride depressed ICP in all four groups. Diabetes and/or hypertension alone increased fibrosis, proinflammatory NF-kB/ICAM-1 expression, mast cell numbers, CD68 expression and infiltration, Caspase 3-mediated apoptosis, Beclin-1/LC3-II-mediated autophagy and mild Nrf-2/HO-1 expression and depressed eNOS expression in the ED penis. The novel NO donor, CCL5, was more efficient than L-arginine to improve diabetes and/or hypertension-induced ED by the significant increase of ICP.

CONCLUSION

Diabetes combined with hypertension synergistically exacerbated ED through enhanced oxidative stress, inflammation, apoptosis and autophagy and depressed eNOS activity and NO production.

Potential Effect of the Circadian Clock on Erectile Dysfunction

The circadian rhythm is an internal timing system, which is generated by circadian clock genes. Because the circadian rhythm regulates numerous cellular, behavioral, and physiological processes, organisms have evolved with intrinsic biological rhythms to adapt the daily environmental changes. A variety of pathological events occur at specific times, while disturbed rhythms can lead to metabolic syndrome, vascular dysfunction, inflammatory disorders, and cancer. Therefore, the circadian clock is considered closely related to various diseases. Recently, accumulated data have shown that the penis is regulated by the circadian clock, while erectile function is impaired by an altered sleep-wake cycle. The circadian rhythm appears to be a novel therapeutic target for preventing and managing erectile dysfunction (ED), although research is still progressing. In this review, we briefly summarize the superficial interactions between the circadian clock and erectile function, while focusing on how disturbed rhythms contribute to risk factors of ED. These risk factors include NO/cGMP pathway, atherosclerosis, diabetes mellitus, lipid abnormalities, testosterone deficiency, as well as dysfunction of endothelial and smooth muscle cells. On the basis of recent findings, we discuss the potential role of the circadian clock for future therapeutic strategies on ED, although further relevant research needs to be performed.

The relation between obesity, kisspeptin, leptin, and male fertility

Over the past decades, obesity and infertility in men increased in parallel, and the association between both phenomena have been examined by several researchers. despite the fact that there is no agreement, obesity appears to affect the reproductive potential of men through various mechanisms, such as changes in the hypothalamic-pituitary-testicular (HPT) axis, spermatogenesis, sperm quality and/or alteration of sexual health. Leptin is a hormone produced by the adipose tissue, and its production elevates with increasing body fat. Many studies have supported the relationship between raised leptin production and reproductive function regulation. In fact, Leptin acts on the HPT axis in men at all levels. However, most obese men are insensitive to increased production of endogenous leptin and functional leptin resistance development. Recently, it has been recommended that Kisspeptin neurons mediate the leptin's effects on the reproductive system. Kisspeptin binding to its receptor on gonadotropin-releasing hormone (GnRH) neurons, activates the mammal's reproductive axis and stimulates GnRH release. Increasing infertility associated with obesity is probably mediated by the Kisspeptin-GnRH pathway. In this review, the link between obesity, kisspeptin, leptin, and male fertility will be discussed.

Preservation of Sexual Function 5 Years After Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia

Background

Erectile dysfunction (ED) and ejaculatory dysfunction (EjD) are known outcomes of traditional surgery and some pharmacotherapies for treatment of benign prostatic hyperplasia (BPH). Minimally invasive treatment options, including water vapor thermal therapy (WVTT), are now available to treat lower urinary tract symptoms (LUTS) due to BPH.

Aim

The objective of this analysis was to evaluate long-term impact of a single water vapor thermal therapy procedure on erectile and ejaculatory function in subjects enrolled in the Rezum II prospective, multicenter, randomized, blinded controlled trial.

Methods

Fifteen centers enrolled 197 subjects with International Prostate Symptom Score (IPSS) ≥ 13, maximum flow rate (Qmax) ≤ 15 mL/s, and prostate volume 30–80 cc. Subjects were randomized (2:1) to (WVTT) or sham procedure (control) and followed for 5 years. Erectile and ejaculatory functions were quantitatively assessed at baseline and yearly thereafter. After 3 months, control subjects could opt to requalify for cross-over to WVTT and were followed for 5 years. Results of the per protocol analysis were reported previously. The current post hoc analysis was performed on all treated subjects who were sexually active at baseline with no other surgical or medical management for BPH during the 5-year study period.

Outcomes

LUTS was evaluated using IPSS, Benign Prostatic Hyperplasia Impact Index (BPHII), and Qmax. Sexual function was assessed using the International Index of Erectile Function (IIEF-EF) and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD).

Results

A total of 197 subjects (136 treated, 61 control) were enrolled in the study, and 53 control subjects opted to cross-over and receive WVTT. All subgroups experienced significant, durable improvement in IPSS (P < .0001). Subjects with normal sexual function at baseline had little change in function over 5 years (IIEF-EF: −2.4 ± 8.9, P = .1414; MSHQ-EjD Function: −1.6 ± 3.2, P = .0083; MSHQ-EjD Bother: −0.5 ± 1.6, P = .1107). Subjects with baseline medical history of ED and EjD showed slight decline over time that was not clinically significant (ED, IIEF-EF: −3.0 ± 10.1, P = .1259; MSHQ EjD Function: −2.3 ± 4.7, P = .0158; MSHQ-EjD Bother: −0.1 ± 2.6, P = .7764; EjD, IIEF-EF: −4.1 ± 9.2, P = .0127; MSHQ EjD Function: −1.6 ± 4.8, P = .1970; MSHQ-EjD Bother: −0.4 ± 2.6, P = .440).

Clinical Implications

Treatment for BPH with Rezum durably improved IPSS without clinically significant impact on sexual function. Patients with baseline ED/EjD may expect continued decline from other causes but are unimpacted by the therapy.

Strengths & Limitations, Conclusion

The results are limited by the post-hoc nature of the analysis and attrition over the 5-year follow-up but provide long-term evidence of durable outcomes after treatment with Rezum without impact on sexual function scores. McVary KT, El-Arabi A, Roehrborn C. Preservation of Sexual Function 5 Years After Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia. Sex Med 2021;9:100454.

Sexual history taking: Doctors' clinical decision-making in primary care in the North West province, South Africa

BACKGROUND

Clinical reasoning is an important aspect of making a diagnosis for providing patient care. Sexual dysfunction can be as a result of cardiovascular or neurological complications of patients with chronic illness, and if a patient does not raise a sexual challenge, then the doctor should know that there is a possibility that one exists and enquire.

AIM

The aim of this research study was to assess doctors' clinical decision-making process with regards to the risk of sexual dysfunction and management of patients with chronic illness in primary care facilities of the North West province based on two hypothetical patient scenarios.

SETTING

This research study was carried out in 10 primary care facilities in Dr Kenneth Kaunda health district, North West province, a rural health district.

METHODS

This vignette study using two hypothetical patient scenarios formed part of a broader grounded theory study to determine whether sexual dysfunction as comorbidity formed part of the doctors' clinical reasoning and decision-making. After coding the answers, quantitative content analysis was performed. The questions and answers were then compared with standard answers of a reference group.

RESULTS

One of the doctors (5%) considered sexual dysfunction, but failed to follow through without considering further exploration, investigations or management. For the scenario of a female patient with diabetes, the reference group considered cervical health questions (p = 0.001) and compliance questions (p = 0.004) as standard enquiries, which the doctors from the North West province failed to consider. For the scenario of a male patient with hypertension and an ex-smoker, the reference group differed significantly by expecting screening for mental health and vision (both p = 0.001), as well as for HIV (p 0.001). The participating doctors did not meet the expectations of the reference group.

CONCLUSION

Good clinical reasoning and decision-making are not only based on knowledge, intuition and experience but also based on an awareness of human well-being as complex and multidimensional, to include sexual well-being.

Cardiovascular Disease, Hypogonadism and Erectile Dysfunction: Early Detection, Prevention and the Positive Effects of Long-Term Testosterone Treatment: Prospective Observational, Real-Life Data

Purpose

Erectile dysfunction (ED) is associated with testosterone deficiency and is a symptom of functional hypogonadism. A correlation between ED and cardiovascular disease (CVD) has been recognized, and ED has been proposed as an early marker of CVD. However, the relationship between ED and CVD risk in hypogonadism requires clarification and whether testosterone therapy (TTh) can be a beneficial treatment strategy, but long-term data are limited. This study investigates long-term TTh in men with hypogonadism and ED with a history of CVD.

Methods

Seventy-seven patients with a history of CVD and diagnosed with functional hypogonadism and erectile dysfunction (erectile function domain score <21 on the International Index of Erectile Function questionnaire (IIEF questions 1–5)) were enrolled and TTh effects on anthropometric and metabolic parameters investigated for a maximum duration of 12 years. All men received long-acting injections of testosterone undecanoate at 3-monthly intervals. Eight-year data were analysed. Data collection registry started in November 2004 till January 2015.

Results

In hypogonadal men receiving TTh, IIEF increased by 5.4 (p<0.001). Total weight loss was 23.6 ± 0.6 kg after 8 years. HbA1c had declined by an average of 2.0% (P<0.0001). Total cholesterol levels significantly declined following TTh after only 1 year (P<0.0001), and HDL increased from 1.6±0.5 at baseline to 2±0.5 mmol/L following 8 years of TTh (P<0.0001). SBP decreased from 164±14 at baseline to 133±9 mmHg, signifying a reduction of 33±1 mmHg (P<0.0001).

Conclusion

In hypogonadal men with a history of CVD, TTh improves and preserves erectile function over prolonged periods with concurrent sustained improvements in cardiometabolic risk factors. Measuring ED and testosterone status may serve as an important male health indicator predicting subsequent CVD-related events and mortality and TTh may be an effective add-on treatment in secondary prevention of cardiovascular events in hypogonadal men with a history of CVD.

Culture and purification of SD rat corpus cavernosum endothelial cells by enzymatic digestion combined with mechanical extrusion and fixed-point digestion

To explore a new method of in vitro culture and purification of rat corpus cavernosum endothelial cells (CCECs). Male Sprague-Dawley rats' penile tissue were digested with elastase or collagenase combined with mechanical extrusion to isolate and culture the CCECs. The fixed-point digestion method was used to purify the primary cells. High-purity CCECs were successfully isolated. Following the digestion of the primary CCECs by elastase or collagenase coupled with mechanical extrusion, the cells were paving stone- and cobblestone-shaped over 10 days. The cell purity yielded in the second generation (P2) CCECs after using the fixed-point digestion method was significantly high. Compared with primary CCECs extracted by elastase digestion combined with the mechanical extrusion method, CCECs cultured by collagenase digestion yielded higher purity and a more stable morphology after fixed-point digestion and purification. Immunofluorescence staining of the third generation CCECs and the expression results of endothelial cell-associated marker antibodies CD31 and VWF were positive, and flow cytometry showed the purity of CCECs was 96.9%. Enzymatic digestion combined with mechanical extrusion and fixed-point digestion is a simple, economical method for in vitro culture and purification of CCECs, which is conducive to studying the pathophysiological mechanisms of endothelial dysfunction and erectile dysfunction.

Weight Loss Through Bariatric Surgery in Men Presents Beneficial Effects on Sexual Function, Symptoms of Testosterone Deficiency, and Hormonal Profile

Introduction

Male obesity has a negative correlation with plasma testosterone (T) levels and sexual function (SF).

Aim

To evaluate the effect of weight loss through bariatric surgery (BS) on SF, low T symptoms, and hormonal profiles in obese men.

Methods

Thirty-three men who underwent BS participated in this cohort study. Before surgery, all participants underwent clinical examinations, including anthropometric, lipid, glycemic, and hormonal evaluations. SF was evaluated using the International Index of Erectile Function (IIEF) questionnaire; low T symptoms were evaluated using the Aging Males’ Symptoms (AMS) and Androgen Deficiency in the Aging Male (ADAM) questionnaires. The participants were reevaluated 6 months post-surgery.

Main outcome measures

Sex hormone profile, SF, and low T symptoms

Results

After BS, a significant increase in mean total T (201 ± 111–548 ± 190 ng/dL, P < .001), free T (5.8 ± 2.8–9.3 ± 3.4 ng/dL, P < .001), bioavailable T (110.3 ± 57.8–198.6 ± 74.3 ng/dL, P < .001), and sexual hormone-binding globulin (19.8 ± 13.7–54.6 ± 23.2 nmol/L, P < .001) levels. There was a significant decrease in estradiol (64.6 ± 27.4–29.2 ± 20.0 [pg/mL], P < .001). SF significantly improved. The total IIEF score increased 5.2 points (62.3 ± 7.4–67.5 ± 7.4, P = .004), erectile function subdomain increased 2.4 points (25.7 ± 4.1–28.1 ± 3.9, P = .011), desire subdomain increased 1.0 points (8.3 ± 1.5–9.3 ± 1.6, P = .006), and intercourse satisfaction subdomain increased 1.2 points (11.4 ± 1.9–12.6 ± 1.8, P = .012). Post-surgery, a 44% reduction (P = .001) was observed in the positive ADAM questionnaire, and improvements in all domains of the AMS questionnaire were found (P < .001).

Conclusion

Significant weight loss through BS improves erectile function, hormonal profile, and symptoms of T deficiency.

Machado FP, Rhoden EL, Pioner SR, et al. Weight Loss Through Bariatric Surgery in Men Presents Beneficial Effects on Sexual Function, Symptoms of Testosterone Deficiency, and Hormonal Profile. Sex Med 2021;9:100400.

Association of erectile dysfunction and cardiovascular disease: an umbrella review of systematic reviews and meta-analyses

OBJECTIVES

To present an overall picture of the evidence regarding the association of erectile dysfunction (ED) with cardiovascular disease (CVD).

METHODS

Systematic reviews and meta-analyses that studied the association of ED with any CVD were included in this umbrella review. We did not restrict the population to a particular group or age. PubMed, Embase, the Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, and the PROSPERO register were searched to find relevant systematic reviews, with or without meta-analyses, from inception to April 2020. The JBI Checklist for Systematic Reviews and Research Syntheses was used for the critical appraisal. Only studies with acceptable quality were included. Two independent reviewers extracted the data using the JBI data extraction tool for qualitative and quantitative data extraction.

RESULTS

The summary estimate showed a higher risk of CVD (relative risk [RR] 1.45, 95% confidence interval [CI] 1.36-1.54; P < 0.001), coronary heart disease (RR 1.50, 95% CI 1.37-1.64; P < 0.001), cardiovascular-related mortality (RR 1.50, 95% CI 1.37-1.64; P < 0.001), all-cause mortality (RR 1.25, 95% CI 1.18-1.32; P < 0.001), myocardial infarction (RR 1.55, 95% CI 1.33-1.80; P < 0.001) and stroke (RR 1.36, 95% CI 1.26-1.46; P < 0.001) in patients with ED than in other patients.

CONCLUSIONS

Our results confirm that ED is an independent predictor of CVD and their outcomes. ED and CVD are two presentations of the same physiological phenomenon. ED normally precedes symptomatic CVD, providing a window of opportunity for healthcare practitioners to screen and detect high-risk patients early to prevent avoidable morbidity and mortality.

Influencing Factors for Erectile Dysfunction of Young Adults with No Response to PDE5i

Erectile dysfunction (ED) is a common male disorder. Although orally-administered phosphodiesterase type 5 inhibitors (PDE5 inhibitors) are now recognized as the primary pharmacological treatment method for ED, 20%-30% of the patients treated with PDE5 inhibitors exhibit no significant effects. This study aims to investigate the influencing factors of ED in young adults with no response to PDE5 inhibitors. ED patients who would take PDE5 inhibitors were included and investigated with a questionnaire. Patients with no response to PDE5 inhibitors (tadalafil and sildenafil) served as study group, and those with response to PDE5 inhibitors as control group. Then Chi square test and logistic regression analysis were applied to find the potential influencing factors. In total, 378 ED patients were included. Ninety-three (24.6%) cases were non-responsive to PDE5 inhibitors, and the remaining 285 (75.4%) responded to PDE5 inhibitors. In multiple logistic regression analysis, we found that history of drinking (OR=3.152; 95%CI 1.672-6.975), spousal noncooperation (OR=2.994; 95%CI 1.589-5.638), number of fixed sex partners (OR=0.358; 95%CI 0.132-0.651), duration of ED (OR=3.356; 95%CI 1.352-8.333), and depression (OR=3.689; 95%CI 1.579-8.979) could be the influencing factors for ED patients' non-response to PDE5 inhibitors. In conclusion, history of drinking, spousal noncooperation, number of fixed sex partner, long duration of ED, and depression could be the influencing factors for ED patients' non-response to PDE5 inhibitors. Patients and doctors should pay attention to these factors.

Hypothalamic-Pituitary Diseases and Erectile Dysfunction

Several hormones contribute to ensure penile erection, a neurovascular phenomenon in which nitric oxide plays a major role. Erectile dysfunction (ED), which is defined as the persistent inability to obtain or maintain penile erection sufficient for a satisfactory sexual performance, may be due to arteriogenic, neurogenic, iatrogenic, but also endocrinological causes. The hypothalamus-pituitary axis plays a central role in the endocrine system and represents a fundamental link between the brain and peripheral glands, including gonads. Therefore, the hormonal production of the hypothalamic-pituitary axis can control various aspects of sexual function and its dysregulation can compromise erectile function. In addition, excess and deficiency of pituitary hormones or metabolic alterations that are associated with some pituitary diseases (e.g., Cushing's disease and acromegaly, hypopituitarism) can determine the development of ED with different mechanisms. Thus, the present review aimed to explore the relationship between hypothalamic and pituitary diseases based on the most recent clinical and experimental evidence.

How to Keep Sustainable Development Between Enterprises and Employees? Evaluating the Impact of Person-Organization Fit and Person-Job Fit on Innovative Behavior

High-tech industries often regard workers as their main source of value creation. In order to stimulate their employees' willingness to innovate and their innovative behavior and reduce the turnover intention, companies are now seeking to establish employer-employee relationships in which their employee's willingness to stay is not simply driven by extrinsic motivations. Therefore, it is an important topic in human resources for companies to implement measures that encourage employees to willingly devote themselves to their jobs and consider organizational growth as a component of their career development. This study aimed to investigate the effect of person-organization fit and person-job fit on employees' innovative behavior and turnover intention via the mediators including job satisfaction and organizational commitment. Six hundred ninety-seven employees from China's eight major high-tech industries were examined in this study, and the empirical results were analyzed using partial least squares. Based on the results, it is suggested that the person-organization fit and person-job fit are both crucial factors affecting employees' job satisfaction and organizational commitment, which, in turn, increase employees' willingness to innovate in their jobs and reduce their turnover intentions. Furthermore, this study could serve as a reference for companies in selecting employees, promoting job satisfaction, and developing strategies for sustainable development.

Effect of high-density lipoprotein on penile erection: A cross-sectional study

Previous studies have shown that elevated levels of high-density lipoprotein (HDL) could inhibit penile erection, but the relationship between HDL and the erection of the penile tip or base has not been extensively researched. We investigated the effects of HDL on erection of the penile tip and base through a cross-sectional study of 113 patients with erectile dysfunction, using a cut-off score of ≤21 on the International Index of Erectile Function-5. The following patient data were collected: nocturnal penile tumescence; blood pressure; platelet count; platelet distribution width; mean platelet volume; plateletcrit; and levels of serum glucose, total cholesterol, triglyceride, HDL, and low-density lipoprotein. Univariate and multivariate analyses were used to assess the association between HDL levels and the erection of the penile tip and base. We confirmed that HDL had a beneficial effect on penile erectile function. We also found that when the HDL level exceeded the normal range, the change in HDL had a significant effect on the penile base. In addition, our study did not find any relationship between platelet parameters and erection of the penile tip or penile base.

Association of erectile dysfunction with tinnitus: a nationwide population-based study

With many previous studies indicating a higher prevalence of sexual problems in patients with tinnitus, the association between tinnitus and erectile dysfunction (ED) has become an interesting topic that warrants further research. In our study, we hypothesized that tinnitus may be associated with ED and aimed to further explore the relationship between these two medical conditions using a nationwide population-based database. After retrieving data of 19,329 patients with ED and 19,329 propensity score-matched patients without ED (controls) from Taiwan’s National Health Insurance Dataset, we defined the diagnosis date (the date of the first ED claim) for patients with ED as the index date for cases, and the date of the first utilization of ambulatory care by patients without ED during the index year of their matched case as the index date for controls. We found that 1247 out of 38,658 sampled patients (3.23%) had received a tinnitus diagnosis within the year before the index date, with 792 (4.10%) from cases and 455 (2.35%) from controls. We then utilized multiple logistic regression analysis and observed that cases were more likely to have had a prior tinnitus diagnosis compared to controls (OR 1.772; 95% CI 1.577–1.992; p < 0.001). Lastly, we adjusted the data for co-morbid medical disorders and social economic factors, with the end results showing that cases were more likely than controls to have a prior diagnosis of tinnitus (OR 1.779, 95% CI 1.582–2.001, p < 0.001). Through our investigation, we have ultimately detected a novel association between ED and tinnitus and urge physicians to be alert to the possibility of the development of ED in patients treated for tinnitus.

Frequency and anatomic distribution of arterial obstructions in patients with vasculogenic erectile dysfunction not responding to intracavernous prostaglandin

Background: The extent of arterial disease in patients with erectile dysfunction (ED) non-responsive to intracavernosal injection of Alprostadil is of importance for therapeutic options. However, published evidence, in particular angiographically validated is scarce. Here we investigated arterial lesion patterns in this specific patient cohort by selective angiography. Patients and methods: A cohort of 239 patients received a clinical and duplex-sonographic workup for ED of suspected vascular origin. Duplex ultrasound of the cavernosal arteries was performed after intracavernosal injection of 10 μg Alprostadil. Consequently, standardized workup included grading of the erectile and determination of peak systolic velocity (PSV) and end-diastolic velocity (EDV) in both cavernosal arteries. PSV-values below 30 cm/sec indicated reduced arterial flow, whereas EDV-values above 15 cm/sec indicated a venous leak of the pudendal veins. All patients with suspected arterial ED based on duplex sonography underwent contrast-enhanced computed tomography. Endovascular therapy was carried out in ED patients not responsive or with significant side effects to PDE-5-inhibitors or Alprostadil by selective angiographic depiction of erection-related arteries. Results: 54 patients with a mean age of 61.2 (±9.8) years underwent angioplasty of erectionr elated arteries. Out of these 48/54 (89%) patients presented with an erection considered insufficient for penetration (E0-E3) subsequent to intracavernous application of 10 μg Alprostadil. 14/48 (29%) patients had bilateral arterial obstructions and 34/48 (71%) had unilateral disease. Commonly affected was the internal pudendal artery (n = 31, 65%), followed closely by the common penile artery (n = 30, 64%). The least affected arteries were the dorsal penile (n = 6, 13%), hypogastric (n = 4, 8%), common iliac (n = 4, 8%), cavernosal (n = 4, 8%), and inferior gluteal (n = 1, 2%) arteries. Conclusions: Arterial obstructions amenable to endovascular revascularization are frequent in patients non-responsive to intracavernosal prostaglandin administration. Therapeutic strategies in ED patients non-responsive to conservative measures should therefore consider endovascular treatment opportunities.

Lifestyle in urology: Benign diseases

Modifiable lifestyle-related risk factors are the object of increasing attention, with a view to primary and tertiary prevention, to limit the onset and development of diseases.Also in the urological field there is accumulating evidence of the relationship between urological diseases and lifestyle-related risk factors that can influence their incidence and prognosis. Risk factors such as nutrition, physical activity, sexual habits, tobacco smoking, or alcohol consumption can be modified to limit morbidity and reduce the social impact and the burdensome costs associated with diagnosis and treatment.This review synthesizes the current clinical evidence available on this topic, trying to satisfy the need for a summary on the relationships between the most important lifestyle factors and the main benign urological diseases, focusing on benign prostatic hyperplasia (BPH), infections urinary tract (UTI), urinary incontinence (UI), stones, erectile dysfunction, and male infertility.

Erectile Dysfunction in a Sample of Sexually Active Young Adult Men from a U.S. Cohort: Demographic, Metabolic and Mental Health Correlates

PURPOSE

Little is understood about physiological and psychological correlates of erectile dysfunction among younger men. We examined prevalence and correlates of erectile dysfunction in a large U.S. sample of 18 to 31-year-old men.

MATERIALS AND METHODS

Erectile dysfunction prevalence and severity (defined using the International Index of Erectile Function-5 scale) were examined in cross-sectional survey data from 2,660 sexually active men, age 18 to 31 years, from the 2013 Growing Up Today Study. Erectile dysfunction medication and supplement use were self-reported. Multivariable models estimated associations of moderate-to-severe erectile dysfunction with demographic (age, marital status), metabolic (body mass index, waist circumference, history of diabetes, hypertension, hypercholesterolemia) and mental health (depression, anxiety, antidepressant use, tranquilizer use) variables.

RESULTS

Among sexually active men 11.3% reported mild erectile dysfunction and 2.9% reported moderate-to-severe erectile dysfunction. Married/partnered men had 65% lower odds of erectile dysfunction compared to single men. Adjusting for history of depression, antidepressant use was associated with more than 3 times the odds of moderate-to-severe erectile dysfunction. Anxiety was associated with greater odds of moderate-to-severe erectile dysfunction, as was tranquilizer use. Few men (2%) reported using erectile dysfunction medication or supplements. However, among them, 29.7% misused prescription erectile dysfunction medication. Limitations include reliance upon cross-sectional data and the sample's limited racial/ethnic and socioeconomic diversity.

CONCLUSIONS

Erectile dysfunction was common in a large sample of sexually active young adult men from a U.S. cohort and was associated with relationship status and mental health. Health providers should screen for erectile dysfunction in young men, and monitor use of prescription erectile dysfunction medications and supplements for sexual functioning.

Hyperhomocysteinemia: Focus on Endothelial Damage as a Cause of Erectile Dysfunction

Erectile Dysfunction (ED) is defined as the inability to maintain and/or achieve a satisfactory erection. This condition can be influenced by the presence of atherosclerosis, a systemic pathology of the vessels that also affects the cavernous arteries and which can cause an alteration of blood flow at penile level. Among the cardiovascular risk factors affecting the genesis of atherosclerosis, hyperhomocysteinemia (HHcys) plays a central role, which is associated with oxidative stress and endothelial dysfunction. This review focuses on the biological processes that lead to homocysteine-induced endothelial damage and discusses the consequences of HHcys on male sexual function