Hyperuricaemia is an important risk factor of the erectile dysfunction: A systematic review and meta-analysis

XGBoost model for predicting erectile dysfunction risk after radical prostatectomy: development and validation using machine learning

BACKGROUND

Erectile dysfunction (ED) is a frequent complication following radical prostatectomy, significantly affecting patients' quality of life. Traditional predictive methods often struggle to capture complex nonlinear risk factors. This study aims to develop a machine learning-based model to improve ED risk stratification and guide personalized management.

METHODS

A total of 1,147 prostate cancer patients were analyzed, among whom 285 (24.85%) developed postoperative ED. Univariate and multivariate analyses identified age, smoking history, Gleason score, prostate volume, T-stage, surgical approach, operative time, intraoperative bleeding, and PCT levels as independent risk factors (P < 0.05). Machine learning models, including XGBoost, Random Forest, Support Vector Machine, and k-Nearest Neighbors, were trained for ED risk prediction. Key predictors included advanced age, smoking history, Gleason score ≥ 8, prostate volume ≥ 40 ml, T-stage, laparoscopic-assisted surgery, and prolonged operative duration.

RESULTS

XGBoost exhibited the highest predictive accuracy (AUC: 0.980 in training; 0.960 in validation), outperforming other models. Calibration curves confirmed strong concordance between predicted and actual probabilities, while decision curve analysis demonstrated superior clinical utility, with XGBoost providing the greatest net benefit. Ten-fold cross-validation indicated stable performance (validation AUC: 0.9127 ± 0.0770; test AUC: 0.9592; accuracy: 0.9111), and external validation confirmed model generalizability (AUC: 0.84). SHAP analysis highlighted key risk contributors, enabling individualized risk assessment and targeted clinical interventions.

CONCLUSION

The XGBoost model exhibited superior predictive performance and clinical applicability in assessing ED risk after radical prostatectomy, offering a robust tool for personalized postoperative management.

Exploring the causal associations of gout and serum uric acid levels on erectile dysfunction: A Mendelian randomization study

Several observational studies have suggested a possible link between gout, serum uric acid (UA) levels, and erectile dysfunction (ED). Nonetheless, the current body of evidence does not allow for a conclusive determination regarding the influence of gout and serum UA on the likelihood of developing ED. The primary aim of this research was to explore the potential causal relationship between gout and serum UA levels in relation to ED utilizing Mendelian randomization (MR) analysis. The principal analytical method employed was inverse variance weighting (IVW). Following this, a sensitivity analysis was performed using Cochran Q-test, funnel plots, MR-Egger regression, and the leave-one-out method. The findings from the IVW analysis revealed no significant association between gout and ED (odds ratio [OR] = 1.004, 95% confidence interval [CI]: 0.948-1.063, P = .888), nor between serum UA levels and ED (OR = 1.013, 95% CI: 0.775-2.126, P = .333). The results from the supplementary methods corroborated those obtained from the IVW approach. This study confirmed the absence of heterogeneity and horizontal pleiotropy, with consistent results across all sensitivity analyses. The MR analysis did not yield genetic-level evidence to substantiate a direct causal relationship between gout, serum UA, and ED.

Sexual Dysfunction in Patients with Chronic Non-Genital Physical Disease: An Umbrella Review

Many primary studies and reviews have been published on the influence of chronic diseases (CDs) on sexual dysfunction (SD), but CDs not involving the genitals are less well represented in the literature.

AIM

To determine the prevalence of SD in patients with non-genital CD and assess the overall impact on sexual functioning.

METHODS

An umbrella review was performed of published systematic reviews on the relationship between the occurrence of CDs not involving the genitals and patients' sexual functioning, following the PRISMA guidelines. PubMed, EMBASE, the Cochrane Library, PsycInfo, Scopus, and CINAHL were used to find publications for inclusion in the review, with two independent researchers performing the search and selection of articles, data extraction, and quality assessment. The relative risk (RR) or odds ratio (OR) with 95% confidence was used as an indicator of the association between CD and SD across studies. The quality of studies included in the review was assessed using Amstar-2.

OUTCOMES

Forty-three systematic reviews, thirty of which included a meta-analysis, met the inclusion criteria, representing a total of 880,586 patients (756,629 (85.9%) men, 68,388 (7.8%) women, and 55,569 (6.3%) unspecified).

RESULTS

Among men, CD is associated with erectile dysfunction, and among females, with lower levels of desire, arousal, lubrication, orgasm, and sexual satisfaction and with increased pain during intercourse. For both men and women, depression, anxiety, and fatigue are also reported, while women with CD are more affected by a poor body image than men.

CLINICAL IMPLICATIONS

Patients with CD, especially females, should be more routinely assessed for the impact of their condition on sexual functioning. The impact of CD on men's sexuality has been extensively studied in terms of erectile capacity, but other aspects of their sexuality are largely neglected. Strengths and limitations: This is the first umbrella review to bring together the documented findings regarding sexual dysfunction among patients with various non-genital CDs. While the heterogeneity of the CDs makes the study unique and clinically relevant, it renders the interpretation of the results more difficult. The overrepresentation of men in existing studies reflects the current state of research but limits the applicability of the findings for women.

CONCLUSIONS

Women and men with non-genital CDs can suffer from SD or reduced sexual function. Health professionals should pay more attention to managing these sexual disorders, even when the disease does not affect the genitals.

Mechanisms of erectile dysfunction induced by aging: A comprehensive review

BACKGROUND

With the increasing trend ofpopulation aging, erectile dysfunction (ED) among elderly men has emerged as apressing health concern. Despite extensive research on the relationship betweenED and aging, ongoing discoveries and evidence continue to arise.

OBJECTIVE

Through this comprehensiveanalysis, we aim to provide a more nuanced theoretical framework for thedevelopment of preventive and therapeutic strategies for senile ED, ultimatelyenhancing the quality of life for elderly men.

METHODS

This review delves deeper into thecore mechanisms underlying ED in the context of aging and offers acomprehensive overview of published meta-analyses and systematic reviewspertinent to these conditions.

RESULTS AND CONCLUSION

Our findings revealthat local structural damage to the penis, vascular dysfunction, neuronalinjury, hormonal alterations, other physiological changes, and psychologicalbarriers all play pivotal roles in the pathogenesis of aging-related ED.Furthermore, more than 20 diseases closely associated with aging have beenimplicated in the occurrence of ED, further compounding the complexity of thisissue.

Gout and erectile dysfunction: Increased carotid intima-media thickness is independently associated with greater likelihood for erectile dysfunction

Objectives

The study aimed to compare gout patients and healthy subjects in terms of erectile dysfunction, carotid intima-media thickness (CIMT), and other variables and to investigate the relationship between CIMT and erectile dysfunction.

Patients and methods

This cross-sectional study was conducted with 134 male gout patients (median age: 56 years; range, 48 to 62 years) and 104 healthy males (median age: 47 years; range, 40.5 to 54.5 years) between September 2022 and June 2023. Age, comorbidities, height, weight, laboratory results, gout treatment data, insulin resistance evaluated by the homeostatic model assessment for insulin resistance, presence and severity of erectile dysfunction evaluated by the six-item International Index of Erectile Function erectile function domain (IIEF-EF), and CIMT measured by ultrasound were assessed.

Results

Hypertension, hyperlipidemia, greater insulin resistance, erectile dysfunction, and bilaterally increased CIMT were significantly more common in the gout group. The mean IIEF-EF score of gout patients was significantly lower than that of controls. Multivariable logistic regression revealed increased CIMT as the sole parameter independently associated with erectile dysfunction (p=0.010). When both groups were categorized into CIMT-based subsets, erectile dysfunction was present in 97.9% of patients with coexistence of gout and increased CIMT (≥0.9 mm), a significantly higher proportion compared to the other three subsets (p<0.001).

Conclusion

Increased CIMT was the only factor independently associated with a greater likelihood of erectile dysfunction in patients with and without gout; however, coexistence of gout and increased CIMT appears to result in a significantly elevated risk for erectile dysfunction.

Uncovering the Potential Mechanisms and Effects of Hyperuricemia and its Associated Diseases on Male Reproduction

Male fertility and metabolic disorders, including obesity and diabetes, are closely connected. Since hyperuricemia and metabolic syndrome are strongly related, male fertility and hyperuricemia may, to some degree, be associated. According to recent studies, hyperuricemia imposes various effects on sex hormones, semen quality, and male erectile dysfunction. Some researchers claim that uric acid worsens male semen and raises the risk of erectile dysfunction (ED), while others state that it safeguards both penile erection and male semen. Additionally, it has been shown that gout and metabolic syndrome also raise the risk of ED. To clarify this controversy, the influence and potential mechanisms of hyperuricemia on ED, semen quality, sex hormone levels, and the effects of hyperuricemia-related disorders on ED will be comprehensively summarized.

Association of serum uric acid with male sexual hormones and erectile dysfunction: a bidirectional 2-sample Mendelian randomization analysis

Background

Observational studies indicated that serum uric acid (SUA) was associated with male sexual hormones and erectile dysfunction (ED). However, their relationship was still heterogeneous.

Aim

This study conducted 2-sample univariate mendelian randomization (UVMR) and multivariate mendelian randomization (MVMR) to explore the causal relationship between SUA and sexual hormones as well as ED.

Methods

Genetic variants associated with SUA were derived from the UK Biobank database (N = 437 354). Outcomes from the IEU Open GWAS and summary data sets were sexual hormones (sex hormone-binding globulin [SHBG], testosterone, estradiol [E2], follicle-stimulating hormone, luteinizing hormone) and ED, with 3301 to 625 650 participants. UVMR analysis primarily utilized the inverse variance weighted method, complemented by MVMR analysis. Thorough sensitivity analyses were carried out to ensure the reliability of results. Moreover, mediation analysis was conducted to estimate the mediated effect between SUA and outcomes.

Outcomes

The primary outcomes included results of UVMR and MVMR analysis and mediation analysis, along with sensitivity analyses involving the Cochran Q test, the MR Egger intercept test, leave-1-out analysis, and the MR-PRESSO method (mendelian randomization pleiotropy residual sum and outlier).

Results

UVMR analysis revealed that an elevated SUA level could decrease levels of SHBG (β = -0.10, P = 1.70 × 10-7) and testosterone (β = -0.10, P = 5.94 × 10-3) and had a positive causal effect on ED (odds ratio, 1.10; P = .018). According to reverse mendelian randomization results, increased levels of SHBG (β = -0.06, P = 4.82 × 10-4) and E2 (β = -0.04, P = .037) could also reduce SUA levels. As shown by MVMR analysis, SUA had a negative effect on SHBG and testosterone levels (P < .05), while the significant causal relationship between SUA and ED disappeared. Furthermore, SHBG mediated 98.1% of the effect of SUA on testosterone levels. Results of other mendelian randomization analyses were not statistically significant. No pleiotropy was found by sensitivity analysis in this study.

Clinical Implications

Given the causal relationship between SUA and sexual hormones, we must focus on SUA and E2 levels in men, especially patients with hypogonadism and ED.

Strengths and Limitations

This study evaluated the causal effect of SUA on male sexual hormones and ED genetically for the first time, clarifying the common biases in observational studies and confirming the negative relationship between SUA and testosterone level. Limitations include a population based on European ancestry, some crossover of the samples, and unobserved confounding factors.

Conclusion

Genetic studies provide evidence for the causal relationship between SUA and male sexual hormones (SHBG, testosterone, E2), while the relationship between SUA and ED should be further evaluated.

Mechanistic insights of soluble uric acid-induced insulin resistance: Insulin signaling and beyond

Hyperuricemia is a metabolic disease caused by purine nucleotide metabolism disorder. The prevalence of hyperuricemia is increasing worldwide, with a growing trend in the younger populations. Although numerous studies have indicated that hyperuricemia may be an independent risk factor for insulin resistance, the causal relationship between the two is controversial. There are few reviews, however, focusing on the relationship between uric acid (UA) and insulin resistance from experimental studies. In this review, we summarized the experimental models related to soluble UA-induced insulin resistance in pancreas and peripheral tissues, including skeletal muscles, adipose tissue, liver, heart/cardiomyocytes, vascular endothelial cells and macrophages. In addition, we summarized the research advances about the key mechanism of UA-induced insulin resistance. Moreover, we attempt to identify novel targets for the treatment of hyperuricemia-related insulin resistance. Lastly, we hope that the present review will encourage further researches to solve the chicken-and-egg dilemma between UA and insulin resistance, and provide strategies for the pathogenesis and treatment of hyperuricemia related metabolic diseases.

Erectile Dysfunction: Pharmacological Pathways with Understudied Potentials

Erectile dysfunction (ED) is a public health concern worldwide. In the past, it was perceived as a phenomenon attributed to age advancement. However, more individuals are affected every year that do not fall under that age criterion. Epidemiological research revealed that this abnormality has an association with endothelial dysfunction connected to several cardiovascular (CV) risk factors. Currently, ED is interpreted as a clinical marker for future adverse events and not only as a present health issue that negatively affects the quality of life. The management of ED involves lifestyle modifications, therapeutic optimization for comorbid conditions, and pharmacological and psychosexual therapy. Phosphodiesterase type 5 (PDE5) inhibitors are the first-line pharmacological agents to be prescribed for such a condition. Nonetheless, other pharmacological pathways and agents remain underinvestigated or were investigated at some stage. This review aimed to present to future researchers interested in this field with some pharmacological agents that showed favorable effects on a limited number of studies on human subjects or experimental models.