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Xu Z, Chu W, Lei X, Chen C. Higher oxidative balance score was associated with decreased risk of erectile dysfunction: a population-based study. Nutr J 2024; 23:54. [PMID: 38760760 PMCID: PMC11102141 DOI: 10.1186/s12937-024-00956-y] [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: 03/17/2023] [Accepted: 05/02/2024] [Indexed: 05/19/2024] Open
Abstract
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.
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Affiliation(s)
- Zhixiao Xu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weiwei Chu
- Department of Pulmonary and Critical Care Medicine, The Lu 'an People's Hospital of Anhui Province, The Lu 'an Hospital Affiliated to Anhui Medical University, Lu 'an, China
| | - Xiong Lei
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chengshui Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- Key Laboratory of Interventional Pulmonology of Zhejiang Province, Wenzhou, China.
- Zhejiang Province Engineering Research Center for Endoscope Instruments and Technology Development, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China.
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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] [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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Duarte Romero B, Waterhouse M, Baxter C, McLeod DSA, English DR, Armstrong BK, Chung E, Ebeling PR, Hartel G, van der Pols JC, Roberts M, Venn AJ, Webb PM, Whiteman DC, Neale RE. The effect of three years of vitamin D supplementation on erectile dysfunction: Results from the randomized placebo-controlled D-Health Trial. Clin Nutr ESPEN 2024; 60:109-115. [PMID: 38479897 DOI: 10.1016/j.clnesp.2024.01.011] [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: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS Erectile dysfunction is common among older men and has been associated with low serum 25-hydroxy vitamin D concentration. However, this association may be due to uncontrolled confounding, and there is a paucity of evidence from interventional studies. We aimed to examine the effect of vitamin D supplementation on the prevalence of erectile dysfunction, in an exploratory analysis using data from a large randomized controlled trial. METHODS The D-Health Trial recruited Australians aged 60-84 years between January 2014 and May 2015 and randomly assigned them to supplementation with 60,000 IU of vitamin D or placebo per month for up to 5 years. Blood samples were collected annually from randomly selected participants (total N = 3943). We assessed erectile dysfunction at the end of the third year of follow-up. We used log-binomial regression to examine the effect of vitamin D on the prevalence of erectile dysfunction overall, and within sub-groups. RESULTS Of the 11,530 men enrolled, 8920 (77.4 %) completed the erectile dysfunction question and were included in the analysis. After three years of supplementation, the mean serum 25-hydroxy vitamin D concentration was 76 nmol/L (standard deviation (SD) 24.94) in the placebo group and 106 nmol/L (SD 26.76) in the vitamin D group (p < 0.0001). The prevalence of erectile dysfunction was 58.8 % and 59.0 % in the vitamin D and placebo groups, respectively (prevalence ratio 1.00, 95 % CI 0.97, 1.03); there was no evidence of an effect of vitamin D in any subgroup analyses. CONCLUSION Supplementing older men with vitamin D is unlikely to prevent or improve erectile dysfunction. CLINICAL TRIALS REGISTRY (ACTRN12613000743763).
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Affiliation(s)
- Briony Duarte Romero
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Mary Waterhouse
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Catherine Baxter
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Donald S A McLeod
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Dallas R English
- Melbourne School of Population Health, University of Melbourne, Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia
| | | | - Eric Chung
- University of Queensland, Department of Urology, Princess Alexadra Hospital, Brisbane, Australia; AndroUrology Centre, Brisbane, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Gunter Hartel
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jolieke C van der Pols
- Queensland University of Technology (QUT), Faculty of Health, School of Exercise and Nutrition Sciences, Brisbane, Australia
| | - Matthew Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Penelope M Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - David C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - Rachel E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia.
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Lin W, Lin ME. Novel anthropometric measures are positively associated with erectile dysfunction: a cross-sectional study. Int Urol Nephrol 2024; 56:855-865. [PMID: 37843775 DOI: 10.1007/s11255-023-03840-6] [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: 07/10/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Currently, a growing number of research studies have shown a positive association between obesity and erectile dysfunction, while traditional anthropometric measures, such as BMI, have limited ability to assess the risk of erectile dysfunction. Therefore, this study aimed to investigate the association between the new anthropometric index and erectile dysfunction. METHODS A study involving 3594 participants from the National Health and Nutrition Examination Survey was conducted. The study calculated various anthropometric indices such as waist circumference (WC), waist-to-height ratio (WtHR), body mass index (BMI), a body shape index (ABSI), conicity index (CI), and body roundness index (BRI). The relationship between anthropometric indices and erectile dysfunction (ED) was investigated using multivariate logistic regression and restricted cubic splines (RCS). Interaction analysis was conducted on subgroups to confirm the findings. Additionally, the efficacy of various anthropometric indicators in predicting the risk of erectile dysfunction was assessed using the receiver operating characteristic curve (ROC). RESULTS After adjusting for potential confounding factors, we identified a positive and independent correlation between erectile dysfunction (ED) and all other anthropometric measures except for BMI. Additionally, the risk of ED increased by 49% and 42% for each standard deviation increment in ABSI and CI, respectively. Dose-response curve analysis demonstrated that WC, BMI, WtHR, and CI displayed a non-linear correlation with the risk of ED. The subgroup analysis revealed that individuals classified as White, who had higher levels of WC, ABSI, and CI, were more susceptible to erectile dysfunction compared to people from other races. ROC analysis showed that ABSI was superior in detecting erectile dysfunction (area under the curve: 0.750; 95% CI 0.732-0.768; optimal cutoff value: 0.083) as compared to other indices. The combination of obesity defined by BMI and other anthropometric measures showed that higher ABSI and CI levels were positively associated with the prevalence of erectile dysfunction, independent of BMI (P < .001). CONCLUSION In this study, anthropometric indicators including ABSI, BRI, WtHR, CI, and WC were positively associated with erectile dysfunction. To improve the prevention and treatment of this condition, it is recommended that new anthropometric indicators receive greater consideration.
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Affiliation(s)
- Weilong Lin
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, 515041, China
| | - Ming-En Lin
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, 515041, China.
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Glover F, Mehta A, Richardson M, Muncey W, Del Giudice F, Belladelli F, Seranio N, Eisenberg ML. Investigating the prevalence of erectile dysfunction among men exposed to organophosphate insecticides. J Endocrinol Invest 2024; 47:389-399. [PMID: 37574529 DOI: 10.1007/s40618-023-02155-8] [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: 03/16/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) poses a significant disease morbidity and contributor to male infertility, where an estimated 20-40% of men are affected annually. While several risk factors have been identified in the etiology of ED (e.g., aging, heart disease, diabetes, and obesity), the complete pathogenesis remains to be elucidated. Over the last few decades, the contribution of environmental exposures to the pathogenesis of ED has gained some attention, though population studies are limited and results are mixed. Among environmental contaminants, organophosphate (OP) insecticides represent one of the largest chemical classes, and chlorpyrifos is the most commonly used OP in the U.S. OP exposure has been implicated in driving biological processes, including inflammation, reactive oxygen species production, and endocrine and metabolism disruption, which have been demonstrated to adversely affect the hypothalamus and testes and may contribute to ED. Currently, studies evaluating the association between OPs and ED within the U.S. general population are sparse. METHODS Data were leveraged from the National Health and Nutrition Examination Survey (NHANES), which is an annually conducted, population-based cross-sectional study. Urinary levels of 3,5,6-trichloro-2-pyridinol (TCPy), a specific metabolite of the most pervasive OP insecticide chlorpyrifos, were quantified as measures of OP exposure. ED was defined by responses to questionnaire data, where individuals who replied "sometimes able" or "never able" to achieve an erection were classified as ED. Chi-square, analysis of variance (ANOVA), and multivariable, weighted linear and logistic regression analyses were used to compare sociodemographic variables between quartiles of TCPy exposure, identify risk factors for TCPy exposure and ED, and to analyze the relationship between TCPy and ED. RESULTS A total of 671 adult men were included in final analyses, representing 28,949,379 adults after survey weighting. Approximately 37% of our cohort had ED. Smoking, diabetes, aging, Mexican-American self-identification, and physical inactivity were associated with higher ED prevalence. Analysis of TCPy modeled as a continuous variable revealed nonsignificant associations with ED (OR = 1.02 95% CI [0.95, 1.09]). Stratification of total TCPy into quartiles revealed increased odds of ED among adults in the second and fourth quartiles, using the first quartile as the reference (OR = 2.04 95% CI [1.11, 3.72], OR = 1.51 95% CI [0.58, 3.93], OR = 2.62 95% CI [1.18, 5.79], for quartiles 2, 3, and 4, respectively). CONCLUSIONS The results of our study suggest a potential role for chlorpyrifos and other OPs the pathogenesis of ED. Future studies are warranted to validate these findings, determine clinical significance, and to investigate potential mechanisms underlying these associations.
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Affiliation(s)
- F Glover
- Emory University School of Medicine, Atlanta, GA, 30322, USA.
| | - A Mehta
- Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - M Richardson
- Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - W Muncey
- Department of Urology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - F Del Giudice
- Department of Urology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - F Belladelli
- Department of Urology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - N Seranio
- Department of Urology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - M L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, 94305, USA
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Lin WL, Zheng C, Wang HX, Zhang W, Lin ME. Relationship between dietary niacin intake and erectile dysfunction: a population-based study. Asian J Androl 2024:00129336-990000000-00159. [PMID: 38305697 DOI: 10.4103/aja202378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/11/2023] [Indexed: 02/03/2024] Open
Abstract
ABSTRACT Existing research on the precise link between dietary niacin intake and erectile dysfunction (ED) is scarce. Thus, this study aimed to investigate the potential association between dietary niacin intake and the risk of ED. Multivariate logistic regression and restricted cubic splines (RCSs) were used to examine the relationship between dietary niacin intake and ED. Subgroup interaction analysis was performed to assess the impact of different subgroups on the study outcomes. In addition, 1:1 propensity score matching (PSM) was employed to adjust for potential confounding factors, ensuring the reliability of the results. The analyzed data were collected from the 2001-2004 National Health and Nutrition Examination Survey (NHANES) in the USA. The study encompassed 3184 adults, among whom 863 participants were identified as having ED. Following adjustments for potential confounders, the findings revealed that higher niacin intake, specifically in the highest tertile, was associated with a decreased risk of ED compared to that in the lowest tertile, showing an odds ratio (OR) of 0.56 (95% confidence interval [CI]: 0.37-0.85). Analysis of dose-response curves illustrated a negative correlation between dietary niacin intake and the risk of ED. Subgroup and interaction analyses fortified the consistency of these results. Furthermore, PSM corroborated the validity of the findings. This study suggests an inverse association between dietary niacin intake and the risk of ED. However, establishing a cause-and-effect relationship remains elusive, and defining the safe threshold of niacin intake to prevent ED requires further investigation.
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Affiliation(s)
- Wei-Long Lin
- Department of Urology, The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou 515041, China
| | - Cheng Zheng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510260, China
| | - Hao-Xu Wang
- Department of Urology, The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou 515041, China
| | - Wei Zhang
- Department of Urology, The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou 515041, China
| | - Ming-En Lin
- Department of Urology, The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou 515041, China
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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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Cao S, Hu X, Shao Y, Wang Y, Tang Y, Ren S, Li X. Relationship between weight-adjusted-waist index and erectile dysfunction in the United State: results from NHANES 2001-2004. Front Endocrinol (Lausanne) 2023; 14:1128076. [PMID: 37181040 PMCID: PMC10167952 DOI: 10.3389/fendo.2023.1128076] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Objective The purpose of this study is to examine the association between a novel adiposity parameter, the weight-adjusted-waist index (WWI), and erectile dysfunction (ED). Methods According to National Health and Nutrition Examination Survey (NHANES) 2001-2004, a total of 3884 participants were categorized as ED and non-ED individuals. WWI was calculated as waist circumference (WC, cm) divided by the square root of weight (kg). Weighted univariable and multivariable logistic regression models were conducted to assess the correlation between WWI and ED. Smooth curve fitting was utilized to examine the linear association. The receiver operating characteristic (ROC) curve and DeLong et al.'s test were applied to compare the area under curve (AUC) value and predictive power among WWI, body mass index (BMI), and WC for ED. Results WWI was positively related to ED with the full adjustment [odds ratio (OR)=1.75, 95% confidence interval (95% CI): 1.32-2.32, p=0.002]. After converting WWI to a categorical variable by quartiles (Q1-Q4), compared to Q1 the highest WWI quartile was linked to an obviously increased likelihood of ED (OR=2.78, 95% CI: 1.39-5.59. p=0.010). Subgroup analysis revealed the stability of the independent positive relationship between WWI and ED. It was shown that WWI had a stronger prediction for ED (AUC=0.745) than BMI (AUC=0.528) and WC (AUC=0.609). Sensitivity analysis was performed to verify the significantly positive connection between WWI and stricter ED (OR=2.00, 95% CI: 1.36-2.94, p=0.003). Conclusion An elevated WWI was related to higher risks of ED in the United State adults, and a stronger predictive power of WWI for ED was observed than BMI and WC.
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Affiliation(s)
- Shangqi Cao
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Xu Hu
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yanxiang Shao
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yaohui Wang
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yaxiong Tang
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Shangqing Ren
- Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Xiang Li
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
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Liu RJ, Li SY, Xu ZP, Yu JJ, Mao WP, Sun C, Xu B, Chen M. Dietary metal intake and the prevalence of erectile dysfunction in US men: Results from National Health and Nutrition Examination Survey 2001-2004. Front Nutr 2022; 9:974443. [PMID: 36407550 PMCID: PMC9668876 DOI: 10.3389/fnut.2022.974443] [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: 06/24/2022] [Accepted: 10/20/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Erectile dysfunction (ED) mainly affects men over 40 years of age and is a common clinical condition. In addition to hypertension and diabetes, environment, and lifestyle are also significantly associated with erectile dysfunction. The relationship between dietary trace metal intake and ED has not been studied. MATERIALS AND METHODS Data on participants were obtained from the National Health and Nutrition Examination Survey for this study, and those with incomplete information on clinical variables were excluded. Dose-response curve analysis was used to investigate the relationship between dietary trace metal intake and ED prevalence. Multivariate logistic regression analysis was used to adjust for confounders to further investigate the relationship between dietary trace metal intake and ED prevalence. 1:1 propensity score matching (PSM) was performed to adjust for differences between clinical variables for data reanalysis to confirm the reliability of the results. RESULTS A total of 3,745 individuals were included in the study, including 1096 ED patients and 2,649 participants without ED. Dietary intake of trace metals (Mg, Zn, Cu, and Se) was significantly higher in participants without ED than in ED patients (all P < 0.001). Dose-response curve analysis showed a significant negative association between these dietary metal intakes and ED prevalence (all P < 0.001). Multivariate logistic regression analysis adjusted for confounders (age, education, BMI, annual household income, hypertension, diabetes, marital status, race, and current health status) revealed that increased dietary metal intake reduced the odds ratio of ED. 1:1 PSM reanalysis further confirmed the validity of the results. CONCLUSION Increasing dietary intake of trace metals (magnesium, zinc, copper, and selenium) within the upper limit is beneficial in reducing the prevalence of ED.
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Affiliation(s)
- Rui-Ji Liu
- Department of Urology, People’s Hospital of Putuo District, Shanghai, China
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Shu-Ying Li
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Cancer Hospital Affiliate to School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhi-Peng Xu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Jun-Jie Yu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Wei-Pu Mao
- Department of Urology, People’s Hospital of Putuo District, Shanghai, China
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Chao Sun
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Bin Xu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
- Nanjing Lishui District People’s Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
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Liu C, Mao W, You Z, Xu B, Chen S, Wu J, Sun C, Chen M. Associations between exposure to different heavy metals and self-reported erectile dysfunction: a population-based study using data from the 2001-2004 National Health and Nutrition Examination Survey. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:73946-73956. [PMID: 35643996 DOI: 10.1007/s11356-022-20910-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
Heavy metals are ubiquitous and nonbiodegradable pollutants that are widely distributed in the environment. Heavy metal exposure can damage various biological tissues and cause several diseases. This study aimed to investigate the association between blood and urinary cadmium, lead, and mercury levels and erectile dysfunction (ED) based on data from the 2001-2004 National Health and Nutrition Examination Survey. In total, 3681 participants were included in the analysis. Results showed that participants with ED had high blood cadmium, mercury, creatinine, urinary lead, cadmium levels, low blood lead, serum cotinine, and urinary mercury levels. Multivariate logistic regression analysis showed that only blood cadmium level was an independent risk factor of ED (tertile [T]2 vs T1: odds ratio = 1.495, 95% confidence interval: 1.181-1.892, p = 0.001; T3 vs T1: odds ratio = 2.089, 95% confidence interval: 1.554-2.809, p < 0.001). The dose-response curve showed a positive nonlinear association between blood cadmium and lead levels and ED and a negative nonlinear association between blood and urinary mercury levels and ED after propensity score matching. In conclusion, heavy metal exposure is closely correlated with the development of ED, and a high blood cadmium level is an independent risk factor of ED.
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Affiliation(s)
- Chunhui Liu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Weipu Mao
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Zonghao You
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Bin Xu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Shuqiu Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Jianping Wu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Chao Sun
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China.
- Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China.
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11
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Anderson LJ, Migula D, Abay R, Crabtree S, Graf SA, Matsumoto AM, Chauncey TR, Garcia JM. Androgens and estrogens predict sexual function after autologous hematopoietic stem cell transplant in men. Andrology 2022; 10:291-302. [PMID: 34624176 PMCID: PMC8760151 DOI: 10.1111/andr.13117] [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: 04/15/2021] [Revised: 09/07/2021] [Accepted: 09/29/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Autologous hematopoietic stem cell transplantation (AHSCT) is associated with sexual dysfunction and hypogonadism. Androgens are associated with sexual function in healthy men, but the role of estrogens is less well-known, and the association of these sex steroids with sexual function during AHSCT has not been characterized. OBJECTIVES The purpose of this study was to determine the predictive value of sex hormones before and acutely after AHSCT on sexual function recovery. MATERIALS AND METHODS We examined sex hormones and self-reported sexual function before (PRE) and 1-month post-AHSCT (MONTH1; n = 19), and sexual function again 1-year post-AHSCT in men (YEAR1; n = 15). RESULTS Sexual function decreased from PRE to MONTH1 (p ≤ 0.05) with no differences between PRE and YEAR1. Erectile dysfunction was prevalent at PRE (68.4%) and increased at MONTH1 (100%; p ≤ 0.05) but was not different between PRE and YEAR1 (60.0%). From PRE to MONTH1, total testosterone (TT), dihydrotestosterone (DHT), follicle-stimulating hormone, and sex-hormone-binding globulin (SHBG) increased (p ≤ 0.02) while estradiol (p ≤ 0.026) and estrone decreased (p ≤ 0.001). MONTH1 TT and DHT were associated with sexual function at MONTH1, while PRE SHBG, MONTH1 estradiol, and change in estrone predicted sexual function at YEAR1. DISCUSSION Sexual dysfunction is very prevalent prior to AHSCT and is transiently and severely worsened acutely after. AHSCT induces acute decreases in total and free estrogens, with SHBG increases leading to increases in total androgens, without changes in free androgens. CONCLUSION Androgens and estrogens are both adversely affected by AHSCT but may predict sexual dysfunction in this population. This supports the premise that estrogen impacts sexual function independent from androgens and that steroid hormones are associated with acute changes in sexual function in this setting. Larger, controlled trials with long-term sex hormone assessment will need to confirm the association between early changes in estrogens and long-term sexual function recovery.
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Affiliation(s)
- Lindsey J. Anderson
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, 98195, WA, USA
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, 98108, WA, USA
| | - Dorota Migula
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, 98108, WA, USA
| | - Rebecca Abay
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, 98108, WA, USA
| | - Stephanie Crabtree
- Bone Marrow Transplant Unit, Veterans Affairs Puget Sound Health Care System, Seattle, 98108, WA, USA
| | - Solomon A. Graf
- Bone Marrow Transplant Unit, Veterans Affairs Puget Sound Health Care System, Seattle, 98108, WA, USA
- Oncology, University of Washington Department of Medicine, Seattle, 98195, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, 98109, WA, USA
| | - Alvin M. Matsumoto
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, 98195, WA, USA
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, 98108, WA, USA
| | - Thomas R. Chauncey
- Bone Marrow Transplant Unit, Veterans Affairs Puget Sound Health Care System, Seattle, 98108, WA, USA
- Oncology, University of Washington Department of Medicine, Seattle, 98195, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, 98109, WA, USA
| | - Jose M. Garcia
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, 98195, WA, USA
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, 98108, WA, USA
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12
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Blamey G, Van Tassel B, Sagermann E, Stain AM, Waterhouse L, Iorio A. Sexual issues in people with haemophilia: Awareness and strategies for overcoming communication barriers. Haemophilia 2021; 28:36-41. [PMID: 34784071 PMCID: PMC9299037 DOI: 10.1111/hae.14447] [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: 07/16/2020] [Revised: 02/12/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
Introduction The Haemophilia Experiences, Results and Opportunities (HERO) Study identified sexual health as an important psychosocial issue affecting people with haemophilia (PWH) worldwide. However, sexual health is inadequately addressed at haemophilia treatment centres (HTCs), because PWH and healthcare professionals (HCPs) experience barriers to broaching the subject. There is a clear need for HCP training to support communication in this area and improve comprehensive care. Aim The Sexual Health: Strategies for Effective Communication pilot programme was trialled in Canada to assess HCP readiness and ability to discuss sexual health issues with PWH and test communication tools to facilitate these conversations. Methods The pilot programme consisted of two 3‐h sessions attended by seven HCPs from Calgary's Alberta Children's and Foothills Hospitals. The sessions included lectures and case scenarios and explained the check‐in–affirm–clarify–answer and head–heart–body tools designed by the Centre for Sexuality to aid communication. The pilot was evaluated through discussions and an online questionnaire. Results The pilot was well received by all HCP participants. Questionnaire data showed improvements in participants’ knowledge, skills and comfort level in conducting sexual health discussions. Greatest improvements were noted in knowledge (100% ‘good’ or ‘excellent’ after the pilot, compared with 29% beforehand). Importantly, 86% felt that the material presented would be applicable in clinical practice. Conclusion The Canadian pilot demonstrated the effectiveness of the proposed educational programme. The underlying principles could be adapted to similar programmes for other HTCs to facilitate sexual health discussions.
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Affiliation(s)
- Greig Blamey
- Health Sciences Centre, Winnipeg, Manitoba, Canada
| | | | | | - Ann Marie Stain
- Department of Nursing, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linda Waterhouse
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Alfonso Iorio
- Department of Health Research, Methods, Evidence, and Impact, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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13
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Grashow R, Weisskopf MG, Miller KK, Nathan DM, Zafonte R, Speizer FE, Courtney TK, Baggish A, Taylor HA, Pascual-Leone A, Nadler LM, Roberts AL. Association of Concussion Symptoms With Testosterone Levels and Erectile Dysfunction in Former Professional US-Style Football Players. JAMA Neurol 2021; 76:1428-1438. [PMID: 31449296 PMCID: PMC6714010 DOI: 10.1001/jamaneurol.2019.2664] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Question Are professional US-style football players with a history of multiple concussion symptoms more likely to report indicators of low testosterone levels or erectile dysfunction (ED)? Findings In this cross-sectional study of 3409 former players, a monotonically increasing association was found between the number of concussion symptoms and the odds of reporting an indicator of low testosterone level and ED. Meaning Concussion symptoms among former football players were associated with low testosterone levels and ED indicators, suggesting that men with a history of head injury may benefit from discussions with their health care clinicians regarding these treatable outcomes. Importance Small studies suggest that head trauma in men may be associated with low testosterone levels and sexual dysfunction through mechanisms that likely include hypopituitarism secondary to ischemic injury and pituitary axonal tract damage. Athletes in contact sports may be at risk for pituitary insufficiencies or erectile dysfunction (ED) because of the high number of head traumas experienced during their careers. Whether multiple symptomatic concussive events are associated with later indicators of low testosterone levels and ED is unknown. Objective To explore the associations between concussion symptom history and participant-reported indicators of low testosterone levels and ED. Design, Setting, and Participants This cross-sectional study of former professional US-style football players was conducted in Boston, Massachusetts, from January 2015 to March 2017. Surveys on past football exposures, demographic factors, and current health conditions were sent via electronic and postal mail to participants within and outside of the United States. Analyses were conducted in Boston, Massachusetts; the data analysis began in March 2018 and additional analyses were performed through June 2019. Of the 13 720 male former players eligible to enroll who were contacted, 3506 (25.6%) responded. Exposures Concussion symptom score was calculated by summing the frequency with which participants reported 10 symptoms, such as loss of consciousness, disorientation, nausea, memory problems, and dizziness, at the time of football-related head injury. Main Outcomes and Measures Self-reported recommendations or prescriptions for low testosterone or ED medication served as indicators for testosterone insufficiency and ED. Results In 3409 former players (mean [SD] age, 52.5 [14.1] years), the prevalence of indicators of low testosterone levels and ED was 18.3% and 22.7%, respectively. The odds of reporting low testosterone levels or ED indicators were elevated for previously established risk factors (eg, diabetes, sleep apnea, and mood disorders). Models adjusted for demographic characteristics, football exposures, and current health factors showed a significant monotonically increasing association of concussion symptom score with the odds of reporting the low testosterone indicator (highest vs lowest quartile, odds ratio, 2.39; 95% CI, 1.79-3.19; P < .001). The ED indicator showed a similar association (highest quartile vs lowest, odds ratio, 1.72; 95% CI, 1.30-2.27; P < .001). Conclusions and Relevance Concussion symptoms at the time of injury among former football players were associated with current participant-reported low testosterone levels and ED indicators. These findings suggest that men with a history of head injury may benefit from discussions with their health care clinicians regarding testosterone deficiency and sexual dysfunction.
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Affiliation(s)
- Rachel Grashow
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Environmental and Occupational Medicine and Epidemiology Program, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Karen K Miller
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - David M Nathan
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital Diabetes Center, Boston.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ross Zafonte
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts.,Massachusetts General Hospital, Harvard Medical School, Boston.,Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank E Speizer
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Theodore K Courtney
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Environmental and Occupational Medicine and Epidemiology Program, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Aaron Baggish
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Herman A Taylor
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia
| | - Alvaro Pascual-Leone
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lee M Nadler
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Dana Farber Cancer Institute, Boston, Massachusetts
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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14
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Yaacov D, Nelinger G, Kalichman L. The Effect of Pelvic Floor Rehabilitation on Males with Sexual Dysfunction: A Narrative Review. Sex Med Rev 2021; 10:162-167. [PMID: 33931383 DOI: 10.1016/j.sxmr.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Increasing evidence has suggested that pelvic floor exercises and manual physical therapy may improve premature ejaculation (PE) and erectile dysfunction (ED) in males. OBJECTIVES To examine the effects of pelvic floor physical therapy treatment in men suffering from PE and ED. METHODS We searched Google Scholar, PubMed, Medline, PEDro databases from inception till January 2020 applying the following keywords: pelvic floor, erectile dysfunction, impotence, physiotherapy, exercises, rehabilitation, and pelvic floor muscle exercises. RESULTS The review included 37 papers reporting on PE and ED, of which 5 were randomized controlled trials, 2 meta-analyses, and 4 observational studies. Pelvic floor physical therapy treatment included education and rehabilitation. The rehabilitation part encompassed manual therapy techniques that contribute to the normalization of muscle tone and improvement of muscle relaxation. Moreover, exercises, according to the patients' clinical assessment were presented. Most of the studies reported that by strengthening the pelvic floor muscles (PFMs), ED and PE can be improved if manual physical therapy treatments are combined with PFM training. CONCLUSIONS A multifaceted approach should be chosen by physical therapists when evaluating and treating ED and PE and contending with both musculoskeletal dysfunction and behavioral contributions. It is recommended that exercises be monitored and situations involving, that is, hyperactivity/increased tone of the PFMs should be avoided. PFM training is simple, safe, and noninvasive; therefore, it should be a preferred approach in the management of ED and PE. This paper presents narrative reviews with a potential bias that systematic reviews or meta-analyses do not have, however, we strove to be all-encompassing and unbiased. There is a demand for high-quality scientific reviews examining the effectiveness of PFM training, manual therapy, and the rationale of pelvic floor physical therapy, in general, in treating individuals with PE and ED.
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Affiliation(s)
- David Yaacov
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gadi Nelinger
- Physical Therapy Outpatient Clinic, Maccabi Health Care Services, Holon, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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15
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Corona G, Isidori AM, Aversa A, Bonomi M, Ferlin A, Foresta C, La Vignera S, Maggi M, Pivonello R, Vignozzi L, Lombardo F. Male and female sexual dysfunction in diabetic subjects: Focus on new antihyperglycemic drugs. Rev Endocr Metab Disord 2020; 21:57-65. [PMID: 31863254 DOI: 10.1007/s11154-019-09535-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The association between diabetes mellitus (and its micro- and macro-vascular complications) and erectile dysfunction is widely known and the presence of hypogonadism may further complicate sexual dysfunction and quality of life, given the association between hypogonadism and reduced libido, ejaculatory disorders, and depressive symptoms. However, the recent introduction of novel antidiabetic agents with a wide range of mechanism of action may have a significant impact both on male and female sexuality directly (by inducing side effects as urinary tract infections) and indirectly (improving metabolic status and reducing diabetes complications behind sexual dysfunctions). To date only few papers are reporting the sexual effects of these treatments and, often, these are not comparable in their results. Conversely, female sexual dysfunctions are somehow under-investigated. Data on prevalence is heterogeneous and specific pathogenic mechanisms, as well as the burden of psychological factors, are still heatedly debated. The aim of this narrative review is to summarize current knowledge and stressing out the need to diagnose male and female sexual dysfunctions also in light of the impact of treatments with novel antidiabetic agents. This would highlight the still unmet needs for sexual care in a diabetes care setting and could represent an incentive for future discussions, as well as a required theoretical starting point for studies on this subject.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, "Magna Graecia" University, Catanzaro, Italy
| | - Marco Bonomi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Department of Endocrine and Metabolic Diseases and Lab of Endocrine and Metabolic Research, Milan, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Brescia, Italy
| | - Carlo Foresta
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, Policlinico "G. Rodolico", University of Catania, 95123, Catania, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Rosario Pivonello
- Division of Endocrinology, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Linda Vignozzi
- Endocrinology Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Francesco Lombardo
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
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16
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Kessler A, Sollie S, Challacombe B, Briggs K, Van Hemelrijck M. The global prevalence of erectile dysfunction: a review. BJU Int 2019; 124:587-599. [PMID: 31267639 DOI: 10.1111/bju.14813] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the global prevalence of erectile dysfunction (ED); as well as its association with physiological and pathological ageing by examining the relationship between ED and cardiovascular disease (CVD), benign prostatic hyperplasia (BPH), and dementia. We also aimed to characterise discrepancies caused by the use of different ED screening tools. METHODS The Excerpta Medica dataBASE (EMBASE) and Medical Literature Analysis and Retrieval System Online (MEDLINE) were searched to find population-based studies investigating the prevalence of ED and the association between ED and CVD, BPH, and dementia in the general population. RESULTS The global prevalence of ED was 3-76.5%. ED was associated with increasing age. Use of the International Index of Erectile Function (IIEF) and Massachusetts Male Aging Study (MMAS)-derived questionnaire identified a high prevalence of ED in young men. ED was positively associated with CVD. Men with ED have an increased risk of all-cause mortality odds ratio (OR) 1.26 (95% confidence interval [CI] 1.01-1.57), as well as CVD mortality OR 1.43 (95% CI 1.00-2.05). Men with ED are 1.33-6.24-times more likely to have BPH then men without ED, and 1.68-times more likely to develop dementia than men without ED. CONCLUSION ED screening tools in population-based studies are a major source of discrepancy. Non-validated questionnaires may be less sensitive than the IIEF and MMAS-derived questionnaire. ED constitutes a large burden on society given its high prevalence and impact on quality of life, and is also a risk factor for CVD, dementia, and all-cause mortality.
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Affiliation(s)
- Anna Kessler
- School of Cancer and Pharmaceutical Sciences, King's College London, Translational Oncology and Urology Research (TOUR), London, UK
| | - Sam Sollie
- School of Cancer and Pharmaceutical Sciences, King's College London, Translational Oncology and Urology Research (TOUR), London, UK
| | - Ben Challacombe
- Urology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Karen Briggs
- Urology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, King's College London, Translational Oncology and Urology Research (TOUR), London, UK
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17
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Uddin SMI, Mirbolouk M, Dardari Z, Feldman DI, Cainzos-Achirica M, DeFilippis AP, Greenland P, Blankstein R, Billups KL, Miner MM, Nasir K, Blaha MJ. Erectile Dysfunction as an Independent Predictor of Future Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis. Circulation 2019; 138:540-542. [PMID: 29891569 DOI: 10.1161/circulationaha.118.033990] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- S M Iftekhar Uddin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., Z.D., D.I.F., M.C.-A., M.J.B.)
| | - Mohammadhassan Mirbolouk
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., Z.D., D.I.F., M.C.-A., M.J.B.)
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., Z.D., D.I.F., M.C.-A., M.J.B.)
| | - David I Feldman
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., Z.D., D.I.F., M.C.-A., M.J.B.).,The University of Miami Miller School of Medicine, FL (D.I.F.)
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., Z.D., D.I.F., M.C.-A., M.J.B.).,Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain (M.C.-A.)
| | - Andrew P DeFilippis
- Division of Cardiovascular Medicine, University of Louisville, Jewish Hospital/Kentucky One Health, KY (A.P.D.)
| | - Philip Greenland
- Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (P.G.)
| | - Ron Blankstein
- Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.)
| | - Kevin L Billups
- Department of Surgery, Meharry Medical College, Nashville, TN (K.L.B.)
| | - Martin M Miner
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI (M.M.M.)
| | - Khurram Nasir
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, FL (K.N.)
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.M.I.U., M.M., Z.D., D.I.F., M.C.-A., M.J.B.)
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18
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Male sexual dysfunction in obesity: The role of sex hormones and small fibre neuropathy. PLoS One 2019; 14:e0221992. [PMID: 31509565 PMCID: PMC6738611 DOI: 10.1371/journal.pone.0221992] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/30/2019] [Indexed: 01/01/2023] Open
Abstract
Context Multiple factors contribute to sexual dysfunction in men with obesity. Sex hormone levels are commonly abnormal in men with obesity and this abnormality is often the focus of management in clinical practice. The role of small fibre neuropathy in obesity-related sexual dysfunction is not well established. Objective We aimed to investigate the relationship between sexual function, sex hormone levels and small nerve fibre morphology in men with severe obesity. Materials and methods A prospective study of 29 men with severe obesity was undertaken. Sexual function was assessed using the European Male Ageing Study Sexual Function Questionnaire. Small nerve fibre morphology was quantified using corneal confocal microscopy. Sex hormone levels were measured by mass spectrophotometry. Results Erectile dysfunction was present in 72% of the cohort with a higher prevalence of diabetes among the symptomatic group (88% vs 38%, p = 0.006). Corneal nerve fibre length (CNFL) and corneal nerve fibre density (CNFD) were both significantly lower in participants with erectile dysfunction compared to those without (p = 0.039 and p = 0.048 respectively). The erectile function score correlated with CNFL (r = -0.418, p = 0.034) and CNFD (r = -0.411, p = 0.037). Total testosterone and calculated free testosterone levels did not differ significantly between men with or without erectile dysfunction (median 8.8 nmol/L vs 9.0 nmol/L, p = 0.914; and median 176 pmol/L vs 179 pmol/L, p = 0.351 respectively), infrequent sexual thoughts (median 8.1 nmol/L vs 9.2 nmol/L, p = 0.650; and median 184 pmol/L, vs 176 pmol/L, p = 0.619 respectively) and decreased morning erections (median 9.0 nmol/L vs 8.8 nmol/L, p = 0.655; and median 170 pmol/L vs 193 pmol/L, p = 0.278 respectively). Conclusion Sexual dysfunction is highly prevalent in men with severe obesity. We found an association between small fibre neuropathy with erectile dysfunction with presence of diabetes a likely a significant contributing factor. We found no associations between testosterone levels with sexual symptoms (including frequency of sexual thoughts). The influence of small nerve fibre neuropathy on response to therapeutic interventions and whether interventions that improve small fibre neuropathy can improve erectile function in this population merits further study.
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Ruiz-García A, Arranz-Martínez E, Cabrera-Vélez R, Palacios-Martínez D, Rivera-Teijido M, García-Álvarez JC, Morales-Cobos LE, Moreno-Fernández JC, García-Fernández ME, Peña-Antón N, Díez-Pérez MC, Montero-Costa A, Lorenzo-Borda MS, García-Granado MD, Casaseca-Calvo TF, Cique-Herráinz JA, García-Villasur MP, Marañón-Henrich N, Zarzuelo-Martín N, Baltuille-Aller MC, Arribas-Álvaro P, Macho-Barrio AI, Ribot-Catalá C, Capitán-Caldas M, Ciria-de-Pablo C, Sanz-Velasco C, Vargas-Machuca-Cabañero C, Simonaggio-Stancampiano P, Cabello-Igual MP, Sarria-Sánchez MT. Prevalence of erectile dysfunction in Spanish primary care setting and its association with cardiovascular risk factors and cardiovascular diseases. SIMETAP-ED study. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2019; 31:101-110. [PMID: 30979438 DOI: 10.1016/j.arteri.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/09/2018] [Accepted: 01/02/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Few studies conducted in primary care setting report about age-adjusted prevalence rates of erectile dysfunction (ED). Aims of SIMETAP-ED study were to determine crude and age-adjusted prevalence rates of ED diagnosis, to compare these rates with other similar studies, and to compare prevalence rates of cardiovascular risk factors (CVRF), cardiovascular diseases (CVD), metabolic diseases and chronic kidney disease (CKD) between populations with and without ED. METHODS Cross-sectional observational study conducted in primary care setting. Population-based random sample: 2934 adult men. Response rate: 66%. A clinical interview was conducted to diagnose ED using a question derived from ED definition. The medical records of patients were reviewed to identify their CVRF and diseases associated with ED. The age-adjustments were standardized to Spanish population. RESULTS The prevalence rates of metabolic diseases, CVD, CVRF, and CKD in population with ED were higher than population without ED, highlighting the CVD. The crude prevalence of ED was 17.2% (95% confidence interval: 15.8-18.6). The age-adjusted prevalence rates of ED were 0.71% in men under 40 years, 12.4% in men over 18 years, 10.8% in men aged 40-69 years, 18.9% in men over 40 years, and 48.6% in men over 70 years. CONCLUSIONS SIMETAP-ED study showed association of ED with metabolic diseases, CKD, CVRF, and highlighting CVD. The age-adjusted prevalence of ED was 12.4% in adult men, 19% in men over 40 years, and almost 50% in men over 70 years.
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Affiliation(s)
- Antonio Ruiz-García
- University Health Center Pinto, Lipids and Cardiovascular Prevention Unit, Madrid Health Service, C/ Marqués, s/n, 28320 Pinto-Madrid, Spain.
| | | | - Roberto Cabrera-Vélez
- University Health Center Espronceda, Madrid Health Service, C/ Espronceda 24, 28003 Madrid, Spain
| | - David Palacios-Martínez
- University Health Center Isabel II, Madrid Health Service, C/ Isabel II, 15, 28982 Parla-Madrid, Spain
| | - Montserrat Rivera-Teijido
- University Health Center Isabel II, Madrid Health Service, C/ Isabel II, 15, 28982 Parla-Madrid, Spain
| | - Juan Carlos García-Álvarez
- University Health Center Dr. Mendiguchia Carriche, Madrid Health Service, Pza. Comunidad de Madrid s/n, 28914 Leganés-Madrid, Spain
| | - Luis Enrique Morales-Cobos
- University Health Center Las Americas, Madrid Health Service, Av. de América, 6, 28981 Parla-Madrid, Spain
| | | | | | - Nuria Peña-Antón
- Health Center El Restón, Madrid Health Service, Av. del Mar Mediterráneo, 1, 28341 Valdemoro-Madrid, Spain
| | - Maria Cruz Díez-Pérez
- Health Center Los Cármenes, Madrid Health Service, C/ Vía Carpetana, 202, 28047 Madrid, Spain
| | | | | | | | | | - Juan A Cique-Herráinz
- Health Center Torito, Madrid Health Service, Camino de vinateros 140, 28030 Madrid, Spain
| | | | - Nuria Marañón-Henrich
- Health Center Las Olivas, Madrid Health Service, P° Deleite, 30, 28300 Aranjuez-Madrid, Spain
| | - Nieves Zarzuelo-Martín
- Health Center Las Olivas, Madrid Health Service, P° Deleite, 30, 28300 Aranjuez-Madrid, Spain
| | | | - Pilar Arribas-Álvaro
- Health Center Campamento, Madrid Health Service, C/ Mirueña s/n, 28024 Madrid, Spain
| | - Ana Isabel Macho-Barrio
- Health Center Vicente Soldevilla, Madrid Health Service, C/ Sierra de Alquife 8, 28053 Madrid, Spain
| | - Carlos Ribot-Catalá
- Health Center Jaime Vera, Madrid Health Service, Av. Europa 1, 28915 Leganés-Madrid, Spain
| | - Mercedes Capitán-Caldas
- Health Center Las Ciudades, Madrid Health Service, C/ Palestina s/n, 28903 Getafe-Madrid, Spain
| | - Cristina Ciria-de-Pablo
- Health Center Hoyo de Manzanares, Madrid Health Service, Pza. Cervantes s/n, 28260 Hoyo de Manzanares-Madrid, Spain
| | - Carmelina Sanz-Velasco
- University Health Center Sector III, Madrid Health Service, Av. Juan Carlos I, 1, 28905 Getafe-Madrid, Spain
| | | | - Paula Simonaggio-Stancampiano
- Health Center San Martin de la Vega, Madrid Health Service, Av. Doce de Octubre, 6, 28330 San Martín de la Vega-Madrid, Spain
| | - María Pilar Cabello-Igual
- Health Center Parque Europa, Madrid Health Service, Pza. David Martín s/n, 28320 Pinto-Madrid, Spain
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Matz EL, Pearlman AM, Terlecki RP. Safety and feasibility of platelet rich fibrin matrix injections for treatment of common urologic conditions. Investig Clin Urol 2017; 59:61-65. [PMID: 29333517 PMCID: PMC5754585 DOI: 10.4111/icu.2018.59.1.61] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/10/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose Autologous platelet rich plasma (PRP) is used increasingly in a variety of settings. PRP injections have been used for decades to improve angiogenesis and wound healing. They have also been offered commercially in urology with little to no data on safety or efficacy. PRP could theoretically improve multiple urologic conditions, such as erectile dysfunction (ED), Peyronie's disease (PD), and stress urinary incontinence (SUI). A concern with PRP, however, is early washout, a situation potentially avoided by conversion to platelet rich fibrin matrix (PRFM). Before clinical trials can be performed, safety analysis is desirable. We reviewed an initial series of patients receiving PRFM for urologic pathology to assess safety and feasibility. Materials and Methods Data were reviewed for patients treated with PRFM at our center from November 2012 to July 2017. Patients were observed immediately post-injection and at follow-up for complications and tolerability. Where applicable, International Index of Erectile Function (IIEF-5) scores were reviewed before and after injections for ED and/or PD. Pad use data was collected pre/post injection for SUI. Results Seventeen patients were identified, with a mean receipt of 2.1 injections per patient. Post-procedural minor adverse events were seen in 3 men, consisting of mild pain at injection site and mild penile bruising. No patients experienced complications at follow-up. No decline was observed in men completing pre/post IIEF-5 evaluations. Conclusions PRFM appears to be a safe and feasible treatment modality in patients with urologic disease. Further placebo-controlled trials are warranted.
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Affiliation(s)
- Ethan L Matz
- Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Amy M Pearlman
- Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Ryan P Terlecki
- Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
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Male Sexual Function in New Zealand: A Population-Based Cross-Sectional Survey of the Prevalence of Erectile Dysfunction in Men Aged 40-70 Years. J Sex Med 2017; 14:928-936. [PMID: 28673435 DOI: 10.1016/j.jsxm.2017.05.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/02/2017] [Accepted: 05/19/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Sexual function declines with age and erectile dysfunction (ED) is a common condition worldwide; however, prevalence rates vary markedly between populations and reliable data specific to New Zealand (NZ) are lacking. AIM To assess the prevalence of ED in NZ men using a population-based cross-sectional survey. METHODS Postal questionnaires were sent, according to a modified Dillman method, to a randomly selected age-stratified population-based sample of 2,000 men 40 to 70 years old obtained from the electoral roll. Self-reported erectile function was assessed using the five-item International Index of Erectile Function (IIEF-5) and the single-question self-assessment tool. OUTCOMES The prevalence of ED is presented as crude, age-adjusted to the distribution of the NZ population, and standardized to the World Health Organization World Standard Population (WSP). Associations between sexual function and age were analyzed using χ2 test. RESULTS The response rate was 30% (599) and 28% (562) were complete for analysis. The crude prevalence of ED was 42% (22% mild, 10% mild to moderate, 6% moderate, and 4% severe), the age-adjusted prevalence was 38%, and the WSP-adjusted prevalence was 37%. Among men reporting ED, 16% were medically diagnosed and 22% were treated. ED affected 24% of men in their 40s, 38% in their 50s, and 60% in their 60s (P < .001). Age was associated with a significant increase in diagnosed ED (P = .001), treated ED (P = .006), dissatisfaction with current sexual function (P < .001), associated anxiety or depression (P = .023), and a decrease in sexual activity (P < .001). CLINICAL TRANSLATION Approximately one in three NZ men 40 to 70 years old might have ED. Although comparable to overseas populations, this prevalence is high. STRENGTHS AND LIMITATIONS This study provides the most reliable, comprehensive, and current information on ED and its risk factors in NZ men. Strengths include the large sample, the use of random selection from a population-based sampling frame, established effective survey methods, and the validated IIEF-5. Limitations include the inability of cross-sectional data to determine causation, non-sampling errors associated with the population-based sampling frame, the low response rate, the inability to assess non-respondents, the possibility of men with ED who were sexually inactive not responding or not completing the IIEF-5, and the inherent inability to rule out recall bias. CONCLUSION ED is a marker of subclinical cardiovascular disease. The high prevalence and low levels of diagnosis and treatment indicate a lost opportunity for timely intervention to delay or prevent the progression toward clinical disease. Quilter M, Hodges L, von Hurst P, et al. Male Sexual Function in New Zealand: A Population-Based Cross-Sectional Survey of the Prevalence of Erectile Dysfunction in Men Aged 40-70 Years. J Sex Med 2017;14:928-936.
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Abstract
The relationships between sport and sexuality in males are of great social and clinical interest, because of sports and motor activities that highly promote social and sexual relationships. Even if few literature exist, two main questions should be taken into account: whether and how physical exercise and sport positively or negatively influence sexual health and behavior and/or whether and how sexual behavior may affect a sub-sequent sport performance. Physical exercise and sport per se can influence, positively or negatively, the hypothalamic-pituitary-testicular axis function and, consequently, the individual's reproductive and/or sexual health. This depends on individual factors such as genetic and epigenetic ones and on different variables involved in the practice of sport activities (type of sport, intensity and duration of training, doping and drug use and abuse, nutrition, supplements, psychological stress, allostatic load, etc.). If well conducted, motor and sport activities could have beneficial effects on sexual health in males. Among different lifestyle changes, influencing sexual health, regular physical activity is fundamental to antagonize the onset of erectile dysfunction (ED). However, competitive sport can lead both reproductive and/or sexual tract damages and dysfunctions, transient (genital pain, hypoesthesia of the genitalia, hypogonadism, DE, altered sexual drive, etc.) or permanent (hypogonadism, DE, etc.), by acting directly (traumas of the external genitalia, saddle-related disorders in cyclists, etc.) or indirectly (exercise-related hypogonadism, drug abuse, doping, stress, etc.). Sexual activities shortly performed before a sport competition could differently influence sport performance. Due to the few existing data, it is advisable to avoid an absolute pre-competition sexual abstinence.
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Affiliation(s)
- P Sgrò
- Unit of Endocrinology, Section of Health Sciences, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - L Di Luigi
- Unit of Endocrinology, Section of Health Sciences, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
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Akinola O, Ginsburg L, Welliver C, Mechlin CW, Fisher HAG, Mian BM, Kaufman RP, McCullough AR. Preoperative PDE5i use is a prognostic metric for poor postoperative erectile function in men undergoing radical prostatectomy: An addition to patient counseling. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415815612630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: In patients scheduled for radical prostatectomies (RP), preoperative (pre-op) erectile function (EF) characterization may be complicated by social and medical factors. We investigated pre-op use of phosphodiesterase type 5 inhibitor (PDE5i) as a simple metric for predicting long-term postoperative EF. Materials and methods: Electronic medical records (EMRs) for consecutive men who underwent RP between January 2004 and March 2009 at our institution were retrospectively reviewed. Data extracted included demographics, pre-op PDE5i use, cancer treatment details, post-op EF and ED treatment. Predictor variable data were categorical pre-op PDE5i use (pre-op PDE5i use vs. pre-op PDE5i naïve). ANOVA and Chi squared test were used. Results: A total of 250 individuals out of 436 charts met inclusion criteria. Mean follow-up length was 4.2 years (range 2–7). Thirty-seven men (15%) used PDE5i preoperatively. There were no differences in mean age at RP, type of nerve-sparing surgery (NSS), or medical comorbidities between groups. No men with pre-op PDE5i use regained unassisted EF but 37% regained PDE5i-assisted EF after bilateral nerve sparing (BNS). No men with pre-op PDE5i use regained unassisted or PDE5i-assisted EF after unilateral (UNS) or non-nerve-sparing surgery (NNS). Conclusions: Pre-op PDE5i use predicts poor long-term EF outcomes after RP and should be included in pre-op patient counseling.
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Bozorgmehri S, Fink HA, Parimi N, Canales B, Ensrud KE, Ancoli-Israel S, Canales M. Association of Sleep Disordered Breathing with Erectile Dysfunction in Community Dwelling Older Men. J Urol 2016; 197:776-782. [PMID: 27697577 DOI: 10.1016/j.juro.2016.09.089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE We investigated the association between sleep disordered breathing and erectile dysfunction in older men. MATERIALS AND METHODS We performed a cross-sectional analysis of community dwelling men age 67 years or older enrolled in the Osteoporotic Fractures in Men Sleep Study. Participants underwent overnight polysomnography (2003 to 2005) and completed sexual health questionnaires (2005 to 2006). We defined sleep disordered breathing using the apnea-hypopnea index or nocturnal hypoxemia. Erectile dysfunction was defined using the MMAS (Massachusetts Male Aging Study) scale and, in sexually active men, the International Index of Erectile Function. We used logistic regression to examine the association between sleep disordered breathing and erectile dysfunction. RESULTS Mean participant age was 76±5 years. Of the 2,676 men completing the MMAS, 70% had moderate to complete erectile dysfunction. Among 1,099 sexually active men completing the IIEF-5 (5-item International Index of Erectile Function), 26% had moderate to severe erectile dysfunction. A higher apnea-hypopnea index was associated with greater odds of MMAS defined moderate to complete erectile dysfunction after adjusting for age and study site (OR 1.39, 95% CI 1.00-1.92 for severe sleep disordered breathing vs none, p trend=0.008), but not after further adjustment for body mass index, socioeconomic status and comorbidities (OR 1.05, 95% CI 0.75-1.49, p trend=0.452). Greater nocturnal hypoxemia was associated with increased odds of MMAS defined moderate to complete erectile dysfunction (unadjusted OR 1.36, 95% Cl 1.04-1.80 vs none) but this was attenuated after adjustment for age and study site (OR 1.24, 95% CI 0.92-1.66). Sleep disordered breathing was not associated with erectile dysfunction by 5-item International Index of Erectile Function. CONCLUSIONS In this cross-sectional analysis in older men sleep disordered breathing was associated with higher odds of erectile dysfunction in unadjusted analyses that was largely explained by higher body mass index and increased comorbidity among men with sleep disordered breathing. Prospective studies accounting for obesity and multimorbidity would further clarify the association of sleep disordered breathing and erectile dysfunction.
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Affiliation(s)
- Shahab Bozorgmehri
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, and Malcom-Randall VAMC, Gainesville, Florida.
| | - Howard A Fink
- Department of Medicine, and Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Center for Chronic Disease Outcomes Research, Veterans Affairs Health System, Minneapolis, Minnesota; Geriatric Research Education and Clinical Center, Veterans Affairs Health System, Minneapolis, Minnesota
| | - Neeta Parimi
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Benjamin Canales
- Department of Urology, College of Public Health and Health Professions & College of Medicine, University of Florida, and Malcom-Randall VAMC, Gainesville, Florida
| | - Kristine E Ensrud
- Department of Medicine, and Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Center for Chronic Disease Outcomes Research, Veterans Affairs Health System, Minneapolis, Minnesota
| | - Sonia Ancoli-Israel
- Departments of Psychiatry and Medicine, University of California, San Diego, La Jolla, California
| | - Muna Canales
- Department of Medicine (Nephrology), College of Public Health and Health Professions & College of Medicine, University of Florida, and Malcom-Randall VAMC, Gainesville, Florida
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McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD, Laumann E, Lee SW, Segraves RT. Incidence and Prevalence of Sexual Dysfunction in Women and Men: A Consensus Statement from the Fourth International Consultation on Sexual Medicine 2015. J Sex Med 2016; 13:144-52. [PMID: 26953829 DOI: 10.1016/j.jsxm.2015.12.034] [Citation(s) in RCA: 243] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The incidence and prevalence of various sexual dysfunctions in women and men are important to understand to designate priorities for epidemiologic and clinical research. AIM This manuscript was designed to conduct a review of the literature to determine the incidence and prevalence of sexual dysfunction in women and men. METHODS Members of Committee 1 of the Fourth International Consultation on Sexual Medicine (2015) searched and reviewed epidemiologic literature on the incidence and prevalence of sexual dysfunctions. Key older studies and most studies published after 2009 were included in the text of this article. MAIN OUTCOME MEASURES The outcome measures were the reports in the various studies of the incidence and prevalence of sexual dysfunction among women and men. RESULTS There are more studies on incidence and prevalence for men than for women and many more studies on prevalence than incidence for women and men. The data indicate that the most frequent sexual dysfunctions for women are desire and arousal dysfunctions. In addition, there is a large proportion of women who experience multiple sexual dysfunctions. For men, premature ejaculation and erectile dysfunction are the most common sexual dysfunctions, with less comorbidity across sexual dysfunctions for men compared with women. CONCLUSION These data need to be treated with caution, because there is a high level of variability across studies caused by methodologic differences in the instruments used to assess presence of sexual dysfunction, ages of samples, nature of samples, methodology used to gather the data, and cultural differences. Future research needs to use well-validated tools to gather data and ensure that the data collection strategy is clearly described.
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Affiliation(s)
- Marita P McCabe
- Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia.
| | | | - Ron Lewis
- Georgia Regents University, Augusta, GA, USA
| | | | - Richard Balon
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | | | - Edward Laumann
- Department of Sociology, University of Chicago, Chicago, IL, USA
| | - Sun Won Lee
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
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Levy J. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14746514020020040801] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Jonathan Levy
- Levy Diabetes Research Laboratories, Oxford Centre for Diabetes Endocrinology and Metabolism, Radcliffe Infirmary, Woodstock Road, Oxford, OX2 6HE, UK,
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Vitamin D deficiency is independently associated with greater prevalence of erectile dysfunction: The National Health and Nutrition Examination Survey (NHANES) 2001-2004. Atherosclerosis 2016; 252:61-67. [PMID: 27505344 DOI: 10.1016/j.atherosclerosis.2016.07.921] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/07/2016] [Accepted: 07/26/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Erectile dysfunction (ED) and atherosclerotic cardiovascular disease (ASCVD) share many common risk factors, and vascular ED is a marker for increased ASCVD risk. Low 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with increased ASCVD risk, but less is known regarding the relationship of low 25(OH)D with ED. We determined whether 25(OH)D deficiency is associated with ED independent of ASCVD risk factors. METHODS We performed cross-sectional analyses of 3390 men aged ≥20 years free of ASCVD who participated in NHANES 2001-2004. Serum 25(OH)D was measured by the DiaSorin radioimmunoassay; deficiency was defined as levels <20 ng/ml (<50 nmol/L). Self-reported ED, assessed by a single validated question, was defined as men who reported being "never" or "sometimes able" to maintain an erection. We assessed the relationship between 25(OH)D deficiency and ED prevalence using adjusted Poisson regression methods. RESULTS After accounting for NHANES sampling, the weighted prevalence of 25(OH)D deficiency and of ED were 30% and 15.2%, respectively. 25(OH)D levels were lower in men with vs. those without ED (mean 22.8 vs 24.3 ng/mL, respectively; p = 0.0005). After adjusting for lifestyle variables, comorbidities, and medication use, men with 25(OH)D deficiency had a higher prevalence of ED compared to those with levels ≥30 ng/ml (Prevalence Ratio 1.30, 95% CI 1.08-1.57). CONCLUSION In this cross-sectional analysis of a representative sample of U.S. men, vitamin D deficiency was associated with an increased prevalence of ED independent of ASCVD risk factors. Additional research is needed to evaluate whether treating vitamin D deficiency improves erectile function.
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Feldman DI, Cainzos-Achirica M, Billups KL, DeFilippis AP, Chitaley K, Greenland P, Stein JH, Budoff MJ, Dardari Z, Miner M, Blumenthal RS, Nasir K, Blaha MJ. Subclinical Vascular Disease and Subsequent Erectile Dysfunction: The Multiethnic Study of Atherosclerosis (MESA). Clin Cardiol 2016; 39:291-8. [PMID: 27145089 DOI: 10.1002/clc.22530] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 01/30/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The association between subclinical cardiovascular disease and subsequent development of erectile dysfunction (ED) remains poorly described. HYPOTHESIS Among multiple subclinical atherosclerosis and vascular dysfunction measurements, coronary artery calcium (CAC) score best predicts ED. METHODS After excluding participants taking ED medications at baseline, we studied 1862 men age 45 to 84 years free of known cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA) with comprehensive baseline subclinical vascular disease phenotyping and ED status assessed at MESA visit 5 (9.4 ± 0.5 years after baseline) using a standardized question on ED symptoms. Multivariable logistic regression was used to assess the associations between baseline measures of vascular disease (atherosclerosis domain: CAC, carotid intima-media thickness, carotid plaque, ankle-brachial index; vascular stiffness/function domain: aortic stiffness, carotid stiffness, brachial flow-mediated dilation) and ED symptoms at follow-up. RESULTS Mean baseline age was 59.5 ± 9 years, and 839 participants (45%) reported ED symptoms at follow-up. Compared with symptom-free individuals, participants with ED had higher baseline prevalence of CAC score >100 (36.4% vs 17.2%), carotid intima-media thickness Z score >75th percentile (35.3% vs 16.6%), carotid plaque score ≥2 (39% vs 21.1%), carotid distensibility <25th percentile (34.6% vs 17.1%), aortic distensibility <25th percentile (34.2% vs 18.7%), and brachial flow-mediated dilation <25th percentile (28.4% vs 21.3%); all P < 0.01. Only CAC >100 (odds ratio: 1.43, 95% confidence interval: 1.09-1.88) and carotid plaque score ≥2 (odds ratio: 1.33, 95% confidence interval: 1.02-1.73) were significantly associated with ED. CONCLUSIONS Subclinical vascular disease is common in men who later self-report ED. Early detection of subclinical atherosclerosis, particularly advanced CAC and carotid plaque, may provide opportunities for predicting the onset of subsequent vascular ED.
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Affiliation(s)
- David I Feldman
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Kevin L Billups
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.,The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Andrew P DeFilippis
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Cardiology, KentuckyOne Health-Jewish Hospital, University of Louisville, Louisville, Kentucky
| | - Kanchan Chitaley
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington
| | - Philip Greenland
- Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James H Stein
- Cardiovascular Medicine Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Matthew J Budoff
- Department of Internal Medicine, Division of Cardiology, Harbor-UCLA Medical Center, Torrance, California
| | - Zeina Dardari
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Martin Miner
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Khurram Nasir
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, Florida
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Echeverri Tirado LC, Ferrer JE, Herrera AM. Aging and Erectile Dysfunction. Sex Med Rev 2016; 4:63-73. [DOI: 10.1016/j.sxmr.2015.10.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 06/22/2015] [Indexed: 01/23/2023]
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30
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Abstract
Over the past 20 years, there have been numerous reports on the epidemiology of erectile dysfunction (ED). Most studies have reported prevalence rates in a variety of different populations using a variety of methodologies and a variety of definitions of ED. The varying methodologies, definitions, and populations make comparison difficult, but in high-quality studies there is a consistent association with age, and analytical studies suggest an association with cardiovascular risk factors, depression, and lower urinary tract symptoms. There is emerging evidence of a link with smoking and obesity. A smaller number of studies have reported the incidence of ED, again using a variety of different methodologies, definitions, and study populations. While the methodological differences were again prominent, there was a consistent correlation with increasing age. Only two reports have studied the natural history of ED, and both demonstrated not only that there was commonly disease progression, but also that in some men there was remission of ED. Remission was commoner in younger men, suggesting that in these men psychological and lifestyle factors might be the cause of temporary self-limiting ED. These studies also suggest that lifestyle modifications might be helpful in the prevention and treatment of ED. Eardley I. The incidence, prevalence, and natural history of erectile dysfunction. Sex Med Rev 2013;1:3-16.
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Affiliation(s)
- Ian Eardley
- Department of Urology, St. James University Hospital, Leeds, UK.
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Logue J, Stewart S, Munro J, Bruce J, Grieve E, Lean M, Lindsay RS, Bruce D, Ali A, Briggs A, Sattar N, Ford I. SurgiCal Obesity Treatment Study (SCOTS): protocol for a national prospective cohort study of patients undergoing bariatric surgery in Scotland. BMJ Open 2015; 5:e008106. [PMID: 26002692 PMCID: PMC4442215 DOI: 10.1136/bmjopen-2015-008106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The efficacy of bariatric surgery for large-scale, long-term weight loss is well established. However, many questions remain over the continual benefits and cost-effectiveness of that weight loss for overall health, particularly when accounting for potential complications and adverse events of surgery. Health research institutes in the UK and the USA have called for high-quality longitudinal cohort studies of patients undergoing bariatric surgery, assessing outcomes such as surgical complications, mortality, diabetes remission, microvascular complications, cardiovascular events, mental health, cost and healthcare use. METHODS AND ANALYSIS SurgiCal Obesity Treatment Study (SCOTS) is a national, prospective, observational, cohort study of patients undergoing primary bariatric surgical procedures in Scotland. This study aims to recruit 2000 patients and conduct a follow-up for 10 years postbariatric surgery using multiple data collection methods: surgeon-recorded data, electronic health record linkage, and patient-reported outcome measures. Outcomes measured will include: mortality, weight change, diabetes, surgical, cardiovascular, cancer, behavioural, reproductive/urological and nutritional variables. Healthcare utilisation and economic productivity will be collected to inform cost-effectiveness analysis. ETHICS AND DISSEMINATION The study has received a favourable ethical opinion from the West of Scotland Research Ethics committee. All publications arising from this cohort study will be published in open-access peer-reviewed journals. All SCOTS investigators (all members of the research team at every recruiting site) will have the ability to propose research suggestions and potential publications using SCOTS data; a publications committee will approve all requests for use of SCOTS data and propose writing committees and timelines. Lay-person summaries of all research findings will be published simultaneously on the SCOTS website (http://www.scotsurgeystudy.org.uk).
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Affiliation(s)
- Jennifer Logue
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sally Stewart
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jane Munro
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Julie Bruce
- Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Eleanor Grieve
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mike Lean
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Abdulmajid Ali
- University Hospital Ayr, NHS Ayrshire and Arran, Ayr, UK
| | - Andrew Briggs
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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Parisot J, Yiou R, Salomon L, de la Taille A, Lingombet O, Audureau E. Erection hardness score for the evaluation of erectile dysfunction: further psychometric assessment in patients treated by intracavernous prostaglandins injections after radical prostatectomy. J Sex Med 2014; 11:2109-18. [PMID: 24840184 DOI: 10.1111/jsm.12584] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) affects quality of life in patients treated by radical prostatectomy (RP). The Erection Hardness Score (EHS) is a single-item scale that has demonstrated good psychometric properties for assessing erectile function (EF) in patients treated by sildenafil, but its applicability to other treatment contexts has not yet been tested. AIM This study aims to test the validity and time and treatment responsiveness of the EHS to assess ED in men with post-RP ED treated with alprostadil injections. METHODS This is a 1-year follow-up cohort study of 75 patients treated by RP for localized prostate cancer in a urology department setting between January 2007 and December 2008. Data were prospectively collected at 6 and 12 months post-RP. MAIN OUTCOME MEASURES The EHS, the International Index of Erectile Function (IIEF) reference questionnaire, the Global Assessment Questionnaire (GAQ), and Numeric Pain Scale (NPS) were collected. Convergent validity (Spearman correlation coefficients with IIEF domains), known-groups validity (comparing EHS scores across ED severity groups), time and treatment responsiveness (effect size with/without treatment and over the follow-up period), and predictive ability (area under the receiver operating characteristics curve [AUC-ROC]) were analyzed for this study. RESULTS The EHS showed good convergent validity (all Spearman coefficients significant at the P<0.05 level), adequate known-groups validity (global differentiation between IIEF-EF severity groups; P<0.001), and treatment responsiveness (effect size: +1.8 [6 months], +2.1 [12 months]), but limited time responsiveness and predictive ability of the EHS for a normal EF at 12 months follow-up when compared with the IIEF-EF domain (AUC-ROC: 0.72 vs. 0.85; P<0.01). CONCLUSION Our findings support the overall good psychometric properties of the EHS in patients with post-RP ED treated with alprostadil injections. However, evidence for limited predictive validity and responsiveness to change over time should be considered for its use in clinical follow-up in this population.
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Affiliation(s)
- Juliette Parisot
- Public Health Department, Henri Mondor Teaching Hospital, Créteil, France; Laboratoire d'Investigation Clinique, EA 4393, Université Paris Est Créteil, Créteil, France
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Walsh TJ, Hotaling JM, Smith A, Saigal C, Wessells H. Men with diabetes may require more aggressive treatment for erectile dysfunction. Int J Impot Res 2013; 26:112-5. [PMID: 24352244 DOI: 10.1038/ijir.2013.46] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 09/29/2013] [Accepted: 10/20/2013] [Indexed: 11/09/2022]
Abstract
Diabetes mellitus (DM) and erectile dysfunction (ED) are common health problems that markedly increase in prevalence and incidence with advancing age. DM is a known risk factor for developing ED; however, among men with ED it is unknown if DM alters the need for more invasive therapies. We sought to determine whether DM is associated with increased ED severity, reduced effectiveness of first-line (oral) therapies, and therefore higher utilization of second- and third-line therapies. The Inovus I3 database was queried to identify men with ED. Claims were followed for 48 months. Men with incomplete follow-up data and those diagnosed with DM after ED diagnosis were excluded from analysis. Rates of second-line (penile suppositories or injectables) and third-line (penile prostheses) ED therapies were compared between men with and without preexisting DM. Risk of progressing to second- and third-line therapies associated with DM was assessed with logistic regression and Kaplan-Meier analysis. From 1 January 2002 to 31 December 2006, 136 306 men were identified with prevalent and incident ED. Among this group, 19 236 men had DM that preceded their ED diagnosis. Men with DM were more than 50% more likely to be prescribed secondary ED treatments over the 2-year observation period, and more than twice as likely to undergo penile prosthesis surgery. Among a large population-based cohort of men with ED, those with DM are more likely to require more aggressive treatments. These data suggest that ED among men with diabetes may be less responsive to first-line treatments (oral agents), worsen more rapidly, or both.
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Affiliation(s)
- T J Walsh
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - J M Hotaling
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - A Smith
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - C Saigal
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - H Wessells
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
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Corona G, Giorda CB, Cucinotta D, Guida P, Nada E. The SUBITO-DE study: sexual dysfunction in newly diagnosed type 2 diabetes male patients. J Endocrinol Invest 2013; 36:864-8. [PMID: 23686080 DOI: 10.3275/8969] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION No data on the prevalence of erectile dysfunction (ED) in subjects with newly diagnosed Type 2 diabetes mellitus (T2DM) are currently available. AIM The aim of the present study was to estimate the prevalence of ED and its associated causes in a sample of male patients with recently diagnosed DM (<24 months) attending a diabetes care center. METHODS The study comprised two phases: a cross-sectional analysis and a longitudinal reassessment of the data collected during the first phase. During the first phase, 1503 subjects (mean age 58.7±8.9 yr) from 27 centers were interviewed: 666 (43.3%) reported experiencing ED, 499 of which (mean age 58.8±8.8 yr) agreed to participate in the study (final enrolment rate, 33.3%). Concurrent morbidities were hypertension (55.3%), dyslipidemia (39.5%), and coronary heart disease (7.8%); chronic complications were neuropathy (8.9%), nephropathy (12.6%) and retinopathy (7.6%) in about one third of the sample at enrolment. RESULTS Overall, about 20% of the patients reported having used ED drugs, but more than 50% had abandoned therapy because of the drug's ineffectiveness or high cost. The prevalence of hypogonadism was 46.9% (total testosterone level, 3.5 ng/ml). Some 20% of patients reported symptoms suggestive of depression. CONCLUSION The present study provides data showing a high prevalence of ED, hypogonadism and depressive symptoms among male patients with newly diagnosed T2DM. Further analysis of the data will elucidate the specific determinants of such conditions and their longitudinal significance.
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Affiliation(s)
- G Corona
- Endocrinology Unit, Medical Department, Azienda USL Bologna, Maggiore-Bellaria Hospital, Largo Nigrisoli 2, 50133 Bologna, Italy.
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Abstract
Erectile dysfunction (ED) impacts more than 50% of men older than 40 years; Peyronie disease (PD) affects up to 10% of men, with an adverse impact on normal sexual function and overall well-being. ED can also be the first sign of other underlying disease. The office-based evaluation of ED and PD is the first step in the management of these devastating conditions of men's health. New and exciting nonsurgical therapies are now available to help treat these conditions and restore sexual function and quality of life.
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Weber MF, Smith DP, OˈConnell DL, Patel MI, Souza PL, Sitas F, Banks E. Risk factors for erectile dysfunction in a cohort of 108 477 Australian men. Med J Aust 2013; 199:107-11. [DOI: 10.5694/mja12.11548] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 03/06/2013] [Indexed: 11/17/2022]
Affiliation(s)
| | - David P Smith
- Cancer Research Division, Cancer Council NSW, Sydney, NSW
| | | | - Manish I Patel
- Discipline of Surgery, University of Sydney, Westmead, NSW
| | | | - Freddy Sitas
- Cancer Research Division, Cancer Council NSW, Sydney, NSW
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
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Mamoulakis C, Skolarikos A, Schulze M, Scoffone CM, Rassweiler JJ, Alivizatos G, Scarpa RM, de la Rosette JJ. Bipolar vs monopolar transurethral resection of the prostate: evaluation of the impact on overall sexual function in an international randomized controlled trial setting. BJU Int 2013; 112:109-20. [DOI: 10.1111/j.1464-410x.2012.11662.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Andreas Skolarikos
- Second Department of Urology; Sismanoglio Hospital; University of Athens Medical School; Athens; Greece
| | - Michael Schulze
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn; Germany
| | - Cesare M. Scoffone
- Department of Urology, San Luigi Hospital; University of Turin; Orbassano; Turin; Italy
| | - Jens J. Rassweiler
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn; Germany
| | - Gerasimos Alivizatos
- Second Department of Urology; Sismanoglio Hospital; University of Athens Medical School; Athens; Greece
| | - Roberto M. Scarpa
- Department of Urology, San Luigi Hospital; University of Turin; Orbassano; Turin; Italy
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Garimella PS, Paudel ML, Ensrud KE, Marshall LM, Taylor BC, Fink HA. Association between body size and composition and erectile dysfunction in older men: Osteoporotic Fractures in Men Study. J Am Geriatr Soc 2013; 61:46-54. [PMID: 23311552 DOI: 10.1111/jgs.12073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To examine the association between body size and composition and erectile dysfunction (ED) in older men. DESIGN Cross-sectional analysis of the Osteoporotic Fractures in Men study. SETTING Six U.S. clinical sites. PARTICIPANTS Community-dwelling men aged 65 and older. MEASUREMENTS Body composition measures using anthropometry (body weight, body mass index (BMI)) and dual X-ray absorptiometry (total body fat percentage, trunk fat percentage, ratio of trunk and total body fat). ED was assessed using the single-item Massachusetts Male Aging Study (MMAS) scale and the five-item International Index of Erectile Function questionnaire (IIEF-5). RESULTS In men completing the MMAS scale (n = 4,108), prevalence of complete ED was 42%. In sexually active men completing the IIEF-5 questionnaire (n = 1,659), prevalence of moderate to severe ED was 56%. In multivariate-adjusted analyses reporting prevalence ratios (PRs) and 95% confidence intervals (CIs), the prevalence of MMAS-defined complete ED was significantly greater in men in the highest quartile of body weight (PR = 1.24, 95% CI = 1.16-1.34), total body fat percentage (PR = 1.25, 95% CI = 1.13-1.40), and trunk fat percentage (PR = 1.24, 95% CI = 1.15-1.38), and was greater in men with a BMI greater than 30.0 kg/m(2) than in those with BMI of 22.0 to 24.9 kg/m(2) (PR = 1.17, 95% CI = 1.05-1.31). Associations appeared similar for IIEF-5-defined moderate to severe ED in analyses adjusted for age and study site. CONCLUSION In a cohort of older men, high body weight, BMI, and total body fat percentage were independently associated with greater prevalence of moderate to severe and complete ED. Future studies should investigate whether interventions to promote weight loss and fat loss will improve erectile function in older men.
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Affiliation(s)
- Pranav S Garimella
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA.
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Banks E, Joshy G, Abhayaratna WP, Kritharides L, Macdonald PS, Korda RJ, Chalmers JP. Erectile dysfunction severity as a risk marker for cardiovascular disease hospitalisation and all-cause mortality: a prospective cohort study. PLoS Med 2013; 10:e1001372. [PMID: 23382654 PMCID: PMC3558249 DOI: 10.1371/journal.pmed.1001372] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 12/04/2012] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Erectile dysfunction is an emerging risk marker for future cardiovascular disease (CVD) events; however, evidence on dose response and specific CVD outcomes is limited. This study investigates the relationship between severity of erectile dysfunction and specific CVD outcomes. METHODS AND FINDINGS We conducted a prospective population-based Australian study (the 45 and Up Study) linking questionnaire data from 2006-2009 with hospitalisation and death data to 30 June and 31 Dec 2010 respectively for 95,038 men aged ≥45 y. Cox proportional hazards models were used to examine the relationship of reported severity of erectile dysfunction to all-cause mortality and first CVD-related hospitalisation since baseline in men with and without previous CVD, adjusting for age, smoking, alcohol consumption, marital status, income, education, physical activity, body mass index, diabetes, and hypertension and/or hypercholesterolaemia treatment. There were 7,855 incident admissions for CVD and 2,304 deaths during follow-up (mean time from recruitment, 2.2 y for CVD admission and 2.8 y for mortality). Risks of CVD and death increased steadily with severity of erectile dysfunction. Among men without previous CVD, those with severe versus no erectile dysfunction had significantly increased risks of ischaemic heart disease (adjusted relative risk [RR] = 1.60, 95% CI 1.31-1.95), heart failure (8.00, 2.64-24.2), peripheral vascular disease (1.92, 1.12-3.29), "other" CVD (1.26, 1.05-1.51), all CVD combined (1.35, 1.19-1.53), and all-cause mortality (1.93, 1.52-2.44). For men with previous CVD, corresponding RRs (95% CI) were 1.70 (1.46-1.98), 4.40 (2.64-7.33), 2.46 (1.63-3.70), 1.40 (1.21-1.63), 1.64 (1.48-1.81), and 2.37 (1.87-3.01), respectively. Among men without previous CVD, RRs of more specific CVDs increased significantly with severe versus no erectile dysfunction, including acute myocardial infarction (1.66, 1.22-2.26), atrioventricular and left bundle branch block (6.62, 1.86-23.56), and (peripheral) atherosclerosis (2.47, 1.18-5.15), with no significant difference in risk for conditions such as primary hypertension (0.61, 0.16-2.35) and intracerebral haemorrhage (0.78, 0.20-2.97). CONCLUSIONS These findings give support for CVD risk assessment in men with erectile dysfunction who have not already undergone assessment. The utility of erectile dysfunction as a clinical risk prediction tool requires specific testing.
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Affiliation(s)
- Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
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Dargis L, Trudel G, Cadieux J, Villeneuve L, Préville M, Boyer R. Validation of the International Index of Erectile Function (IIEF) and presentation of norms in older men. SEXOLOGIES 2013. [DOI: 10.1016/j.sexol.2012.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Dargis L, Trudel G, Cadieux J, Villeneuve L, Préville M, Boyer R. Validation de l’Index International de la Fonction Érectile (IIFE) et présentation de normes chez les hommes aînés. SEXOLOGIES 2013. [DOI: 10.1016/j.sexol.2012.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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MORA PABLOA, MUSUMECI-SZABO TAMARA, POPAN JASON, BEAMON TEERAH, LEVENTHAL HOWARD. Exploring the Relationship Among the Undesired Self, Health, and Mood in Older Adults 1. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2012. [DOI: 10.1111/j.1559-1816.2012.00930.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lippi G, Plebani M, Montagnana M, Cervellin G. Biochemical and genetic markers of erectile dysfunction. Adv Clin Chem 2012; 57:139-62. [PMID: 22870589 DOI: 10.1016/b978-0-12-394384-2.00005-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Erectile dysfunction (ED) is a very common pathology, affecting over 150 million men worldwide. The pathogenesis is typically multifactorial, involving a kaleidoscope of organic, endocrine, and psychogenic factors. In general, ED is divided into organic and psychogenic impotence, but most men with organic etiologies have an associated psychogenic component. Given the high frequency of this pathology, the identification of biochemical and genetic correlates and/or markers is of pivotal interest not only for treating preciously these patients and preventing serious psychological consequences but also for the high risk for occult cardiovascular disease (CVD) that often accompanies or follows this pathology. A variety of cardiovascular risk factors have been associated with both the onset and the severity of ED, including markers of endothelial function, thrombosis, and especially dyslipidemia, so that their measurement should now be considered as an important part of the increased global cardiometabolic risk profile in patients with ED. While nitric oxide (NO), asymmetric dimethylarginine (ADMA), and endothelin (ET) hold some promises as biochemical markers of both CVD and ED, there are several technical and clinical drawbacks that make their measurement overall meaningless in the clinical practice. As regards genetic polymorphisms, controversial results have been provided so far. Although some genetic markers were consistently associated with ED, other studies failed to demonstrate significant associations, highlighting a substantial bias in standardization of methodologies and patient enrolment. Nevertheless, further research in this area should be encouraged, since the first promising evidence that gene therapy might be effective to restore the decline in ED has been provided in the animal model.
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Londoño DC, Slezak JM, Quinn VP, Van Den Eeden SK, Loo RK, Jacobsen SJ. Population-based study of erectile dysfunction and polypharmacy. BJU Int 2011; 110:254-9. [DOI: 10.1111/j.1464-410x.2011.10761.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tal R, Rabbani F, Scardino PT, Mulhall JP. Measuring erectile function after radical prostatectomy: comparing a single question with the International Index of Erectile Function. BJU Int 2011; 109:414-7. [DOI: 10.1111/j.1464-410x.2011.10404.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stolic RV, Bukumiric ZM, Jovanovic AN, Peric VM, Sovtic SR, Belic BP, Mitic NB. Residual renal function and erectile dysfunction in patients on hemodialysis. Int Urol Nephrol 2011; 44:891-5. [DOI: 10.1007/s11255-011-9931-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 02/16/2011] [Indexed: 10/18/2022]
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BAR-CHAMA N, SNYDER S, ALEDORT L. Sexual evaluation and treatment of ageing males with haemophilia. Haemophilia 2011; 17:875-83. [DOI: 10.1111/j.1365-2516.2011.02507.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Gleason JM, Slezak JM, Jung H, Reynolds K, Van den Eeden SK, Haque R, Quinn VP, Loo RK, Jacobsen SJ. Regular nonsteroidal anti-inflammatory drug use and erectile dysfunction. J Urol 2011; 185:1388-93. [PMID: 21334642 DOI: 10.1016/j.juro.2010.11.092] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Previous data suggest a potential relationship between inflammation and erectile dysfunction. If it is causal, nonsteroidal anti-inflammatory drug use should be inversely associated with erectile dysfunction. To this end we examined the association between nonsteroidal anti-inflammatory drug use and erectile dysfunction in a large, ethnically diverse cohort of men enrolled in the California Men's Health Study. MATERIALS AND METHODS This prospective cohort study enrolled male members of the Kaiser Permanente managed care plans who were 45 to 69 years old beginning in 2002. Erectile dysfunction was assessed by questionnaire. Nonsteroidal anti-inflammatory drug exposure was determined by automated pharmacy data and self-reported use. RESULTS Of the 80,966 men in this study 47.4% were considered nonsteroidal anti-inflammatory drug users based on the definitions used and 29.3% reported moderate or severe erectile dysfunction. Nonsteroidal anti-inflammatory drug use and erectile dysfunction strongly correlated with age with regular drug use increasing from 34.5% in men at ages 45 to 49 years to 54.7% in men 60 to 69 years old with erectile dysfunction increasing from 13% to 42%. The unadjusted OR for the association of nonsteroidal anti-inflammatory drugs and erectile dysfunction was 2.40 (95% CI 2.27, 2.53). With adjustment for age, race/ethnicity, smoking status, diabetes mellitus, hypertension, hyperlipidemia, peripheral vascular disease, coronary artery disease and body mass index, a positive association persisted (adjusted OR 1.38). The association persisted when using a stricter definition of nonsteroidal anti-inflammatory drug exposure. CONCLUSIONS These data suggest that regular nonsteroidal anti-inflammatory drug use is associated with erectile dysfunction beyond what would be expected due to age and comorbidity.
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Affiliation(s)
- Joseph M Gleason
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
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Han M, Trock BJ, Partin AW, Humphreys EB, Bivalacqua TJ, Guzzo TJ, Walsh PC. The impact of preoperative erectile dysfunction on survival after radical prostatectomy. BJU Int 2011; 106:1612-7. [PMID: 20590546 DOI: 10.1111/j.1464-410x.2010.09472.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE Erectile dysfunction (ED) and cardiovascular disease (CVD) share etiology and pathophysiology. The underlying pathology for preoperative ED may adversely affect survival following radical prostatectomy (RP). We examined the association between preoperative ED and survival following RP. MATERIALS AND METHODS Between 1983 and 2000, a single surgeon performed RP on 2511 men, with preoperative ED (ED group, n= 231, 9.2%) or without ED (No ED group, n= 2280, 90.8%). We retrospectively analysed their CVD-specific survival (CVDSS), prostate cancer-specific survival (PCSS), non-PCSS (NPCSS) and overall survival (OS) from time of surgery. RESULTS With median follow-up of 13 years after RP, 449 men (18%) died (140 from prostate cancer, 309 from other causes). Kaplan-Meier analyses demonstrated significant differences in CVDSS (P < 0.001), NPCSS (P < 0.001) and OS (P < 0.001), but not in PCSS (P= 0.12), between the ED group vs No ED group. In univariate proportional hazards analyses, preoperative ED was associated with a significant decrease in OS, hazard ratio (HR), 1.71 (95% CI, 1.34-2.23), P < 0.001. However, in multivariable analyses, the association of ED with survival became non-significant (HR, 1.25 (95% CI, 0.97-1.66), P= 0.111) after adjusting for other prognostic factors, such as age, preoperative prostate-specific antigen (PSA) level, Gleason score, pathologic stage, body mass index and Charlson Comorbidity Index. CONCLUSIONS Preoperative ED is associated with decreased overall survival and survival from causes other than prostate cancer following RP. However, preoperative ED was not an independent predictor of overall survival after adjusting for other predictors of survival. Urologists should carefully assess pretreatment ED status to enhance appropriate treatment recommendation for men with prostate cancer.
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Affiliation(s)
- Misop Han
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Raina R, Pahlajani G, Agarwal A, Jones S, Zippe C. Long-term potency after early use of a vacuum erection device following radical prostatectomy. BJU Int 2011; 106:1719-22. [PMID: 20394611 DOI: 10.1111/j.1464-410x.2010.09360.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the long-term potency after radical prostatectomy (RP) with the early use of a vacuum erection device (VED), and reasons for sexual inactivity and long-term attrition and maintenance of sexual activity, as RP is one of the most common treatments for prostate cancer but erectile dysfunction (ED) is a common side-effect. PATIENTS AND METHODS We identified 141 sexually active patients who underwent RP at Cleveland Clinic Foundation. Patients were offered various non-oral treatment options to prevent ED and were also motivated for early penile rehabilitation. At 5 years 62% remained sexually active, of whom 71% had natural erections sufficient for intercourse without assistance, 8.5% were still using sildenafil, 10% were using combined therapy (sildenafil plus VED). At 5 years 38% (43/113) men were sexually inactive. The reasons included loss of interest in 17 (40%), cardiovascular/neurological diseases in 18 (42%), hormonal therapy in three (7%), loss of partner in three (7%) and two had other surgery. The natural rate of erections for sufficient vaginal penetration without an erection aid were preserved and maintained in the early-prophylaxis group, and almost 60% of them had used a VED as early prophylaxis. CONCLUSION Despite current phosphodiesterase-5 inhibitor treatments for ED, VED is becoming recognized again as having a primary role in early penile rehabilitation in many patients, specifically those treated for prostate cancer.
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Affiliation(s)
- Rupesh Raina
- Department of Urology, Case Medical Center, Cleveland, OH, USA
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