Erectile dysfunction(ED)is prevalent among men,but its relationship with dietary habits is uncertain.The aim of our study was to assess whether dietary patterns enhance erectile function by reviewing the literature pu...Erectile dysfunction(ED)is prevalent among men,but its relationship with dietary habits is uncertain.The aim of our study was to assess whether dietary patterns enhance erectile function by reviewing the literature published before August 1,2022,via PubMed,Web of Science,and EMBASE databases.The data compiled included author details;publication dates,countries,treatments,patient numbers,ages,follow-ups,and clinical trial outcomes,such as ED cases,odds ratios(ORs),confidence intervals(CIs),and International Index of Erectile Function-5(IIEF-5)scores with means and standard deviations.An analysis of 14 studies with 27389 participants revealed that plant-based diets(OR=0.71,95%CI:0.66-0.75;P<0.00001),low-fat diets(OR=0.27,95%CI:0.13-0.53;P=0.0002),and alternative diets such as intermittent fasting and organic diets(OR=0.54,95%CI:0.36-0.80;P=0.002)significantly reduced ED risk.High-protein low-fat diets(hazard ratio[HR]=1.38,95%CI:1.12-1.64;P<0.00001)and high-carb low-fat diets(HR=0.79,95%CI:0.55-1.04;P<0.00001)improved IIEF-5 scores.Combined diet and exercise interventions decreased the likelihood of ED(OR=0.49,95%CI:0.28-0.85;P=0.01)and increased the IIEF-5 score(OR=3.40,95%CI:1.69-5.11;P<0.0001).Diets abundant in fruits and vegetables(OR=0.97,95%CI:0.96-0.98;P<0.00001)and nuts(OR=0.54,95%CI:0.37-0.80;P=0.002)were also correlated with lower ED risk.Our meta-analysis underscores a strong dietary-ED association,suggesting that low-fat/Mediterranean diets rich in produce and nuts could benefit ED management.展开更多
In most types of erectile dysfunction,particularly in advanced stages,typical pathological features observed are reduced parenchymal cells coupled with increased tissue fibrosis.However,the current treatment methods h...In most types of erectile dysfunction,particularly in advanced stages,typical pathological features observed are reduced parenchymal cells coupled with increased tissue fibrosis.However,the current treatment methods have shown limited success in reversing these pathologic changes.Recent research has revealed that changes in autophagy levels,along with alterations in apoptosis and fibrosis-related proteins,are linked to the progression of erectile dysfunction,suggesting a significant association.Autophagy,known to significantly affect cell fate and tissue fibrosis,is currently being explored as a potential treatment modality for erectile dysfunction.However,these present studies are still in their nascent stage,and there are limited experimental data available.This review analyzes erectile dysfunction from a pathological perspective.It provides an in-depth overview of how autophagy is involved in the apoptotic processes of smooth muscle and endothelial cells and its role in the fibrotic processes occurring in the cavernosum.This study aimed to develop a theoretical framework for the potential effectiveness of autophagy in preventing and treating erectile dysfunction,thus encouraging further investigation among researchers in this area.展开更多
The relationship between hyperuricemia(HUA)and erectile dysfunction(ED)remains inadequately understood.Given that HUA is often associated with various metabolic disorders,this study aims to explore the multivariate li...The relationship between hyperuricemia(HUA)and erectile dysfunction(ED)remains inadequately understood.Given that HUA is often associated with various metabolic disorders,this study aims to explore the multivariate linear impacts of metabolic parameters on erectile function in ED patients with HUA.A cross-sectional analysis was conducted involving 514 ED patients with HUA in the Department of Andrology,Jiangsu Province Hospital of Chinese Medicine(Nanjing,China),aged 18 to 60 years.General demographic information,medical history,and laboratory results were collected to assess metabolic disturbances.Sexual function was evaluated using the 5-item version of the International Index of Erectile Function(IIEF-5)questionnaire.Based on univariate analysis,variables associated with IIEF-5 scores were identified,and the correlations between them were evaluated.The effects of these variables on IIEF-5 scores were further explored by multiple linear regression models.Fasting plasma glucose(β=−0.628,P<0.001),uric acid(β=−0.552,P<0.001),triglycerides(β=−0.088,P=0.047),low-density lipoprotein cholesterol(β=−0.164,P=0.027),glycated hemoglobin(HbA1c;β=−0.562,P=0.012),and smoking history(β=−0.074,P=0.037)exhibited significant negative impacts on erectile function.The coefficient of determination(R²)for the model was 0.239,and the adjusted R²was 0.230,indicating overall statistical significance(F-statistic=26.52,P<0.001).Metabolic parameters play a crucial role in the development of ED.Maintaining normal metabolic indices may aid in the prevention and improvement of erectile function in ED patients with HUA.展开更多
Low-intensity pulsed ultrasound(LIPUS)is a non-invasive sonodynamic therapy that has been approved by the U.S.Food and Drug Administration for clinical use.Clinical trials have demonstrated that LIPUS ameliorates mild...Low-intensity pulsed ultrasound(LIPUS)is a non-invasive sonodynamic therapy that has been approved by the U.S.Food and Drug Administration for clinical use.Clinical trials have demonstrated that LIPUS ameliorates mild-to-moderate erectile dysfunction without adverse events.Histological analysis of the corpus cavernosum suggests that the therapeutic benefits of LIPUS may be attributed to alleviation of fibrosis,enhanced neovascularization,and promotion of innervation.Further investigations have revealed that LIPUS facilitates cavernous tissue repair through non-thermal mechanisms,including a cavitation effect,acoustic streaming,mass transfer enhancement,and direct mechanical stimulation.Mechanobiological transduction triggers molecular signaling cascades within endogenous cavernous cells,thereby stimulating cell proliferation,angiogenesis,extracellular matrix remodeling,and stem cell differentiation.Although LIPUS has the potential to induce cavernous rehabilitation in the treatment of erectile dysfunction,further investigations are necessary to elucidate the mechanisms via which LIPUS regulates each type of cavernous cell to determine the optimal parameters for this innovative therapy.展开更多
Background: Erectile dysfunction (ED) is a common, bothersome and relatively under diagnosed complication of diabetes mellitus. This study was aimed to determine the prevalence of erectile dysfunction and its determin...Background: Erectile dysfunction (ED) is a common, bothersome and relatively under diagnosed complication of diabetes mellitus. This study was aimed to determine the prevalence of erectile dysfunction and its determinants. Methods: A cross-sectional hospital-based study was carried out in the Diabetology Units of the Buea and Limbe Regional Hospitals involving 332 male patients with diabetes and aged over 21 years. Data was analyzed using Stata and R version 3.5.3. Results: The mean age of the participants was 55years. Most participants (64.46%) were married. About half (50.60%) of the participants actively consumed alcohol, 11.45% were smokers and 57.83% were sedentary. 18 participants (5.42%) recorded high risk sexual behaviour. 54.32% of participants had a comorbidity and 43.90% were overweight. The prevalence of diabetic ED was 78.92%. Age, Fasting Blood Sugar and Glycated hemoglobin were found to be positive determinants of diabetic ED (odds ratio (OR) = 0.77, 95% CI −0.1 - 0.07). Conclusion: The prevalence of diabetic ED in this hospital population study is high, and both physician and patient—initiated measures are needed to reduce this prevalence and improve awareness, recognition and care of this condition.展开更多
Prostate cancer is the second most common malignancy and the sixth leading cause of cancer-related death in men worldwide.Radical prostatectomy(RP)is the standard treatment for localized prostate cancer,but the proced...Prostate cancer is the second most common malignancy and the sixth leading cause of cancer-related death in men worldwide.Radical prostatectomy(RP)is the standard treatment for localized prostate cancer,but the procedure often results in postoperative erectile dysfunction(ED).The poor efficacy of phosphodiesterase 5 inhibitors after surgery highlights the need to develop new therapies to enhance cavernous nerve regeneration and improve the erectile function of these patients.In the present study,we aimed to examine the potential of heparin-binding epidermal growth factor-like growth factor(HB-EGF)in preserving erectile function in cavernous nerve injury(CNI)mice.We found that HB-EGF expression was reduced significantly on the 1st day after CNI in penile tissue.Ex vivo and in vitro studies showed that HB-EGF promotes major pelvic ganglion neurite sprouting and neuro-2a(N2a)cell migration.In vivo studies showed that exogenous HB-EGF treatment significantly restored the erectile function of CNI mice to 86.9%of sham levels.Immunofluorescence staining showed that mural and neuronal cells were preserved by inducing cell proliferation and reducing apoptosis and reactive oxygen species production.Western blot analysis showed that HB-EGF upregulated protein kinase B and extracellular signal-regulated kinase activation and neurotrophic factor expression.Overall,HB-EGF is a major promising therapeutic agent for treating ED in postoperative RP.展开更多
Recent studies have revealed a significant relationship between erectile dysfunction(ED)and lower urinary tract symptoms(LUTS),both of which commonly affect middle-aged and older men.These conditions share underlying ...Recent studies have revealed a significant relationship between erectile dysfunction(ED)and lower urinary tract symptoms(LUTS),both of which commonly affect middle-aged and older men.These conditions share underlying causes,particularly endothelial dysfunction,atherosclerosis,and chronic pelvic ischemia(CPI).This study investigated the therapeutic potential of LDD175,a large-conductance Ca2+-activated K+channel(BKCa channel)opener,in simultaneously treating both conditions using a CPI animal model of male Sprague Dawley rats.Our study investigated the induction of CPI through surgical endothelial damage combined with a high-cholesterol diet.We assessed erectile and voiding functions by measuring intracavernosal pressure(ICP)and intraurethral pressure(IUP),respectively,after nerve stimulation.We performed histological examinations of vascular changes and western blot analyses of cavernous and prostate tissues to understand the underlying mechanisms.This study evaluated the effectiveness of LDD175 compared to standard treatments,such as sildenafil for ED and tamsulosin for LUTS.Therefore,the CPI model successfully demonstrated ED and LUTS symptoms with decreased ICP and increased IUP.Analysis revealed elevated levels of hypoxia-inducible factor-1α,transforming growth factor-β1 andβ2 in cavernous tissue,and increasedα1A-adrenoceptor expression in prostate tissue.LDD175 administration showed promising results,with dose-dependent improvements in ICP and IUP,and therapeutic effects comparable to those of established treatments.Our findings suggest a novel therapeutic approach that can simultaneously address ED and LUTS,opening new possibilities for clinical application in the treatment of these interconnected conditions.展开更多
Penile fracture is a rare urological emergency that may cause erectile dysfunction(ED).We analyzed the factors affecting erectile function in patients who underwent surgical repair for the management of penile fractur...Penile fracture is a rare urological emergency that may cause erectile dysfunction(ED).We analyzed the factors affecting erectile function in patients who underwent surgical repair for the management of penile fractures.Eighty-two patients who underwent penile fracture surgery in the Department of Urology,University of Gaziantep(Gaziantep,Türkiye)between January 2012 and January 2023 were evaluated.Age,body mass index,time elapsed from the incident of penile fracture to surgery,size,laterality,level of the defect,causes of fracture,presenting signs and symptoms,and relevant complications were recorded.Erectile function of the patients was evaluated preoperatively and at postoperative 3rd and 6th months according to the International Index of Erectile Function-5(IIEF-5)scoring system.The factors decreasing the erection quality of the patients after surgical repair of penile fractures were investigated using IIEF-5 scoring system.Only age,defect size,and time elapsed from fracture onset to surgery were found to be effective on the occurrence of ED(P=0.005,P<0.001,and P<0.001,respectively).In the receiver operating characteristic(ROC)analysis,the cut-off values were 12.5 mm for defect size(P<0.001),8.5 h for the time elapsed from fracture onset to surgery(P=0.036),and 40.5 years for the age of the patients(P=0.005).Delayed surgery,defect size,and advanced age had significant and negative effects on erectile function in cases of penile fracture.Before repair of the defect,patients should be given appropriate counseling about the possibility of ED,and early penile rehabilitation should be initiated.展开更多
Objective:Prostate cancer is a common malignancy in men over 50 years old,and radical prostatectomy,particularly via laparoscopic and robotic-assisted techniques,significantly impacts quality of life,especially in ter...Objective:Prostate cancer is a common malignancy in men over 50 years old,and radical prostatectomy,particularly via laparoscopic and robotic-assisted techniques,significantly impacts quality of life,especially in terms of erectile dysfunction.This systematic review and meta-analysis aimed to evaluate the preservation of erectile function following robotic-assisted and laparoscopic radical prostatectomy,with a separate analysis of randomized clinical trials and non-randomized studies.Methods:This review was carried out using randomized and non-randomized studies involving adult patients diagnosed with localized prostate cancer undergoing radical prostatectomy,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in PROSPERO.Applicable literature from PubMed,Cochrane,Embase,and the Latin American and Caribbean Health Sciences Literature database was analysed.The bias in randomized clinical trials was assessed using the Cochrane Risk of Bias 2.0 tool,and observational studies were evaluated via the Newcastle-Ottawa Scale.The statistical analysis was performed using Review Manager version 5.4.Results:Our analysis included 13 studies involving 6281 patients.Comparative meta-analysis of non-randomized studies demonstrated that robotic techniques were significantly more effective in preserving erectile function at 3 months(risk difference[RD]0.05,95%confidence interval[CI]0.00-0.11;p=0.040),6 months(RD 0.10,95%CI 0.03-0.17;p=0.006),and 12 months postoperatively(RD 0.06,95%CI 0.02-0.10;p=0.002).Conclusion:Robotic-assisted surgery showed greater preservation of erectile function 3 months,6 months,and 12 months after radical prostatectomy.However,additional studies with meticulous methodological criteria are necessary for future analysis.展开更多
Stem cell treatment may enhance erectile dysfunction(ED)in individuals with cavernous nerve injury(CNI).Nevertheless,no investigations have directly ascertained the implications of varying amounts of human umbilical c...Stem cell treatment may enhance erectile dysfunction(ED)in individuals with cavernous nerve injury(CNI).Nevertheless,no investigations have directly ascertained the implications of varying amounts of human umbilical cord-derived mesenchymal stem cells(HUC-MSCs)on ED.We compare the efficacy of three various doses of HUC-MSCs as a therapeutic strategy for ED.Sprague–Dawley rats(total=175)were randomly allocated into five groups.A total of 35 rats underwent sham surgery and 140 rats endured bilateral CNI and were treated with vehicles or doses of HUC-MSCs(1×106 cells,5×106 cells,and 1×107 cells in 0.1 ml,respectively).Penile tissues were harvested for histological analysis on 1 day,3 days,7 days,14 days,28 days,60 days,and 90 days postsurgery.It was found that varying dosages of HUC-MSCs enhanced the erectile function of rats with bilateral CNI and ED.Moreover,there was no significant disparity in the effectiveness of various dosages of HUC-MSCs.However,the expression of endothelial markers(rat endothelial cell antigen-1[RECA-1]and endothelial nitric oxide synthase[eNOS]),smooth muscle markers(alpha smooth muscle actin[α-SMA]and desmin),and neural markers(neurofilament[RECA-1]and neurogenic nitric oxide synthase[nNOS])increased significantly with prolonged treatment time.Masson’s staining demonstrated an increased in the smooth muscle cell(SMC)/collagen ratio.Significant changes were detected in the microstructures of various types of cells.In vivo imaging system(IVIS)analysis showed that at the 1st day,the HUC-MSCs implanted moved to the site of damage.Additionally,the oxidative stress levels were dramatically reduced in the penises of rats administered with HUC-MSCs.展开更多
Background: Diabetes mellitus (DM) is one of the leading causes of Erectile Dysfunction (ED) in men of all ages. The unawareness, coupled with common myths surrounding ED, confound the attempts of patients to seek and...Background: Diabetes mellitus (DM) is one of the leading causes of Erectile Dysfunction (ED) in men of all ages. The unawareness, coupled with common myths surrounding ED, confound the attempts of patients to seek and receive treatment and the attempts of doctors to help them. Objective: The study was aimed to assess the quality of care sought and received by Diabetic patients with ED. Methods: A cross-sectional hospital-based study was carried out in the Diabetic Units of the Limbe and Buea Regional Hospitals involving 322 male diabetic patients and aged over 21 years. Data analysis was done using Stata and R version 3.5.3. Results: The mean age of the participants was 55 years with a prevalence of ED of 78.92%. Only 37.40% of participants with ED sought care for it. Main barriers to care-seeking were health ignorance, health misinformation and fear of stigma. Majority (85.71%) of those who sought care sought medical care. Respondents correctly informed about diabetic ED and those regularly screened by their physician were more likely to seek medical care over non-medical care (p = 0.0021, p = 0.0013). Those who sought medical care reported higher improvement in ED symptoms over those who sought non-medical or combined forms of care (p = 0.0183). Conclusion: Both physician and patient-initiated measures are needed to reduce the prevalence and improve awareness, recognition and medical care of this condition.展开更多
The premature ejaculation diagnostic tool （PEDT） is a brief diagnostic measure to assess premature ejaculation （PE）. However, there is insufficient evidence regarding its validity in the new evidence-based-defined...The premature ejaculation diagnostic tool （PEDT） is a brief diagnostic measure to assess premature ejaculation （PE）. However, there is insufficient evidence regarding its validity in the new evidence-based-defined PE. This study was performed to evaluate the validity of PEDT and its association with IIEF-15 in different types of evidence-based-defined PE. From June 2015 to January 2016, a total of 260 men complaining of PE and defined as lifelong PE （LPE）/acquired PE （APE） according to the evidence-based definition from Andrology Clinic of the First Affiliated Hospital of Anhui Medical University, along with 104 male healthy controls without PE from a medical examination center, were enrolled in this study. All individuals completed questionnaires including demographics, medical and sexual history, as well as PEDT and IIEF-15. After statistical analysis, it was found that men with PE reported higher PEDT scores （14.28 ± 3.05） and lower IIEF-15 （41.26 ± 8.20） than men without PE （PEDT： 5.32 ± 3.42, IIEF-15：52.66 ± 6.86, P 〈 0.001 for both）. It was suggested that a score of 〉9 indicated PE in both LPE and APE by sensitivity and specificity analyses （sensitivity： 0.875, 0.913; specificity： 0.865, 0.865, respectively）. In addition, IIEF-15 were higher in men with LPE （42.64 ± 8.11） than APE （39.43 ± 7.84, P 〈 0.001）. After adjusting for age, IIEF-15 was negatively related to PEDT in men with LPE （adjust r = -0.225, P 〈 0.001） and APE （adjust r = -0.378, P 〈 0.001）. In this study, we concluded that PEDT was valid in the diagnosis of evidenced-based-defined PE. Furthermore, IIEF-15 was negatively related to PEDT in men with different types of PE.展开更多
The introduction of oral phosphodiesterase-5 inhibitors （PDE51s） in the late 1990s and early 2000s revolutionized the field of sexual medicine and PDE51s are currently first-line monotherapy for erectile dysfunction...The introduction of oral phosphodiesterase-5 inhibitors （PDE51s） in the late 1990s and early 2000s revolutionized the field of sexual medicine and PDE51s are currently first-line monotherapy for erectile dysfunction （ED）. However, a significant proportion of patients with complex ED will be therapeutic non-responders to PDE51 monotherapy. Combination therapy has recently been adopted for more refractory cases of ED, but a critical evaluation of current combination therapies is lacking. A thorough PubMed and Cochrane Library search was conducted focusing on the effectiveness of combination therapies for ED in therapeutic non-responders to PDE51 therapy. Journal articles spanning the time period between January 1990 and December 2010 were reviewed. Criteria included all pertinent review articles, randomized controlled trials, cohort studies and retrospective analyses. References from retrieved articles were also manually scanned for additional relevant publications. Published combination therapies include PDE51 plus vacuum erectile device （VED）, intraurethral medication, intracavernosal injection （ICI）, androgen supplement, a-blocker or miscellaneous combinations. Based on this review, some of these combination treatments appeared to be quite effective in preliminary testing. Caution must be advised, however, as the majority of combination therapy articles in the last decade have numerous limitations including study biases and small subject size. Regardless of limitations, present combination therapy research provides a solid foundation for future studies in complex ED management.展开更多
Erectile dysfunction(ED)has been identified as one of the most frequent chronic complications of diabetes mellitus(DM).The prevalence of ED is estimated to be about 67.4%in all DM cases worldwide.The pathophysiologica...Erectile dysfunction(ED)has been identified as one of the most frequent chronic complications of diabetes mellitus(DM).The prevalence of ED is estimated to be about 67.4%in all DM cases worldwide.The pathophysiological process leading to ED involves endothelial,neurological,hormonal,and psychological factors.In DM,endothelial and neurological factors play a crucial role.Damages in the blood vessels and erectile tissue due to insulin resistance are the hallmark of ED in DM.The current treatments for ED include phosphodiesterase-5 inhibitors and penile prosthesis surgery.However,these treatments are limited in terms of just relieving the symptoms,but not resolving the cause of the problem.The use of stem cells for treating ED is currently being studied mostly in experimental animals.The stem cells used are derived from adipose tissue,bone,or human urine.Most of the studies observed an improvement in erectile quality in the experimental animals as well as an improvement in erectile tissue.However,research on stem cell therapy for ED in humans remains to be limited.Nevertheless,significant findings from studies using animal models indicate a potential use of stem cells in the treatment of ED.展开更多
We analyzed the efficacy of penile low-intensity extracorporeal shockwave treatment for erectile dysfunction(ED)combined with cavernous artery disease(CAD).ED was evaluated by the International Index of Erectile Funct...We analyzed the efficacy of penile low-intensity extracorporeal shockwave treatment for erectile dysfunction(ED)combined with cavernous artery disease(CAD).ED was evaluated by the International Index of Erectile Function,subdividing patients into mild and moderate/severe forms.CAD was assessed using penile color Doppler ultrasonography.Patients(n=111)with a positive outcome after treatment,based upon the minimal clinically important difference of the International Index of ED,were followed up for 3 months and 6 months.We found a significant mean increase in the index of erectile function,with an overall improvement in hemodynamic parameters of the cavernous artery.In particular,93.9%of the patients with mild ED without CAD responded to treatment and 72.7%resumed normal erectile function.Only 31.2%of the patients with moderate/severe ED and CAD responded to treatment,and none resumed normal erectile function.All patients with mild ED and no CAD maintained the effects of therapy after 3 months,while no patients with moderate/severe ED and CAD maintained the benefits of treatment after 3 months.Thus,patients with mild ED and no CAD have better and longer lasting responses to such treatment,with a higher probability of resuming normal erectile function than patients with moderate/severe ED and CAD.展开更多
Cavernous nerve injury is an important cause of erectile dysfunction(ED).Although protective nerve technology has been widely used in nerve-sparing radical prostatectomy(nsRP),the incidence of ED is still very high af...Cavernous nerve injury is an important cause of erectile dysfunction(ED).Although protective nerve technology has been widely used in nerve-sparing radical prostatectomy(nsRP),the incidence of ED is still very high after surgery.The purpose of our study was to evaluate erectile function(EF)and penile length in the non-erectile state(PLNES)following scheduled phosphodiesterase 5 inhibitor(PDE5i),vacuum erectile device(VED)treatment,and combination therapy after nsRP.One hundred patients with localized prostate cancer and normal EF were randomized to scheduled PDE5i group,VED treatment group,a combined treatment group,and the control group without any intervention.The International Index of Erectile Function-5(IIEF-5)scores and PLNES were evaluated after 6 months and 12 months of treatment.Sexual Encounter Profile(SEP-Question 2 and SEP-Question 3)were evaluated after 12 months of treatment.Ninety-one of the 100 randomized patients completed the study.We found that the 5 mg tadalafil once a day(OaD)combined with VED can help improve IIEF-5 scores in nsRP patients after both 6 months and 12 months.VED alone or combined with tadalafil OaD can help patients maintain PLNES.VED combined with tadalafil OaD can improve the rate of successful penetration(SEP-Question 2)after 12 months.There were no significant differences in the return to target EF after 12 months among the groups.No significant correlation was noted between the variables and return to target EF(IIEF≥17),and between the variables and effective shortening of the patient’s penis(shortening≥1 cm)after 12 months of intervention.展开更多
We compared the efficacy and safety between once-daily dosing and on-demand use of udenafil for type 2 diabetic patients with erectile dysfunction （ED）. A multi-center, randomized, open-label, parallel-group, 12-wee...We compared the efficacy and safety between once-daily dosing and on-demand use of udenafil for type 2 diabetic patients with erectile dysfunction （ED）. A multi-center, randomized, open-label, parallel-group, 12-week study was conducted. 161 patients who improved with on-demand 200 mg of udenafil according to Sexual Encounter Profile （SEP） diary Question 2 and 3 （Q2 and Q3） were randomized into 200 mg on-demand （n = 80） or 50 mg once-daily （n = 81） dosing groups for 8 weeks. The dosing period was followed by a 4-week treatment-free period. The primary efficacy endpoint was the change of the International Index of Erectile Function （IIEF） erectile function domain （EFD） score. The secondary efficacy endpoints included changes to the SEP diary Q2, Q3, IIEF Q3, Q4, other domains of IIEF, Global Assessment Question, and shift to the normal rate （EFD 〉 26）. Vascular endothelial markers were also assessed. The IIEF-EFD score of both groups improved after 8 weeks of treatment （P 〈 0.0001）. There was no statistically significant difference between two groups. Improvement was not maintained after the treatment-free follow-up period. Similar results were observed in the secondary efficacy endpoints. There was also no significant difference in vascular endothelial markers. Daily udenafil was well-tolerated, and there was no significant difference in the adverse drug reactions and adverse events between the two groups. Flushing and headache were the most frequent adverse events. Both regimens improved ED in diabetic patients and were well-tolerated. Further studies are needed to assess the effect of daily udenafil treatment in diabetic patients.展开更多
Erectile dysfunction(ED),a condition closely related to cardiovascular morbidity and mortality,is frequently associated with obesity.In this study,we aimed to determine the prevalence of ED and evaluate the associated...Erectile dysfunction(ED),a condition closely related to cardiovascular morbidity and mortality,is frequently associated with obesity.In this study,we aimed to determine the prevalence of ED and evaluate the associated risk factors in a cohort of 254 young(18–49 years)nondiabetic obese(body mass index[BMI]≥30 kg m−2)men from primary care.Erectile function(International Index of Erectile Function[IIEF-5]questionnaire),quality of life(Aging Males'Symptoms[AMS scale]),and body composition analysis(Tanita MC-180MA)were determined.Total testosterone was determined using high-performance liquid chromatography–mass spectrometry.Multivariate logistic regression analysis was used to study the factors associated with ED.ED prevalence was 42.1%.Subjects with ED presented higher BMI,waist circumference,number of components of the metabolic syndrome,AMS score,insulin resistance,and a more unfavorable body composition than those without ED.Multivariate logistic regression analysis showed that a pathological AMS score(odds ratio[OR]:4.238,P<0.001),degree of obesity(BMI≥40 kg m−2,OR:2.602,P=0.005,compared with BMI 30–34.9 kg m−2),high-density lipoprotein(HDL)-cholesterol levels(OR:0.956,P=0.004),and age(OR:1.047,P=0.016)were factors independently associated with ED.In conclusion,we demonstrate that,in a primary care-based cohort of nondiabetic young obese men,ED affected>40%of subjects.A pathological AMS score,the degree of obesity,and age were positively associated with ED,while elevated HDL-cholesterol levels were inversely associated with the odds of presenting ED.Further prospective studies are needed to evaluate the long-term consequences of ED in this population.展开更多
Previous published studies have shown an improvement of penile hemodynamic parameters after low-intensity extracorporeal shockwave therapy(Li-ESWT).However,the clinical significance of these findings remains unclear,a...Previous published studies have shown an improvement of penile hemodynamic parameters after low-intensity extracorporeal shockwave therapy(Li-ESWT).However,the clinical significance of these findings remains unclear,and definitive selection criteria for Li-ESWT based on preexisting comorbidities have yet to be established.This was an observational study of 113 patients with ED,evaluated between January 2019 and December 2021 in Andrology Unit at the Department of Urology and Renal Transplantation,University of Foggia(Foggia,Italy).Penile dynamic Doppler was performed to evaluate vascular parameters and 5-item version of the International Index of Erectile Dysfunction(IIEF-5)questionnaire was administered to assess the severity of ED.This was repeated 1 month after treatment.Patients with a peak systolic velocity(PSV)<30 cm s−1 were considered eligible for Li-ESWT.Our protocol consisted of 8 weekly sessions with 1500 strokes distributed in 5 different locations along the penis.After treatment,a significant mean(±standard deviation[s.d.])PSV increase of 5.0(±3.4)cm s−1 was recorded and 52/113(46.0%)patients reached a PSV>30 cm s−1 at posttherapeutic penile dynamic Doppler.A clinically significant IIEF-5 score improvement was observed in 7 patients,21 patients,and 2 patients with mild-to-moderate,moderate,and severe pretreatment ED,respectively.No different outcomes were assessed based on smoking habits,previous pelvic surgery,or use of oral phosphodiesterase-5 inhibitor(PDE5i).On the other side,only 1(6.7%)in 15 patients with diabetes mellitus showed an IIEF-5 score improvement after Li-ESWT.Shockwave treatment determined a significant increase in PSV and correlated IIEF-5 improvement in ED patients.This advantage seemed particularly evident for moderate ED and was not affected by smoking habits,previous pelvic surgery,and use of PDE5i.Conversely,diabetic patients did not benefit from the treatment.展开更多
Noninvasive low-intensity extracorporeal shockwave treatment(Li-ESWT)has been widely used to treat erection disorders.There is no clear information regarding either the selection of patients for the treatment or the t...Noninvasive low-intensity extracorporeal shockwave treatment(Li-ESWT)has been widely used to treat erection disorders.There is no clear information regarding either the selection of patients for the treatment or the treatment protocol.In this study,we aimed to investigate the efficacy of extracorporeal shockwave therapy in diabetic patients with severe erectile dysfunction(International Index of Erectile Function-5[IIEF-5]scores of 5 to 7).Sixty-three diabetes mellitus patients with erectile dysfunction having IIEF-5 scores of 5 to 7 and not showing a recovery of potency despite phosphodiesterase type 5 inhibitor therapy for the past 6 months were included in the study.The patients were evaluated based on their IIEF-5 scores and Erection Hardness Scale scores.The IIEF-5 score(mean±standard deviation[s.d.])increased from 5.29±1.67 to 5.56±1.85,with a difference of 0.27±0.18(P>0.05).The Erection Hardness Scale scores(mean±s.d.),on the other hand,increased from 1.46±0.50 to 1.48±0.50,with a difference of 0.02±0(P>0.05).In conclusion,the response to phosphodiesterase type 5 inhibitors did not change after extracorporeal shockwave treatment in diabetes mellitus patients with severe erectile dysfunction(IIEF-5 scores of 5 to 7).展开更多
基金supported by the grant from National Natural Science Foundation of China(grant No.81602236).
文摘Erectile dysfunction(ED)is prevalent among men,but its relationship with dietary habits is uncertain.The aim of our study was to assess whether dietary patterns enhance erectile function by reviewing the literature published before August 1,2022,via PubMed,Web of Science,and EMBASE databases.The data compiled included author details;publication dates,countries,treatments,patient numbers,ages,follow-ups,and clinical trial outcomes,such as ED cases,odds ratios(ORs),confidence intervals(CIs),and International Index of Erectile Function-5(IIEF-5)scores with means and standard deviations.An analysis of 14 studies with 27389 participants revealed that plant-based diets(OR=0.71,95%CI:0.66-0.75;P<0.00001),low-fat diets(OR=0.27,95%CI:0.13-0.53;P=0.0002),and alternative diets such as intermittent fasting and organic diets(OR=0.54,95%CI:0.36-0.80;P=0.002)significantly reduced ED risk.High-protein low-fat diets(hazard ratio[HR]=1.38,95%CI:1.12-1.64;P<0.00001)and high-carb low-fat diets(HR=0.79,95%CI:0.55-1.04;P<0.00001)improved IIEF-5 scores.Combined diet and exercise interventions decreased the likelihood of ED(OR=0.49,95%CI:0.28-0.85;P=0.01)and increased the IIEF-5 score(OR=3.40,95%CI:1.69-5.11;P<0.0001).Diets abundant in fruits and vegetables(OR=0.97,95%CI:0.96-0.98;P<0.00001)and nuts(OR=0.54,95%CI:0.37-0.80;P=0.002)were also correlated with lower ED risk.Our meta-analysis underscores a strong dietary-ED association,suggesting that low-fat/Mediterranean diets rich in produce and nuts could benefit ED management.
基金supported by the Health Commission Research Project of China(No.HDSL202001057)the Jiangxi Provincial Health Commission Research Project(No.SKJP20203656)the Doctoral Start-up Fund of the First Affiliated Hospital of Gannan Medical University(No.QD063).
文摘In most types of erectile dysfunction,particularly in advanced stages,typical pathological features observed are reduced parenchymal cells coupled with increased tissue fibrosis.However,the current treatment methods have shown limited success in reversing these pathologic changes.Recent research has revealed that changes in autophagy levels,along with alterations in apoptosis and fibrosis-related proteins,are linked to the progression of erectile dysfunction,suggesting a significant association.Autophagy,known to significantly affect cell fate and tissue fibrosis,is currently being explored as a potential treatment modality for erectile dysfunction.However,these present studies are still in their nascent stage,and there are limited experimental data available.This review analyzes erectile dysfunction from a pathological perspective.It provides an in-depth overview of how autophagy is involved in the apoptotic processes of smooth muscle and endothelial cells and its role in the fibrotic processes occurring in the cavernosum.This study aimed to develop a theoretical framework for the potential effectiveness of autophagy in preventing and treating erectile dysfunction,thus encouraging further investigation among researchers in this area.
基金supported by Jiangsu Provincial Science and Technology Plan Special Project(No.BK20231379)Key Project of Jiangsu Provincial Health Commission(No.ZDA2020025)+1 种基金Jiangsu Traditional Chinese Medicine Science and Technology Development Plan Project(No.MS2022023)Excellent Young Doctor Training Program of Jiangsu Province Hospital of Chinese Medicine(No.2023QB0126).
文摘The relationship between hyperuricemia(HUA)and erectile dysfunction(ED)remains inadequately understood.Given that HUA is often associated with various metabolic disorders,this study aims to explore the multivariate linear impacts of metabolic parameters on erectile function in ED patients with HUA.A cross-sectional analysis was conducted involving 514 ED patients with HUA in the Department of Andrology,Jiangsu Province Hospital of Chinese Medicine(Nanjing,China),aged 18 to 60 years.General demographic information,medical history,and laboratory results were collected to assess metabolic disturbances.Sexual function was evaluated using the 5-item version of the International Index of Erectile Function(IIEF-5)questionnaire.Based on univariate analysis,variables associated with IIEF-5 scores were identified,and the correlations between them were evaluated.The effects of these variables on IIEF-5 scores were further explored by multiple linear regression models.Fasting plasma glucose(β=−0.628,P<0.001),uric acid(β=−0.552,P<0.001),triglycerides(β=−0.088,P=0.047),low-density lipoprotein cholesterol(β=−0.164,P=0.027),glycated hemoglobin(HbA1c;β=−0.562,P=0.012),and smoking history(β=−0.074,P=0.037)exhibited significant negative impacts on erectile function.The coefficient of determination(R²)for the model was 0.239,and the adjusted R²was 0.230,indicating overall statistical significance(F-statistic=26.52,P<0.001).Metabolic parameters play a crucial role in the development of ED.Maintaining normal metabolic indices may aid in the prevention and improvement of erectile function in ED patients with HUA.
文摘Low-intensity pulsed ultrasound(LIPUS)is a non-invasive sonodynamic therapy that has been approved by the U.S.Food and Drug Administration for clinical use.Clinical trials have demonstrated that LIPUS ameliorates mild-to-moderate erectile dysfunction without adverse events.Histological analysis of the corpus cavernosum suggests that the therapeutic benefits of LIPUS may be attributed to alleviation of fibrosis,enhanced neovascularization,and promotion of innervation.Further investigations have revealed that LIPUS facilitates cavernous tissue repair through non-thermal mechanisms,including a cavitation effect,acoustic streaming,mass transfer enhancement,and direct mechanical stimulation.Mechanobiological transduction triggers molecular signaling cascades within endogenous cavernous cells,thereby stimulating cell proliferation,angiogenesis,extracellular matrix remodeling,and stem cell differentiation.Although LIPUS has the potential to induce cavernous rehabilitation in the treatment of erectile dysfunction,further investigations are necessary to elucidate the mechanisms via which LIPUS regulates each type of cavernous cell to determine the optimal parameters for this innovative therapy.
文摘Background: Erectile dysfunction (ED) is a common, bothersome and relatively under diagnosed complication of diabetes mellitus. This study was aimed to determine the prevalence of erectile dysfunction and its determinants. Methods: A cross-sectional hospital-based study was carried out in the Diabetology Units of the Buea and Limbe Regional Hospitals involving 332 male patients with diabetes and aged over 21 years. Data was analyzed using Stata and R version 3.5.3. Results: The mean age of the participants was 55years. Most participants (64.46%) were married. About half (50.60%) of the participants actively consumed alcohol, 11.45% were smokers and 57.83% were sedentary. 18 participants (5.42%) recorded high risk sexual behaviour. 54.32% of participants had a comorbidity and 43.90% were overweight. The prevalence of diabetic ED was 78.92%. Age, Fasting Blood Sugar and Glycated hemoglobin were found to be positive determinants of diabetic ED (odds ratio (OR) = 0.77, 95% CI −0.1 - 0.07). Conclusion: The prevalence of diabetic ED in this hospital population study is high, and both physician and patient—initiated measures are needed to reduce this prevalence and improve awareness, recognition and care of this condition.
文摘Prostate cancer is the second most common malignancy and the sixth leading cause of cancer-related death in men worldwide.Radical prostatectomy(RP)is the standard treatment for localized prostate cancer,but the procedure often results in postoperative erectile dysfunction(ED).The poor efficacy of phosphodiesterase 5 inhibitors after surgery highlights the need to develop new therapies to enhance cavernous nerve regeneration and improve the erectile function of these patients.In the present study,we aimed to examine the potential of heparin-binding epidermal growth factor-like growth factor(HB-EGF)in preserving erectile function in cavernous nerve injury(CNI)mice.We found that HB-EGF expression was reduced significantly on the 1st day after CNI in penile tissue.Ex vivo and in vitro studies showed that HB-EGF promotes major pelvic ganglion neurite sprouting and neuro-2a(N2a)cell migration.In vivo studies showed that exogenous HB-EGF treatment significantly restored the erectile function of CNI mice to 86.9%of sham levels.Immunofluorescence staining showed that mural and neuronal cells were preserved by inducing cell proliferation and reducing apoptosis and reactive oxygen species production.Western blot analysis showed that HB-EGF upregulated protein kinase B and extracellular signal-regulated kinase activation and neurotrophic factor expression.Overall,HB-EGF is a major promising therapeutic agent for treating ED in postoperative RP.
文摘Recent studies have revealed a significant relationship between erectile dysfunction(ED)and lower urinary tract symptoms(LUTS),both of which commonly affect middle-aged and older men.These conditions share underlying causes,particularly endothelial dysfunction,atherosclerosis,and chronic pelvic ischemia(CPI).This study investigated the therapeutic potential of LDD175,a large-conductance Ca2+-activated K+channel(BKCa channel)opener,in simultaneously treating both conditions using a CPI animal model of male Sprague Dawley rats.Our study investigated the induction of CPI through surgical endothelial damage combined with a high-cholesterol diet.We assessed erectile and voiding functions by measuring intracavernosal pressure(ICP)and intraurethral pressure(IUP),respectively,after nerve stimulation.We performed histological examinations of vascular changes and western blot analyses of cavernous and prostate tissues to understand the underlying mechanisms.This study evaluated the effectiveness of LDD175 compared to standard treatments,such as sildenafil for ED and tamsulosin for LUTS.Therefore,the CPI model successfully demonstrated ED and LUTS symptoms with decreased ICP and increased IUP.Analysis revealed elevated levels of hypoxia-inducible factor-1α,transforming growth factor-β1 andβ2 in cavernous tissue,and increasedα1A-adrenoceptor expression in prostate tissue.LDD175 administration showed promising results,with dose-dependent improvements in ICP and IUP,and therapeutic effects comparable to those of established treatments.Our findings suggest a novel therapeutic approach that can simultaneously address ED and LUTS,opening new possibilities for clinical application in the treatment of these interconnected conditions.
文摘Penile fracture is a rare urological emergency that may cause erectile dysfunction(ED).We analyzed the factors affecting erectile function in patients who underwent surgical repair for the management of penile fractures.Eighty-two patients who underwent penile fracture surgery in the Department of Urology,University of Gaziantep(Gaziantep,Türkiye)between January 2012 and January 2023 were evaluated.Age,body mass index,time elapsed from the incident of penile fracture to surgery,size,laterality,level of the defect,causes of fracture,presenting signs and symptoms,and relevant complications were recorded.Erectile function of the patients was evaluated preoperatively and at postoperative 3rd and 6th months according to the International Index of Erectile Function-5(IIEF-5)scoring system.The factors decreasing the erection quality of the patients after surgical repair of penile fractures were investigated using IIEF-5 scoring system.Only age,defect size,and time elapsed from fracture onset to surgery were found to be effective on the occurrence of ED(P=0.005,P<0.001,and P<0.001,respectively).In the receiver operating characteristic(ROC)analysis,the cut-off values were 12.5 mm for defect size(P<0.001),8.5 h for the time elapsed from fracture onset to surgery(P=0.036),and 40.5 years for the age of the patients(P=0.005).Delayed surgery,defect size,and advanced age had significant and negative effects on erectile function in cases of penile fracture.Before repair of the defect,patients should be given appropriate counseling about the possibility of ED,and early penile rehabilitation should be initiated.
文摘Objective:Prostate cancer is a common malignancy in men over 50 years old,and radical prostatectomy,particularly via laparoscopic and robotic-assisted techniques,significantly impacts quality of life,especially in terms of erectile dysfunction.This systematic review and meta-analysis aimed to evaluate the preservation of erectile function following robotic-assisted and laparoscopic radical prostatectomy,with a separate analysis of randomized clinical trials and non-randomized studies.Methods:This review was carried out using randomized and non-randomized studies involving adult patients diagnosed with localized prostate cancer undergoing radical prostatectomy,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in PROSPERO.Applicable literature from PubMed,Cochrane,Embase,and the Latin American and Caribbean Health Sciences Literature database was analysed.The bias in randomized clinical trials was assessed using the Cochrane Risk of Bias 2.0 tool,and observational studies were evaluated via the Newcastle-Ottawa Scale.The statistical analysis was performed using Review Manager version 5.4.Results:Our analysis included 13 studies involving 6281 patients.Comparative meta-analysis of non-randomized studies demonstrated that robotic techniques were significantly more effective in preserving erectile function at 3 months(risk difference[RD]0.05,95%confidence interval[CI]0.00-0.11;p=0.040),6 months(RD 0.10,95%CI 0.03-0.17;p=0.006),and 12 months postoperatively(RD 0.06,95%CI 0.02-0.10;p=0.002).Conclusion:Robotic-assisted surgery showed greater preservation of erectile function 3 months,6 months,and 12 months after radical prostatectomy.However,additional studies with meticulous methodological criteria are necessary for future analysis.
基金supported by the Xuzhou City 2022 Special Program for Promoting Science and Technology Innovation(grant No.KC22096)Shandong Provincial Hospital Research Incubation Fund(No.2022FY063).
文摘Stem cell treatment may enhance erectile dysfunction(ED)in individuals with cavernous nerve injury(CNI).Nevertheless,no investigations have directly ascertained the implications of varying amounts of human umbilical cord-derived mesenchymal stem cells(HUC-MSCs)on ED.We compare the efficacy of three various doses of HUC-MSCs as a therapeutic strategy for ED.Sprague–Dawley rats(total=175)were randomly allocated into five groups.A total of 35 rats underwent sham surgery and 140 rats endured bilateral CNI and were treated with vehicles or doses of HUC-MSCs(1×106 cells,5×106 cells,and 1×107 cells in 0.1 ml,respectively).Penile tissues were harvested for histological analysis on 1 day,3 days,7 days,14 days,28 days,60 days,and 90 days postsurgery.It was found that varying dosages of HUC-MSCs enhanced the erectile function of rats with bilateral CNI and ED.Moreover,there was no significant disparity in the effectiveness of various dosages of HUC-MSCs.However,the expression of endothelial markers(rat endothelial cell antigen-1[RECA-1]and endothelial nitric oxide synthase[eNOS]),smooth muscle markers(alpha smooth muscle actin[α-SMA]and desmin),and neural markers(neurofilament[RECA-1]and neurogenic nitric oxide synthase[nNOS])increased significantly with prolonged treatment time.Masson’s staining demonstrated an increased in the smooth muscle cell(SMC)/collagen ratio.Significant changes were detected in the microstructures of various types of cells.In vivo imaging system(IVIS)analysis showed that at the 1st day,the HUC-MSCs implanted moved to the site of damage.Additionally,the oxidative stress levels were dramatically reduced in the penises of rats administered with HUC-MSCs.
文摘Background: Diabetes mellitus (DM) is one of the leading causes of Erectile Dysfunction (ED) in men of all ages. The unawareness, coupled with common myths surrounding ED, confound the attempts of patients to seek and receive treatment and the attempts of doctors to help them. Objective: The study was aimed to assess the quality of care sought and received by Diabetic patients with ED. Methods: A cross-sectional hospital-based study was carried out in the Diabetic Units of the Limbe and Buea Regional Hospitals involving 322 male diabetic patients and aged over 21 years. Data analysis was done using Stata and R version 3.5.3. Results: The mean age of the participants was 55 years with a prevalence of ED of 78.92%. Only 37.40% of participants with ED sought care for it. Main barriers to care-seeking were health ignorance, health misinformation and fear of stigma. Majority (85.71%) of those who sought care sought medical care. Respondents correctly informed about diabetic ED and those regularly screened by their physician were more likely to seek medical care over non-medical care (p = 0.0021, p = 0.0013). Those who sought medical care reported higher improvement in ED symptoms over those who sought non-medical or combined forms of care (p = 0.0183). Conclusion: Both physician and patient-initiated measures are needed to reduce the prevalence and improve awareness, recognition and medical care of this condition.
文摘The premature ejaculation diagnostic tool （PEDT） is a brief diagnostic measure to assess premature ejaculation （PE）. However, there is insufficient evidence regarding its validity in the new evidence-based-defined PE. This study was performed to evaluate the validity of PEDT and its association with IIEF-15 in different types of evidence-based-defined PE. From June 2015 to January 2016, a total of 260 men complaining of PE and defined as lifelong PE （LPE）/acquired PE （APE） according to the evidence-based definition from Andrology Clinic of the First Affiliated Hospital of Anhui Medical University, along with 104 male healthy controls without PE from a medical examination center, were enrolled in this study. All individuals completed questionnaires including demographics, medical and sexual history, as well as PEDT and IIEF-15. After statistical analysis, it was found that men with PE reported higher PEDT scores （14.28 ± 3.05） and lower IIEF-15 （41.26 ± 8.20） than men without PE （PEDT： 5.32 ± 3.42, IIEF-15：52.66 ± 6.86, P 〈 0.001 for both）. It was suggested that a score of 〉9 indicated PE in both LPE and APE by sensitivity and specificity analyses （sensitivity： 0.875, 0.913; specificity： 0.865, 0.865, respectively）. In addition, IIEF-15 were higher in men with LPE （42.64 ± 8.11） than APE （39.43 ± 7.84, P 〈 0.001）. After adjusting for age, IIEF-15 was negatively related to PEDT in men with LPE （adjust r = -0.225, P 〈 0.001） and APE （adjust r = -0.378, P 〈 0.001）. In this study, we concluded that PEDT was valid in the diagnosis of evidenced-based-defined PE. Furthermore, IIEF-15 was negatively related to PEDT in men with different types of PE.
文摘The introduction of oral phosphodiesterase-5 inhibitors （PDE51s） in the late 1990s and early 2000s revolutionized the field of sexual medicine and PDE51s are currently first-line monotherapy for erectile dysfunction （ED）. However, a significant proportion of patients with complex ED will be therapeutic non-responders to PDE51 monotherapy. Combination therapy has recently been adopted for more refractory cases of ED, but a critical evaluation of current combination therapies is lacking. A thorough PubMed and Cochrane Library search was conducted focusing on the effectiveness of combination therapies for ED in therapeutic non-responders to PDE51 therapy. Journal articles spanning the time period between January 1990 and December 2010 were reviewed. Criteria included all pertinent review articles, randomized controlled trials, cohort studies and retrospective analyses. References from retrieved articles were also manually scanned for additional relevant publications. Published combination therapies include PDE51 plus vacuum erectile device （VED）, intraurethral medication, intracavernosal injection （ICI）, androgen supplement, a-blocker or miscellaneous combinations. Based on this review, some of these combination treatments appeared to be quite effective in preliminary testing. Caution must be advised, however, as the majority of combination therapy articles in the last decade have numerous limitations including study biases and small subject size. Regardless of limitations, present combination therapy research provides a solid foundation for future studies in complex ED management.
基金Supported by Mandate Research Grant from Universitas Airlangga,No.1408/UN3/2019.
文摘Erectile dysfunction(ED)has been identified as one of the most frequent chronic complications of diabetes mellitus(DM).The prevalence of ED is estimated to be about 67.4%in all DM cases worldwide.The pathophysiological process leading to ED involves endothelial,neurological,hormonal,and psychological factors.In DM,endothelial and neurological factors play a crucial role.Damages in the blood vessels and erectile tissue due to insulin resistance are the hallmark of ED in DM.The current treatments for ED include phosphodiesterase-5 inhibitors and penile prosthesis surgery.However,these treatments are limited in terms of just relieving the symptoms,but not resolving the cause of the problem.The use of stem cells for treating ED is currently being studied mostly in experimental animals.The stem cells used are derived from adipose tissue,bone,or human urine.Most of the studies observed an improvement in erectile quality in the experimental animals as well as an improvement in erectile tissue.However,research on stem cell therapy for ED in humans remains to be limited.Nevertheless,significant findings from studies using animal models indicate a potential use of stem cells in the treatment of ED.
文摘We analyzed the efficacy of penile low-intensity extracorporeal shockwave treatment for erectile dysfunction(ED)combined with cavernous artery disease(CAD).ED was evaluated by the International Index of Erectile Function,subdividing patients into mild and moderate/severe forms.CAD was assessed using penile color Doppler ultrasonography.Patients(n=111)with a positive outcome after treatment,based upon the minimal clinically important difference of the International Index of ED,were followed up for 3 months and 6 months.We found a significant mean increase in the index of erectile function,with an overall improvement in hemodynamic parameters of the cavernous artery.In particular,93.9%of the patients with mild ED without CAD responded to treatment and 72.7%resumed normal erectile function.Only 31.2%of the patients with moderate/severe ED and CAD responded to treatment,and none resumed normal erectile function.All patients with mild ED and no CAD maintained the effects of therapy after 3 months,while no patients with moderate/severe ED and CAD maintained the benefits of treatment after 3 months.Thus,patients with mild ED and no CAD have better and longer lasting responses to such treatment,with a higher probability of resuming normal erectile function than patients with moderate/severe ED and CAD.
基金supported by the National Natural Science Foundation of China(No.81971376 and No.81800591)the 3-year action plan to promote clinical skills and clinical innovation in municipal hospitals in Shanghai(No.16CR3067B)Shanghai Sailing Program(No.18YF1412800).
文摘Cavernous nerve injury is an important cause of erectile dysfunction(ED).Although protective nerve technology has been widely used in nerve-sparing radical prostatectomy(nsRP),the incidence of ED is still very high after surgery.The purpose of our study was to evaluate erectile function(EF)and penile length in the non-erectile state(PLNES)following scheduled phosphodiesterase 5 inhibitor(PDE5i),vacuum erectile device(VED)treatment,and combination therapy after nsRP.One hundred patients with localized prostate cancer and normal EF were randomized to scheduled PDE5i group,VED treatment group,a combined treatment group,and the control group without any intervention.The International Index of Erectile Function-5(IIEF-5)scores and PLNES were evaluated after 6 months and 12 months of treatment.Sexual Encounter Profile(SEP-Question 2 and SEP-Question 3)were evaluated after 12 months of treatment.Ninety-one of the 100 randomized patients completed the study.We found that the 5 mg tadalafil once a day(OaD)combined with VED can help improve IIEF-5 scores in nsRP patients after both 6 months and 12 months.VED alone or combined with tadalafil OaD can help patients maintain PLNES.VED combined with tadalafil OaD can improve the rate of successful penetration(SEP-Question 2)after 12 months.There were no significant differences in the return to target EF after 12 months among the groups.No significant correlation was noted between the variables and return to target EF(IIEF≥17),and between the variables and effective shortening of the patient’s penis(shortening≥1 cm)after 12 months of intervention.
文摘We compared the efficacy and safety between once-daily dosing and on-demand use of udenafil for type 2 diabetic patients with erectile dysfunction （ED）. A multi-center, randomized, open-label, parallel-group, 12-week study was conducted. 161 patients who improved with on-demand 200 mg of udenafil according to Sexual Encounter Profile （SEP） diary Question 2 and 3 （Q2 and Q3） were randomized into 200 mg on-demand （n = 80） or 50 mg once-daily （n = 81） dosing groups for 8 weeks. The dosing period was followed by a 4-week treatment-free period. The primary efficacy endpoint was the change of the International Index of Erectile Function （IIEF） erectile function domain （EFD） score. The secondary efficacy endpoints included changes to the SEP diary Q2, Q3, IIEF Q3, Q4, other domains of IIEF, Global Assessment Question, and shift to the normal rate （EFD 〉 26）. Vascular endothelial markers were also assessed. The IIEF-EFD score of both groups improved after 8 weeks of treatment （P 〈 0.0001）. There was no statistically significant difference between two groups. Improvement was not maintained after the treatment-free follow-up period. Similar results were observed in the secondary efficacy endpoints. There was also no significant difference in vascular endothelial markers. Daily udenafil was well-tolerated, and there was no significant difference in the adverse drug reactions and adverse events between the two groups. Flushing and headache were the most frequent adverse events. Both regimens improved ED in diabetic patients and were well-tolerated. Further studies are needed to assess the effect of daily udenafil treatment in diabetic patients.
基金The authors wish to thank all the study participants for their collaboration.The research group belongs to the“Centros de Investigacion en Red”(CIBERobn,of the“Instituto de Salud Carlos III).MMV was supported by a“Rio Hortega”grant from“Instituto de Salud Carlos III,”Madrid,Spain(CM18/00120)JCFG was supported by a research contract from Servicio Andaluz de Salud(SAS,B-0003-2017)+2 种基金FCD and LGS were supported by Nicolas Monardes(C-0032-2016,C-0028-2018)from Consejeria de Salud,cofunded by the Fondo Europeo de Desarrollo Regional-FEDER,Madrid,SpainDCC by FPU(FPU13/04211)from Ministerio de Educacion,Cultura y DeporteThis work was supported in part by a grant from Servicio Andaluz de Salud(PI-0173-2013).
文摘Erectile dysfunction(ED),a condition closely related to cardiovascular morbidity and mortality,is frequently associated with obesity.In this study,we aimed to determine the prevalence of ED and evaluate the associated risk factors in a cohort of 254 young(18–49 years)nondiabetic obese(body mass index[BMI]≥30 kg m−2)men from primary care.Erectile function(International Index of Erectile Function[IIEF-5]questionnaire),quality of life(Aging Males'Symptoms[AMS scale]),and body composition analysis(Tanita MC-180MA)were determined.Total testosterone was determined using high-performance liquid chromatography–mass spectrometry.Multivariate logistic regression analysis was used to study the factors associated with ED.ED prevalence was 42.1%.Subjects with ED presented higher BMI,waist circumference,number of components of the metabolic syndrome,AMS score,insulin resistance,and a more unfavorable body composition than those without ED.Multivariate logistic regression analysis showed that a pathological AMS score(odds ratio[OR]:4.238,P<0.001),degree of obesity(BMI≥40 kg m−2,OR:2.602,P=0.005,compared with BMI 30–34.9 kg m−2),high-density lipoprotein(HDL)-cholesterol levels(OR:0.956,P=0.004),and age(OR:1.047,P=0.016)were factors independently associated with ED.In conclusion,we demonstrate that,in a primary care-based cohort of nondiabetic young obese men,ED affected>40%of subjects.A pathological AMS score,the degree of obesity,and age were positively associated with ED,while elevated HDL-cholesterol levels were inversely associated with the odds of presenting ED.Further prospective studies are needed to evaluate the long-term consequences of ED in this population.
文摘Previous published studies have shown an improvement of penile hemodynamic parameters after low-intensity extracorporeal shockwave therapy(Li-ESWT).However,the clinical significance of these findings remains unclear,and definitive selection criteria for Li-ESWT based on preexisting comorbidities have yet to be established.This was an observational study of 113 patients with ED,evaluated between January 2019 and December 2021 in Andrology Unit at the Department of Urology and Renal Transplantation,University of Foggia(Foggia,Italy).Penile dynamic Doppler was performed to evaluate vascular parameters and 5-item version of the International Index of Erectile Dysfunction(IIEF-5)questionnaire was administered to assess the severity of ED.This was repeated 1 month after treatment.Patients with a peak systolic velocity(PSV)<30 cm s−1 were considered eligible for Li-ESWT.Our protocol consisted of 8 weekly sessions with 1500 strokes distributed in 5 different locations along the penis.After treatment,a significant mean(±standard deviation[s.d.])PSV increase of 5.0(±3.4)cm s−1 was recorded and 52/113(46.0%)patients reached a PSV>30 cm s−1 at posttherapeutic penile dynamic Doppler.A clinically significant IIEF-5 score improvement was observed in 7 patients,21 patients,and 2 patients with mild-to-moderate,moderate,and severe pretreatment ED,respectively.No different outcomes were assessed based on smoking habits,previous pelvic surgery,or use of oral phosphodiesterase-5 inhibitor(PDE5i).On the other side,only 1(6.7%)in 15 patients with diabetes mellitus showed an IIEF-5 score improvement after Li-ESWT.Shockwave treatment determined a significant increase in PSV and correlated IIEF-5 improvement in ED patients.This advantage seemed particularly evident for moderate ED and was not affected by smoking habits,previous pelvic surgery,and use of PDE5i.Conversely,diabetic patients did not benefit from the treatment.
文摘Noninvasive low-intensity extracorporeal shockwave treatment(Li-ESWT)has been widely used to treat erection disorders.There is no clear information regarding either the selection of patients for the treatment or the treatment protocol.In this study,we aimed to investigate the efficacy of extracorporeal shockwave therapy in diabetic patients with severe erectile dysfunction(International Index of Erectile Function-5[IIEF-5]scores of 5 to 7).Sixty-three diabetes mellitus patients with erectile dysfunction having IIEF-5 scores of 5 to 7 and not showing a recovery of potency despite phosphodiesterase type 5 inhibitor therapy for the past 6 months were included in the study.The patients were evaluated based on their IIEF-5 scores and Erection Hardness Scale scores.The IIEF-5 score(mean±standard deviation[s.d.])increased from 5.29±1.67 to 5.56±1.85,with a difference of 0.27±0.18(P>0.05).The Erection Hardness Scale scores(mean±s.d.),on the other hand,increased from 1.46±0.50 to 1.48±0.50,with a difference of 0.02±0(P>0.05).In conclusion,the response to phosphodiesterase type 5 inhibitors did not change after extracorporeal shockwave treatment in diabetes mellitus patients with severe erectile dysfunction(IIEF-5 scores of 5 to 7).
