Associations between organic erectile dysfunction and the risk of herpes zoster and postherpetic neuralgia in men

BACKGROUND

Whether erectile dysfunction (ED) leads to considerable stress for affected men remains unclear? In this study, we investigated whether organic ED (OED) is associated with increased risks of herpes zoster (HZ) and postherpetic neuralgia (PHN).

METHODS

A representative subset of Taiwan's National Health Insurance Research Database was employed for this study. Enrollees with OED from the years 2000 to 2018 were selected. To ensure comparability between the case and control groups, we implemented 1:1 propensity score matching based on age, index year, comorbidities, and medications.

RESULTS

The case group included 20,808 patients with OED, while the control group consisted of 20,808 individuals without OED. The OED group exhibited a significantly elevated risk of HZ (adjusted hazard ratio [aHR] = 1.74) and PHN (aHR = 1.56) compared to the non-OED group.

CONCLUSIONS

Men experiencing OED seem to face elevated risks of HZ and PHN compared to those without OED. ED may serve as a warning sign for individuals at HZ risk.

Patient-reported Side Effects 1 Year After Radical Prostatectomy or Radiotherapy for Prostate Cancer: A Register-based Nationwide Study

BACKGROUND

Data on functional and psychological side effects following curative treatment for prostate cancer are lacking from large, contemporary, unselected, population-based cohorts.

OBJECTIVE

To assess urinary symptoms, bowel disturbances, erectile dysfunction (ED), and quality of life (QoL) 12 mo after robot-assisted radical prostatectomy (RARP) and radiotherapy (RT) using patient-reported outcome measures in the Swedish prostate cancer database.

DESIGN, SETTING, AND PARTICIPANTS

This was a nationwide, population-based, cohort study in Sweden of men who underwent primary RARP or RT between January 1, 2018 and December 31, 2020.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Absolute proportions and odds ratios (ORs) were calculated using multivariable logistic regression, with adjustment for clinical characteristics.

RESULTS AND LIMITATIONS

A total of 2557 men underwent RARP and 1741 received RT. Men who underwent RT were older (69 vs 65 yr) and had more comorbidities at baseline. After RARP, 13% of men experienced incontinence, compared to 6% after RT. The frequency of urinary bother was similar, at 18% after RARP and 18% after RT. Urgency to defecate was reported by 14% of men after RARP and 34% after RT. At 1 yr, 73% of men had ED after RARP, and 77% after RT. High QoL was reported by 85% of men after RARP and 78% of men after RT. On multivariable regression analysis, RT was associated with lower risks of urinary incontinence (OR 0.25, 95% confidence interval [CI] 0.19-0.33), urinary bother (OR 0.79, 95% CI 0.66-0.95), and ED (OR 0.54, 95% CI 0.46-0.65), but higher risk of bowel symptoms (OR 2.86, 95% CI 2.42-3.39). QoL was higher after RARP than after RT (OR 1.34, 95% CI 1.12-1.61).

CONCLUSIONS

Short-term specific side effects after curative treatment for prostate cancer significantly differed between RARP and RT in this large and unselected cohort. Nevertheless, the risk of urinary bother was lower after RT, while higher QoL was common after RARP.

PATIENT SUMMARY

In our study of patients treated for prostate cancer, urinary bother and overall quality of life are comparable at 1 year after surgical removal of the prostate in comparison to radiotherapy, despite substantial differences in other side effects.

The association of smoking with urinary and sexual function recovery following radical prostatectomy for localized prostate cancer: a systematic review and meta-analysis

BACKGROUND

Urinary and sexual dysfunction after radical prostatectomy remains a major cause of morbidity, despite widespread availability of pharmacological and rehabilitative treatments. Smoking is a modifiable risk factor known to correlate with erectile and urinary dysfunction and we hypothesise that smoking cessation may improve post-prostatectomy urinary and sexual function recovery. Our objective is to systematically evaluate literature describing the association of smoking status with urinary and sexual function in men following radical prostatectomy.

METHODS

In total, 310 unique records were identified through a systematic search of the MEDLINE, EMBASE, Scopus, Web of Science, CINAHL and CENTRAL databases up to February 2023. Nine studies reported smoking status and post radical prostatectomy urinary and sexual function outcomes in men with localized prostate cancer. Risk of bias was assessed and meta-analysis included six studies.

RESULTS

Smokers had inferior erectile function after prostatectomy compared to non-smokers (OR 0.73, [95% CI 0.56-0.95]) during follow-up, while urinary incontinence was not statistically different between groups (OR 1.20, [95% CI 0.75-1.91]). Smoking cessation improved the EPIC-26 sexual domain score with 6.6 points on average [p = 0.03] to a clinically significant maximum of 12.5 points at 18-24 months.

CONCLUSIONS

Smoking is associated with impaired sexual function recovery after radical prostatectomy and quitting may improve sexual function >18 months. Current evidence shows no such association for urinary outcomes. Further studies are needed to corroborate findings.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

The relationship between oxidative balance score and erectile dysfunction in the U.S. male adult population

Oxidative stress strongly influences the pathophysiology of erectile dysfunction (ED). In this study, we used the oxidative balance score (OBS), a composite index, to measure the effects of oxidative stress triggered by diet and lifestyle factors. Here, we conducted a cross-sectional study to determine the statistical relationship between OBS and ED among adult males in the U.S. The data from 3318 participants in the National Health and Nutrition Examination Survey (NHANES) 2001-2004 were analyzed. Weighted logistic regression was used to correct for confounding factors and acquire nationwide representative estimates. Generalized additive modeling was used to explore the nonlinear relationship. We also supplemented subgroup and sensitivity analysis to examine the robustness of the main results. Multivariate logistic regression indicated a consistent negative linear association between OBS and ED across all participants [OR (95% CI) = 0.96 (0.94, 0.98)]. After categorizing OBS into tertiles, participants in the highest tertile had 43% lower odds of having ED than those in the lowest tertile [OR (95% CI) = 0.57 (0.37, 0.87)]. The generalized additive model also visualized the linear trend of this association. Furthermore, this linear relationship remained relatively consistent, regardless of whether subgroup or sensitivity analyses were performed. Our findings suggest that adopting a lifestyle and diet pattern that promotes favorable OBS may effectively protect against the development of ED, regardless of the underlying causes.

Cold hypersensitivity in the hands and feet is associated with erectile dysfunction in young Taiwanese men

Cold hypersensitivity in the hands and feet (CHHF) is a protective or predisposing factor for many diseases; however, the relationship between CHHF and erectile dysfunction (ED) remains unclear. We aimed to investigate associations between CHHF and ED among young men of Southeast Asian origin. In this cross-sectional study, sexually active Taiwanese men aged 20-40 years were enrolled via an online questionnaire comprising general demographic information, comorbidities, subjective thermal sensations of their hands and feet in the past 6 months, and their erectile function using the International Index of Erectile Function-5 (IIEF-5). Participants who reported cold sensation of hands and feet were classified to have CHHF; those with IIEF-5 score ≤ 21 were considered to have ED. Total 54.2% and 27.9% of participants had ED and CHHF, respectively. Men with CHHF were significantly younger, had lower body mass index and IIEF-5 scores (p < 0.001), and a lower prevalence of diabetes mellitus (p = 0.033) along with higher prevalence of ED, psychiatric disorders, and insomnia (p < 0.001). After adjusting for predisposing factors of ED, CHHF (odds ratio 1.410, 95% confidence interval 1.159-1.714; p = 0.001) remained an independent predictor of ED. Thus, CHHF is independently associated with ED, affecting more than a quarter of young Taiwanese men. Autonomic dysregulation and subclinical endothelial dysfunction may be common pathophysiologies of CHHF and ED.

High prevalence of erectile dysfunction in men with hyperthyroidism: a meta-analysis

OBJECTIVE

The objective of this study was to evaluate the association between hyperthyroidism and the risk of developing erectile dysfunction (ED).

METHODS

A comprehensive search of multiple databases, including PubMed, Embase, Cochrane, and Web of Science, was conducted to identify relevant studies investigating the relationship between hyperthyroidism and ED in men. The quality of the included studies was assessed using the Newcastle‒Ottawa Quality Rating Scale, and a meta-analysis was performed using Stata 16.0 and RevMan 5.3 software.

RESULTS

A total of four papers encompassing 25,519 study subjects were included in the analysis. Among these, 6,429 individuals had hyperthyroidism, while 19,090 served as controls. The overall prevalence of ED in patients with hyperthyroidism was determined to be 31.1% (95% CI 0.06-0.56). In patients with uncomplicated hyperthyroidism, the incidence of ED was 21.9% (95% CI 0.05-0.38). The combined odds ratio (OR) for the four studies was 1.73 (OR: 1.73; 95% CI [1.46-2.04]; p < .00001).

CONCLUSION

Our findings demonstrate a higher incidence of ED in patients with hyperthyroidism. These results provide valuable information for healthcare professionals and can facilitate discussions surrounding appropriate treatment options for ED in patients with hyperthyroidism.

Male sexual dysfunction in patients with chronic kidney disease: a cross-sectional study

Sexual dysfunction is common in males with chronic kidney disease (CKD), but yet the prevalence and specific relationship between CKD and sexual dysfunction, especially premature ejaculation (PE), remain to be investigated in China; This study aims to examine the prevalence and association between CKD and sexual dysfunction in male patients in China; In this cross-sectional, non-interventional, observational study conducted at a single center. 72 male patients with CKD were enrolled. Data collection included socio-demographic information, assessments via the 5-item version of the International Index of Erectile Function (IIEF-5), the Chinese version of the Premature Ejaculation Diagnostic Tool, the Patient Health Quentionnnaire-9 and the General Anxiety Disorder-7. Data analysis was performed using R version 3.5.2 and SPSS software version 25.0; Among the 72 CKD patients, 56.9% experienced erectile dysfunction and 29.2% had PE. Various factors including estimated Glomerular Filtration Rate, Albumin-to-Creatinine Ratio, psychological aspects, medication use were found to be associated with sexual dysfunction in these CKD patients; Sexual dysfunction is prevalent in males with CKD and is, influenced by multiple factors. It is important for clinicians to focus on sexual dysfunction in this patient group and further investigate its underlying mechanisms.

Association between leucocyte telomere length and erectile dysfunction in US adults: a secondary study based on 2001-2002 NHANES data

OBJECTIVE

We aimed to explore the association between the leucocyte telomere length (LTL) and erectile dysfunction (ED) among a nationally representative sample of US adults.

DESIGN

Secondary population-based study.

SETTING

The National Health and Nutrition Examination Survey (NHANES) (2001-2002).

PARTICIPANTS

A total of 1694 male participants were extracted from the NHANES database for 2001-2002.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary focus of the study was to determine the association between the LTL and ED, using multivariate logistic regression and restricted cubic spline models for examination. The secondary outcome measures involved conducting stratified subgroup analyses to exclude interactions of different variables with the LTL.

RESULTS

Participants with ED had shorter LTLs than those without ED (p<0.05). After adjusting for confounding factors, compared with the reference lowest LTL quartile, the ORs and 95% CIs for the second, third and fourth LTL quartiles were (OR 1.51; 95% CI 1.01 to 2.26), (OR 1.79; 95% CI 1.24 to 2.58) and (OR 1.25; 95% CI 0.74 to 2.11), respectively. In addition, restricted cubic splines showed an inverted J-curve relationship between the LTL and ED. At an LTL of 1.037, the curve showed an inflection point. The ORs (95% CI) of ED on the left and right sides of the inflection point were (OR 1.99; 95% CI 0.39 to 10.20; p=0.385) and (OR 0.17; 95% CI 0.03 to 0.90; p=0.039).

CONCLUSION

Our results demonstrated an inverted J-curve relationship between the LTL and ED. When the LTL was ≥1.037, the incidence of ED decreased with increasing LTL.

Risk factors for erectile dysfunction in diabetes mellitus: a systematic review and meta-analysis

Background

Previous studies have established that diabetes mellitus (DM) markedly raises the risk of developing erectile dysfunction (ED). Despite extensive investigations, the risk factors associated with ED in diabetic men have yet to be unequivocally determined, owing to incongruent and inconclusive results reported in various studies.

Objective

The objective of this systematic review and meta-analysis was to assess the risk factors for ED in men with DM.

Methods

A comprehensive systematic review was conducted, encompassing studies published in the PubMed, Scopus and Embase databases up to August 24th, 2023. All studies examining the risk factors of ED in patients with DM were included in the analysis. To identify significant variations among the risk factors, odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were employed. The risk of bias was evaluated using the Newcastle-Ottawa Scale(NOS) for longitudinal studies and the Agency for Healthcare Research and Quality Scale(AHRQ) for cross-sectional studies.

Results

A total of 58 studies, including a substantial participant pool of 66,925 individuals diagnosed with DM, both with or without ED, were included in the meta-analysis. Mean age (OR: 1.31, 95% CI=1.24-1.37), smoking status (OR: 1.32, 95% CI=1.18-1.47), HbA1C (OR: 1.44, 95% CI=1.28-1.62), duration of DM (OR: 1.39, 95% CI=1.29-1.50), diabetic neuropathy (OR: 3.47, 95% CI=2.16-5.56), diabetic retinopathy (OR: 3.01, 95% CI=2.02-4.48), diabetic foot (OR: 3.96, 95% CI=2.87-5.47), cardiovascular disease (OR: 1.92, 95% CI=1.71-2.16), hypertension (OR: 1.74, 95% CI=1.52-2.00), microvascular disease (OR: 2.14, 95% CI=1.61-2.85), vascular disease (OR: 2.75, 95% CI=2.35-3.21), nephropathy (OR: 2.67, 95% CI=2.06-3.46), depression (OR: 1.82, 95% CI=1.04-3.20), metabolic syndrome (OR: 2.22, 95% CI=1.98-2.49), and diuretic treatment (OR: 2.42, 95% CI=1.38-4.22) were associated with increased risk factors of ED in men with DM.

Conclusion

Our study indicates that in men with DM, several risk factors for ED have been identified, including mean age, HbA1C, duration of DM, diabetic neuropathy, diabetic retinopathy, diabetic foot, cardiovascular disease, hypertension, microvascular disease, vascular disease, nephropathy, depression, metabolic syndrome, and diuretic treatment. By clarifying the connection between these risk factors and ED, clinicians and scientific experts can intervene and address these risk factors, ultimately reducing the occurrence of ED and improving patient management.

Erectile dysfunction and Peyronie's disease diagnosis rates after penile fracture-a retrospective claims database cohort analysis

Our objective was to analyze the rates of erectile dysfunction and Peyronie's disease following a penile fracture using a large, multi-institutional claims database. Inclusion criteria included men ages 15 or older with a diagnosis of penile fracture and any office visit within 5 years of the penile fracture. Exclusion criteria included prior erectile dysfunction, prescription of erectile aids, or penile prosthesis placement. Our primary outcome was the diagnosis of erectile dysfunction or prescription of phosphodiesterase-5 inhibitors within 5 years. A secondary analysis assessed rates of Peyronie's disease following penile fracture. 1242 men were identified with penile fracture and subsequently matched to men without penile fracture, resulting in equal cohorts of 1227 men. Men with a history of penile fracture were more likely to receive a diagnosis of erectile dysfunction or require phosphodiesterase-5 inhibitors (RR 3.18, 95% CI: 2.30-4.40). Men who did not undergo immediate repair had higher rates of erectile dysfunction or treatment (RR: 1.84, 95% CI: 1.22-2.78). Men over the age of 45 years who had a penile fracture were more likely to develop erectile dysfunction or treatment compared to men under 45 years (RR: 1.65, 95% CI: 1.14-2.39). Rates of Peyronie's disease were higher in men with a history of penile fracture (5.8% vs 0%, p < 0.0001). Rates of Peyronie's disease were lower if immediate repair of the fracture was performed (RR: 0.20, 95% CI: 0.10-0.41). Men over the age of 45 years with penile fracture were more likely to develop Peyronie's Disease within 5 years compared to men under the age of 45 years penile fracture (RR: 3.72, 95% CI: 1.94-7.16). Penile fracture increases the risk of both erectile dysfunction and Peyronie's disease, especially those treated with conservative measures or over the age of 45 years compared to patients under 45 years with a penile fracture.

Major adverse cardiovascular events related to phosphodiesterase 5 inhibitors: analysis of real-life data from Eudra-Vigilance database

BACKGROUND

Phosphodiesterase 5 inhibitors (PDE5i) are the standard medical treatment for erectile dysfunction. Aim of our study was to evaluate the rate of major adverse cardiovascular events (MACE) reported during PDE5i treatment based on Eudra-Vigilance (EV) reports.

METHODS

EV database is the system for managing and analyzing data on suspected adverse reactions to medicines which have been authorized or being studied in clinical trials in the European Economic Area. MACE are defined as non-fatal stroke, non-fatal myocardial infarction, non-fatal congestive heart failure, revascularization after aorto-coronary graft bypass and cardiovascular death. We recorded the number of MACE for sildenafil, tadalafil, vardenafil, avanafil per category and severity until 1st July 2023. Pooled Relative Risk (PRR) was used to compare data between drugs.

RESULTS

Overall, 951 MACE events were reported. Most of them were observed in younger patients <65 years old (452/951 events, 48%). Overall, 377/8939 (4%) MACE events were observed for sildenafil, 221/5213 (4%) for tadalafil, 50/1029 (4%) for vardenafil and no events for avanafil. No significative differences were reported comparing sildenafil and tadalafil (PRR 0.71-0.99, IQR 0.61-1.35, P>0.05), neither sildenafil vs. vardenafil (PRR 0.68-0.79, IQR 0.43-1.55, P>0.05), neither tadalafil vs. vardenafil (PRR 0.77-0.95, IQR 0.64-1.30. P>0.05) even when compared for age. Comparison between different classes of age showed MACE were more frequent in patients younger than 65 years old taking sildenafil and tadalafil when compared to patients older than 85 years old (PRR 0.02-0.11. IQR 0.01-0.40. P<0.01) and when compared to patients in 65-85 class of age (PRR 0.02-0.12, IQR 0.01-0.95, P<0.01).

CONCLUSIONS

Real life data is consistent with MACE related to PDE5i. PDE5is are infrequently (<5%) associated with MACE. However, risk seems higher in younger patients, particularly for sildenafil (452/951 events, 48%). Clinicians should consider these data when prescribing PDE5i especially in young patients.

The effect of three years of vitamin D supplementation on erectile dysfunction: Results from the randomized placebo-controlled D-Health Trial

BACKGROUND & AIMS

Erectile dysfunction is common among older men and has been associated with low serum 25-hydroxy vitamin D concentration. However, this association may be due to uncontrolled confounding, and there is a paucity of evidence from interventional studies. We aimed to examine the effect of vitamin D supplementation on the prevalence of erectile dysfunction, in an exploratory analysis using data from a large randomized controlled trial.

METHODS

The D-Health Trial recruited Australians aged 60-84 years between January 2014 and May 2015 and randomly assigned them to supplementation with 60,000 IU of vitamin D or placebo per month for up to 5 years. Blood samples were collected annually from randomly selected participants (total N = 3943). We assessed erectile dysfunction at the end of the third year of follow-up. We used log-binomial regression to examine the effect of vitamin D on the prevalence of erectile dysfunction overall, and within sub-groups.

RESULTS

Of the 11,530 men enrolled, 8920 (77.4 %) completed the erectile dysfunction question and were included in the analysis. After three years of supplementation, the mean serum 25-hydroxy vitamin D concentration was 76 nmol/L (standard deviation (SD) 24.94) in the placebo group and 106 nmol/L (SD 26.76) in the vitamin D group (p < 0.0001). The prevalence of erectile dysfunction was 58.8 % and 59.0 % in the vitamin D and placebo groups, respectively (prevalence ratio 1.00, 95 % CI 0.97, 1.03); there was no evidence of an effect of vitamin D in any subgroup analyses.

CONCLUSION

Supplementing older men with vitamin D is unlikely to prevent or improve erectile dysfunction.

CLINICAL TRIALS REGISTRY

(ACTRN12613000743763).

Erectile Dysfunction in Alcohol Use Disorder and the change in erectile function after one month of abstinence

OBJECTIVE

The association between alcohol use and erectile dysfunction (ED) has not been explored adequately. The aim of this study is (i) to determine the prevalence of ED in patients with Alcohol use disorder (AUD), (ii) the association of ED with sociodemographic and clinical variables, (iii) the association between severity of drinking and sociodemographic and clinical variables, and (iv) the assess the change in ED after one month of abstinence from alcohol.

METHODS

203 consecutive patients were recruited into the study after taking written informed consent. Sociodemographic data was collected using a proforma and ED was assessed using International Index of Erectile Function-5 (IIEF-5). The patients were also followed up after 1 month of abstinence to assess the change in erectile function.

RESULTS

The prevalence of ED was 68.5%. Out of the 203 subjects, 28.1% had mild ED, 24.1% had mild to moderate ED, 9.9% had moderate ED and 6.4% had severe ED. Significant association were seen between ED and age, marital status, diabetes mellitus, hypertension, total duration, and severity of drinking. A significant association was seen between severity of drinking and age, diabetes mellitus, hypertension, alcoholic liver disease, tobacco use and duration of drinking. The improvement in ED after 1 month abstinence was found to be significant.

CONCLUSIONS

ED is a common problem in patients with AUD. Routine assessment of sexual functioning is warranted in patients with AUD and the information that ED improves with abstinence can provide an impetus to change.

Erectile dysfunction prevalence in the United States: report from the 2021 National Survey of Sexual Wellbeing

BACKGROUND

There has been a great deal of public speculation regarding a surge in erectile dysfunction (ED) in younger men despite data consistently indicating that the ED prevalence rates increase with age.

AIM

In this study we sought to assess the prevalence and risk of experiencing ED in a nationally representative sample of men in the United States across various social groups, describe comorbidities, and examine barriers to treatment.

METHODS

Data from the 2021 National Survey of Sexual Wellbeing were analyzed by utilizing the Ipsos KnowledgePanel®, a probability-based online panel, for the purpose of obtaining US nationally representative data of adults aged 18 years and older. The analytic sample consisted of 1822 cisgender men ranging in age from 18 to 87 years, with a mean age of 47.5 years.

OUTCOMES

Study outcomes were ED as measured by the 5-item version of the International Index of Erectile Function (IIEF-5), as well as self-reported diagnosis by a medical professional, comorbidities with other health issues, medications taken for ED, and barriers to treatment.

RESULTS

The ED prevalence rate based on IIEF-5 scores was 24.2%. Prevalence increased with age: 52.2% of the 75+ age group, and 48.0% of the 65-74 age group meeting diagnostic criteria for ED. Diagnostic criteria were met for more participants in the 18-24 age group (17.9%) than the 25-34 (13.3%) or 35-44 (12.7%) age groups, but less than the 45-54 (25.3%) or 55-64 (33.9%) age groups. Only 7.7% (n = 141) of the sample reported having been diagnosed by a provider (n = 4 in 25-34, n = 6 in 35-44, n = 13 in 45-54, n = 39 in 55-64, n = 44 in 65-74, and n = 34 in ≥75-year olds), indicating a gap in access to treatment. The most common reason selected for not accessing care for ED concerns was a lack of need to see a provider in the past year.

CLINICAL IMPLICATIONS

The discrepancy between ED self-report and medical diagnosis is critical, given that ED can be an indication of underlying health risks.

STRENGTHS AND LIMITATIONS

This study is the first nationally representative update to information regarding the prevalence of ED in almost 2 decades. Standard administration of the IIEF-5 is limited to participants who have had sex in the last 6 months, so these rates do not include those men with ED who have been avoiding penetrative sex for a significant time.

CONCLUSION

The results indicate that ED prevalence and severity remain highest in older age groups and that most individuals who meet criteria for ED have not sought medical care related to this concern.

Sexual Dysfunctions among Diabetic and Non-diabetic People Attending in Tribhuvan University Teaching Hospital, Kathmandu Nepal

BACKGROUND

Sexual dysfunctions including erectile dysfunction among men, a widespread sexual health issue, pose challenges to sexual satisfaction. This cross-sectional study aimed to assess the prevalence and determinants of sexual dysfunctions in both diabetic and non-diabetic individuals aged 30-70.

METHODS

A study at Tribhuvan University Teaching Hospital in Kathmandu, Nepal, surveyed 350 participants (176 men, 174 women), aged 30-70, with 52.6% having diabetes. The structured interviews and validated questionnaires like IIEF-5 for men and FSFI-6 for women to assess the prevalence and factors associated with erectile dysfunction were used. Statistical tools were employed to measure the associations of different variables with Sexual dysfunctions.

RESULTS

Overall, the prevalence of sexual dysfunction was 73.7% (95% CI: 72.4- 73.7) with higher rates in men 83.9% (95% CI: 83.1- 84.7) than women 63.6% (95% CI: 62.0 - 65.2). Individuals with diabetes experienced an 81.5% prevalence of sexual dysfunction (95% CI: 80.6-82.4), whereas non-diabetic individuals exhibited a 65.1% prevalence (95% CI: 63.5-66.7). In the diabetic male population, the prevalence of sexual dysfunction was 97.5% (95% CI: 97.4-97.6), while diabetic females had a prevalence of 68.9% (95% CI: 67.5-70.3). Among non-diabetic men, the percentage of erectile dysfunction was 72% (95% CI: 70.7-73.3), and among non-diabetic women, sexual dysfunction remained 56.2% (95% CI: 54.4-58.0). Among individuals with diabetes, those who used tobacco exhibited a sexual dysfunction prevalence of 93.8% (95% CI: 93.5-94.1), while non-tobacco users had a prevalence of 74.8% (95% CI: 73.6-76.0). In non-diabetic individuals, obesity was associated with a higher prevalence of sexual dysfunctions, reaching 84.6% (95% CI: 83.8-84.6). High blood pressure showed a strong association with sexual dysfunctions in both diabetic (83% with 95% CI: 81.9-83.4) and non-diabetic (70% with 95% CI: 67.7-70.1) groups. Individuals with diabetes for more than five years had a higher rate of sexual dysfunction as 87.8% (95% CI: 86.6-89.0) with 100% in men and 79% in women. However, there was no significant difference in the prevalence of sexual dysfunctions related to obesity and alcohol consumption between diabetics and non-diabetics.

CONCLUSIONS

The research highlights a noteworthy association of sexual dysfunctions with individuals with diabetes, male sex, tobacco use, and hypertension. The observed high prevalence of sexual dysfunctions in both diabetic and non diabetic people is a public health concern, emphasizing the need for culturally tailored approaches to address the sexual health of the affected individuals.

Novel anthropometric measures are positively associated with erectile dysfunction: a cross-sectional study

BACKGROUND

Currently, a growing number of research studies have shown a positive association between obesity and erectile dysfunction, while traditional anthropometric measures, such as BMI, have limited ability to assess the risk of erectile dysfunction. Therefore, this study aimed to investigate the association between the new anthropometric index and erectile dysfunction.

METHODS

A study involving 3594 participants from the National Health and Nutrition Examination Survey was conducted. The study calculated various anthropometric indices such as waist circumference (WC), waist-to-height ratio (WtHR), body mass index (BMI), a body shape index (ABSI), conicity index (CI), and body roundness index (BRI). The relationship between anthropometric indices and erectile dysfunction (ED) was investigated using multivariate logistic regression and restricted cubic splines (RCS). Interaction analysis was conducted on subgroups to confirm the findings. Additionally, the efficacy of various anthropometric indicators in predicting the risk of erectile dysfunction was assessed using the receiver operating characteristic curve (ROC).

RESULTS

After adjusting for potential confounding factors, we identified a positive and independent correlation between erectile dysfunction (ED) and all other anthropometric measures except for BMI. Additionally, the risk of ED increased by 49% and 42% for each standard deviation increment in ABSI and CI, respectively. Dose-response curve analysis demonstrated that WC, BMI, WtHR, and CI displayed a non-linear correlation with the risk of ED. The subgroup analysis revealed that individuals classified as White, who had higher levels of WC, ABSI, and CI, were more susceptible to erectile dysfunction compared to people from other races. ROC analysis showed that ABSI was superior in detecting erectile dysfunction (area under the curve: 0.750; 95% CI 0.732-0.768; optimal cutoff value: 0.083) as compared to other indices. The combination of obesity defined by BMI and other anthropometric measures showed that higher ABSI and CI levels were positively associated with the prevalence of erectile dysfunction, independent of BMI (P < .001).

CONCLUSION

In this study, anthropometric indicators including ABSI, BRI, WtHR, CI, and WC were positively associated with erectile dysfunction. To improve the prevention and treatment of this condition, it is recommended that new anthropometric indicators receive greater consideration.

Unrecognised orgasmic phase disorders in men presenting with new-onset erectile dysfunction-Findings from a real-life, cross-sectional study

BACKGROUND

Orgasmic phase disorders in men worsen the burden of erectile dysfunction on sexual satisfaction.

OBJECTIVES

To investigate the prevalence of and predictors of unreported orgasmic phase disorder in a cohort of men looking for their first urological assessment for new-onset erectile dysfunction in a real-life setting.

MATERIALS AND METHODS

Data from 1107 heterosexual, sexually active men consecutively assessed for new-onset erectile dysfunction were analysed. Throughout a comprehensive medical and sexual history, all patients were asked to self-report any orgasmic phase disorder and to complete the International Index of Erectile Function and the Beck's Inventory for Depression (depressive symptoms scored as Beck's Inventory for Depression ≥11). Men self-reporting orgasmic phase disorder during the interview were excluded from further analyses. The median value of the International Index of Erectile Function-orgasmic function domain was arbitrarily used to categorise men with (International Index of Erectile Function-orgasmic function ≤5) and without unreported orgasmic phase disorder (International Index of Erectile Function-orgasmic function >5). Circulating hormones were measured in every patient. Descriptive statistics and logistic regression models were used to test the association between clinical variables and unreported orgasmic phase disorder.

RESULTS

Of 1098 patients with non-self-reporting orgasmic phase disorder, 314 (28.6%) had International Index of Erectile Function-orgasmic function ≤5. Patients with erectile dysfunction + unreported orgasmic phase disorder were older (median [interquartile range]: 58 [44-66] years vs. 51 [40-60] years), had higher body mass index [25.8 (23.7-28.1) kg/m2 vs. 25.2 (23.3-27.4) kg/m2 ], higher prevalence of type 2 diabetes (36 [11.5%] vs. 45 [5.7%]) and lower International Index of Erectile Function-erectile function scores (6 [2-10] vs. 18 [11-24]) than men with erectile dysfunction-only (all p < 0.05). Patients with erectile dysfunction + unreported orgasmic phase disorder depicted higher rates of severe erectile dysfunction (75.5% vs. 25%) and Beck's Inventory for Depression ≥11 (22.6% vs. 17.9%) (all p < 0.05). In the multivariable logistic regression analysis, older age (odds ratio: 1.02) and lower International Index of Erectile Function-erectile function scores (odds ratio: 0.83) were independently associated with unreported orgasmic phase disorder (all p < 0.05).

CONCLUSIONS

Almost one in three men seeking first medical help for erectile dysfunction depicted criteria suggestive of unreported orgasmic phase disorder. Men with unreported orgasmic phase disorder were older and had higher rates of severe erectile dysfunction and concomitant depressive symptoms. These real-life findings outline the clinical relevance of a comprehensive investigation of concomitant sexual dysfunction in men only complaining of erectile dysfunction to more effectively tailor patient management.

Factors associated with sexual dysfunction in patients with colorectal cancer in Iran: a cross-sectional study

Sexual dysfunction is a prevalent issue among individuals diagnosed with colorectal cancer (CRC), significantly impacting their quality of life. However, limited research has explored the factors associated with sexual dysfunction in CRC patients in Iran. This cross-sectional study aimed to identify the demographic factors that may contribute to sexual dysfunction in this population. A cross-sectional study involving CRC patients was conducted from April 1, 2022, to May 1, 2022, in Tabriz, Iran. Ethical approvals were obtained, and convenience sampling was employed at outpatient chemotherapy centers in five Tabriz hospitals. Validated questionnaires, including participants characteristics form, the Female Sexual Function Index (FSFI) for females and International Index of Erectile Function (IIEF) for males, were utilized. Data were analyzed using IBM SPSS Statistics version 24, employing descriptive statistics and stepwise linear regression to assess association between mentioned factors and sexual function. Among 256 participants, 50.4% were males, 49.6% were females, and 80.5% were married. The predominant age range was 50-60 years. The study findings revealed a high prevalence of sexual dysfunction among both female (Mean ± SD: 10.91 ± 8.67, Min-Max: 3.20-33.00) and male (Mean ± SD: 27.64 ± 16.28, Min-Max: 11-62) CRC patients. Factors such as the presence of a colostomy for FSFI (P < 0.001), type of treatment received for both FSFI and IIEF (P < 0.001), type of housing for both FSFI and IIEF (P < 0.001), occupation for FSFI (P < 0.001), presence of other diseases for FSFI (P = 0.047), and time since the last chemotherapy session for FSFI (P = 0.018), Education for IIEF (P = 0.026), and Age for IIEF (P = 0.002) were identified as significant factors of sexual dysfunction. These demographic factors demonstrated varying effects on sexual function, underscoring the complexity of this issue. The results underscore the significance of addressing sexual health concerns in CRC patients and highlight the necessity for tailored interventions to enhance their overall well-being. Healthcare providers should recognize the influence of demographic factors on sexual function and contemplate integrating sexual health assessments and interventions into the care of CRC patients. Further research is needed to comprehend better the underlying mechanisms and devise effective strategies for managing sexual dysfunction in this population.

Phosphodiesterase Type 5 Inhibitors in Men With Erectile Dysfunction and the Risk of Alzheimer Disease: A Cohort Study

BACKGROUND AND OBJECTIVES

Repurposing phosphodiesterase type 5 inhibitors (PDE5Is) as drugs for Alzheimer disease (AD) risk reduction has shown promise based on animal studies. However, evidence in humans remains inconclusive. Therefore, we conducted a cohort study to evaluate the association between PDE5I initiation compared with nonuse and the risk of developing AD in men with erectile dysfunction (ED).

METHODS

Using electronic health records from IQVIA Medical Research Data UK (formerly known as the THIN database), we identified men aged ≥40 years with a new diagnosis of ED between 2000 and 2017. Individuals with a previous diagnosis of dementia, cognitive impairment, confusion, or prescription for dementia symptoms were excluded. The occurrence of incident AD was identified using diagnostic read codes. To minimize immortal-time bias, PDE5I initiation was treated as a time-varying exposure variable. Potential confounders were adjusted using inverse probability of treatment weighting based on propensity scores. Cox proportional hazard models were used to estimate the adjusted hazard ratio (HR) with 95% CIs. A secondary analysis explored the association between AD and the cumulative number of PDE5I prescriptions. Sensitivity analyses included lag (delay) periods of 1 and 3 years after cohort entry to address the prodromal stage of AD.

RESULTS

The study included 269,725 men, with 1,119 newly diagnosed with AD during a median follow-up of 5.1 (interquartile range 2.9-8.9) years. The adjusted HR in PDE5I initiators compared with nonuse was 0.82 (95% CI 0.72-0.93). The associated risk of AD decreased in individuals issued >20 prescriptions: HR 0.56 (95% CI 0.43-0.73) for 21-50 prescriptions and HR 0.65 (95% CI 0.49-0.87) for >50 prescriptions. Sensitivity analysis with a 1-year lag period supported the primary findings (HR 0.82, 95% CI 0.72-0.94), but the results differed with the inclusion of a 3-year lag period (HR 0.93, 95% CI 0.80-1.08).

DISCUSSION

PDE5I initiation in men with ED was associated with a lower risk of AD, particularly in those most frequently issued prescriptions. The differences between primary and sensitivity analyses highlight the need to explore the optimal lag period. To enhance the generalizability of our findings, a randomized controlled trial including both sexes and exploring various PDE5I doses would be beneficial to confirm the association between PDE5I and AD.

Sexual dysfunction in patients with diabetes: association between remnant cholesterol and erectile dysfunction

BACKGROUND

Erectile dysfunction (ED) is closely associated with dyslipidemia; however, it is yet unknown how ED and remnant cholesterol (RC) are related. As such, this research sought to explore the correlation between RC and ED among individuals with diagnosed with diabetes.

METHODS

This cross-sectional study used information from 215 males from National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004. RC was calculated as follows: the values of high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) were subtracted from the total cholesterol (TC) value, while ED diagnoses were based on self-reports. Weighted logistic regression analyses using both univariate and multivariate approaches were conducted to assess the correlation between RC and ED.

RESULTS

After comprehensive adjustment, multivariable logistic regression models revealed a strong correlation between RC and ED in subjects with diabetes (with an odds ratio (OR) of 7.49 and a 95% confidence interval (CI) of 1.98-28.37; P = 0.004). On categorizing RC into 3 grades (T1-T3), the OR corresponding to higher RC grade increased. Despite the results not reaching statistical significance upon categorization, a consistent and statistically significant trend (P for trend < 0.05) was observed.

CONCLUSION

This study indicated a correlation between increased RC levels and a higher prevalence of ED in diabetic males. RC may serve as a promising predictor of ED in individuals with diabetes. However, additional studies are required to confirm these findings.

Dietary calcium, phosphorus, and potassium intake associated with erectile dysfunction in the National Health and Nutrition Examination Survey (NHANES) 2001 to 2004

BACKGROUND

Erectile dysfunction is now a common disorder of sexual function, and its relationship to dietary calcium, phosphorus, and potassium has not been well studied. We set out to determine if dietary intakes of calcium, phosphorus, and potassium are related to erectile dysfunction in U.S. men.

METHODS

For this cross-sectional investigation, we used data from NHANES 2001-2004. To investigate the connection of dietary calcium, phosphorus, and potassium intake with erectile dysfunction, we employed multivariate logistic regression, smoothed curve fitting, and subgroup analysis.

RESULTS

This cross-sectional study comprised 3,556 eligible male subjects in total, with a weighted mean age of 49.93±18.13 years. After controlling for race and age, the greatest tertile of calcium consumption was found to have a 34% lower risk of erectile dysfunction than the lowest tertile (OR = 0.66; 95% CI = 0.52-0.84; p = 0.0006). The risk of erectile dysfunction was found to be reduced by 33% (OR = 0.67; 95% CI = 0.52-0.87; p = 0.0024) for the highest tertile of phosphorus intake compared to the lowest tertile of phosphorus intake and by 35% (OR = 0.65; 95% CI = 0.50-0.83; p = 0.0006) for the highest tertile of potassium intake compared to the lowest tertile of potassium intake in the fully adjusted model.

CONCLUSION

Erectile dysfunction and dietary consumption of calcium, phosphorus, and potassium are inversely associated with the U.S. population. To confirm the accuracy of our findings, additional prospective studies are necessary. Furthermore, it is imperative to do further fundamental research at the molecular level to gain a deeper understanding of the underlying mechanisms.

Iron homeostasis alterations and erectile dysfunction: A new issue in erectile disfunction treatment?

To the Editor, Erectile dysfunction (ED) is one of the most prevalent conditions affecting men globally, with significant psychological and social consequences. The prevalence varies across different populations, and it is estimated around 50% in men aged between 40 to 70. The etiology of ED is multifactorial, involving a complex crosstalk between psychological, hormonal, neurogenic, vascular, and structural factors [...].

Sleep disorders are associated with testosterone deficiency and erectile dysfunction-a U.S. claims database analysis

The relationship between male genitourinary conditions and sleep disorders has previously only been reported in single-institution studies with small cohorts. Our objective was to assess the association of erectile dysfunction (ED) and testosterone deficiency with various sleep disorders using a large claims database. The TriNetX Diamond database was queried in June 2022. In men aged 40-70 years, insomnia, sleep apnea, and circadian rhythm sleep disorder were each independently assessed to determine the association with ED and testosterone deficiency and then followed by propensity score matching performed for age, hypertension, hyperlipidemia, diabetes mellitus, ischemic heart disease, tobacco usage, and obesity. Testosterone deficiency was more likely to be found in men diagnosed with sleep apnea (odds ratio (OR) 1.66 [95% confidence interval (CI) 1.65-1.67]), insomnia (OR 1.74 [95% CI 1.73-1.76]), and circadian rhythm dysfunction (OR 2.63 [95% CI 2.54-2.73]) compared to matched controls. ED was more likely to be found in men diagnosed with sleep apnea (OR 1.02 [95% CI 1.01-1.03]), insomnia (OR 1.30 [95% CI 1.30-1.31]), and circadian rhythm dysfunction (OR 1.54 [95% CI 1.49-1.59]) compared to matched controls. Our results emphasize the negative impact of poor sleep on diseases of the male genitourinary system by identifying these relationships in the largest cohort in the U.S. reported to date.

Do oral antiviral drugs used in the treatment of chronic hepatitis B cause erectile dysfunction?

OBJECTIVE

The effect of antiviral drugs on the erectile dysfunction (ED) problem expressed by some patients using antiviral drugs due to chronic hepatitis B infection (HBV) was investigated.

METHODS

A total of 102 male patients receiving antiviral therapy for HBVinfection without any known non-cirrhotic and comorbid disease that may cause ED and whodon't use any drugs with an ED formation potential were analyzed through the InternationalIndex of Erectile Function test.

RESULTS

Among the patients admitted to the study, anxiety disorder was detected as 24.5% (n = 25) and depression as 46.1% (n = 47). 70.6% (n = 72) of the patients suffered ED. Severe ED was only detected in 3 (n = 2.9%) patients. ED was detected in 70.6% of the entecavir, 64.2% of tenofovir, and 80% of Tenofovir alafenamide users ( P  = 0.287). On the other hand, the logistics regression analysis revealed that the most important factors that increase the risk of ED are age (>55 age; RR: 2.66; P  < 0.001), and anxiety disorder (RR: 2.30; P  < 0.0001). The cumulative effect of antiviral drugs on ED was 5.7% (RR: 0.8; P  = 0.156).

CONCLUSION

We could not find any mounting evidence relating to the effect ofcommonly used antiviral drugs for hepatitis B causing ED. The incidence rate of ED on ourpatients was at a similar rate with population studies in the literature based on society. It is notappropriate to terminate antiviral therapy in hepatitis B for this reason.

Serum albumin levels as a useful complementary marker for erectile dysfunction in ulcerative colitis: A cross-sectional study

OBJECTIVE

Recently, a close association between ulcerative colitis (UC) and erectile dysfunction (ED) was reported. An inverse relationship between serum albumin and ED is found in patients with chronic disease. However, the association between serum albumin levels and ED in patients with UC is unclear. This study aims to investigate this issue in Japanese patients with UC.

METHODS

One hundred and thirty-six Japanese male UC patients were enrolled in this study. Information on serum albumin levels and medications for UC from medical records, Sexual Health Inventory for Men (SHIM) score information from self-administered questionnaires and information on the severity of UC from physician reports were obtained from medical records, self-administered questionnaires, and reports from physicians. The participants were divided into tertiles based on the total protein, serum globulin, serum albumin, aspartate aminotransferase, and C-reactive protein levels. The definition of ED and severe ED was SHIM score < 22 and SHIM score < 8, respectively. The association between these serum markers and ED was assessed by multivariate logistic regression.

RESULTS

The prevalence of severe ED in the low, moderate, and high albumin groups was 66.0%, 51.0%, and 28.3%, respectively. After adjusting for confounding factors, the low albumin group was independently and positively associated with severe ED (adjusted odds ratio: 2.74, 95% confidence interval: 1.03-7.48, p for trend =0.044). No association between other marker and ED was found.

CONCLUSION

Serum albumin was independently inversely associated with severe ED in Japanese patients with UC. Hypoalbuminemia might be a useful complementary marker for assessing the prevalence and severity of ED in UC patients.

The association of tadalafil exposure with lower rates of major adverse cardiovascular events and mortality in a general population of men with erectile dysfunction

BACKGROUND

Tadalafil is a long-acting phosphodiesterase-5 inhibitor (PDE-5i) indicated for erectile dysfunction (ED).

HYPOTHESIS

Our hypothesis was that tadalafil will reduce the risk of major adverse cardiovascular events (MACE: composite of cardiovascular death, myocardial infarction, coronary revascularization, unstable angina, heart failure, stroke) and all-cause death in men with ED.

METHODS

A retrospective observational cohort study was conducted in a large US commercial insurance claims database in men with a diagnosis of ED without prior MACE within 1 year. The exposed group (n = 8156) had ≥1 claim for tadalafil; the unexposed group (n = 21 012) had no claims for any PDE-5i.

RESULTS

Primary outcome was MACE; secondary outcome was all-cause death. Groups were matched for cardiovascular risk factors, including preventive therapy. Over a mean follow-up of 37 months for the exposed group and 29 months for the unexposed group, adjusted rates of MACE were 19% lower in men exposed to tadalafil versus those unexposed to any PDE-5i (hazard ratio [HR] = 0.81; 95% confidence intervals [CI] = 0.70-0.94; p = .007). Tadalafil exposure was associated with lower adjusted rates of coronary revascularization (HR = 0.69; 95% CI = 0.52-0.90; p = .006); unstable angina (HR = 0.55; 95% CI = 0.37-0.81; p = .003); and cardiovascular-related mortality (HR = 0.45; CI = 0.22-0.93; p = .032). Overall mortality rate was 44% lower in men exposed to tadalafil (HR = 0.56; CI = 0.43-0.74; p < .001). Men in the highest quartile of tadalafil exposure had the lowest rates of MACE (HR: 0.40; 95% CI: 0.28-0.58; p < .001) compared to lowest exposure quartile.

CONCLUSION

In men with ED, exposure to tadalafil was associated with significant and clinically meaningful lower rates of MACE and overall mortality.

Prevalence and predictors of erectile dysfunction among men in the diabetes prevention program outcomes study

OBJECTIVE

To determine burden and identify correlates of erectile dysfunction (ED) among men with prediabetes (PreD) and type 2 diabetes (T2D) enrolled in the Diabetes Prevention Program (DPP) Outcomes Study (DPPOS).

RESEARCH DESIGN AND METHODS

The 2017 DPPOS visit included administration of the International Index of Erectile Function. Of 648 male participants, 88 % (n = 568) completed the survey. Associations between sociodemographic, behavioral, clinical, and glycemic measures at time of ED assessment, and ED were examined using multivariable logistic regression models in men with PreD and T2D separately.

RESULTS

Overall, 218 (38 %) men met ED criteria. Prevalence was similar in men with PreD (41 %) and T2D (37 %) (p = 0.4). In all men, age (p < 0.001) increased odds of ED. Among men with PreD, those assigned to intensive lifestyle intervention (ILS), but not metformin, had decreased odds of ED compared with the placebo group (OR = 0.35, 95 % CI = 0.13, 0.94). Non-Hispanic White race was associated with increased odds of ED compared with other races (OR = 4.3; 95 % CI = 1.92, 9.65). Among men with T2D, ED risk did not differ by DPP treatment assignment; however, individuals with metabolic syndrome defined by National Cholesterol Education Program criteria, had increased odds of ED (OR = 1.85, 95 % CI = 1.14, 3.01), as did individuals with depression (OR = 2.05; 95 % CI = 1.10, 3.79).

CONCLUSIONS

ED is prevalent in men with PreD and T2D. Our finding of reduced odds of ED in men randomized to ILS and with PreD suggests a potential opportunity for risk mitigation in the prediabetes interval. In men who have progressed to T2D, metabolic factors appear to be associated with ED.

Sexual dysfunction in men with young onset Parkinson's disease

Sexual dysfunction (SD) is a common, yet under-reported non-motor symptom of PD. Common sexual symptoms among male PD patients include erectile dysfunction, premature ejaculation, and decreased sexual desire. Few research papers have examined sexual dysfunction in PD, especially in YOPD male patients, and there is no Indian research study on sexual dysfunction in YOPD. In this study, we determined the frequency of sexual dysfunction in men with YOPD, and its correlation with other motor and NMS. This prospective cross-sectional study was conducted on YOPD males who presented to the Department of Neurology, NIMHANS, Bangalore, India, from May 2021 to April 2023. The diagnosis of YOPD was made based on MDS criteria for IPD 2015. Sexual functions were evaluated by ASEX, PEDT, QUIP-RS, and sex hormone assay. The patients also underwent other motor and non-motor assessments. Statistical analysis was done using SPSS version 22.0. The study was funded by the PDMD fund. This study included 62 male YOPD patients. The mean age of cases was 44.74 ± 8.54 years. The mean duration of symptoms was 8.45 ± 6.23 years. 43.5% of the cases of PD were Akinetic rigid type. By ASEX Score grading, 46.8% of the cases had erectile dysfunction and 71% of the cases of YOPD had premature ejaculation by PEDT Score grading. 9.7% of the cases had hypersexuality by QUIP-RS. Duration of YOPD was a better predictor of Erectile Dysfunction and premature ejaculation when compared with other variables. SD was related to anxiety and depression and it had a negative impact on the patient's health-related quality of life (HR-QoL). SD should be investigated and treated as an integral part of the neurological assessment in YOPD.

Investigating the prevalence of erectile dysfunction among men exposed to organophosphate insecticides

INTRODUCTION

Erectile dysfunction (ED) poses a significant disease morbidity and contributor to male infertility, where an estimated 20-40% of men are affected annually. While several risk factors have been identified in the etiology of ED (e.g., aging, heart disease, diabetes, and obesity), the complete pathogenesis remains to be elucidated. Over the last few decades, the contribution of environmental exposures to the pathogenesis of ED has gained some attention, though population studies are limited and results are mixed. Among environmental contaminants, organophosphate (OP) insecticides represent one of the largest chemical classes, and chlorpyrifos is the most commonly used OP in the U.S. OP exposure has been implicated in driving biological processes, including inflammation, reactive oxygen species production, and endocrine and metabolism disruption, which have been demonstrated to adversely affect the hypothalamus and testes and may contribute to ED. Currently, studies evaluating the association between OPs and ED within the U.S. general population are sparse.

METHODS

Data were leveraged from the National Health and Nutrition Examination Survey (NHANES), which is an annually conducted, population-based cross-sectional study. Urinary levels of 3,5,6-trichloro-2-pyridinol (TCPy), a specific metabolite of the most pervasive OP insecticide chlorpyrifos, were quantified as measures of OP exposure. ED was defined by responses to questionnaire data, where individuals who replied "sometimes able" or "never able" to achieve an erection were classified as ED. Chi-square, analysis of variance (ANOVA), and multivariable, weighted linear and logistic regression analyses were used to compare sociodemographic variables between quartiles of TCPy exposure, identify risk factors for TCPy exposure and ED, and to analyze the relationship between TCPy and ED.

RESULTS

A total of 671 adult men were included in final analyses, representing 28,949,379 adults after survey weighting. Approximately 37% of our cohort had ED. Smoking, diabetes, aging, Mexican-American self-identification, and physical inactivity were associated with higher ED prevalence. Analysis of TCPy modeled as a continuous variable revealed nonsignificant associations with ED (OR = 1.02 95% CI [0.95, 1.09]). Stratification of total TCPy into quartiles revealed increased odds of ED among adults in the second and fourth quartiles, using the first quartile as the reference (OR = 2.04 95% CI [1.11, 3.72], OR = 1.51 95% CI [0.58, 3.93], OR = 2.62 95% CI [1.18, 5.79], for quartiles 2, 3, and 4, respectively).

CONCLUSIONS

The results of our study suggest a potential role for chlorpyrifos and other OPs the pathogenesis of ED. Future studies are warranted to validate these findings, determine clinical significance, and to investigate potential mechanisms underlying these associations.

Incidence of erectile dysfunction among middle-aged and aging sexual minority men living with or without HIV

Introduction

Erectile dysfunction (ED) has been established as a comorbidity among men living with HIV, but comparisons by HIV serostatus of ED incidence in a longitudinal follow-up cohort of men are lacking. We sought to evaluate the incidence of ED spanning a period of 12 years in a longitudinal cohort of sexual minority men (SMM) living with and without HIV.

Methods

We analyzed ED incidence data for 625 participants in the longitudinal Multicenter AIDS Cohort Study from visits spanning October 2006 to April 2019.

Results

SMM living with HIV were more likely to have incident ED compared with those living without HIV (rate ratio: 1.41; 95% CI: 1.14-1.75). Older age, current diabetes, cumulative cigarette use, and cumulative antidepressant use were associated with increased incidence of ED in the entire sample. Self-identifying as Hispanic, current diabetes, and cumulative antidepressant use were positively associated with ED incidence among SMM living with HIV. Cumulative cigarette use was positively associated with greater ED incidence only among SMM living without HIV.

Discussion

In summary, age (full sample/ with HIV), current diabetes (full sample/with HIV), cumulative cigarette use (full sample/without HIV), and cumulative antidepressant use (full sample/with HIV) were associated with increased ED incidence. Skillful management of diabetes and careful titration of antidepressants, along with smoking cessation practices, are recommended to mitigate ED in this population.

The Association Between Insomnia, Insomnia Medications, and Erectile Dysfunction

BACKGROUND

Sleep quality and duration have been investigated for their association with health. Insomnia affects up to one-third of adults and may impact male erectile function. In addition, medical treatments for insomnia (many of which are sedatives) may also affect erectile quality.

OBJECTIVE

To investigate the association of erectile dysfunction (ED) in patients diagnosed with and treated for insomnia.

DESIGN, SETTING, AND PARTICIPANTS

We utilized the IBM MarketScan (2007-2016) Commercial and Medicare Supplemental Databases (v 2.0). Age- and enrollment-matched controls were selected among patients without insomnia diagnosis or treatment.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Cox proportional hazard models were used to estimate the risk of incident ED (ie, diagnosis alone, or diagnosis and treatment with phosphodiesterase-5 inhibitors [PDE5i], intracavernous injection (ICI)/urethral suppositories, and penile prosthesis) after the diagnosis or treatment of insomnia while adjusting for relevant comorbidities.

RESULTS AND LIMITATIONS

In total, 539 109 men with an insomnia diagnosis were identified. Of these men, 356 575 were also medically treated for insomnia. The mean (±standard deviation) follow-up times for patients diagnosed with insomnia and those diagnosed with and treated for insomnia were 2.8 ± 1.6 and 3.1 ± 1.8 yr, respectively. Men with insomnia were more commonly smokers and had a higher number of office visits and comorbidities than controls (p < 0.001). On an adjusted analysis, both untreated and treated insomnia were associated with increased risks of ED diagnosis (hazard ratio or HR [95% confidence interval {CI}]: 1.58 [1.54-1.62] and 1.66 [1.64-1.69], respectively; p < 0.001). Similarly, men with treated insomnia had a higher risk of having ED treated with PDE5i (HR [95% CI]: 1.52 [1.49-1.55]; p < 0.001) and ICI (HR [95% CI]: 1.32 [1.14-1.54]; p < 0.001) when compared with controls. A limitation of this study was that a lack of granularity regarding patient clinical characteristics (eg, severity of disease, laboratory data, etc.) is inherent to insurance claims data. In addition, the follow-up was limited and may affect associations at longer time points.

CONCLUSIONS

In the current report, a consistent association between insomnia and ED diagnosis was identified. Men diagnosed with insomnia only were found to have a higher risk of developing ED. Moreover, men with pharmacological insomnia treatments were more often prescribed treatments for ED. Given the prevalence of insomnia, future studies are warranted to delineate the association of insomnia and its treatment with erectile function.

PATIENT SUMMARY

Insomnia affects up to one-third of adults and impact male erectile function. Men only diagnosed with insomnia were found to have a higher risk of developing erectile dysfunction (ED). Moreover, men with pharmacological insomnia treatments were more often prescribed treatments for ED.

A clinical guide to rare male sexual disorders

Conditions referred to as 'male sexual dysfunctions' usually include erectile dysfunction, ejaculatory disorders and male hypogonadism. However, some less common male sexual disorders exist, which are under-recognized and under-treated, leading to considerable morbidity, with adverse effects on individuals' sexual health and relationships. Such conditions include post-finasteride syndrome, restless genital syndrome, post-orgasmic illness syndrome, post-selective serotonin reuptake inhibitor (SSRI) sexual dysfunction, hard-flaccid syndrome, sleep-related painful erections and post-retinoid sexual dysfunction. Information about these disorders usually originates from case-control trials or small case series; thus, the published literature is scarce. As the aetiology of these diseases has not been fully elucidated, the optimal investigational work-up and therapy are not well defined, and the available options cannot, therefore, adequately address patients' sexual problems and implement appropriate treatment. Thus, larger-scale studies - including prospective trials and comprehensive case registries - are crucial to better understand the aetiology, prevalence and clinical characteristics of these conditions. Furthermore, collaborative efforts among researchers, health-care professionals and patient advocacy groups will be essential in order to develop evidence-based guidelines and novel therapeutic approaches that can effectively address these disorders. By advancing our understanding and refining treatment strategies, we can strive towards improving the quality of life and fostering healthier sexual relationships for individuals suffering from these rare sexual disorders.

Screening of Associated Factors for Erectile Dysfunction after Radical Prostatectomy and Construction of a Clinical Risk Assessment Model: A Retrospective Study

OBJECTIVE

In this article, the associated factors for erectile dysfunction (ED) after radical prostatectomy (RP) were explored, and a clinical risk assessment model was constructed.

METHODS

A total of 155 patients who underwent RP in People's Hospital of Hunan Province from November 2020, to November 2021, were selected as the study group. In accordance with the results of International Index of Erectile Function (IIEF-5) at 6 months after surgery, 88 patients were included in the ED group (IIEF-5 <22), and 67 patients were included in the non-ED group (IIEF-5 ≥22). Univariate and multivariate logistic regression analyses were conducted to screen the risk factors for ED after RP, and a risk model was constructed on this basis. In addition, 43 patients with ED after RP and 41 patients with non-ED after RP from January 2022, to January 2023, were included in the test group to evaluate the predictive efficacy of the clinical risk assessment model on the basis of the receiver operating characteristic curve.

RESULTS

The study group had a lower postoperative IIEF-5 score than before surgery (p < 0.001). The incidence of ED after RP in the study group was 56.77% (88/155). Multivariate analysis showed that advanced age (odds ratio (OR) = 1.155), large prostate volume (OR = 1.077), smoking (OR = 5.676), drinking (OR = 3.495), hypertension (OR = 8.079), diabetes (OR = 6.082), low preoperative serum testosterone (T) level (OR = 0.684) and high preoperative serum endothelin-1 (ET-1) level (OR = 1.192) were risk factors for ED after RP (p < 0.05). A risk model was constructed as follows: Z = 0.144 × (age) + 0.074 × (prostate volume) + 1.736 × (smoking) + 1.251 × (drinking) + 2.089 × (hypertension) + 1.805 × (diabetes) - 0.380 × (preoperative serum T) + 0.175 × (preoperative serum ET-1). The area under curve (AUC), sensitivity, specificity and 95% CI of this model were 0.906, 97.70%, 73.20%, and 0.848-0.964, respectively (p < 0.001).

CONCLUSIONS

The clinical risk assessment model constructed on the basis of the above factors provides some references for the scientific prevention and treatment of ED after RP.

Sexual dysfunction among early-onset colorectal cancer survivors: Sex-specific correlates of sexual health discussions between patients and providers

PURPOSE

To examine the prevalence of female sexual dysfunction (FSD), male erectile dysfunction (ED), and the prevalence and correlates of sexual health discussions between early-onset CRC survivors and their health care providers.

METHODS

An online, cross-sectional survey was administered in partnership with a national CRC advocacy organization. Respondents (n = 234; diagnosed < 50 years, 6-36 months from diagnosis/relapse) were colon (36.8%) and rectal (63.3%) cancer survivors (62.5% male). The Female Sexual Function Index (FSFI-6) was used to measure FSD, and the International Index of Erectile Function (IIEF-5) was used to measure ED. Survivors reported whether a doctor communicated with them about sexual issues during/after treatment.

RESULTS

Among females (n = 87), 81.6% had FSD (mean FSFI-6 score = 14.3 [SD±6.1]). Among males (n = 145), 94.5% had ED (mean IIEF-5 score = 13.6 [SD±3.4]). Overall, 59.4% of males and 45.4% of females reported a sexual health discussion. Among the total sample, older age of diagnosis and relapse were significantly associated with reporting a discussion, while female sex was negatively associated with reporting a sexual health discussion. Among males, older age at diagnosis and relapse, and among females, older age of diagnosis, were significantly associated with reporting a sexual health discussion.

CONCLUSION

The prevalence of FSD and ED were high (8 in 10 females reporting FSD, almost all males reporting ED), while reported rates of sexual health discussion were suboptimal (half reported discussion). Interventions to increase CRC provider awareness of patients at risk for not being counseled are needed to optimize long-term health outcomes.

Men with erectile dysfunction (ED) should be screened for cardiovascular risk factors - Cost-benefit considerations in Swiss men

Background: Current evidence indicates that erectile dysfunction (ED) is an independent risk factor for future cardiovascular events. This study aimed to estimate the cost-effectiveness of screening and subsequent preventive treatment for cardiovascular risk factors among men newly diagnosed with ED from the Swiss healthcare system perspective. Methods: Based on known data on ED and cardiovascular disease (CVD) prevalence and incidence costs and effects of a screening intervention for cardiovascular risk including corresponding cardiovascular prevention in men with ED were calculated for the Swiss population over a period of 10 years. Results: Screening and cardiovascular prevention over a period of 10 years in Swiss men with ED of all seriousness degrees, moderate and severe ED only, or severe ED only can probably avoid 41,564, 35,627, or 21,206 acute CVD events, respectively. Number needed to screen (NNS) to prevent one acute CVD event is 30, 23, and 10, respectively. Costs for the screening intervention are expected to be covered at the seventh, the fifth, and the first year, respectively. Conclusion: Screening and intervention for cardiovascular risk factors in men suffering from ED is a cost-effective tool not only to strengthen prevention and early detection of cardiovascular diseases but also to avoid future cardiovascular events.

[Urinary incontinence after radical prostatectomy for prostate cancer-data from 17,149 patients from 125 certified centers]

BACKGROUND

In addition to erectile dysfunction, urinary incontinence is the most common functional limitation after radical prostatectomy (RPE) for prostate cancer (PCa). The German S3 guideline recommends informing patients about possible effects of the therapy options, including incontinence. However, only little data on continence from routine care in German-speaking countries after RPE are currently available, which makes it difficult to inform patients.

OBJECTIVE

The aim of this work is to present data on the frequency and severity of urinary incontinence after RPE from routine care.

MATERIALS AND METHODS

Information from the PCO (Prostate Cancer Outcomes) study is used, which was collected between 2016 and 2022 in 125 German Cancer Society (DKG)-certified prostate cancer centers in 17,149 patients using the Expanded Prostate Cancer Index Composite Short Form (EPIC-26). Changes in the "incontinence" score before (T0) and 12 months after RPE (T1) and the proportion of patients who used pads, stratified by age and risk group, are reported.

RESULTS

The average score for urinary incontinence (value range: 0-worst possible to 100-best possible) was 93 points at T0 and 73 points 12 months later. At T0, 97% of the patients did not use a pad, compared to 56% at T1. 43% of the patients who did not use a pad before surgery used at least one pad a day 12 months later, while 13% use two or more. The proportion of patients using pads differs by age and risk classification.

CONCLUSION

The results provide a comprehensive insight into functional outcome 12 months after RPE and can be taken into account when informing patients.

Oral phosphodiesterase type 5 inhibitors and priapism: A VigiBase analysis

PURPOSE

To explore the differences of priapism events among a diverse cohort taking erectogenic medicines (i.e., phosphodiesterase type 5 inhibitors [PDE5i] and intracavernousal drugs).

METHODS

We queried the World Health Organization global database of individual case safety reports (VigiBase) for records of the adverse drug reactions (ADR) with sildenafil, tadalafil, avanafil, vardenafil, papaverine, and alprostadil. Disproportionality analyses (case/non-case approach) were performed to assess the reporting odds ratio (ROR) of priapism reporting in PDE5i consumers compared to intracavernousal drug recipients.

RESULTS

From a total of 133 819 ADR events for erectogenic medications, 632 were priapism (PDE5is: n = 550, 0.41%; intracavernousal drugs: n = 82, 9.92%). Priapism disproportionality signals from intracavernousal drugs were 25 times stronger than PDE5is (ROR = 34.7; confidence interval [CI] 95%: 27.12-43.94 vs. ROR = 1.38; 95% CI: 1.24-1.54). For all PDE5i agents, the 12-17 years age group had the highest ROR (9.49, 95% CI: 3.76-19.93) followed by 2-11 years (4.31, 95% CI: 1.57-9.4). Disproportionality signals for consumers under 18 for both all PDE5is as a whole (ROR = 4.57, 95% CI: 2.48-7.73) and sildenafil (ROR = 4.89, 95% CI: 2.51-8.62) were stronger than individuals 18 or older (ROR = 1.06, 95% CI: 0.93-1.21 and ROR = 1.08, 95% CI: 0.91-1.26, respectively).

CONCLUSIONS

PDE5i use shows disproportionate priapism signals which are higher in young patients.

Erectile function and androgen and estrogen beta receptor gene polymorphisms in acromegalic men

PURPOSE

Sexual dysfunctions are often experienced by male patients with acromegaly, due to a combination of hypogonadism and other comorbidities, but are a scarcely investigated complication. Erectile dysfunction is also closely related to cardiovascular diseases through endothelial dysfunction. Therefore, this project aimed to assess the prevalence of erectile dysfunction in a population of acromegalic men and evaluate its association with cardio-metabolic disorders, also exploring associations with androgen and estrogen receptor gene polymorphisms.

METHODS

Sexually active men aged 18-65 with previous diagnosis of acromegaly were recruited. Clinical and laboratory data were retrospectively collected. Each patient also provided a blood sample for AR and ERβ gene polymorphisms analyses and filled out the IIEF-15 questionnaire.

RESULTS

Twenty men with previous diagnosis of acromegaly (mean age 48.4 ± 10.0 years) were recruited. 13/20 subjects (65%) had erectile dysfunction, but only four had a concurrent biochemical hypogonadism, with no significant correlation with IIEF-15 scores. Total testosterone negatively correlated with sexual intercourse satisfaction domain (ρ = - 0.595; p = 0.019) and general satisfaction domain (ρ = - 0.651; p = 0.009). IGF-1 levels negatively correlated with biochemical hypogonadism (ρ = - 0.585; p = 0.028). The number of CAG and CA repeats in AR and ERβ receptors genes was not significantly associated with IIEF-15 scores or with GH/IGF-1 levels, but a negative correlation between CA repeats and the presence of cardiomyopathy (ρ = - 0.846; p = 0.002) was present.

CONCLUSIONS

Men with acromegaly have a high prevalence of erectile dysfunction, but it does not appear to be correlated with treatments, testosterone levels and AR/ER-beta signaling. Nonetheless, a shorter CA polymorphic trait (ERbeta) is associated with the presence of cardiomyopathy. If confirmed, these data may suggest an association between an incorrect hormonal balance and increased cardiovascular risk in acromegaly subjects.

Comparing the Strength of Associations Between Male Genital Problems and Mental Illnesses and Sleep Disorders

This study compares the rate of selected types of mental illnesses (stress, anxiety, depression) and sleep disorders (insomnia, sleep apnea) according to the status of eight male genital problems. Analyses utilize medical claims data for male employees aged 18 to 64 years of a large corporation, 2017 to 2021. Approximately 1,076 (7.3%) men per year have one or more genital problems. The most common being benign prostatic hyperplasia (BPH; 3.8%) and then erectile dysfunction (ED; 1.7%). For BPH patients, the rate experiencing stress, anxiety, depression, or a combination of these is 0.96%, 6.2%, 5.3%, and 5.1%, respectively. Corresponding rates for ED are 1.5%, 7.2%, 5.9%, and 7.5%. For BPH patients, the rate experiencing insomnia, sleep apnea, or both is 3.1%, 22.7%, and 2.0%, respectively. Corresponding rates for ED are 1.2%, 20.6%, and 2.2%. Male genital problems positively associate with having one or more mental illnesses (stress, anxiety, depression), except for hydrocele, with ED and penis disorder having the strongest associations. Male genital problems also positively associate with having insomnia and/or sleep apnea, except for infertility and orchitis, with BPH and ED having the strongest associations. The positive associations involving BPH and ED with mental illnesses are each more pronounced in the younger age group (18-49 vs. 50-64). Similar results are seen in the models involving sleep disorders. Thus, comorbid male genital problems, mental illnesses, and sleep disorders exist, with the strength of associations unique to the male genital problem and sometimes modified by age.

Effects of obesity-related anthropometric indices and body composition on erectile dysfunction mediated by coronary artery disease: A Mendelian randomization study

BACKGROUND

The causal relationship between obesity-related anthropometric indicators/body composition and erectile dysfunction has not been established in previous observational studies.

METHOD

We screened single nucleotide polymorphisms significantly associated with exposure from genome-wide association studies as instrumental variables (p < 5.0 × 10-8 ). The summary statistics for erectile dysfunction were collected from a genome-wide association study with a sample size of 223,805. Exposure and outcome populations included are of European ancestry. We used univariate and multivariate Mendelian randomization (i) to investigate the causal relationship between genetically predicted obesity-related anthropometric indicators/body composition and erectile dysfunction and (ii) to examine the mediating role of coronary artery disease. Mendelian randomization analysis was conducted using an inverse variance weighted method. A series of sensitivity analyses validated the results of the Mendelian randomization analysis. Causal estimates are expressed as odds ratios with 95% confidence intervals.

RESULTS

Obesity-related anthropometric indicators/body composition were associated with an increased risk of erectile dysfunction in univariate Mendelian randomization analyses. For the 1-SD increase in body mass index, the odds ratio was 1.841 (95% confidence interval: 1.049-1.355, p = 0.006). For the 1-SD increase in waist circumference and hip circumference, the odds ratios were 1.275 (95% confidence interval: 1.101-1.478, p = 0.001) and 1.156 (95% confidence interval: 1.015-1.317, p = 0.009), respectively. The odds ratio for the 1-SD increase in whole body fat mass was 1.221 (95% confidence interval: 1.047-1.388, p = 0.002). For the 1-SD increase in leg fat percentage (left and right), the odds ratios were 1.256 (95% confidence interval: 1.006-1.567, p = 0.044) and 1.285 (95% confidence interval: 1.027-1.608, p = 0.028), respectively. For the 1-SD increase in leg fat mass (left and right), the odds ratios were 1.308 (95% confidence interval: 1.108-1.544, p = 0.001) and 1.290 (95% confidence interval: 1.091-1.524, p = 0.003), respectively. For the 1-SD increase in arm fat mass (left and right), the odds ratios were 1.269 (95% confidence interval: 1.113-1.447, p < 0.001) and 1.254, respectively. Multivariate Mendelian randomization analysis showed that after adjusting for coronary artery disease, some genetic predispositions to obesity-related anthropometric indicators and body composition were still associated with an increased risk of erectile dysfunction. Significant associations were found for waist circumference-erectile dysfunction (odds ratio: 1.218, 95% confidence interval: 1.036-1.432), leg fat percentage (left)-erectile dysfunction (odds ratio: 1.245, 95% confidence interval: 1.035-1.497), leg fat mass (left)-erectile dysfunction (odds ratio: 1.264, 95% confidence interval: 1.051-1.521), arm fat mass (right)-erectile dysfunction (odds ratio: 1.186, 95% confidence interval: 1.024-1.373), and arm fat mass (left)-erectile dysfunction (odds ratio: 1.17, 95% confidence interval: 1.018-1.360). Meanwhile, coronary artery disease mediated the effects of fat on erectile dysfunction, and the proportion of coronary artery disease-mediated cases ranged from 10% to 22%.

CONCLUSION

There is a potential causal relationship between obesity-related anthropometric indicators/body composition and erectile dysfunction. Higher waist circumference, leg fat percentage, and arm fat mass may increase the risk of erectile dysfunction, and coronary artery disease partly mediates this overall effect. Understanding the causal relationship between obesity and erectile dysfunction and the mediating role of coronary artery disease may provide more information for erectile dysfunction intervention and prevention strategies.

Low risk of erectile dysfunction after nontransecting bulbar urethroplasty for urethral stricture: a systematic review and meta-analysis

BACKGROUND

Sexual function after urethroplasty may be a concern for patients, but there are still some controversies regarding the consequences of nontransecting bulbar urethroplasty (ntBU) in terms of erectile dysfunction (ED).

AIM

This meta-analysis aimed to compare the efficacy and safety of ntBU with that of transecting bulbar urethroplasty (tBU).

METHODS

The PubMed, Web of Science, Cochrane, and Embase databases were searched and reviewed up to October 31, 2022. Quality evaluation was performed using the Newcastle-Ottawa scale system and Cochrane tools for the nonrandomized and randomized studies, respectively. Baseline characteristics, preoperative information, and postoperative outcomes were collected.

OUTCOMES

Outcomes included success rate, ED, overall complication, and maximum urinary flow.

RESULTS

Thirteen studies comprising 1683 patients met the inclusion criteria, with 596 and 1087 patients undergoing ntBU and tBU, respectively. The results revealed that compared with the tBU group, the patients who underwent ntBU had a significantly lower incidence of ED, while there were no significant differences in the other perioperative outcomes. In subgroup analysis, the nontransecting anastomotic urethroplasty group had a lower incidence of ED than excision and primary anastomosis, and other perioperative outcomes were similar between the 2 groups.

CLINICAL IMPLICATIONS

The results of the study may help clinicians choose procedures that protect sexual function in the treatment of urethral stricture.

STRENGTHS AND LIMITATIONS

The strength of this study is that it is, to our knowledge, the first meta-analysis to evaluate the efficacy and safety of ntBU. A limitation is that most of the included studies were retrospective cohort studies.

CONCLUSION

ntBU preserves the high efficacy of its transecting counterpart while reducing postoperative ED.

Prevalence and associated factors of moderate to severe erectile dysfunction among adult men in Malaysia

Erectile dysfunction (ED) is a pervasive problem among men, often shrouded in silence and stigma. This manuscript analysed the National Health and Morbidity Survey 2019 data to identify the prevalence of moderate to severe ED among men aged 18 and above in Malaysia and describe its associated factors. Self-administered questionnaire on ED utilised a locally validated International Index of Erectile Function. Variables on sociodemographics, risky lifestyles and comorbidities were obtained via an interviewer-administered questionnaire. The prevalence was determined using complex sampling analysis, and logistic regression was used to determine the associated factors of ED. A sample of 2403 men aged ≥ 18 participated, with a moderate to severe ED prevalence was 31.6% (95% CI 28.8, 34.6). The mean (± SD) of the total score of IIEF-5 for overall respondents was 18.16 (± 4.13). Multiple logistic regression analysis revealed a significant association between moderate to severe ED among men aged 60 years and above, single or divorcee, men without formal, primary, and secondary education, non-government employees, unemployed, and retiree, as well as physically inactive men. Focused public health interventions are necessary to improve education in sexual health, increase health promotion programs, and promote healthy ageing across the population.

Correlation between visceral adiposity index and erectile dysfunction in American adult males: a cross-sectional study based on NHANES

Background

The risk of visceral obesity on erectile function has recently attracted much attention. The visceral adiposity index (VAI) is a brief and reliable indicator of visceral obesity measurement. Nevertheless, the association between VAI and erectile dysfunction (ED) is not completely clarified.

Methods

Data from NHANES 2001-2004 were enrolled in this study. Erectile function was assessed by a database-self-administered questionnaire. VAI was calculated with body mass index (BMI), waist circumference (WC), triglyceride (TG), and high-density lipoprotein (HDL) cholesterol. The weighted logistic regression model was performed to evaluate the association between VAI and ED.

Results

Ultimately, 3380 participants were enrolled in the study, including 900 with ED and 2480 without ED. Compared to participants without ED, those with ED generally had higher levels of VAI (1.76 vs. 1.53). The weighted logistic regression analyses demonstrated increased odds of developing ED in participants within the 4th quartile (Q4) of VAI compared to the 1st quartile (Q1) of VAI (OR = 2.023; 95% CI, 1.534-2.669; P < 0.001). Similar results were still obtained after adjusting for the relevant covariates (OR = 1.404; 95% CI, 1.008-1.954; P = 0.044). In subgroup analyses grouped by smoking status, higher VAI was associated with increased odds of developing ED only in the current smoking group (OR = 1.092; 95% CI, 1.021-1.167; P = 0.010).

Conclusion

This study indicated that higher VAI is independently related to ED risk and that early intervention is necessary to reduce the progression of ED with high VAI levels.

Correlation between visceral fat metabolism score and erectile dysfunction: a cross-sectional study from NHANES 2001-2004

Backgrounds

The factors associated with erectile dysfunction (ED) are diverse, and obesity is a significant component. Metabolic Score for Visceral Fat (METS-VF) can assess obesity more accurately than body mass index (BMI). However, the association between METS-VF and ED remains unclear.

Objective

This study aimed to investigate the association between the METS-VF and ED using National Health and Nutrition Examination Survey (NHANES) 2001-2004 data.

Methods

Data were sourced from NHANES 2001-2004. The relationship between METS-VF and ED was analyzed using multivariate logistic regression, followed by subgroup analyses to identify sensitive populations. Nonlinear correlation was evaluated through smoothed curve fitting, and a threshold effect analysis validated the findings. Comparative logistic regression of the Receiver Operating Characteristic (ROC) curve assessed the diagnostic capability of METS-VF against the classical obesity index for ED.

Results

The study enrolled 3625 participants, of whom 961 self-reported ED history and 360 reported severe ED. After adjusting for confounders, METS-VF exhibited a positive association with asthma prevalence (OR= 3.47, 95% CI: 2.83, 14.24). Stratification based on median METS-VF revealed higher ED prevalence in participants with elevated METS-VF (OR= 2.81,95% CI:2.32, 3.41). Nonlinear correlation was observed, with a significant association between METS-VF and ED when METS-VF exceeded 6.63. Subgroup analysis highlighted a stronger correlation in participants aged 50-85 years, Caucasians, hypertensive individuals, diabetics, and those with coronary heart disease. Sensitivity analysis using severe ED as the outcome reaffirmed the nonlinear positive association with METS-VF (OR=3.86, 95% CI:2.80,5.33), particularly when METS-VF surpassed 6.68.

Conclusion

Elevated METS-VF was nonlinearly correlated with increased ED incidence. Individuals with METS-VF above 6.63 should be vigilant about heightened ED risk. Special attention should be given to participants aged 50-85 years, Caucasians, hypertensive individuals, diabetics, and those with coronary heart disease.

Changes in frequency of urology clinic visits and diagnosis of erectile dysfunction in Germany before and during COVID-19

OBJECTIVES

To explore and analyze [1] the differences in the total number of patients visiting urology practices in Germany, [2] explore and analyze any differences in the number of newly diagnosed erectile dysfunction (ED) patients as well as [3] the number of new drug prescription, before and during the COVID-19 pandemic in Germany (April 2019-March 2020 and April 2020-March 2021).

METHODS

This retrospective cross-sectional study used data from the Disease Analyzer database (IQVIA) and included all patients aged ≥18 years with at least one visit to one of 85 urology practices across Germany. Outcomes were the mean number of patients with [1] new diagnosis of ED and [2] new prescription of drugs for erectile dysfunction per practice, in pandemic (April 2020-March 2021) versus non-pandemic (April 2019-March 2020) time periods. Differences between the periods were assessed using Wilcoxon tests.

RESULTS

In the non-pandemic period, there were 195,895 men, and in the pandemic period, 192,659 men visiting urology practices in Germany. A total of 10,977 men were initially diagnosed with ED in non-pandemic and 12,213 (+11.26%) men in pandemic time periods. Although the differences of new ED diagnoses were not statistically significant, a non-significant increase of new ED diagnoses was observed across all age groups. Also, a non-significant increase in new ED prescription drugs was detected across all age groups.

CONCLUSIONS

Even though less urology practice-visits of men with ED were recorded during the COVID-19 pandemic, an increase of new ED diagnosis was observed across all age groups between April 2020 and March 2021.

[Influence factors of erectile dysfunction in patients with localized prostate cancer after radical surgery]

OBJECTIVE

To analyze the influential factors of erectile dysfunction (ED) in patients with localized prostate cancer (LPC) after radical surgery.

METHODS

The clinical data of 150 male patients diagnosed with LPC and normal erectile function (EF) before surgery admitted to the Department of Urology of the Eastern Theatre General Hospital from January 2021 to January 2023 were retrospectively analyzed. The EF status of the patients 6 months after surgery was assessed using the International Erectile Function Index -5(IIEF-5). Age, Gleason score, PSA level, TNM stage, preoperative International prostatic symptom score (IPSS), preoperative prostate volume, smoking index, alcohol consumption index, educational level, comorbidities, operation mode, and psychosexual state were used as influencing factors to analyze their effects on postoperative ED.

RESULTS

Of the 150 patients, 88 had ED and 62 had normal EF. Univariate analysis showed that age, preoperative IPSS, preoperative prostate volume, comorbidities and sexual and psychological status were significantly correlated with postoperative ED. Further multivariate logistic regression analysis showed that age, preoperative prostate volume, comorbidities and sexual and psychological status were independent factors influencing the occurrence of ED after RP in LPC patients.

CONCLUSION

The recovery of sexual function of patients with localized prostate cancer after radical surgery is generally poor, and the incidence of ED is high. Its independent influencing factors include age, preoperative prostate volume, comorbidities and sexual psychological state, etc. Correct intervention of different influencing factors is required in clinical work. In order to provide a better diagnosis and treatment scheme for LPC patients undergoing radical treatment, reduce the incidence of postoperative ED and improve the quality of life of patients after surgery.

Heart Failure and Erectile Dysfunction: a Review of the Current Evidence and Clinical Implications

PURPOSE OF REVIEW

Heart failure (HF) and erectile dysfunction (ED) are two common conditions that affect millions of men worldwide and impair their quality of life. ED is a frequent complication of HF, as well as a possible predictor of cardiovascular events and mortality. ED deserves more attention from clinicians and researchers.

RECENT FINDINGS

The pathophysiology of ED in HF involves multiple factors, such as endothelial dysfunction, reduced cardiac output, neurohormonal activation, autonomic imbalance, oxidative stress, inflammation, and drug side effects. The diagnosis of ED in HF patients should be based on validated questionnaires or objective tests, as part of the routine cardiovascular risk assessment. The therapeutic management of ED in HF patients should be individualized and multidisciplinary, considering the patient's preferences, expectations, comorbidities, and potential drug interactions. The first-line pharmacological treatment for ED in HF patients with mild to moderate symptoms (NYHA class I-II) is phosphodiesterase type 5 inhibitors (PDE5Is), which improve both sexual function and cardiopulmonary parameters. PDE5Is are contraindicated in patients who use nitrates or nitric oxide donors for angina relief, and these patients should be advised to avoid sexual activity or to use alternative treatments for ED. Non-pharmacological treatments for ED, such as psychotherapy or couples therapy, should also be considered if there are significant psychosocial factors affecting the patient's sexual function or relationship. This review aims to summarize the most recent evidence regarding the prevalence of ED, the pathophysiology of this condition with an exhaustive analysis of factors involved in ED development in HF patients, a thorough discussion on diagnosis and management of ED in HF patients, providing practical recommendations for clinicians.

Higher systemic immune-inflammation index is associated with increased risk of erectile dysfunction: Result from NHANES 2001-2004

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) to investigate the association between the systemic immune-inflammation index (SII) and erectile dysfunction (ED) in adult males. The SII is a novel index derived from the counts of neutrophils, lymphocytes, and platelets in the peripheral blood and serves as a comprehensive indicator of the immune response and inflammation levels. The study included 3601 participants from the NHANES 2001-2004 cycle. Covariates such as age, race, marital status, education, smoking, alcohol consumption, BMI, hypertension, and diabetes were taken into account. Weighted analysis and logistic regression models were applied to assess the relationship between SII and ED, adjusting for potential confounding factors. The prevalence of ED was found to be 6.28%. Overall, there is a linear correlation between SII (nonlinear P > .05) and ED. After adjusting for various confounding factors, a significant association was observed between high levels of the SII and ED. The odds ratio (OR) for ED in individuals with high SII levels was 1.45 (95% CI: 1.01-2.17, P = .045). Subgroup analysis further identified specific participant subgroups with a significant association between SII and ED. Our findings suggest that higher levels of the SII are independently associated with an increased risk of ED in adult males. The SII may serve as a valuable biomarker for identifying individuals at higher risk of ED and may aid in the development of tailored treatment approaches. Further research is needed to explore the underlying mechanisms and potential therapeutic implications.