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Wang C, Zhang H, Wang F, Guo J, Yuan J, Hou G, Gao M, Li Z, Zhang Y. Efficacy and safety of PDE5 inhibitors in middle-aged and old patients with and without hypogonadism. Aging Male 2024; 27:2288347. [PMID: 38146937 DOI: 10.1080/13685538.2023.2288347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/19/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE Although several reviews have evaluated the use of PDE5 inhibitors (PDE5i) for treating erectile dysfunction (ED), their specific use in middle-aged and old patients has not been fully evaluated. Given that elderly patients with ED often have a complex combination of systemic and sexual health risk factors, the safety and efficacy of PDE5i in such a context are hereby reviewed. MATERIALS AND METHODS A thorough examination of existing literature has been conducted on PubMed. RESULTS PDE5i has good safety and efficacy, but the situation is more complex for patients with hypogonadism than those with normal testosterone levels, with reduced responsiveness to PDE5i. In this case, combination therapy with testosterone is recommended, safe and effective. CONCLUSIONS Eliminating or reducing reversible risk factors and controlling or slowing the development of irreversible factors is an important foundation for using PDE5i to treat ED in all patients, especially middle-aged and elderly ones.
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Affiliation(s)
- Chunlin Wang
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Hui Zhang
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fu Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jun Guo
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ming Gao
- Department of Andrology, Xi'an Daxing Hospital affiliated to Yan'an University, Xi'an, China
| | - Zheng Li
- Shanghai Key Laboratory of Reproductive Medicine, Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhang
- Department of Infertility and Sexual Medicine, 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Gao Y, Liu C, Lu X, Lu K, Zhang L, Mao W, Pan K, Liang Z, Sun C, Chen M. Lycopene intake and the risk of erectile dysfunction in US adults: NHANES 2001-2004. Andrology 2024; 12:45-55. [PMID: 37038051 DOI: 10.1111/andr.13439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Erectile dysfunction is a condition with a high incidence among adult men. Lycopene has been shown to lower blood glucose and reduce weight in diabetic patients because of its antioxidant and anti-inflammatory properties. However, the association between lycopene and the incidence of erectile dysfunction is unclear. OBJECTIVE The aim of this study was to examine the dietary lycopene intake and its association with erectile dysfunction risk in the US population. MATERIALS AND METHODS We investigated the lycopene intake of adult participants with complete information on clinical variables from the National Health and Nutrition Examination Survey between 2001 and 2004. Dose-response curve analysis was applied to explore the association between lycopene intake and erectile dysfunction. Logistic regression models were used to adjust for confounders. Different ethnicities, body mass index level, hypertension status, diabetes status, and smoking status were analyzed as subgroups. Propensity score matching was employed to eliminate the effects of potential confounders to confirm the reliability of the results. RESULTS A total of 3265 participants with lycopene consumption data were included in our study, including 931 individuals with erectile dysfunction and 2334 without erectile dysfunction during National Health and Nutrition Examination Survey 2001-2004. We found more consumption of lycopene in the non-erectile dysfunction group than in the erectile dysfunction group. Dose-response curve analysis revealed a significant negative association between lycopene intake and erectile dysfunction prevalence. After adjusting for age, race, cigarette smoking, body mass index, annual family income, education, physical activity, hypertension, diabetes, depression, and testosterone level, we found that increased lycopene intake reduced the odds ratio of erectile dysfunction. Low lycopene intake was positively related to erectile dysfunction in almost all subgroups, especially in Mexican American, non-Hispanic white, body mass index <25, hypertension positive, diabetes mellitus negative, and smoke negative. Furthermore, the results were confirmed in the 1:1 matched group. CONCLUSION Our national data suggest that lower dietary lycopene intake is positively associated with an increased risk of erectile dysfunction in US men.
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Affiliation(s)
- Yue Gao
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, China
| | - Chunhui Liu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Xun Lu
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, China
| | - Kai Lu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Lei Zhang
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Weipu Mao
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Kehao Pan
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, China
| | - Zichun Liang
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, China
| | - Chao Sun
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
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Kianian R, Andino JJ, Morrison JJ, Grundy D, Appleton A, Lavold AJ, Eleswarapu SV, Mills JN. Potential primary prevention of Peyronie's disease post prostatectomy?-retrospective analysis of peri-operative multi-modal penile rehabilitation. Transl Androl Urol 2023; 12:1708-1712. [PMID: 38106686 PMCID: PMC10719776 DOI: 10.21037/tau-23-281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/01/2023] [Indexed: 12/19/2023] Open
Abstract
The surgical management of prostate cancer through radical prostatectomy has the potential to impact patients' sexual function, including erectile dysfunction and Peyronie's disease (PD). Historical data suggests the incidence of PD in post-prostatectomy patients is higher than in the general population at 15.9%. Our study objective was to measure the rate of the development of PD among patients that receive penile rehabilitation (PR) regimen prior to and immediately after radical prostatectomy. In this study, we retrospectively reviewed the charts of 581 patients who were diagnosed with prostate cancer, treated with radical prostatectomy, and engaged in a PR program. Patients with the diagnosis of PD prior to prostatectomy were excluded from this study. The PR program consists of daily tadalafil, L-citrulline, and weekly vacuum erectile device with the option of intracavernosal injections if patients fail to respond to the regular regimen. We found the incidence of PD to be 2.9%, suggesting that PR regimens programs may be associated with a reduced incidence of PD in post-prostatectomy patients. Ten (out of 17) patients were diagnosed with PD after 2 years of follow up. The return of erections was not statistically different among patients who developed PD and the rest of the patients. Prospective, multi-institutional trials will be required to elucidate whether PR can prevent the development of PD in this patient population.
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Affiliation(s)
| | - Juan J. Andino
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeff J. Morrison
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dayna Grundy
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ashley Appleton
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Abigail J. Lavold
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sriram V. Eleswarapu
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Almsaoud NA, Safar O, Alshahrani ST, Alwadai R, Alkhaldi SM, Almurayyi M, Alrweili HH, Assiri HM, Al Jubran A, Hakami B, Alzahrani MA. The effect of penile traction device in men with Peyronie's disease on penile curvature, penile length, and erectile dysfunction: a systematic review and meta-analysis. Transl Androl Urol 2023; 12:1673-1685. [PMID: 38106680 PMCID: PMC10719764 DOI: 10.21037/tau-23-310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/20/2023] [Indexed: 12/19/2023] Open
Abstract
Background Peyronie's disease (PD) results in curvature, pain, and erectile dysfunction (ED). Penile traction devices (PTDs) are a non-invasive treatment option for PD by applying mechanical forces to elicit biochemical responses that reduce curvature and improve penile function. In the present study, we systematically reviewed and analyzed the literature investigating the use of PTD to treat PD. Methods We have conducted electronic and manual search strategies within the databases and included articles to find relevant studies. A total of Five studies met all the predefined inclusion criteria and were selected for inclusion in the review. Outcomes assessed are penile length, penile curvature, and erectile function (EF). The study population consisted of patients with PD, the intervention was penile traction therapy (PTT), the comparison was matched placebo or follow-up, and the study design was randomized controlled trials (RCTs) or cohort studies. The Cochrane risk of bias assessed the studies' quality for randomized studies and the Newcastle-Ottawa scale (NOS) for non-randomized observational studies. All statistical analyses were performed using R software. Results were considered statistically significant for P<0.05. Results Only five studies met inclusion and exclusion criteria and were published between 2014 and 2021. The sample sizes range [51-110], totaling 419, with a mean of 83.8 patients-the follow-up with a mean of 6.75 months. This meta-analysis evaluated the efficacy of PTD on curvature degree, penile length, and EF in patients. There is a significant positive effect on the curvature degree (P=0.0373), while there is no significant effect on penile length and EF (P=0.5315 and 0.1010), respectively. They are Indicating low heterogeneity with an estimated total heterogeneity of 0. Overall, the available evidence does not support the efficacy of the intervention for penile length or EF. Conclusions The current evidence suggests that PTDs can be a safe and effective treatment option for men with PD to reduce penile curvature. However, further research, including more RCTs with extended follow-up periods, is needed to fully understand their efficacy and determine the ideal timing and patient subtypes that would benefit from PTD.
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Affiliation(s)
- Nazal A. Almsaoud
- Urology Department, Prince Mutaib Bin Abdulaziz Hospital, Sakaka, Al-Jouf Region, Saudi Arabia
| | - Omar Safar
- Urology Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia
| | | | - Raed Alwadai
- Urology Department, King Abdullah Hospital, Bishah, Assir, Saudi Arabia
| | - Sulaiman M. Alkhaldi
- Urology Department, Prince Mutaib Bin Abdulaziz Hospital, Sakaka, Al-Jouf Region, Saudi Arabia
| | - Muath Almurayyi
- Urology Department, King Khaled University Medical city-Abha, Assir, Saudi Arabia
| | - Hana Hazi Alrweili
- Urology Department, Prince Mutaib Bin Abdulaziz Hospital, Sakaka, Al-Jouf Region, Saudi Arabia
| | - Hassan M. Assiri
- Urology Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia
| | - Abdulkareem Al Jubran
- Urology Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia
| | - Basel Hakami
- Urology Department, King Faisal Medical City for Southern Region (KFMCity), Abha, Saudi Arabia
- Urology Department, King Fahad Central Hospital, Jazan, Saudi Arabia
| | - Meshari A. Alzahrani
- Urology Department, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
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Helo S, Betcher HK, Ziegelmann M. Assessing psychiatric risk with a focus on optimizing patient satisfaction with penile prosthesis placement-a narrative review. Transl Androl Urol 2023; 12:1761-1771. [PMID: 38106683 PMCID: PMC10719777 DOI: 10.21037/tau-23-144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/11/2023] [Indexed: 12/19/2023] Open
Abstract
Background and Objective Treatment for medication-refractory erectile dysfunction (ED) is based on a shared decision-making model. The gold standard treatment for medication refractory ED is penile prosthesis (PP) placement. Patient satisfaction rates with PP are high with adequate counseling and expectation-setting. However, as with any elective surgery, patient selection is key to minimizing complications and ultimately patient dissatisfaction. Psychological well-being is an important consideration in the preoperative evaluation and postoperative management of patients undergoing PP placement. Methods We performed a PubMed literature review to identify pertinent studies for this narrative review. Specifically, we sought describe preoperative evaluation including appropriate counseling and patient selection as well relevant intraoperative and postoperative factors for patients undergoing PP placement with a specific focus on optimizing preoperative psychiatric factors and treatment-related patient satisfaction to identify pertinent articles describing ways to optimize patient satisfaction with PP. Key Content and Findings A patient's psychological state can influence the degree of understanding of their condition, affect perception of their treatment team, and limit their ability to cope with complications. All patients should undergo a thorough medical history and physical examination to screen for psychiatric health disorders, substance abuse, and chronic pain conditions. Establishing patient expectations with regards to treatment-related outcomes during the preoperative consultation will ensure congruency between the patient and performing surgeon. Patients with a more significant psychiatric distress related to their underlying sexual dysfunction may require additional evaluation and counseling preoperatively. Conclusions PP placement is associated with high levels of overall satisfaction in appropriately screened patients. Specific considerations during preoperative counseling and careful patient selection, intraoperative decision making to avoid or anticipate possible complications, and postoperative cares are necessary to ensure the best result for an individual patient.
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Affiliation(s)
- Sevann Helo
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Hannah K. Betcher
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Lin X, Long H, Liu J, Xiong W, Jiang R. A low androgen state impairs erectile function by suppressing EPAC1 in rat penile corpus cavernosum. Transl Androl Urol 2023; 12:1528-1539. [PMID: 37969773 PMCID: PMC10643387 DOI: 10.21037/tau-23-314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/22/2023] [Indexed: 11/17/2023] Open
Abstract
Background Exchange proteins activated by cAMP 1 (EPAC1) can promote vasodilatation by regulating endothelial nitric oxide synthase (eNOS) activity through the phosphoinositide 3-kinase/protein kinase B (PI3K/AKT) pathway and prevent vascular smooth muscle contraction by restraining the ras homolog gene family, member A/Rho-associated coiled-coil forming protein kinase (RhoA/ROCK) pathway. However, the relationship among EPAC1, androgen and erectile function is still unknown. Therefore, we attempted to investigate whether EPAC1 expresses in penile corpus cavernosum of rats and how EPAC1 affects erectile function under low androgenic conditions. Methods Thirty 8-week-old Sprague-Dawley male rats were randomly divided into six groups (n=5): sham operation (sham), castrated, castrated + testosterone replacement (castrated + T), sham + EPAC1 over-expression lentivirus (sham + EPAC1), castrated + empty lentivirus vector (castrated + empty vector), and castrated + EPAC1. Four weeks after the operation, the lentivirus vectors carrying the EPAC1 gene were injected into the penile corpus cavernosum of the sham + EPAC1 and castrated + EPAC1 groups (1×108 TU/mL, 20 µL per rat). A week after injection, the ratio of maximum intracavernous pressure to mean arterial pressure (ICPmax/MAP) and the levels of serum testosterone (T), nitric oxide (NO), the active form of RhoA (RhoA-GTP), AKT, phospho-AKT (p-AKT), eNOS, phospho-eNOS (p-eNOS), p-AKT/AKT, p-eNOS/eNOS and EPAC1 levels were measured. Results In comparison to the sham group, ICPmax/MAP and EPAC1 content in the castrated group were significantly reduced. EPAC1 is primarily located in the cyto-membrane and cytoplasm of endothelial cells and smooth muscle cells in the rat penile corpus cavernosum. In comparison to the sham group, the T, ICPmax/MAP and NO levels of the castrated group were significantly reduced (P<0.01). Meanwhile, the RhoA-GTP concentration in the castrated + EPAC1 group was reduced in comparison with the castrated + empty vector group (P<0.01). Compared with the castrated + empty vector group, the p-AKT/AKT, EPAC1 and p-eNOS/eNOS levels in the castrated + EPAC1 group were significantly increased (P<0.05). Conclusions Androgen deficiency can suppress EPAC1 expression in the penile corpus cavernosum of rats, while the up-regulation of which can improve the erectile function of castrated rats.
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Affiliation(s)
- Xi Lin
- Department of Urology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hao Long
- Department of Urology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jing Liu
- Department of Urology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wenju Xiong
- Department of Urology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Rui Jiang
- Department of Urology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nephropathy Clinical Medical Research Center of Sichuan Province, Luzhou, China
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Matthew AN, Rogers DE, Grob G, Blottner M, Kodama S, Krzastek SC. The use of low-intensity extracorporeal shockwave therapy in management of erectile dysfunction following prostate cancer treatment: a review of the current literature. Transl Androl Urol 2023; 12:1023-1032. [PMID: 37426598 PMCID: PMC10323450 DOI: 10.21037/tau-22-791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/09/2023] [Indexed: 07/11/2023] Open
Abstract
Background and Objective Erectile dysfunction (ED) is a prevalent and impactful complication post definitive management of prostate cancer. The mechanism of ED is thought to be secondary to vascular and neural injury as well as corporal smooth muscle damage with resultant fibrosis. The use of penile rehabilitation in ED following treatment for prostate cancer has been studied. Low-intensity extracorporeal shockwave therapy (Li-ESWT) is a novel treatment for ED thought to stimulate neovascularization and nerve regeneration, and as such, has gained interest in treatment of ED related to radical prostatectomy or radiation therapy. Herein, we performed a narrative review on the use of Li-ESWT in management of ED following treatment for prostate cancer. Methods A literature review was performed using PubMed and Google Scholar. Studies evaluating Li-ESWT following prostate cancer treatment were included. Key Content and Findings We identified three randomized controlled trials and two observational studies that assessed use of Li-ESWT for ED after prostate surgery. Use of Li-ESWT across most studies showed improvements in the International Index of Erectile Function-erectile function (IIEF-EF) domain scores, but this improvement was not statistically significant. Additionally, use of Li-ESWT in an early versus delayed fashion does not appear to affect changes in long-term sexual function scores. No data on use of Li-ESWT after radiotherapy were identified. Conclusions There is a paucity of data regarding use of Li-ESWT for penile rehabilitation in treatment of ED post-prostate cancer therapy. Current protocols for Li-ESWT are not standardized and have a limited number of participants with short duration of follow-up. Additional evaluation is needed to determine optimal Li-ESWT protocols. Ideally, studies should have longer follow-up to truly evaluate the clinical significance of Li-ESWT in the treatment of post-prostatectomy ED. Furthermore, the role of Li-ESWT after radiotherapy remains elusive.
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Affiliation(s)
- Ashley N. Matthew
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Devin E. Rogers
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Gabrielle Grob
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Minna Blottner
- School of Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Sarah Kodama
- School of Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Sarah C. Krzastek
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
- Division of Urology, Central Virginia VA Health Care System, Richmond, VA, USA
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Ezemenahi SI, Alabi AN, Ogunfowokan O, Nwaneli CU, Aigbokhaode AQ, Eseigbe P. Quality of life of hypertensive men with erectile dysfunction in a tertiary health centre in southern Nigeria. Afr J Prim Health Care Fam Med 2023; 15:e1-e7. [PMID: 37132563 PMCID: PMC10157441 DOI: 10.4102/phcfm.v15i1.3875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/18/2023] [Accepted: 03/08/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Erectile dysfunction (ED) is the most common disorder of sexual health seen in men in community studies. A man's sexual health has been found to be a key factor in determining the capacity for maintaining a healthy relationship. AIM This study sought to determine the quality of life of hypertensive men with ED attending the out-patient clinics of Federal Medical Centre (FMC), Asaba, South-South, Nigeria. SETTING This study was conducted in the Out Patients Clinics (OPC) of FMC, Asaba, Delta state, Nigeria. METHODS After obtaining approval from the ethics and research committees in Asaba, 184 consenting hypertensive men who met the eligibility criteria were selected by systematic random sampling to participate in the study from October 2015 to January 2016. This study was a cross-sectional survey. Data were collected with a semi-structured interviewer-administered questionnaire adopted from the international index of Sexual Health Inventory for Men (SHIM) and the World Health Organization Quality of Life Scale (WHOQOL-BREF). The study complied with the principles of Helsinki and Good Clinical Practice. RESULTS The results showed the mean score for physical domain (58.78 ± 24.37), the psychological domain (62.68 ± 25.93), the social domain (50.47 ± 29.09), and the environmental domain (62.25 ± 18.52). Over a fifth, 11 (22.0%), of the respondents with severe ED had poor quality of life. CONCLUSION This study showed that ED is common in hypertensive men and their quality of life was more impaired than those with normal erectile function.Contribution: This study contributes to holistic approaches to patient care.
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Affiliation(s)
- Silvia I Ezemenahi
- Department of Family Medicine, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria; and Department of Family Medicine, Faculty of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi.
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Pérez-Aizpurua X, Garranzo-Ibarrola M, Simón-Rodríguez C, García-Cardoso JV, Chávez-Roa C, López-Martín L, Tufet i Jaumot JJ, Alonso-Román J, Maqueda-Arellano J, Gómez-Jordana B, Ruiz de Castroviejo-Blanco J, Osorio-Ospina F, González-Enguita C, García-Arranz M. Stem Cell Therapy for Erectile Dysfunction: A Step towards a Future Treatment. Life (Basel) 2023; 13:life13020502. [PMID: 36836859 PMCID: PMC9963846 DOI: 10.3390/life13020502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Background: The improvement of absent or partial response in the medical treatment of erectile dysfunction (ED) has led to the development of minimally invasive new treatment modalities in the field of regenerative medicine. Methods: A literature review on stem cell therapy for the treatment of ED was performed. We searched for the terms "erectile dysfunction" and "stem cell therapy" in PubMed and Clinicaltrials.gov. Literature searching was conducted in English and included articles from 2010 to 2022. Results: New treatment modalities for ED involving stem cell therapy are not only conceived with a curative intent but also aim to avoid unnecessary adverse effects. Several sources of stem cells have been described, each with unique characteristics and potential applications, and different delivery methods have been explored. A limited number of interventional studies over the past recent years have provided evidence of a safety profile in their use and promising results for the treatment of ED, although there are not enough studies to generate an appropriate protocol, dose or cell lineage, or to determine a mechanism of action. Conclusions: Stem cell therapy is a novel treatment for ED with potential future applications. However, most urological societies agree that further research is required to conclusively prove its potential benefit.
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Affiliation(s)
- Xabier Pérez-Aizpurua
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
- Correspondence:
| | | | | | | | - César Chávez-Roa
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Leticia López-Martín
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | | | - Josué Alonso-Román
- Urology Department, Hospital Universitario Virgen de la Macarena, 41009 Sevilla, Spain
| | | | - Blanca Gómez-Jordana
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | | | - Felipe Osorio-Ospina
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | | | - Mariano García-Arranz
- Instituto de Investigación Sanitaria (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
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10
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Huang Y, Liu W, Liu Y, Zhang M, Lv X, Hu K, Xu S, Lu M. Glycated serum albumin decreases connexin 43 phosphorylation in the corpus cavernosum. Transl Androl Urol 2022; 11:1486-1494. [PMID: 36507487 PMCID: PMC9732700 DOI: 10.21037/tau-22-317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background Glycated serum albumin (GSA) is an early glycosylation product that participates in diabetic vascular complications. This study examined the role of GSA in early damage to the corpus cavernosum and the involved mechanisms. Methods Nine 8-week-old male Sprague-Dawley (SD) rats (250-300 g) were divided into the control (saline vehicle, n=3) and GSA (200 µg/kg, n=6) groups. The corpus cavernosum tissues were harvested. Phosphorylated and non-phosphorylated connexin 43 (Cx43), endothelial nitric oxide synthase (eNOS), phosphatidylinositol 3-kinase (PI3K), and serine-threonine kinase (Akt) were tested by immunohistochemistry and western blotting. Human umbilical vein endothelial cells (HUVECs) overexpressing Cx43 were used to analyze the Cx43 phosphorylation sites (S368, S262, Y265, S255, and S279/282) using western blotting. Results The expression of phosphorylated Cx43 in the penis was significantly lower in GSA-treated rats than in controls. The expression levels of p-Cx43, p-eNOS, p-PI3K, and p-Akt were significantly decreased in HUVECs exposed to GSA in dose- and time-dependent manners. The most significant impact on all four proteins was observed with 1 µg/mL of GSA for 12 h. Phosphorylation at the S368, S262, Y265, S255, and S279/282 sites of Cx43 was downregulated by GSA, and S368 was the most significantly suppressed phosphorylation site compared with the other sites. Conclusions GSA decreases the expression of p-Cx43 in the corpus cavernosum of rats. This effect might be also related to the decreased phosphorylation of p-eNOS, p-PI3K, and p-Akt, as well as by the downregulation of phosphorylation at the S368 site.
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Affiliation(s)
- Yanping Huang
- Department of Urology and Andrology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai, China
| | - Wei Liu
- Department of Urology and Andrology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai, China
| | - Yidong Liu
- Department of Urology and Andrology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai, China
| | - Ming Zhang
- Department of Urology and Andrology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai, China
| | - Xiangguo Lv
- Department of Urology and Andrology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai, China
| | - Kai Hu
- Department of Urology and Andrology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai, China
| | - Shiran Xu
- Department of Urology and Andrology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai, China
| | - Mujun Lu
- Department of Urology and Andrology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai, China
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11
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Harirugsakul K, Wainipitapong S, Phannajit J, Paitoonpong L, Tantiwongse K. Erectile dysfunction among Thai patients with COVID-19 infection. Transl Androl Urol 2022; 10:4376-4383. [PMID: 35070819 PMCID: PMC8749063 DOI: 10.21037/tau-21-807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background Erectile dysfunction (ED) is suspected to be the symptom manifestation of COVID-19. However, scarce data was presented this day. Our study was conducted to determine the prevalence of ED and its associated factors among Thai patients with COVID-19. Methods Sexually active males with COVID-19, hospitalized between May and July 2021 at one university hospital in Bangkok, were screened for erectile dysfunction by the International Index of Erectile Function 5 (IIEF-5). Demographic data and COVID-19 treatment history were collected. Mental health status, including depression and anxiety, was evaluated with the Thai Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), respectively. The sample size was calculated, and logistic regression was used to analyze the association. Results One hundred fifty-three men with COVID-19 were recruited. ED prevalence was 64.7%, of which severity was mostly mild. Logistic regression, adjusted for age, BMI, and medical comorbidities, portrayed a significant association between ED and mental health status. Higher risk of ED was found in participants with major depression [adjusted OR 8.45, 95% CI: 1.01–70.96, P=0.049] and higher GAD-7 total score [adjusted OR 1.15, 95% CI: 1.01–1.31, P=0.039]. Conclusions Thai patients with COVID-19 had high prevalence of ED, which was associated with mental disorders. Thus, screening for mental problems is recommended in individuals with COVID-19 and ED.
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Affiliation(s)
- Kawintharat Harirugsakul
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Sorawit Wainipitapong
- Department of Psychiatry and Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Jeerath Phannajit
- Division of Clinical Epidemiology and Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Leilani Paitoonpong
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Kavirach Tantiwongse
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
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12
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Derosa G, D’Angelo A, Preti PS, Maffioli P. Evaluation of the Effect on Sexual Performance of a Nutraceutical Combination Containing Alpha Lipoic Acid, Vitis vinifera L. and Ginkgo biloba, Compared to Placebo, Avanafil or a Combination of Nutraceutical Plus Avanafil in Males With Type 2 Diabetes Mellitus With Erectile Dysfunction. Front Endocrinol (Lausanne) 2022; 13:847240. [PMID: 35464055 PMCID: PMC9022207 DOI: 10.3389/fendo.2022.847240] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 02/25/2022] [Indexed: 01/28/2023] Open
Abstract
AIM To evaluate if therapy with a nutraceutical combination of alpha lipoic acid, Vitis vinifera L. and Ginkgo biloba (Blunorm forte®) can be helpful and be synergic with Avanafil. METHODS The trial included 123 males with type 2 diabetic mellitus and with erectile dysfunction (ED), aged ≥18 years. Patients were divided in four different arms: 1st arm: placebo during the three months of treatment and before sexual act; 2nd arm: placebo for three months and Avanafil: 1 tablet, 200 mg, 15-30 minutes before sexual act; 3rd arm: Blunorm forte: 1 tablet, 40 minutes before the meal (breakfast) during the three months and Avanafil: 1 tablet, 200 mg, 15-30 minutes before sexual act; 4th arm: Blunorm forte: 1 tablet, 40 minutes before the meal (breakfast and dinner) during the three months and placebo 15-30 minutes before sexual act. RESULTS A significant reduction of fasting plasma glucose, and homeostasis model assessment-insulin resistance index were recorded both in Avanafil + Blunorm forte and with Blunorm forte. Metalloproteinases-2, and -9 were reduced in the Avanafil + Blunorm forte group. High sensitivity-C-reactive protein was decreased by both Avanafil, and Avanafil + Blunorm forte group. No variations were recorded with the other treatments. The group treated with Blunorm forte and Avanafil reached a higher International Index of Erectile Function (IIEF) score after 3 months of therapy compared to baseline and placebo and compared to Avanafil and Blunorm forte taken alone. CONCLUSION Blunorm forte® can be helpful and synergic with Avanafil in increasing sexual performance compared to placebo.
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Affiliation(s)
- Giuseppe Derosa
- Centre of Diabetes and Metabolic Diseases, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Laboratory of Molecular Medicine, University of Pavia, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- *Correspondence: Giuseppe Derosa,
| | - Angela D’Angelo
- Laboratory of Molecular Medicine, University of Pavia, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Paola Stefania Preti
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Pamela Maffioli
- Centre of Diabetes and Metabolic Diseases, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
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13
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Li L, Yao H, Dai W, Chen Y, Liu H, Ding W, Liu Y, Tao L, Wang J, Chen M. A higher TyG index is related with a higher prevalence of erectile dysfunction in males between the ages 20-70 in the United States, according to a cross-sectional research. Front Endocrinol (Lausanne) 2022; 13:988257. [PMID: 36157467 PMCID: PMC9497651 DOI: 10.3389/fendo.2022.988257] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aims to investigate the relationship between triglyceride glucose index (TyG) and erectile dysfunction (ED) among United States (US) adult males. METHODS A logistic regression analysis, subgroup analysis, and the computation of the dose-response curve were used to investigate the relationship between TyG index and ED prevalence among participants from the 2001-2004 National Health and Nutrition Examination Survey (NHANES) database. RESULTS After adjusting for all confounders, each unit increase in TyR index was associated with a 25 percent increase in ED prevalence (OR=1.25, 95%CI:1.03, 1.52), and stratified analysis showed that elevated TyG index was associated with increased ED prevalence in the 50-year old group (OR=1.35, 95% CI:1.05, 1.74), the Mexican-American group (OR=1.50, 95% CI:1.00, 2.23) and BMI 25-29.9 kg/m2 (OR=1.48, 95% CI:1.08, 2.01). The dose-response curve demonstrated a positive linear connection between the TyG index and the risk of ED. CONCLUSION It has been shown that a higher TyG index is associated with a higher prevalence of erectile dysfunction. Although the causal relationship is not clear, it still deserves clinical attention.
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Affiliation(s)
- Lin Li
- Department of Urology, Wuhu City Second People’s Hospital, Wuhu City, China
| | - Hui Yao
- Department of Geriatrics, Wuhu City Second People’s Hospital, Wuhu City, China
| | - Wei Dai
- Department of Urology, Wuhu City Second People’s Hospital, Wuhu City, China
| | - Yan Chen
- Department of General Practice, Wuhu City Second People’s Hospital, Wuhu City, China
| | - Heqian Liu
- Department of Urology, Wuhu City Second People’s Hospital, Wuhu City, China
| | - Wei Ding
- Department of Urology, Wuhu City Second People’s Hospital, Wuhu City, China
| | - Yingqing Liu
- Department of Urology, Wuhu City Second People’s Hospital, Wuhu City, China
| | - Lingsong Tao
- Department of Urology, Wuhu City Second People’s Hospital, Wuhu City, China
- *Correspondence: Lingsong Tao, ; Jiawei Wang, ; Mingwei Chen,
| | - Jiawei Wang
- Department of Urology, Wuhu City Second People’s Hospital, Wuhu City, China
- *Correspondence: Lingsong Tao, ; Jiawei Wang, ; Mingwei Chen,
| | - Mingwei Chen
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei City, China
- *Correspondence: Lingsong Tao, ; Jiawei Wang, ; Mingwei Chen,
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14
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Shin D, Jeon SH, Tian WJ, Kwon EB, Kim GE, Bae WJ, Cho HJ, Hong SH, Lee JY, Kim SW. Extracorporeal shock wave therapy combined with engineered mesenchymal stem cells expressing stromal cell-derived factor-1 can improve erectile dysfunction in streptozotocin-induced diabetic rats. Transl Androl Urol 2021; 10:2362-2372. [PMID: 34295723 PMCID: PMC8261440 DOI: 10.21037/tau-21-79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022] Open
Abstract
Background For erectile dysfunction (ED) in diabetes mellitus (DM) patients who have poor response to drugs, extracorporeal shock wave therapy (ESWT) and engineered mesenchymal stem cell (MSC) therapy have been studied as alternative treatment options. The objective of this study is to investigate whether ESWT in combination with stromal cell-derived factor-1 expressing engineered mesenchymal stem cell (SDF-1 eMSC) therapy can have synergistic effects on ED in streptozotocin-induced diabetic rats. Methods Fifty 8-week-old male Sprague-Dawley rats were randomly divided into five groups (N=10 per group): (I) Normal group, (II) DM ED, (III) DM ED + ESWT group, (IV) DM ED + SDF-1 eMSC group, and (V) DM ED + ESWT + SDF-1 eMSC group. Each groups were treated with bilateral injections of SDF-1 eMSC or ESWT following the experiment protocol for eight weeks. Results The ratio of ICP/MAP was distinctly higher in the DM ED + ESWT + SDF-1 eMSC group than that in the DM ED group. Concentration of α-smooth muscle actin (α-SMA) was elevated the highest in the DM ED + ESWT + SDF-1 eMSC group. Additionally, ESWT increased the intensity of SDF-1 expression in the corpus cavernosum. ESWT + SDF-1 eMSC treatment also induced neuronal nitric oxide synthase (nNOS) and NO/cGMP expression in the corpus cavernosum. Furthermore, numbers of penile progenitor cells were increased in DM ED rats. Conclusions Combined treatment of ESWT with SDF-1 eMSC treatment is more effective than by a single therapy. It could be used as a potential and effective synergistic treatment for DM ED.
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Affiliation(s)
- Dongho Shin
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Hwan Jeon
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Wen Jie Tian
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Eun Bi Kwon
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Ga Eun Kim
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Woong Jin Bae
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyuk Jin Cho
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
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15
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Calleja Hermosa P, Campos-Juanatey F, Varea Malo R, Correas Gómez MÁ, Gutiérrez Baños JL. Sexual function after anterior urethroplasty: a systematic review. Transl Androl Urol 2021; 10:2554-2573. [PMID: 34295743 PMCID: PMC8261436 DOI: 10.21037/tau-20-1307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/27/2021] [Indexed: 11/09/2022] Open
Abstract
Background Urethral surgery outcomes are often evaluated by assessing urinary flow and urethral patency. However, sexual consequences may appear after urethroplasty, impairing quality of life and patient’s perception of success. The aim of this study is to assess the relationship between anterior urethral reconstruction and postoperative sexual dysfunction, including the proposed factors predicting sexual outcomes. Methods We searched in PubMed database using the terms: “anterior urethroplasty”, bulbar urethroplasty” or “penile urethroplasty”, and “sexual dysfunction”, “erectile function” or “ejaculation”. Articles were independently evaluated for inclusion based on predetermined criteria. Systematic data extraction was followed by a comprehensive summary of evidence. Results Thirty-eight studies were included for final analysis. No randomised trial on the topic was found. Urethral surgery might affect different aspects of sexual function: erectile function, ejaculatory function, penile shape and length, and genital sensitivity, leading to severe sexual dysfunction. Patient perception of sexual impairment was related to post-operative satisfaction. Conclusions Sexual dysfunction after anterior urethral reconstruction is an important issue that must be appropriately discussed during preoperative patient counselling. Reported outcomes after anterior urethroplasty should include sexual consequences and relevance, evaluated using validated tools.
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Affiliation(s)
| | - Felix Campos-Juanatey
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain.,Valdecilla Research Institute (IDIVAL), Santander, Spain
| | - Raquel Varea Malo
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain
| | - Miguel Ángel Correas Gómez
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain.,Medical and Surgical Sciences Department, School of Medicine, University of Cantabria, Santander, Spain
| | - Jose Luis Gutiérrez Baños
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain.,Medical and Surgical Sciences Department, School of Medicine, University of Cantabria, Santander, Spain
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16
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Aoun F, Alkassis M, Tayeh GA, Chebel JA, Semaan A, Sarkis J, Mansour R, Mjaess G, Albisinni S, Absil F, Bollens R, Roumeguère T. Sexual dysfunction due to pudendal neuralgia: a systematic review. Transl Androl Urol 2021; 10:2500-2511. [PMID: 34295736 PMCID: PMC8261452 DOI: 10.21037/tau-21-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/26/2021] [Indexed: 01/16/2023] Open
Abstract
Background The pudendal nerve is considered as the main nerve of sexuality. Pudendal neuralgia is an underdiagnosed disease in clinical practice. The aim of this systematic review is to highlight the role of pudendal neuralgia on sexual dysfunction in both sexes. Methods A PubMed search was performed using the following keywords: “Pudendal” AND “Sexual dysfunction” or “Erectile dysfunction” or “Ejaculation” or “Persistent sexual arousal” or “Dyspareunia” or “Vulvodynia”. The search involved patients having sexual dysfunction due to pudendal neuralgia. Treatment received was also reported. Results Five case series, seven cohort studies, two pilot studies, and three randomized clinical trials were included in this systematic review. Pudendal nerve and/or artery entrapment, or pudendal neuralgia, is a reversible cause of multiple sexual dysfunctions. Interventions such as anesthetic injections, neurolysis, and decompression are reported as potential treatment modalities. There are no studies describing the role of pudendal canal syndrome in the pathophysiology or treatment of delayed ejaculation or penile shortening. Discussion Pudendal neuralgia is an underestimated yet important cause of persistent genital arousal, erectile dysfunction (ED), premature ejaculation (PE), ejaculation pain, and vulvodynia. Physicians should be aware of this entity and examine the pudendal canal in such patients before concluding an idiopathic cause of sexual dysfunction.
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Affiliation(s)
- Fouad Aoun
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon.,Urology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Marwan Alkassis
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Georges Abi Tayeh
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Josselin Abi Chebel
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Albert Semaan
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Julien Sarkis
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Raymond Mansour
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon
| | - Georges Mjaess
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon.,Urology Department, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Urology Department, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabienne Absil
- Urology department, Centre Hospitalier EpiCURA, Site de Ath, Ath, Belgium
| | - Renaud Bollens
- Urology department, Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - Thierry Roumeguère
- Urology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.,Urology Department, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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17
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Abstract
Erectile dysfunction is a defined as recurring inability to achieve and maintain satisfactory erection for sexual intercourse associated with relevant life impairment. The underlying etiologies may be manifold and complex. Currently, vascular etiologies are highly prevalent especially amongst elderly men. Of special interest, especially venogenic causes are of increasing relevance. Therapeutic options comprise risk factor modification, pharmacotherapy, surgical treatment, and endovascular treatment. Especially endovascular treatment options have recently increased in popularity including transcatheter embolization procedures for veno-occlusive dysfunction.
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Affiliation(s)
- Hanno Hoppe
- SwissIntervention Microtherapy Center, Bern, Switzerland.,University of Bern, Bern, Switzerland
| | - Nicholas Diehm
- University of Bern, Bern, Switzerland.,Vascular Institute Central Switzerland, Aarau, Switzerland
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18
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Thomas C, Konstantinidis C. Neurogenic Erectile Dysfunction. Where Do We Stand? Medicines (Basel) 2021; 8:3. [PMID: 33430218 DOI: 10.3390/medicines8010003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/16/2020] [Accepted: 01/04/2021] [Indexed: 12/20/2022]
Abstract
Erectile Dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance, causing tremendous effects on both patients and their partners. The pathophysiology of ED remains a labyrinth. The underlying mechanisms of ED may be vasculogenic, neurogenic, anatomical, hormonal, drug-induced and/or psychogenic. Neurogenic ED consists of a large cohort of ED, accounting for about 10% to 19% of all cases. Its diversity does not allow an in-depth clarification of all the underlying mechanisms nor a “one size fits all” therapeutical approach. In this review, we focus on neurogenic causes of ED, trying to elucidate the mechanisms that lie beneath it and how we manage these patients.
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19
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Li H, Zhang Z, Fang D, Tang Y, Peng J. Local continuous glial cell derived neurotrophic factor release using osmotic pump promotes parasympathetic nerve rehabilitation in an animal model of cavernous nerve injury induced erectile dysfunction. Transl Androl Urol 2021; 10:258-271. [PMID: 33532315 PMCID: PMC7844500 DOI: 10.21037/tau-20-1110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Nerve injury-related erectile dysfunction (ED) is one of the types that respond poorly to conventional ED treatments. Our previous experiments have demonstrated the paracrine of various neurotrophic factors (NTFs) by stem cells or other treatment modalities as a potential mechanism in the recovery of nerve injury-related ED. Glial cell derived neurotrophic factor (GDNF) is one of the essential NTFs for the regeneration of nerve fibers, especially for parasympathetic nerves. The aim of this study is to explore if local continuous GDNF administration is beneficial for the functional and histological recovery of nerve injury induced ED. Methods Eight-week-old male Sprague-Dawley rats were used for this study. Rats were randomly grouped into 5: Sham surgery (Sham), bilateral cavernous nerve injury (BCNI) and placebo treatment, BCNI and 0.1 µg/100 µL GDNF treatment (BCNI+GDNF 0.1), BCNI and 1 µg/100 µL GDNF treatment (BCNI+GDNF 1), BCNI and 10 µg/100 µL GDNF treatment (BCNI+GDNF 10). GDNF was administered using an osmotic pump technique which would deliver GDNF locally and continuously for 28 days without the need for external connections or frequent handling of animals. Recovery of sexual function, nerve fibers regeneration, and expression of neurotrophic receptors were examined and compared among groups after the treatment. Results Local continuous GDNF release treatment increased the average number of intromissions in the sexual behavior test and intracavernous pressure (ICP) in the erectile function test in a dose dependent manner. Osmotic pump implantation induced increased local GDNF concentration and mild inflammatory response. Gene expression of GDNF receptors in major pelvic ganglion (MPG) and nerve regeneration along the urethra were partially promoted by GDNF. These changes were associated with increased nerve fibers especially the parasympathetic nerve fibers in dorsal nerve of penis (DNP) in GDNF treated groups. Conclusions In conclusion, our project illustrated the promising effects of local continuous GDNF administration for the functional and histological recovery of nerve injury-induced ED.
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Affiliation(s)
- Huixi Li
- Andrology Center, Department of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Zhichao Zhang
- Andrology Center, Department of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Dong Fang
- Andrology Center, Department of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Yuan Tang
- Andrology Center, Department of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Jing Peng
- Andrology Center, Department of Urology, Peking University First Hospital, Peking University, Beijing, China
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20
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Feng D, Liu S, Yang Y, Bai Y, Li D, Han P, Wei W. Generating comprehensive comparative evidence on various interventions for penile rehabilitation in patients with erectile dysfunction after radical prostatectomy: a systematic review and network meta-analysis. Transl Androl Urol 2021; 10:109-124. [PMID: 33532301 PMCID: PMC7844489 DOI: 10.21037/tau-20-892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background We aim to present a comprehensive comparison of various treatments in the management of penile recovery after radical prostatectomy (RP) and provide recommendations for future research. Methods Literature search of electronic databases including PubMed, the Cochrane Library, Embase, PsycInfo, and Web of Science, and manual retrieval were conducted from inception through March 2020. “Erectile dysfunction” and “prostatectomy” were used as the Mesh terms. The patients, intervention, comparison, outcome, and study design (PICOS) approach were used to define study eligibility. Two authors independently selected studies, evaluated the methodological quality, and extracted data using Cochrane Collaboration’s tools. The data analysis was completed by STATA version 14.2. Results A total of 24 studies with 3,500 patients were incorporated in the final analysis after screening 6,131 records. Our findings indicated that vacuum constriction devices (VCD) ranked 1st which meant that patients in VCD group had the best effect regarding mean IIEF scores within 3 months after RP, and no significant difference was observed between VCD and VCD with 20 mg/day tadalafil (V20DT) (MD: 5.44; 95% CI: −0.81 to 11.69). VCD and 50 mg/day sildenafil (VC50DS) showed superiority over 50 mg/day sildenafil (50DS) (MD: 3.75; 95% CI: 2.74–4.76) and intraurethral alprostadil 125–250 µg (MD: 3.05; 95% CI: 0.38 to 5.72), respectively. Moreover, V20DT showed significant superiority over the other interventions for ≥6 months mean International Index Erectile of Function (IIEF) scores after RP. Monotherapy appeared to have similar efficacy in terms of mean IIEF scores and proportion of patients return to baseline, and the effect of phosphodiesterase type 5 inhibitors (PDE5is) did not seem to be affected by the patterns of administration (regular or on demand). Conclusions The combination therapy showed certain advantages over monotherapy, and we recommended the combination of VCD and PDE5is to be considered in the clinical management of penile rehabilitation after RP.
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Affiliation(s)
- Dechao Feng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shengzhuo Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yubo Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yunjin Bai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Dengxiong Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Han
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Wuran Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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21
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Wu SS, Ericson KJ, Shoskes DA. Retrospective comparison of focused shockwave therapy and radial wave therapy for men with erectile dysfunction. Transl Androl Urol 2020; 9:2122-2128. [PMID: 33209675 PMCID: PMC7658170 DOI: 10.21037/tau-20-911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Low-intensity shockwave therapy (SWT) is an emerging treatment for erectile dysfunction (ED). Devices used for SWT include focused shockwave therapy (fSWT) or radial wave therapy (rWT), which differ in how the waves are generated, their tissue penetration, and the shape of their pressure waves. Most studies of SWT for ED to date have utilized fSWT. Although widely used, the efficacy of rWT for ED is unknown. Our objective is to compare the efficacy of rWT and fSWT for ED at our institution. Methods A retrospective chart review was performed to identify all men with ED treated by fSWT or rWT. Men with history suggesting non-vasculogenic ED were excluded. All men received 6 consecutive weekly treatments. The fSWT group received 3,000 shocks per treatment at 0.09 mJ/mm2. The rWT group received 10,000 shocks per treatment at 90 mJ and 15 Hz. Pre-treatment and 6-week post-treatment Sexual Health Inventory in Men (SHIM) scores were measured. Treatment response was categorized on a scale of 1–3 (1 if no improvement, 2 if erections sufficient for intercourse with phosphodiesterase 5 inhibitors (PDE5i), or 3 if sufficient erections without PDE5i). Primary endpoint was self-reported improvement score of 2 or greater. Results A total of 48 men were included: 24 treated by fSWT and 24 by rWT. There were no significant differences in age, duration of ED, pre-treatment PDE5i use, or pre-treatment SHIM scores between the groups. Following treatment with rWT, the mean SHIM score improved from 9.3 to 16.1 (P<0.001). The mean SHIM following fSWT improved from 9.3 to 15.5 (P<0.001). The mean improvement in SHIM score did not differ between rWT (6.8) and fSWT (6.2) (P=0.42). 54% of men treated by fSWT experienced a significant clinical improvement (≥ grade 2 response) compared to 75% in the rWT group (P=0.42). There were no reported side effects with either device. Conclusions In our patient population, both fSWT and rWT were moderately effective treatments for arteriogenic ED with no observable difference in efficacy between the two modalities.
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Affiliation(s)
- Shannon S Wu
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Kyle J Ericson
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Daniel A Shoskes
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, USA
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22
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Kedia GT, Ückert S, Tsikas D, Becker AJ, Kuczyk MA, Bannowsky A. The Use of Vasoactive Drugs in the Treatment of Male Erectile Dysfunction: Current Concepts. J Clin Med 2020; 9:jcm9092987. [PMID: 32947804 PMCID: PMC7564459 DOI: 10.3390/jcm9092987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022] Open
Abstract
It is widely accepted that disorders of the male (uro)genital tract, such as erectile dysfunction (ED) and benign diseases of the prostate (lower urinary tract symptomatology or benign prostatic hyperplasia), can be approached therapeutically by influencing the function of both the vascular and non-vascular smooth muscle of the penile erectile tissue or the transition zone/periurethral region of the prostate, respectively. As a result of the discovery of nitric oxide (NO) and cyclic guanosine monophosphate (GMP) as central mediators of penile smooth muscle relaxation, the use of drugs known to increase the local production of NO and/or elevate the intracellular level of the second messenger cyclic GMP have attracted broad attention in the treatment of ED of various etiologies. Specifically, the introduction of vasoactive drugs, including orally active inhibitors of the cyclic GMP-specific phosphodiesterase (PDE) 5, has offered great advantage in the pharmacotherapy of ED and other diseases of the genitourinary tract. These drugs have been proven efficacious with a fast on-set of action and an improved profile of side-effects. This review summarizes current strategies for the treatment of ED utilizing the application of vasoactive drugs via the oral, transurethral, topical, or self-injection route.
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Affiliation(s)
- George T. Kedia
- Department of Urology & Urological Oncology, Division of Surgery, Hannover Medical School, 30625 Hannover, Germany; (G.T.K.); (S.Ü.)
- Department of Urology, DIAKOVERE GmbH, Friederikenstft Lutheran Hospital, 30171 Hannover, Germany
| | - Stefan Ückert
- Department of Urology & Urological Oncology, Division of Surgery, Hannover Medical School, 30625 Hannover, Germany; (G.T.K.); (S.Ü.)
| | - Dimitrios Tsikas
- Center of Pharmacology & Toxicology, Core Unit Proteomics, Hannover Medical School, 30625 Hannover, Germany;
| | - Armin J. Becker
- Faculty of Medicine, Academic Hospital Grosshadern, Department of Urology, Ludwig Maximilians University, 81377 Munich, Germany;
| | - Markus A. Kuczyk
- Department of Urology & Urological Oncology, Division of Surgery, Hannover Medical School, 30625 Hannover, Germany; (G.T.K.); (S.Ü.)
- Correspondence: ; Tel.: +49-(0)511-532-3437; Fax: +49-(0)511-532-3684
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23
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Cheng H, Niu Z, Xin F, Yang L, Ruan L. A new method to quantify penile erection hardness: real-time ultrasonic shear wave elastography. Transl Androl Urol 2020; 9:1735-1742. [PMID: 32944534 PMCID: PMC7475665 DOI: 10.21037/tau-20-1096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background An important indicator of penile erectile function is erection hardness (EH), which is currently evaluated by the semi-quantitative erectile hardness score (EHS). EH increases continuously during the course of an erection, so although it is statistically a continuous variable, the EHS is a grade variable. We propose a new method for real-time quantitative measurement of penile EH using ultrasonic shear wave elastography (SWE). Methods The study group comprised 40 patients with erectile dysfunction (ED) and 20 normal controls who all underwent real-time SWE to measure tissue stiffness (Young’s modulus, YM) of the penile corpus cavernosum and tunica albuginea during erection, at rest and at different EH grades induced by intracavernosal injection (ICI) of prostaglandin. The examiner gently placed the high frequency probe on the ventral penis and got the two-dimensional longitudinal US image of penis, then switched to SWE mode, the appropriate region of interest (ROI) was selected, then a 3–5 mm circle (“Q-box”) was automatically set to by machine to measure the SWE of the corpus cavernosum and tunica albuginea on the left side. Results In both the ED patients and normal controls, YM slightly decreased in the corpus cavernosum during erection but the stiffness of tunica albuginea increased significantly with increasing EH (resting: 21.66±4.21 kPa, grades 1–4: 32.61±4.27, 54.86±8.69, 128.02±20.66, and 223.23±23.61 kPa, respectively). Because EH grades 1 and 2 clinically predicted failure to complete sexual intercourse, and EH grades 3 and 4 predicted ability, the cutoff point for the YM of the tunica albuginea to evaluate whether sexual intercourse could be completed was 81.60 kPa. Conclusions Our data demonstrated that tunica albuginea stiffness, not corpus cavernosum stiffness, provided a good clinical imaging index indicator for evaluating penile EH. The tunica albuginea stiffness changed continuously during penile erection, which could be measured quantitatively by SWE. Compared with the EHS, measuring the YM of the penile tunica albuginea using SWE is a new and objective technique for quantitatively assessing EH. Because of its objective and quantifiable characteristics, measuring YM enables more accurate evaluation of the effect on EH of various treatments for ED.
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Affiliation(s)
- Hao Cheng
- Department of Ultrasonography, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Ultrasonography, Shaanxi Province Cancer Hospital, Xi'an, China
| | - Zichang Niu
- Department of Ultrasonography Special Diagnostic, Air Force 986 Hospital, PLA, Xi'an, China
| | - Fengyue Xin
- Department of Ultrasonography, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lin Yang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Litao Ruan
- Department of Ultrasonography, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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24
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Ma J, Liu Z, Wu J, Zhou Z, Zhang X, Cui Y, Lin C. Role of application of tadalafil 5 mg once-daily (≥6 months) in men with erectile dysfunction from six randomized controlled trials. Transl Androl Urol 2020; 9:1405-1414. [PMID: 32676425 PMCID: PMC7354289 DOI: 10.21037/tau-19-809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This meta-analysis was performed to assess the efficacy and safety of taking tadalafil 5 mg once-daily for at least 6 months in the treatment of erectile dysfunction (ED). Based on databases: MEDLINE, EMBASE and Cochrane Controlled Trials Register, this analysis was performed to collect randomized controlled trials (RCTs) of tadalafil 5mg once-daily in treating ED over 6 months. Reviewers also investigated the references of each literature. The meta-analysis covered a total of 1,596 patients in six RCTs. The tadalafil group performed a better effect in terms of the international index of erectile function-erectile function (IIEF) domain (P=0.005) for the treatment of ED compared with the placebo group. Safety assessments including discontinuations due to adverse events (AEs) (P=0.31) and treatment-emergent AEs (P=0.06) indicated that the tadalafil group had a better tolerate. The analysis elucidates that the dose of 5 mg per day of tadalafil showed a good effect after the treatment of at least 6 months relative to the control group with fewer side effects.
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Affiliation(s)
- Jiajia Ma
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Zi Liu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.,Binzhou Medical University, Yantai, China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Zhongbao Zhou
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.,Binzhou Medical University, Yantai, China
| | - Xuebao Zhang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Chunhua Lin
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
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25
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Khera M, Than JK, Anaissie J, Antar A, Song W, Losso B, Pastuszak A, Kohn T, Mirabal JR. Penile vascular abnormalities in young men with persistent side effects after finasteride use for the treatment of androgenic alopecia. Transl Androl Urol 2020; 9:1201-1209. [PMID: 32676403 PMCID: PMC7354335 DOI: 10.21037/tau.2020.03.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background The constellation of persistent sexual, neurological, and physical adverse effects in patients who discontinue 5α-reductase inhibitors (5ARIs) has garnered recent concern. The objective of this study was to evaluate potential penile vascular changes and persistent adverse effects of 5ARIs in men treated for androgenic alopecia (AGA). Methods This was a prospective case-control study with 25 subjects with a history of 5ARI use for AGA and 28 controls. Patient self-reported questionnaires including the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), Patient Health Questionnaire-9 (PHQ-9), the Epworth Sleepiness Scale (ESS) and the Androgen Deficiency in the Aging Male (ADAM) were used. Penile duplex Doppler ultrasound (PDDU) results were evaluated in men with a history of 5ARI use. Results A significant difference in total IIEF score between the 5ARI (median: 35; IQR: 29–43) and control group (median: 29; IQR: 27–32) (P=0.035) was observed. Seventeen 5ARI subjects (68%) had a vascular abnormality on PDDU. The median (IQR) for total IPSS score for the 5ARI group was 10 [5–16] compared to 3 [2–8] for the controls (P<0.01). The 5ARI group had a higher median total PHQ-9 score than controls [10 (6.5–16) vs. 1 (0–2) (P<0.001)]. Two subjects (8%) committed suicide during or after the study. Conclusions While the sexual side effects of 5ARIs are well known, there may be persistent genitourinary, physical, psycho-cognitive, anti-androgenic and penile vascular changes after 5ARI discontinuation. Use of 5ARIs for treatment of AGA may lead to persistent sexual, genitourinary, physical, psycho-cognitive, and anti-androgenic sequelae even after cessation of 5ARI therapy.
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Affiliation(s)
- Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | | | - James Anaissie
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Ali Antar
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Weitao Song
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Boriss Losso
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Alexander Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Taylor Kohn
- The James Buchanan Brady Urological Institute at Johns Hopkins School of Medicine, Baltimore, MD, USA
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26
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Liu MC, Chang ML, Wang YC, Chen WH, Wu CC, Yeh SD. Revisiting the Regenerative Therapeutic Advances Towards Erectile Dysfunction. Cells 2020; 9:cells9051250. [PMID: 32438565 PMCID: PMC7290763 DOI: 10.3390/cells9051250] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022] Open
Abstract
Erectile dysfunction (ED) is an inability to attain or maintain adequate penile erection for successful vaginal intercourse, leading to sexual and relationship dissatisfaction. To combat ED, various surgical and non-surgical approaches have been developed in the past to restore erectile functions. These therapeutic interventions exhibit significant impact in providing relief to patients; however, due to their associated adverse effects and lack of long-term efficacy, newer modalities such as regenerative therapeutics have gained attention due to their safe and prolonged efficacy. Stem cells and platelet-derived biomaterials contained in platelet-rich plasma (PRP) are thriving as some of the major therapeutic regenerative agents. In recent years, various preclinical and clinical studies have evaluated the individual, as well as combined of stem cells and PRP to restore erectile function. Being rich in growth factors, chemokines, and angiogenic factors, both stem cells and PRP play a crucial role in regenerating nerve cells, myelination of axons, homing and migration of progenitor cells, and anti-fibrosis and anti-apoptosis of damaged cavernous nerve in corporal tissues. Further, platelet-derived biomaterials have been proven to be a biological supplement for enhancing the proliferative and differentiation potential of stem cells towards neurogenic fate. Therefore, this article comprehensively analyzes the progresses of these regenerative therapies for ED.
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Affiliation(s)
- Ming-Che Liu
- Department of Urology, Taipei Medical University Hospital, Taipei 11031, Taiwan; (M.-C.L.); (C.-C.W.)
- Clinical Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Graduate Institute of Clinical Medicine, school of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Meng-Lin Chang
- Department of Urology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 242, Taiwan;
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Graduate Institute of Applied Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Ya-Chun Wang
- TCM Biotech International Corp., New Taipei City 22175, Taiwan; (Y.-C.W.); (W.-H.C.)
| | - Wei-Hung Chen
- TCM Biotech International Corp., New Taipei City 22175, Taiwan; (Y.-C.W.); (W.-H.C.)
| | - Chien-Chih Wu
- Department of Urology, Taipei Medical University Hospital, Taipei 11031, Taiwan; (M.-C.L.); (C.-C.W.)
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Shauh-Der Yeh
- Department of Urology and Oncology, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Correspondence:
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27
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Lin JH, Ho DR, Shi CS, Chen CS, Li JM, Huang YC. The influence of smoking exposure and cessation on penile hemodynamics and corporal tissue in a rat model. Transl Androl Urol 2020; 9:637-645. [PMID: 32420170 PMCID: PMC7215033 DOI: 10.21037/tau.2019.12.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background While epidemiological studies have clearly documented that smoking cessation significantly enhances sexual health, the underlying mechanism remains largely unknown. Thus, we wished to explore possible mechanisms by using a rat model of smoking-associated erectile dysfunction (ED). Methods Forty 8-week old male Sprague-Dawley rats were divided into 4 groups. Ten rats were exposed only to room air (N group). The remaining 30 rats were passively exposed to cigarette smoke over a 12-week period. At the end of 12 weeks, the smoking (S, n=10) group underwent immediate erectile function testing and were sacrificed. The remaining 20 rats were exposed to room air only for 4 (Q4W, n=10) or 8 (Q8W, n=10) weeks and then underwent erectile function testing and sacrifice. Erectile function was evaluated by measuring intracavernous pressure (ICP) and mean arterial pressure (MAP). After blood collection for serum testosterone determination, rats were sacrificed to obtain corporal tissue for immunohistochemistry. Results Mean ICP/MAP ratio was significantly lower in the S group compared to the N and Q8W groups (0.52±0.11, 0.94±0.05, and 0.94±0.12, respectively, P=0.0189). Smooth muscle/collagen ratio was also significantly lower in the S group compared to the N and Q8W groups (11.8±0.94, 17.5±1.82, and 16.4±0.60, respectively, P=0.0008). Oxidative stress and apoptotic indices were significantly higher in the S group compared to the N and Q8W groups. Neuronal and endothelial nitric oxide synthases were significantly less expressed in the S group compared to the N and Q8W groups. Conclusions Smoking cessation is associated with partial recovery of penile hemodynamics in a rat model of smoking associated ED.
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Affiliation(s)
- Jian-Hui Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Dong-Ru Ho
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Chung-Sheng Shi
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan
| | - Chih-Shou Chen
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Jhy-Ming Li
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan.,Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Yun-Ching Huang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan
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28
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Jeon SH, Bae WJ, Zhu GQ, Tian W, Kwon EB, Kim GE, Hwang SY, Lee KW, Cho HJ, Ha US, Hong SH, Lee JY, Kim SW. Combined treatment with extracorporeal shockwaves therapy and an herbal formulation for activation of penile progenitor cells and antioxidant activity in diabetic erectile dysfunction. Transl Androl Urol 2020; 9:416-427. [PMID: 32420147 PMCID: PMC7214964 DOI: 10.21037/tau.2020.01.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background A Korean herbal formulation named KH-204 was reported to have an antioxidant effect in our previous study. We hypothesized that Low-intensity extracorporeal shockwave therapy (Li-ESWT) combined with KH-204 would accelerate the treatment of erectile dysfunction (ED) by enhancing antioxidant. We investigated the synergistic effect of Li-ESWT and KH-204 for ED and explored the mechanism. Methods Human umbilical vein endothelial cells (HUVEC) were treated with KH-204 and LI-ESWT in vitro. Fifty 5-week-old male Sprague Dawley rats received an intraperitoneal injection of 5-ethynyl-20-deoxyuridine (EdU) which can label live cells, and were randomly divided into five groups: (I) normal; (II) diabetes mellitus-associated erectile dysfunction (DMED); (III) DMED + KH-204; (IV) DMED + Li-ESWT; and (V) DMED + KH-204/Li-ESWT. Li-ESWT treatment was repeated three times a week every other day for four weeks in group 4 and 5. Meanwhile, rats in group 3 and 5 were orally fed 400 mg/kg of KH-204 daily for 1 month. Following a 1-week washout period, penile tissues were evaluated by immunostaining and Western blotting. Results KH-204 combined with Li-ESWT improved intracavernosal pressure (ICP) in DMED rats. Li-ESWT/KH-204 stimulated HUVEC tube formation and promoted proliferation. Li-ESWT drove progenitor cells to migrate to penile tissue and KH-204 protected penile progenitor cells in the corpus cavernosum. Oxidative stress was relieved by KH-204/Li-ESWT. Treatment with KH-204/Li-ESWT protected penile progenitor cells, which were recruited to the corpus cavernosum by Li-ESWT, from apoptosis via its antioxidant activity. KH-204/Li-ESWT protected penile tissue from oxidative stress by improving the expression of nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1), increasing superoxide dismutase (SOD), decreasing 8-hydroxy-20-deoxyguanosine (8-OHdG), and reducing apoptosis. KH-204/Li-ESWT promoted stromal derived factor-1 (SDF-1) and platelet endothelial cell adhesion molecule-1 (PECAM-1) in DMED rats. Conclusions KH-204 protected penile progenitor cells, which were recruited to the corpus cavernosum by Li-ESWT, from apoptosis via its antioxidant activity. The combination of Li-ESWT and KH-204 as a synergy therapy could be a potential and effective treatment for DMED.
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Affiliation(s)
- Seung Hwan Jeon
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woong Jin Bae
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Guan Qun Zhu
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Wenjie Tian
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Bi Kwon
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ga Eun Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Kyu Won Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyuk Jin Cho
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - U-Syn Ha
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Hoo Hong
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sae Woong Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
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Liu SZ, Feng DC, Liu ZH, Liang JY, Ren ZJ, Zhou C, Wu K, Zhang FX, Zhang F, Lu YP, Wang XD. Development of nanotechnology in andrology. Transl Androl Urol 2020; 9:702-708. [PMID: 32420177 PMCID: PMC7214986 DOI: 10.21037/tau.2020.01.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Since first introduced in 1980s, nanotechnology has always been the eye-catching point as its providing us with new approaches to explore the microscopic world. Many nanotechnology-associated novel technologies have been brought into clinical use in the past decades and uncountable patients benefited from them, which convinces us of a bright prospect of nanotechnology in the field of medicine. In this review, literatures concerning nanotechnology applications in andrology were retrieved and we made a comprehensive discussion on drug delivery, gene therapy and stem cell therapy use in andrology, which calls for the engagement of nanotechnology.
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Affiliation(s)
- Sheng-Zhuo Liu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - De-Chao Feng
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhi-Hong Liu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jia-Yu Liang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zheng-Ju Ren
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chuan Zhou
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kan Wu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Fu-Xun Zhang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Fan Zhang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yi-Ping Lu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xian-Ding Wang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
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Zhu J, Zhang W, Ou N, Song Y, Kang J, Liang Z, Hu R, Yang Y, Liu X. Do testosterone supplements enhance response to phosphodiesterase 5 inhibitors in men with erectile dysfunction and hypogonadism: a systematic review and meta-analysis. Transl Androl Urol 2020; 9:591-600. [PMID: 32420164 PMCID: PMC7215032 DOI: 10.21037/tau.2020.01.13] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Combining testosterone and phosphodiesterase 5 inhibitors (PDE5-Is) has become increasingly common in the treatment of men with erectile dysfunction (ED) and low testosterone levels, but combination therapy involving PDE5-Is and testosterone is highly debated, with strong reasons for and against argued by the various opinion leaders. PDE5-Is can be given prior to, alongside or after the commencement of any testosterone replacement therapy. Meanwhile, combination of PDE5-Is and testosterone is reported to better increase testosterone levels and thus improve International Index of Erectile Function (IIEF) score in hypogonadal men. The objective of this meta-analysis was to assess whether testosterone therapy (TTh) can possibly enhance the reaction to PDE5-Is in men with ED and hypogonadism. Methods Relevant studies and available data were extensively collected form Medline, Embase, and Cochrane Library databases until June 2019. We calculated standard mean differences (SMDs) with their 95% confidence intervals (CIs) for IIEF including IIEF-5 and IIEF-EFD. Trial sequential analysis (TSA) was performed to explore whether the sample size of the accumulated evidence is sufficient. Results There were 8 studies including 913 patients. The pooled SMD of erectile function (EF) component change was 0.663 [(0.299 to 1.027); P<0.0001], which concluded that combination therapy (TTh plus PDE5-Is) is superior to PDE5-Is monotherapy group. We also conducted a subgroup analysis according to trial follow-up, baseline serum total testosterone, baseline EF score and PDE5-Is type, which may explain for the underlying source of heterogeneity in part. The frequency of adverse events and change in PSA levels did not differ between the 2 groups. None of the patients experienced an increase in the prostate specific antigen (PSA) level above 4 ng/mL. Hematocrit increased significantly more in the testosterone group than in the placebo group but not greater than 0.54. Conclusions In summary, the present results confirm that combination therapy is effective and safe. TTh can enhance the reaction to PDE5-Is in men with ED and hypogonadism, but this effect also depends on the specific diagnosis and initial response to PDE5-Is. Most patients with adverse events during treatment are mild, and have a stable overall safety of combination therapy.
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Affiliation(s)
- Jun Zhu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Wei Zhang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Ningjing Ou
- Department of Urology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Yuxuan Song
- Department of Urology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Jiaqi Kang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Zhen Liang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Rui Hu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Yongjiao Yang
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin 300000, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin 300000, China
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Cui W, Li H, Guan R, Li M, Yang B, Xu Z, Lin M, Tian L, Zhang X, Li B, Liu W, Dong Z, Wang Z, Zheng T, Zhang W, Lin G, Guo Y, Xin Z. Efficacy and safety of novel low-intensity pulsed ultrasound (LIPUS) in treating mild to moderate erectile dysfunction: a multicenter, randomized, double-blind, sham-controlled clinical study. Transl Androl Urol 2019; 8:307-319. [PMID: 31555554 DOI: 10.21037/tau.2019.07.03] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background In our previous study, a novel low-intensity pulsed ultrasound (LIPUS) therapeutic device has been shown to improve erectile function non-invasively in a diabetic-induced erectile dysfunction (ED) animal model. Methods In order to investigate the efficacy and safety of LIPUS in the clinical treatment of patients with ED, a multicenter, randomized, double-blind, sham-treated, controlled clinical study was conducted at five medical centers, and 120 patients with mild to moderate ED were enrolled in the study. Patients were randomized into a sham-treated control group (40 patients) or a LIPUS-treated group (80 patients). LIPUS or sham treatment was applied to both sides of the penis shaft and crus for 5 min in each area, twice a week for four weeks. Assessment of efficacy and safety were evaluated using IIEF-5, Sexual Encounter Profile (SEP)-questionnaires 2/3, Global Assessment Question (GAQ), Erectile Hardness Score (EHS), Erection Quality Scale (EQS) score, and pain assessment [Visual Analogue Scale/Score (VAS)]. Results Ten patients in LIPUS treatment group and 6 patients in sham treatment control group were excluded and the dropout rate is 13.33%. Response to treatment was identified as IIEF-5 score increased more than 2/3/4 points of post-treatment (12W) compared to pre-treatment (0W). The response rate in treatment group was 54/80 (67.50%), which was significantly higher than control group 8/40 (20.00%) at 12 weeks (FAS analysis). The percentage of patients with positive answers to SEP-3 (successful vaginal intercourse) were 58.97%, 64.1%, and 73.08% 4, 8, and 12 weeks after treatment which were significantly higher than 28.95%, 31.58%, and 28.95% respectively in control group (FAS, P<0.05). The positive responsive rates for GAQ in treatment group were about 2 to 3 times of that in control group (P<0.05). No treatment-related adverse events (AEs) were found, including local petechia or ecchymosis and hematuria. Conclusions Current study indicates that LIPUS can safely and effectively treat patients with mild to moderate ED without significant AEs, which is related to the mechanical force of LIPUS and can restore the pathological changes of the corpus cavernosum. LIPUS is a promising alternative treatment for ED treatment in the near future, while further research is remanded.
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Affiliation(s)
- Wanshou Cui
- Andrology Center, Peking University First Hospital, Beijing 100034, China
| | - Huixi Li
- Andrology Center, Peking University First Hospital, Beijing 100034, China
| | - Ruili Guan
- Andrology Center, Peking University First Hospital, Beijing 100034, China
| | - Meng Li
- Andrology Center, Peking University First Hospital, Beijing 100034, China
| | - Bicheng Yang
- Andrology Center, Peking University First Hospital, Beijing 100034, China
| | - Zhanwei Xu
- Wanbeili Medical instrument Co., Ltd., Beijing 102200, China
| | - Maofan Lin
- Wanbeili Medical instrument Co., Ltd., Beijing 102200, China
| | - Long Tian
- Department of Urology, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Xiaodong Zhang
- Department of Urology, Beijing Chaoyang Hospital, Beijing 100020, China
| | - Bao Li
- Department of Urology, Affiliated Hospital of Weifang Medical University, Weifang 261031, China
| | - Weiguang Liu
- Department of Urology, Affiliated Hospital of Weifang Medical University, Weifang 261031, China
| | - Zhilong Dong
- Department of Urology, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Zhiping Wang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Tao Zheng
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Weixing Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Guiting Lin
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA, USA
| | - Yinglu Guo
- Andrology Center, Peking University First Hospital, Beijing 100034, China
| | - Zhongcheng Xin
- Andrology Center, Peking University First Hospital, Beijing 100034, China
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Wen Y, Liu G, Jia L, Ji W, Li H. MicroRNA-141 binds to the nerve growth factor receptor associated protein 1 gene and restores the erectile function of diabetic rats through down-regulating the nerve growth factor/neurotrophin receptor p75 (NGF/p75NTR) signaling. J Cell Biochem 2019; 120:7940-7951. [PMID: 30426562 DOI: 10.1002/jcb.28071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/22/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Erectile dysfunction (ED) is one of the major complications in diabetes mellitus (DM). We have previously reported that the nerve growth factor (NGF)/tyrosine kinase receptor (TrkA) signaling is actively involved in DM-induced ED (DMED). Here, we investigate the effect of micro-RNA-141 (miR-141) on the NGF/p75 neurotrophin receptor (p75NTR) signaling and erectile function of diabetic rats. METHODS Sprague-Dawlay (SD) rats were used to establish a DMED model. The dual-luciferase reporter gene assay was first performed to identify the nerve growth factor receptor-associated protein 1 (NGFRAP1) gene as the target gene of miR-141. The regulatory mechanisms underlying miR-141 governing NGFRAP1 in vivo were then validated by modulating the expressions of miR-141 and knocking down NGFRAP1. RESULTS The expressions of miR-141 were decreased while the expressions of NGFRAP1, NGF, and p75NTR were increased in DMED. miR-141 and downregulation of NGFRAP1, respectively, increased the density of corpus cavernosum smooth muscle and the ratio of intracavernosal pressure (ICP)/mean arterial blood pressure (MAP) and promoted the expression of α-actin and desmin as well. miR-141 also upregulated the expressions of NGFRAP1 in DMED, and knockdown of NGFRAP1 inhibited the productions of NGF and p75NTR. Furthermore, miR-141 suppressed the NGF/p75NTR signaling via binding to NGFRAP1. CONCLUSIONS NGF/p75NTR signaling actively participates in the pathogenesis of DMED. miR-141 binds to NGFRAP1 and restores the erectile function of diabetic rats via downregulation of NGF/p75NTR signaling.
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Affiliation(s)
- Yan Wen
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Guohui Liu
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Linpei Jia
- Department of Nephrology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Wei Ji
- Department of Vascular Surgery, Jilin Provincial People's Hospital, Changchun, China
| | - Hai Li
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, China
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Abstract
Background Erectile dysfunction (ED) has not been evaluated among male adult entertainers. Our goal was to evaluate the prevalence of ED and use of erectile aids among men working in the adult entertainment industry. Methods An online survey was distributed to male adult entertainers through collaboration with the Free Speech Coalition (FSC), the North American Trade Association of the Adult Industry. Surveys were sent via email to those who met the criteria of being non-transgender men with biological penises and have experience as adult entertainers. The survey acquired baseline characteristics, use and frequency of erectile aids, and assessed erectile function using the International Index of Erectile Function (IIEF) survey. Statistical analysis was performed in Microsoft Excel. Results Of the 98 respondents, 62 met inclusion criteria. The median age was 36 (IQR 28.25–45) years. Of those included, 69.4% (43/62) used erectile aids. In men who used erectile aids, 58.1% (25/43) used for both work and personal reasons. Erectile aids were used most among young men aged 20–29 (84.2%). Overall, 38.7% (24/62) of men had ED as defined by the IIEF survey. Of note, 26.3% (5/19) of men aged 20–29 had moderate to severe ED. Conclusions This is the first study to evaluate ED among adult male entertainers. Male entertainers between the ages of 20–29 had both the highest prevalence of moderate to severe ED and the highest erectile aid usage among all male adult entertainers.
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Affiliation(s)
- Justin M Dubin
- Department of Urology, University of Miami, Miami, FL, USA
| | - Aubrey B Greer
- Department of Urology, University of Miami, Miami, FL, USA
| | | | | | - Eric P Leue
- The Free Speech Coalition, Canoga Park, CA, USA
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Armstrong JM, Avant RA, Charchenko CM, Westerman ME, Ziegelmann MJ, Miest TS, Trost LW. Impact of anabolic androgenic steroids on sexual function. Transl Androl Urol 2018; 7:483-489. [PMID: 30050806 PMCID: PMC6043738 DOI: 10.21037/tau.2018.04.23] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background To describe the impact of supra-physiologic anabolic-androgenic steroid (AAS) use, including agent, dosage, and duration of therapy, on sexual function. Methods We reviewed data from an online survey of AAS users to evaluate their sexual function on and off AAS. The online survey consisted of questions addressing demographics, anabolic steroid use and patterns, ancillary medications, testosterone (T)-related symptoms while on and off of therapy, as well as sexual function which was assessed using the 5-item, International Index of Erectile Function (IIEF-5). Results A total of 321 men responded to the survey, of which 90 failed to meet inclusion criteria, for a final cohort of 231 AAS users. The majority of men were Caucasian (85%), employed (62%), and younger than 35 years (58%), while an equal mix were single (47%) or married (46%). The mean IIEF-5 was 22.5, with higher scores associated with increased T dosages (>600 mg/week), use of 17-alpha alkylated hormones and anti-estrogens, and absence of concurrent medical conditions. Lower mean IIEF scores were associated with current and pre-AAS low T symptoms, self-reported angry or violent tendencies, self-reported erectile dysfunction (ED), decreased libido, decreased energy, and depression. After controlling for age, low T symptoms and decreased energy remained significantly associated with lower IIEF scores. Among 127 men reporting de novo decreased libido when not taking AAS, several factors were significantly associated including frequency and duration of T and use of adjunctive therapies, while post-cycle therapies were protective. Men who reported any other de novo symptom (decreased energy, libido, muscle mass or depression) after discontinuing T were also more likely to report de novo ED, as well as those using >10 years or for >40 weeks per year. Conclusions The long-term impact of high dose AAS use on sexual function remains poorly defined. Although high T dosages appeared to be protective of erectile function during use, de novo symptoms such as decreased libido and ED occurred more frequently after discontinuing T, particularly among those using more frequently and for longer durations. Given the importance of these findings, long-term studies evaluating the impacts of discontinuing T on sexual dysfunction are indicated.
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Affiliation(s)
| | - Ross A Avant
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Tanner S Miest
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Landon W Trost
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
Background To treat erectile dysfunction (ED), phosphodiesterase type 5 inhibitors (PDE5i) are commonly used. However, to date, only a few studies exist evaluate a possible effect on the incidence of prostate cancer. One such study completed by the authors’ institution suggested men who use PDE5i for ED may have a lower incidence of prostate cancer. This study was meant to address some of the shortcomings of the former study and further characterize the link between prostate cancer and PDE5i use. Methods A retrospective, match-paired analysis was undertaken: 5,717 patients were identified between 2000 and 2011; a 1:2 match pair analysis ultimately identified 394 cases with cancer and 788 controls without cancer. Pairs were matched based on age, ethnicity, and PSA value. Results No correlation existed between PDE5i use and prostate cancer [OR 1.02, 95% confidence interval (CI): 0.78–1.35, P=0.8842] or diabetes mellitus and prostate cancer (OR 1.12, 95% CI: 0.84–1.48, P=0.4499). A statistically significant correlation was demonstrated with PSA and prostate cancer (OR 1.48, 95% CI: 1.38–1.58, P<0.0001). Conclusions The data suggest that there is essentially no association with PDE5i use and prostate cancer.
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Affiliation(s)
- G Luke Machen
- Department of Surgery, Division of Urology; Baylor Scott & White Health/The Texas A&M Health Science Center College of Medicine; Temple, Texas, USA
| | - M Hasan Rajab
- Department of Surgery, Division of Urology; Baylor Scott & White Health/The Texas A&M Health Science Center College of Medicine; Temple, Texas, USA
| | - Jessica Pruszynski
- Department of Surgery, Division of Urology; Baylor Scott & White Health/The Texas A&M Health Science Center College of Medicine; Temple, Texas, USA
| | - K Scott Coffield
- Department of Surgery, Division of Urology; Baylor Scott & White Health/The Texas A&M Health Science Center College of Medicine; Temple, Texas, USA
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Wassersug R, Wibowo E. Non-pharmacological and non-surgical strategies to promote sexual recovery for men with erectile dysfunction. Transl Androl Urol 2017; 6:S776-S794. [PMID: 29238658 PMCID: PMC5715194 DOI: 10.21037/tau.2017.04.09] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/30/2017] [Indexed: 12/22/2022] Open
Abstract
Erectile dysfunction (ED), the most commonly reported sexual problem for men, reduces the quality of life for both patients and their partners. Even when physiologically effective, long-term adherence to ED treatments is poor. We review here the implication of having patients' partners involved in ED treatment, starting with treatment selection. We suggest that having partners engaged from the outset may promote an erotic association of the treatment with the partner, i.e., conceptually linking the aid to the sexual pleasure that the partner provides. We hypothesize that this erotic association should enhance the sexual aid's effectiveness and might potentially help improve long-term adherence. The primary focus of this review, though, is non-pharmacological and non-surgical options for maintaining sexual activity for men with ED. Though not ED treatments per se, anecdotal data suggest that these options may be effective for some patients and their partners in regaining a satisfying sex life. The aids discussed include external penile prostheses, penile sleeves, and penile support devices. These devices can allow men to participate in penetrative sexual intercourse despite moderate to severe ED. External penile prostheses can be personalized so they match in size and shape a man's normal full erection. Penile sleeves can similarly be customized with a lumen that fits best a patient's penis for optimal tactile stimulation. We review how multi-sensory integration can enhance sexual arousal for men who use such devices, allowing them to achieve orgasm despite intractable ED. Patients are not always advised within ED clinics about these options nor why and how they can facilitate non-erection dependent sexual recovery. Clinicians need to be aware of these devices and their positive attributes, so they can objectively counsel and encourage couples to explore their use as an alternative to more invasive treatments. The most commonly promoted non-medical ED aid offered to patients is the vacuum erection device. We discuss how erections achieved with the vacuum erection device have a "hinge effect", that is an underappreciated barrier to the effectiveness of the erection. With a hinged erection, the penis points downward rather than upward. We show how the normal kinematics of the penis during coitus is not strictly linear (i.e., not uniaxial; not just in-and-out), and is impeded by hinging. Positional adjustment, such as the receptive partner being on top, may help overcome this problem for some couples. Lastly, we suggest that, in the case where ED can be anticipated from a pending medical treatment, such as a prostatectomy, pre-habilitative approaches may potentially improve adherence to sexual aid use in the long-term. In conclusion, non-pharmacological and non-surgical options for sexual recovery are available. Scientific studies on the effectiveness of these interventions in restoring satisfying sex are warranted.
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Affiliation(s)
- Richard Wassersug
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Erik Wibowo
- British Columbia Cancer Agency, Vancouver, Canada
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Abstract
With the increased prevalence of Peyronie’s disease (PD) among men, there is also an up-rise of associated erectile dysfunction (ED) which can be devastating psychologically and sexually to most men. A wide range of therapies including medical and surgical procedures are available to satisfactorily address this condition. However when ED coexists, the gold standard treatment is penile prosthetic prosthesis (PP) with or without additional straightening procedures. We herein systematically review the contemporary literature addressing the role of the PP in the management of PD with concomitant ED with particular emphasis on patient’s satisfaction, outcomes and safety.
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Affiliation(s)
- Omer A Raheem
- Department of Urology, University of California San Diego Health, San Diego, California, USA
| | - Tung-Chin Hsieh
- Department of Urology, University of California San Diego Health, San Diego, California, USA
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38
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Abstract
Priapism is a relatively uncommon condition that can result in erectile dysfunction (ED) and corporal fibrosis. Cases of prolonged priapism are particularly prone to ED, which arises when priapism is treatment refractory or had a delayed presentation. Due to the emergent nature of priapism, it behooves urologists to be familiar with all potential treatment modalities to minimize adverse outcomes. In this review paper, we aim to summarize the literature regarding the use of penile prosthesis (PP) implantation in the setting of ischemic priapism (IP). In some patients who present later or have prolonged initial treatment, early insertion of PP may be indicated.
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Affiliation(s)
- Jonathan Moore
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Thomas F Whelan
- Department of Urology, Dalhousie University, Saint John, NB, Canada
| | - Gavin M Langille
- Department of Urology, Dalhousie University, Saint John, NB, Canada
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Abstract
Erectile dysfunction (ED) has long been described by physicians and patients, with treatments for ED proposed starting in the 8th century BC. In the last 50 years, however, there have been many advances in medical and surgical management of ED, notably the introduction of the inflatable penile prosthesis (IPP) in 1973 and phosphodiesterase type 5 inhibitors (PDE5Is) in 1998. Here we review the evolution of the IPP from 1973 through the current day. The 3-piece device was first described in 1973 by Dr. F. Brantley Scott, who helped found American Medical Systems (AMS) to market and sell the device. In 1983, Mentor (now Coloplast) started marketing a competing device. AMS and Mentor have made multiple modifications to the device over the years, which have increased rigidity, durability and patient satisfaction, and have decreased surgical variability, post-operative infection and spontaneous inflation. Today, the IPP is a safe and effective option for many men who have failed medical therapies, with high satisfaction from both patients and partners.
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Affiliation(s)
| | - Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA.,Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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40
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Abstract
Erectile dysfunction (ED) is a common problem in older men and occurs with even greater frequency following the treatment of pelvic malignancies. Inflatable penile prosthesis (IPP) implantation is a safe and effective form of definitive ED treatment for those men who fail more conservative measures, and it can be used with similar outcomes in men following cancer therapy. Although many of these men remain dissatisfied with other therapeutic options for ED, IPPs are underutilized in this population. This review will discuss the current practice patterns, outcomes and nuances to surgical technique regarding the use of IPPs in patients with ED following cancer therapy.
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Affiliation(s)
- Pranav Dadhich
- Department of Urology, Baylor College of Medicine, Houston, Texas, USA
| | - Mark Hockenberry
- Department of Urology, Baylor College of Medicine, Houston, Texas, USA
| | - E Will Kirby
- Department of Urology, Baylor College of Medicine, Houston, Texas, USA
| | - Larry Lipshultz
- Department of Urology, Baylor College of Medicine, Houston, Texas, USA
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Abstract
Background To investigate the correlation between presence and severity of urologic symptoms and self-reported systemic health conditions in minority men. Methods Questionnaires were distributed at a Men’s Minority Health Fair. Urologic symptoms were assessed with the International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM) and NIH Chronic Prostatitis Symptom Score (CPSI). Each was graded as absent/mild [0], moderate [1] or severe [2] by standard criteria for each and totaled for a urologic score (US). Other questions included age, height/weight and queried heart disease, diabetes, anxiety/stress, sleep apnea and neurologic disease. A systemic score (SS) graded each plus obesity for 6 domains (0–2 for each). Results A total of 52 men completed the surveys with a mean age of 58.8 (range, 37–76) years. By symptom score criteria, 17 (33%) had 1 urologic condition, 19 (37%) had 2 and 5 (10%) had all 3. Mean total US was 1.9 (range, 0–6) and mean SS was 2.9 (range, 0–10). There was a strong correlation between US and SS (Spearman Rho =0.73, P<0.0001). The hierarchy of systemic condition impact on US was cardiovascular > anxiety > obesity > diabetes > sleep apnea > neurologic. By multivariable analysis, after adjusting for age, each systemic component strongly correlated with the US. The multivariable model with age plus all of the systemic scores predicted US more accurately than with any one of its components alone. Conclusions Self-reported systemic health conditions correlate strongly with presence and severity of urologic symptoms in minority men.
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Affiliation(s)
- Sarah Coleman Vij
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andrew Turk
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Tianming Gao
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel A Shoskes
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Epifanova MV, Chalyi ME, Krasnov AO. [Investigation of mechanisms of action of growth factors of autologous platelet-rich plasma used to treat erectile dysfunction]. Urologiia 2017:46-48. [PMID: 28952692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To determine the quantitative and qualitative composition of growth factors (PDGF-AA, PDGF-BB, VEGF, VEGF-D, FGF-acid, FGF-basic) and platelets in various modifications of APRP. MATERIALS AND METHODS Blood of 12 male volunteers (control group) and 12 patients with ED was used to prepare APRP and the subsequently determine the concentration of growth factors. The growth factor concentrations (FGF acid, FGF basic, PDGF-AA, PDGF-BB, VEGF, VEGF-D) was determined using a flow cytometry-based xMAP Luminex (Gen-Probe) system. RESULTS Concentration of platelets in APRP obtained by two stage centrifugation, reached 1480 (1120-1644) in the control group and 1232 (956-1502) in patients with ED. The concentration of growth factors in the samples prepared without preliminary freezing was: PDGF-AA 842 (22-3700), PDGF-BB 2837 (1460-4100), FGF-basic 7.9 (0.28-127), FGF-acid 3, 4 (0.14-11), VEGF 19 (4.6-46), VEGF-D 21 (14-38). After thawing, the concentration of all growth factors in the samples increased. DISCUSSION The study findings suggest that the mechanism of erectile function recovery following the use of APRP is through the active substances detected in APRP, i.e. FGF-basic, PDGF-AA, PDGF-BB, VEGF, VEGF-D and FGF-acid. Also, the study showed that the content of growth factors in APRP after of freezing/thawing is higher than in APRP that has not been frozen. This is due to the cell membrane destruction at extremely low temperatures during freezing.
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Affiliation(s)
- M V Epifanova
- Research Institute for Uronephrology and Human Reproductive Health, Moscow, Russia
- Department of Urology, I.M. Sechenov First MSMU of Minzdrav of Russia, Moscow, Russia
| | - M E Chalyi
- Research Institute for Uronephrology and Human Reproductive Health, Moscow, Russia
- Department of Urology, I.M. Sechenov First MSMU of Minzdrav of Russia, Moscow, Russia
| | - A O Krasnov
- Research Institute for Uronephrology and Human Reproductive Health, Moscow, Russia
- Department of Urology, I.M. Sechenov First MSMU of Minzdrav of Russia, Moscow, Russia
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43
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Abstract
Background Prostate cancer (PCa) is the most commonly diagnosed malignancy and the third leading cause of cancer death among men in developed countries. Because some risk factors are common between erectile dysfunction (ED) and PCa, we investigated the association between ED and subsequent PCa. Methods This nationwide population-based cohort study used data from the Taiwan National Health Insurance Research Database for the period 2000–2010. We identified patients newly diagnosed with ED by using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Results In total, 5858 and 23432 patients were enrolled in the ED and non-ED cohorts, respectively. After adjustment for age, sex, and comorbidities, the overall incidence densities of PCa were significantly higher in the ED cohort than in the non-ED cohort, with an adjusted hazard ratio (aHR) of 1.19. The age-specific relative risk of PCa was significantly higher for all age groups in the ED cohort than in the non-ED cohort. Compared with patients without ED, those with organic ED had a 1.27-fold higher risk of PCa. Conclusion ED is a harbinger of PCa in some men. Physicians should consider the possibility of occult PCa in patients with ED regardless of age and comorbidities.
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Affiliation(s)
- Wei-Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Gia-Yi, Taiwan.,Chang Gung University of Science and Technology, Chia-Yi, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Hsu Chang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, LinKo, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Hsi-Chin Wu
- Department of Urology, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Abstract
Traditional Chinese medicine (TCM), including acupuncture and Chinese herbs, is used as an alternative therapy to increase the curative effect for erectile dysfunction (ED). A large number of studies have been conducted to investigate the effect and mechanism of TCM for treating ED. The therapeutic effect of acupuncture on ED is still controversial at present. However, some Chinese herbs exhibited satisfying outcomes and they might improve erectile function by activating nitric oxide synthase (NOS)-cyclic guanosine monophosphate (cGMP) pathway, increasing cyclic adenosine monophosphate (cAMP) expression, elevating testosterone level, reducing intracellular Ca2+ concentration, down-regulating transforming growth factor β1 (TGFβ1)/Smad2 signaling pathway, or ameliorating the oxidative stress.
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Affiliation(s)
- Hao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hongyang Jiang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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45
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Abstract
In the East, many herbal tonics and preparations are used to assist the aging male improve his sexual drive or ability to perform penetrative sex by increasing sexual stimulation, erectile, ejaculatory, orgasmic and other responses for sexual function and satisfaction. The herbs and tonics act as or as “pick-me-ups” and energizing tonics which help the tired and fatigued male and those with sexual asthenia. The myths and realities concerning Tongkat Ali, sea horse, cobra meat and blood, animal penises and testicles amongst many other herbs and portions for oral intake or local application used by traditional “medical” practitioners and village doctors will be discussed.
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Affiliation(s)
- Peter H C Lim
- Andrology, Urology and Continence Center, Gleneagles Hospital, Singapore
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46
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Abstract
Counterfeit phosphodiesterase-5 inhibitors (PDE-5i) are an increasing problem. Already in widespread use, the market for PDE-5i is steadily growing as the population ages. Counterfeiters are taking advantage of this growing market by developing illicit and counterfeit PDE-5i products. Many factors are contributing to the rapid growth of the illicit market, such as the low risk of prosecution, potentially high financial reward, and ease of distribution via Internet pharmacies. Consumers of illicit PDE-5i often do not realize they are using counterfeit products and placing themselves at an unnecessary health risk. Others seek to bypass the legitimate healthcare system due to either embarrassment of the underlying condition or desire for cheaper alternatives. However, taking illicit PDE-5i may harm consumers directly, as many illicit products contain detrimental contaminants and inaccurate amounts of the active ingredient without the appropriate warnings. Bypassing the legitimate healthcare system also endangers consumers indirectly, as erectile dysfunction (ED) is often associated with other medical comorbidities that patients should be screened for. Furthermore, PDE-5i can have potentially dangerous interactions with other pharmaceuticals that are rarely warned against with counterfeit PDE-5i. This communication reviews the literature regarding counterfeit PDE-5i, and summarizes both the scope and dangers of the illicit PDE-5i market.
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Affiliation(s)
- Jason Chiang
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Faysal A Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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47
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Abstract
Despite introduction of oral phosphodiesterase type 5 inhibitors and intracavernosal vasoactive agents, penile prosthesis implant remains a relevant and desired option with sales of penile prostheses continue to stay high, as many men became refractory to medical therapy and/or seeking a more effective and permanent therapy. There are two types of penile prosthesis implants: inflatable and non-inflatable types, and the inflatable penile implants can be subdivided into single-, two- and three-piece devices. Non-inflatable penile prosthesis (non-IPP) may be referred to as semi-rigid rod or malleable prosthesis. IPP is considered a superior option to malleable prosthesis as it produces penile rigidity and flaccidity that closely replicates a normal penile erectile function. Since the introduction of IPP by Scott in 1973, surgical landscape for penile prosthesis implantation has changed dramatically. Advances in prosthesis design, device technologies and surgical techniques have made penile prosthesis implant a more natural, durable and reliable device. The following article reviews the scientific advances and technological innovation in modern penile prosthesis implants over the last four decades.
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Affiliation(s)
- Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia;; AndroUrology Centre, St Andrew's War Memorial Hospital, Brisbane, QLD, Australia
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48
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Campbell J, Alzubaidi R. Understanding the cellular basis and pathophysiology of Peyronie's disease to optimize treatment for erectile dysfunction. Transl Androl Urol 2017; 6:46-59. [PMID: 28217450 PMCID: PMC5313310 DOI: 10.21037/tau.2016.11.01] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Erectile dysfunction (ED) is a common condition that significantly impacts a man’s physical and psychological well-being. ED is often associated with Peyronie’s disease (PD), which is an abnormal curvature of the penis. Delayed treatment of or surgical invention for PD often results in ED and therefore unsatisfied patients. The pathophysiology of PD is incompletely understood, but has been studied extensively and based on our current understanding of PD physiology, many medical treatment options have been proposed. In this paper, we will review what is known about the pathophysiology of PD and the medical treatment options that have been trialed as a result. More investigations in regards to the basic science of PD need to be carried out in order to elucidate the exact mechanisms of the fibrosis, and propose new, more successful treatment options which should be implemented prior to the onset of ED.
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Affiliation(s)
- Jeffrey Campbell
- London Health Sciences Centre and St. Joseph's Health Care, Western University, London, Ontario, Canada
| | - Raidh Alzubaidi
- London Health Sciences Centre and St. Joseph's Health Care, Western University, London, Ontario, Canada
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Kolontarev K, Govorov A, Kasyan G, Priymak D, Pushkar D. Current drug therapy of patients with BPH-LUTS with the special emphasis on PDE5 inhibitors. Cent European J Urol 2016; 69:398-403. [PMID: 28127458 PMCID: PMC5260456 DOI: 10.5173/ceju.2016.879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/04/2016] [Accepted: 10/16/2016] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptom (LUTS) development in men [1]. The intensity of the symptoms may vary from mild to severe, significantly affecting the quality of life. Erectile dysfunction (ED) is one of the most challenging issues in modern urology that significantly influences the quality of life in men worldwide. The objective of this literature review was to analyze the current drug therapies of patients with BPH-LUTS, with the special emphasis on PDE5 inhibitors. MATERIAL AND METHODS The authors searched the literature for the period from 2000 until 2015 in MEDLINE and PubMed. RESULTS Twenty-three articles were selected based on their reliability. A detailed analysis of the selected papers was performed. Primary attention was given to articles describing the use of PDE5. Works describing the use of different groups of drugs in patients with BPH-LUTS were also selected. CONCLUSIONS The current literature analysis suggests that the introduction of PDE5 inhibitors in clinical practice for the treatment of patients with BPH-LUTS will allow for significant expansion of the therapeutic options for the treatment of this disease.
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Affiliation(s)
| | | | - George Kasyan
- Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - Dmitry Pushkar
- Moscow State University of Medicine and Dentistry, Moscow, Russia
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50
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Abstract
Premature ejaculation (PE) is considered the most common male sexual disorder, affecting up to 75% of men at some point in their lives. While medical management is the mainstay of therapy, surgical options such as dorsal nerve neurectomy (DNN), hyaluronic acid (HA) gel glans penis augmentation, and circumcision have been studied as alternative forms of treatment. Preliminary studies have suggested that DNN and HA gel glans penis augmentation are relatively safe and effective, but due to a lack of large, multicenter, randomized-control trials with long-term follow-up, the International Society of Sexual Medicine (ISSM) has been unable to endorse DNN or HA gel glans penis augmentation as options in the treatment of PE. Conflicting data regarding the efficacy and safety of circumcision has similarly led to its exclusion from ISSM recommendations for the treatment of PE. Ethical concerns, particularly the fundamental concept of non-maleficence, are also barriers to the implementation of surgery for PE.
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Affiliation(s)
- James Anaissie
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Faysal A Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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