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
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
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
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
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
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
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
The location of the apocrine hydrocystoma in the penis region is rare. We present a case where we evaluated the erectile function of a patient presenting such an asymptomatic formation. We assessed the psychogenic com...The location of the apocrine hydrocystoma in the penis region is rare. We present a case where we evaluated the erectile function of a patient presenting such an asymptomatic formation. We assessed the psychogenic component of the erectile dysfunction based on the association of the somatic component of the cyst with the patient’s inability to focus on sexual intercourse. The fear of traumatization of the cyst during sexual intercourse was considered as a triggering factor of the chain of insufficient or unsuccessful erections, and the sexual performance anxiety as a factor in maintaining this erectile dysfunction. Apparently, an organic cause induced an erectile dysfunction, through non-organic (predisposition, triggering and maintenance) mechanisms.展开更多
Penile hypersensitivity plays an important role in premature ejaculation （PE）, but differences in penile sensitivity among subtypes of PE are unknown. Therefore, we compared penile sensory thresholds in PE subtypes ...Penile hypersensitivity plays an important role in premature ejaculation （PE）, but differences in penile sensitivity among subtypes of PE are unknown. Therefore, we compared penile sensory thresholds in PE subtypes of lifelong and acquired PE, PE with and without erectile dysfunction （ED）, PE with an intravaginal ejaculation latency time 〈1 min and 〉1 min, and PE with and without orgasmic pleasure perceptual dysfunction. During August 2014 to January 2016, 136 patients with PE were included. Penile warm, cold, and vibratory thresholds were measured. Data of clinical characteristics, sexual life, Premature Ejaculation Diagnostic Tool （PEDT） score, and the 5-item version of the International Index of Erectile Function （IIEF-5） score were collected. Vibratory thresholds of the PE with ED group were higher in the right coronal sulcus （median amplitude： 4.92 vs 3.65 μm, P= 0.02） and the right penile shaft （median amplitude： 3.87 vs 3.30 μm, P = 0.03）, while differences in penile sensory thresholds between other subtypes were not significant. The median PEDT score was lower in the PE without ED group （12 vs 14, P 〈 0.001）. The IIEF-5 and PEDT scores were negatively correlated （r = -0.29, P 〈 0.001）. Patients with orgasmic pleasure perceptual dysfunction had a lower median IIEF-5 score （20 vs 21, P = 0.02）. Patients with PE and ED had lower penile sensitivity, and ED was associated with more severe symptoms and weaker orgasmic pleasure perception. In men with PE, management of comorbid ED is necessary. In case of side effects in erectile function, topical anesthetics should be cautiously used in men with PE and ED.展开更多
Aim: Electrophysiological monitoring of the activity of the penile sympathetic skin responses (PSSR) in healthy menand patients with erectile dysfunction (ED). Methods: PSSR were recorded from the skin of penis with d...Aim: Electrophysiological monitoring of the activity of the penile sympathetic skin responses (PSSR) in healthy menand patients with erectile dysfunction (ED). Methods: PSSR were recorded from the skin of penis with disk elec-trodes at the time of electric stimulation of left median nerves. Results: PSSR were recorded from all the healthymen and almost all the patients. In healthy men the latency of P_0, the latency of N_1, the duration of N_1 and the ampli-tude of N_1 were 1249 ± 111 ms, 2239 ± 286 ms, 1832 ± 505 ms and 470 μV (median), respectively. In ED patientsthe latency of P_0, the latency of N_1, the duration of N_1 and the amplitude of N_1 were 1467 ± 183 ms ( P < 0.01), 2561± 453 ms (P < 0.05), 2560 ± 861 ms (P < 0.01 ) and 91 μV (P < 0.01), respectively. The normal latency of Powas less than 1471 ms. The normal amplitude of N1 was more than 235μV. According to this normal value, of 20 pa-tients 11 showed longer latency of P_0, and 14 showed lower amplitude of N_1 as compared with those of normal subjects.Conclusion: PSSR can be used as an electrophysiological method in assisting the diagnosis of ED.(Asian J Androl 2001; Mar; 3: 45-48)展开更多
Important roles for reactive oxygen species （ROS） in physiology and pathophysiology have been increasingly recognized. Under normal conditions, ROS serve as signaling molecules in the regulation of cellular function...Important roles for reactive oxygen species （ROS） in physiology and pathophysiology have been increasingly recognized. Under normal conditions, ROS serve as signaling molecules in the regulation of cellular functions. However, enhanced ROS production as a result of the activation of nicotinamide adenine dinucleotide phosphate （NADPH） oxidase contributes significantly to the pathogeneses of vascular diseases. Although it has become evident that increased ROS is associated with erectile dysfunction （ED）, the sources of ROS in the penis remain largely unknown. In recent years, emergent evidence suggests the possible role of NADPH oxidase in inducing ED. In this review, we examine the relationship between ROS and ED in different disease models and discuss the current evidence basis for NADPH oxidase-derive＇d ROS in ED.展开更多
We aim to investigate the correlations between hemodynamic parameters, penile rigidity grading, and the therapeutic effects of phosphodiesterase type 5 inhibitors using color Doppler flow imaging after intracavernosal...We aim to investigate the correlations between hemodynamic parameters, penile rigidity grading, and the therapeutic effects of phosphodiesterase type 5 inhibitors using color Doppler flow imaging after intracavernosal injection in patients with erectile dysfunction. This study involved 164 patients. After intracavernosal injection with a mixture of papaverine （60 mg）, prostaglandin E1 （10 μg）, and lidocaine （2%, 0.5-1 ml）, the penile vessels were assessed using color Doppler flow imaging. Penile rigidity was classified based on the Erection Hardness Score system as Grades 4, 3, 2 or 1 （corresponding to Schramek Grades Ⅴ to Ⅱ）. Then, the patients were given oral sildenafil （50-100 mg） and scored according to the International Index of Erectile Function （IIEF-5） questionnaire. The number of patients with penile rigidities of Schramek Grades Ⅱ to Ⅴ was 14, 18, 21, and 111, respectively. The IIEF-5 score was positively correlated with the refilling index of the penile cavernosal artery （r = 0.79, P 〈 0.05）, the peak systolic velocity （r= 0.45, P〈 0.05）, and penile rigidity （r= 0.75, P〈 0.05）, and was negatively correlated with the end diastolic velocity （r = -0.74, P 〈 0.05）. For patients with erectile dysfunction, both the IIEF-5 score after sildenafil administration, which is correlated with penile rigidity, and the hemodynamic parameters detected using color Doppler flow imaging may predict the effects of phosphodiesterase type 5 inhibitor treatment and could provide a reasonable model for the targeted-treatment of erectile dysfunction.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
Diabetic erectile dysfunction(DED)is a common complication of diabetes mellitus,significantly impairing the quality of life of patients.The conventional clinical treatment still has limitations.Stem cells(SCs),as a ty...Diabetic erectile dysfunction(DED)is a common complication of diabetes mellitus,significantly impairing the quality of life of patients.The conventional clinical treatment still has limitations.Stem cells(SCs),as a type of cells with multidirectional or directional differentiation capability and sustainable selfrenewal potential,are widely used in regenerative medicine and tissue engineering.With the continuous update of regenerative medicine theory and the success of animal experiments,SCs as a treatment for male erectile dysfunction,especially DED,have attracted widespread attention because of curable possibility.This review focus on the current progress in the clinical application of SC treatment for DED.Moreover,we summarize the development prospects of SCs in the field of DMED therapy.展开更多
The aim of this study was to ascertain whether some patients with psychogenic erectile dysfunction （PED） who chose psychotherapy spontaneously improved their sexual function immediately after diagnosis. Two hundred ...The aim of this study was to ascertain whether some patients with psychogenic erectile dysfunction （PED） who chose psychotherapy spontaneously improved their sexual function immediately after diagnosis. Two hundred eighty-five patients with PED were retrospectively studied. Complete resolution of PED was analyzed regarding age, primary or secondary PED, marital status, domestic status, prevailing attitude of the female partner to the dysfunction, duration of their partnership, social status, duration of PED, International Index of Erectile Function score, and prevailing attitude of the patient after a diagnosis of PED. The data were analyzed using post-hoc tests. PED was resolved in 32.3% of the patients immediately after diagnosis. These patients were older, more frequently affected by secondary ED, more frequently living with their partner, and more frequently resigned or happy with the diagnosis of PED than the patients who did not resolve their PED. A nonchalant or cooperative female attitude to PED improved the possibility of PED resolution. The other variables did not influence PED resolution. Our data showed that a clear-cut diagnosis of psychogenic erectile deficiency and some psychosocial factors were critical for the management of some patients with PED.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
The natural product,1,7-dimethoxy-2-hydroxyxanthone（1）,isolated from Securidaca inappendiculate Hassk,has a potential in the treatment of erectile dysfunction due to its significant relaxation activity on rabbit Cor...The natural product,1,7-dimethoxy-2-hydroxyxanthone（1）,isolated from Securidaca inappendiculate Hassk,has a potential in the treatment of erectile dysfunction due to its significant relaxation activity on rabbit Corpus cavernosum.However,the isolation of compound 1 is problematic because of its high similarity in structure to its analogs.In this paper,the first synthesis of 1 was reported featuring two key reactions：a copper-catalyzed coupling reaction and an intramolecular cyclization.展开更多
Our previous studies have demonstrated that some male patients suffering from brachial plexus injury, particularly brachial plexus root avulsion, show erectile dysfunction to varying degrees. However, the underlying m...Our previous studies have demonstrated that some male patients suffering from brachial plexus injury, particularly brachial plexus root avulsion, show erectile dysfunction to varying degrees. However, the underlying mechanism remains poorly understood. In this study, we evaluated the erectile function after establishing brachial plexus root avulsion models with or without spinal cord injury in rats. After these models were established, we administered apomorphine （via a sub- cutaneous injection in the neck） to observe changes in erectile function. Rats subjected to simple brachial plexus root avulsion or those subjected to brachial plexus root avulsion combined with spinal cord injury had significantly fewer erections than those subjected to the sham operation. Expression of neuronal nitric oxide synthase did not change in brachial plexus root avulsion rats. However, neuronal nitric oxide synthase expression was significantly decreased in brachial plexus root avulsion ＋ spinal cord injury rats. These findings suggest that a decrease in neuronal nitric oxide synthase expression in the penis may play a role in erectile dysfunction caused by the combi- nation of brachial plexus root avulsion and spinal cord injury.展开更多
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.
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.
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The location of the apocrine hydrocystoma in the penis region is rare. We present a case where we evaluated the erectile function of a patient presenting such an asymptomatic formation. We assessed the psychogenic component of the erectile dysfunction based on the association of the somatic component of the cyst with the patient’s inability to focus on sexual intercourse. The fear of traumatization of the cyst during sexual intercourse was considered as a triggering factor of the chain of insufficient or unsuccessful erections, and the sexual performance anxiety as a factor in maintaining this erectile dysfunction. Apparently, an organic cause induced an erectile dysfunction, through non-organic (predisposition, triggering and maintenance) mechanisms.
文摘Penile hypersensitivity plays an important role in premature ejaculation （PE）, but differences in penile sensitivity among subtypes of PE are unknown. Therefore, we compared penile sensory thresholds in PE subtypes of lifelong and acquired PE, PE with and without erectile dysfunction （ED）, PE with an intravaginal ejaculation latency time 〈1 min and 〉1 min, and PE with and without orgasmic pleasure perceptual dysfunction. During August 2014 to January 2016, 136 patients with PE were included. Penile warm, cold, and vibratory thresholds were measured. Data of clinical characteristics, sexual life, Premature Ejaculation Diagnostic Tool （PEDT） score, and the 5-item version of the International Index of Erectile Function （IIEF-5） score were collected. Vibratory thresholds of the PE with ED group were higher in the right coronal sulcus （median amplitude： 4.92 vs 3.65 μm, P= 0.02） and the right penile shaft （median amplitude： 3.87 vs 3.30 μm, P = 0.03）, while differences in penile sensory thresholds between other subtypes were not significant. The median PEDT score was lower in the PE without ED group （12 vs 14, P 〈 0.001）. The IIEF-5 and PEDT scores were negatively correlated （r = -0.29, P 〈 0.001）. Patients with orgasmic pleasure perceptual dysfunction had a lower median IIEF-5 score （20 vs 21, P = 0.02）. Patients with PE and ED had lower penile sensitivity, and ED was associated with more severe symptoms and weaker orgasmic pleasure perception. In men with PE, management of comorbid ED is necessary. In case of side effects in erectile function, topical anesthetics should be cautiously used in men with PE and ED.
文摘Aim: Electrophysiological monitoring of the activity of the penile sympathetic skin responses (PSSR) in healthy menand patients with erectile dysfunction (ED). Methods: PSSR were recorded from the skin of penis with disk elec-trodes at the time of electric stimulation of left median nerves. Results: PSSR were recorded from all the healthymen and almost all the patients. In healthy men the latency of P_0, the latency of N_1, the duration of N_1 and the ampli-tude of N_1 were 1249 ± 111 ms, 2239 ± 286 ms, 1832 ± 505 ms and 470 μV (median), respectively. In ED patientsthe latency of P_0, the latency of N_1, the duration of N_1 and the amplitude of N_1 were 1467 ± 183 ms ( P < 0.01), 2561± 453 ms (P < 0.05), 2560 ± 861 ms (P < 0.01 ) and 91 μV (P < 0.01), respectively. The normal latency of Powas less than 1471 ms. The normal amplitude of N1 was more than 235μV. According to this normal value, of 20 pa-tients 11 showed longer latency of P_0, and 14 showed lower amplitude of N_1 as compared with those of normal subjects.Conclusion: PSSR can be used as an electrophysiological method in assisting the diagnosis of ED.(Asian J Androl 2001; Mar; 3: 45-48)
文摘Important roles for reactive oxygen species （ROS） in physiology and pathophysiology have been increasingly recognized. Under normal conditions, ROS serve as signaling molecules in the regulation of cellular functions. However, enhanced ROS production as a result of the activation of nicotinamide adenine dinucleotide phosphate （NADPH） oxidase contributes significantly to the pathogeneses of vascular diseases. Although it has become evident that increased ROS is associated with erectile dysfunction （ED）, the sources of ROS in the penis remain largely unknown. In recent years, emergent evidence suggests the possible role of NADPH oxidase in inducing ED. In this review, we examine the relationship between ROS and ED in different disease models and discuss the current evidence basis for NADPH oxidase-derive＇d ROS in ED.
基金ACKNOWLEDGMENTS This work was partly supported by： projects of Technology Development Program of Shandong Province （No. 2014GSF 118033） Youth Funds of National Natural Science Foundation of China （No. 30901488）+2 种基金 Doctor Start Fund of Natural Science Foundation of Guangdong Province （No. 9451008901003001）Medical Science and Technology Research Foundation of Guangdong Province （No. A2008189） Foundation for Outstanding Young Scientist in Shandong Province （No. 2004BS02019） and Independent Innovation Funds of Center for Reproductive Medicine of Shandong University. These organizations aided in the design and conduct of the study as well as in the collection, management, and analysis of the data.
文摘We aim to investigate the correlations between hemodynamic parameters, penile rigidity grading, and the therapeutic effects of phosphodiesterase type 5 inhibitors using color Doppler flow imaging after intracavernosal injection in patients with erectile dysfunction. This study involved 164 patients. After intracavernosal injection with a mixture of papaverine （60 mg）, prostaglandin E1 （10 μg）, and lidocaine （2%, 0.5-1 ml）, the penile vessels were assessed using color Doppler flow imaging. Penile rigidity was classified based on the Erection Hardness Score system as Grades 4, 3, 2 or 1 （corresponding to Schramek Grades Ⅴ to Ⅱ）. Then, the patients were given oral sildenafil （50-100 mg） and scored according to the International Index of Erectile Function （IIEF-5） questionnaire. The number of patients with penile rigidities of Schramek Grades Ⅱ to Ⅴ was 14, 18, 21, and 111, respectively. The IIEF-5 score was positively correlated with the refilling index of the penile cavernosal artery （r = 0.79, P 〈 0.05）, the peak systolic velocity （r= 0.45, P〈 0.05）, and penile rigidity （r= 0.75, P〈 0.05）, and was negatively correlated with the end diastolic velocity （r = -0.74, P 〈 0.05）. For patients with erectile dysfunction, both the IIEF-5 score after sildenafil administration, which is correlated with penile rigidity, and the hemodynamic parameters detected using color Doppler flow imaging may predict the effects of phosphodiesterase type 5 inhibitor treatment and could provide a reasonable model for the targeted-treatment of erectile dysfunction.
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the National Natural Science Foundation of China,No.81971759.
文摘Diabetic erectile dysfunction(DED)is a common complication of diabetes mellitus,significantly impairing the quality of life of patients.The conventional clinical treatment still has limitations.Stem cells(SCs),as a type of cells with multidirectional or directional differentiation capability and sustainable selfrenewal potential,are widely used in regenerative medicine and tissue engineering.With the continuous update of regenerative medicine theory and the success of animal experiments,SCs as a treatment for male erectile dysfunction,especially DED,have attracted widespread attention because of curable possibility.This review focus on the current progress in the clinical application of SC treatment for DED.Moreover,we summarize the development prospects of SCs in the field of DMED therapy.
文摘The aim of this study was to ascertain whether some patients with psychogenic erectile dysfunction （PED） who chose psychotherapy spontaneously improved their sexual function immediately after diagnosis. Two hundred eighty-five patients with PED were retrospectively studied. Complete resolution of PED was analyzed regarding age, primary or secondary PED, marital status, domestic status, prevailing attitude of the female partner to the dysfunction, duration of their partnership, social status, duration of PED, International Index of Erectile Function score, and prevailing attitude of the patient after a diagnosis of PED. The data were analyzed using post-hoc tests. PED was resolved in 32.3% of the patients immediately after diagnosis. These patients were older, more frequently affected by secondary ED, more frequently living with their partner, and more frequently resigned or happy with the diagnosis of PED than the patients who did not resolve their PED. A nonchalant or cooperative female attitude to PED improved the possibility of PED resolution. The other variables did not influence PED resolution. Our data showed that a clear-cut diagnosis of psychogenic erectile deficiency and some psychosocial factors were critical for the management of some patients with PED.
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).
基金Financial support of the National Natural Science Foundation (Nos.81102461,81021062,and 90813034)National Science & Technology Major Project "Key New Drug Creation and Manufacturing Program"(Nos.2012ZX09301001-001 and 2012ZX09103101-024)the Shanghai Science and Technology Commission(Nos.11431921100 and 12DZ1930802)
文摘The natural product,1,7-dimethoxy-2-hydroxyxanthone（1）,isolated from Securidaca inappendiculate Hassk,has a potential in the treatment of erectile dysfunction due to its significant relaxation activity on rabbit Corpus cavernosum.However,the isolation of compound 1 is problematic because of its high similarity in structure to its analogs.In this paper,the first synthesis of 1 was reported featuring two key reactions：a copper-catalyzed coupling reaction and an intramolecular cyclization.
基金supported by the National Key Clinical Specialist Construction Programs of China,No.201402016the Science and Technology Planning Project of Guangdong Province,China,No.2011A032100001
文摘Our previous studies have demonstrated that some male patients suffering from brachial plexus injury, particularly brachial plexus root avulsion, show erectile dysfunction to varying degrees. However, the underlying mechanism remains poorly understood. In this study, we evaluated the erectile function after establishing brachial plexus root avulsion models with or without spinal cord injury in rats. After these models were established, we administered apomorphine （via a sub- cutaneous injection in the neck） to observe changes in erectile function. Rats subjected to simple brachial plexus root avulsion or those subjected to brachial plexus root avulsion combined with spinal cord injury had significantly fewer erections than those subjected to the sham operation. Expression of neuronal nitric oxide synthase did not change in brachial plexus root avulsion rats. However, neuronal nitric oxide synthase expression was significantly decreased in brachial plexus root avulsion ＋ spinal cord injury rats. These findings suggest that a decrease in neuronal nitric oxide synthase expression in the penis may play a role in erectile dysfunction caused by the combi- nation of brachial plexus root avulsion and spinal cord injury.
