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BACKGROUND: Vasculogenic erectile dysfunction is the most common type of erectile dysfunction, and penile Doppler ultrasound (PDUS) is a useful tool to assess erectile hemodynamics in the clinician's effort to discuss prognosis and management strategies with the patient. AIM: We herein describe the PDUS protocol used at our center, including indications, technique, and data interpretation. METHODS: We describe our institutional experience with PDUS and discuss it in the context of a contemporary review of the literature for this investigation. OUTCOME: Our institutional PDUS protocol. RESULTS: To perform PDUS properly, adequate training, equipment, setting, technique, and interpretation are critical. The accuracy of PDUS is entirely predicated on achieving complete cavernosal smooth muscle relaxation. A redosing protocol optimizes the reliability and reproducibility of the hemodynamic data acquired during PDUS. A rigidity-based assessment is performed, and patients are scanned according to the erection rigidity achieved (full hardness) or by administration of maximum dose of the vasoactive agent. Peak systolic velocity is considered a measure of arterial inflow (normal, >30 cm/s), while end diastolic velocity evaluates the veno-occlusive mechanism (normal, <5 cm/s). After the procedure, the patient is evaluated to confirm detumescence. If the patient has a persistent penetration rigidity erection, intracavernosal phenylephrine is administered; however, if detumescence is not achieved with intracavernosal phenylephrine injections alone, corporal aspiration is potentially performed. CONCLUSION: PDUS is a valuable minimally invasive tool for erectile hemodynamics assessment and an accurate assessment of such, provided that complete cavernosal smooth muscle relaxation is achieved.
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Pene , Ultrasonografía Doppler , Humanos , Masculino , Pene/irrigación sanguínea , Pene/diagnóstico por imagen , Ultrasonografía Doppler/métodos , Impotencia Vasculogénica/diagnóstico por imagen , Impotencia Vasculogénica/fisiopatología , Disfunción Eréctil/diagnóstico por imagen , Disfunción Eréctil/tratamiento farmacológico , Disfunción Eréctil/fisiopatología , Erección Peniana/fisiologíaRESUMEN
Background: Erectile dysfunction (ED) is a very common condition among adult men and its prevalence increases with age. The ankle-brachial blood pressure index (ABPI) is a noninvasive tool used to assess peripheral vascular disease (PAD) and vascular stiffness. However, the association between ABPI and ED is unclear. We aimed to explore the association between ABPI and ED in the US population. Methods: Our study used data from two separate National Health and Nutrition Examination Survey (NHANES) datasets (2001-2002 and 2003-2004). Survey-weighted logistic regression models were used to explore the association between ABPI as a continuous variable and quartiles with ED. We further assessed the association between ABPI and ED using restricted cubic regression while selecting ABPI thresholds using two-piecewise Cox regression models. In addition, we performed subgroup analyses stratified by BMI, race, marital status, diabetes, and hypertension. Main outcome measure: ABPI was calculated by dividing the mean systolic blood pressure at the ankle by the mean systolic blood pressure at the arm. Results: Finally, 2089 participants were enrolled in this study, including 750 (35.90%) ED patients and 1339 (64.10%) participants without ED. After adjusting for all confounding covariates, logistic regression analyses showed a significant association between ABPI and ED (OR=0.19; 95% CI, 0.06-0.56, P=0.01); with ABPI as a categorical variable, compared with the lowest quartile, the OR and 95% CI for the second quartile were 0.58 (0.34-0.97; P = 0.04).Besides, splines indicated that there was an L-shaped relationship between ABPI levels and the risk of ED. Piecewise Cox regression demonstrated the inflection point at 1.14, below which the OR for ED was 0.06 (0.02-0.20; P < 0.001), and above which the OR was 2.79 (0.17-4.53; P = 0.469). Conclusion: In our study, lower ABPI was independently associated with ED risk. In addition, the lowest ABPI level associated with ED risk was 1.14, below this level, lower ABPI was associated with higher ED risk.
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Índice Tobillo Braquial , Presión Sanguínea , Disfunción Eréctil , Encuestas Nutricionales , Humanos , Masculino , Disfunción Eréctil/epidemiología , Disfunción Eréctil/fisiopatología , Estudios Transversales , Persona de Mediana Edad , Adulto , Estados Unidos/epidemiología , Presión Sanguínea/fisiología , Anciano , Factores de Riesgo , PrevalenciaRESUMEN
OBJECTIVE: To investigate the impact of age, various hormonal levels, and biochemical markers on penile cavernous body vascular function in patients with erectile dysfunction (ED). Me-thods: A retrospective analysis of clinical data from male patients with ED who underwent color duplex Doppler ultrasonography (CDDU) and intracavernosal injection test (ICI) at the Reproductive Medicine Center of Peking University Third Hospital from January 2020 to August 2023. Data were managed and processed using SPSS 29.0, and a multivariable Logistic regression analysis was conducted. RESULTS: A total of 700 ED patients were included, with 380 showing negative ICI results and 320 positive. In the study, 84 patients had a peak systolic velocity (PSV) < 25 cm/s, while 616 had PSV≥25 cm/s; 202 patients had end-diastolic velocity (EDV)>5 cm/s, and 498 had EDV≤5 cm/s. 264 patients had abnormal PSV and/or EDV results, and 436 had normal results for both. Patients with vascular ED had significantly lower estrogen levels (t=-3.546, P < 0.001), lower testosterone levels (t=-2.089, P=0.037), and a higher rate of hyperglycemia (χ2=12.772, P=0.002) compared with those with non-vascular ED. The patients with arterial ED were older (t=3.953, P < 0.001), had a higher rate of hyperglycemia (χ2=9.518, P=0.009), and a higher estrogen/testosterone ratio (t=2.330, P=0.020) compared with those with non-arterial ED. The patients with mixed arteriovenous ED had higher age (t=3.567, P < 0.001), lower testosterone levels (t=-2.288, P=0.022), a higher rate of hyperglycemia (χ2=12.877, P=0.002), and a larger estrogen/testosterone ratio (t=2.096, P=0.037) compared with those with normal findings. Multifactorial Logistic regression analysis indicated that higher levels of estrogen were a protective factor for vascular ED (OR=1.009, 95%CI: 1.004-1.014), and glucose≥7.0 mmol/L was a risk factor (OR=0.381, 95%CI: 0.219-0.661). Older age was a risk factor for arterial ED (OR=0.960, 95%CI: 0.938-0.982). Additionally, older age (OR=0.976, 95%CI: 0.958-0.993) and glucose levels of 5.6-6.9 mmol/L (OR=0.591, 95%CI: 0.399-0.876) were also risk factors for mixed arterio-venous ED. CONCLUSION: Hyperglycemia and aging may impair penile cavernous body vascular function, while higher levels of estrogen may have a protective effect on it.
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Disfunción Eréctil , Pene , Testosterona , Humanos , Masculino , Estudios Retrospectivos , Pene/irrigación sanguínea , Testosterona/sangre , Disfunción Eréctil/fisiopatología , Ultrasonografía Doppler en Color , Estrógenos/sangre , Persona de Mediana Edad , Factores de Edad , AdultoRESUMEN
BACKGROUND: Metabolic syndrome (MS) has emerged as a new health risk, and its associated metabolic derangements have detrimental effects on the cardiovascular system. In recent years, MS has been reported to affect reproductive health in males. It has been reported to be associated with erectile dysfunction (ED) and has been attributed to be due to endothelial dysfunction. Poor endothelial function in ED usually affects small-sized vasculature, so it can be looked at as a predictor for the endothelial dysfunction of macro vasculature. The aim of the present study was to determine the association of ED in patients with MS and to determine its correlation with endothelial dysfunction. MATERIALS AND METHODS: It was a hospital-based case-control study in which 120 male patients with MS and 120 age-matched controls were enroled. Demographic profiles, anthropometry, past illnesses, and medical history of patients were obtained. MS was diagnosed according to the International Diabetes Federation (IDF) criteria and was measured using the flow-mediated dilation (FMD) method with the help of ultrasound used to assess endothelial dysfunction. Diagnosis of ED was based on the International Index of Erectile Function (IIEF) scale. RESULTS: The study participants had a mean age of 40.91 ± 11.41 years. The majority of cases (57.5%) had ≤6 months of history of MS. The prevalence of ED was 31.7% in cases compared to 5% in controls, thus showing a significant difference between cases and controls. Mean IIEF scores were significantly lower in cases (18.82 ± 5.59) compared to those in controls (23.00 ± 2.57). A moderate positive and significant correlation was observed between FMD and IIEF scores. With an increasing number of MS components, there was a significant increase in the prevalence of ED. Those with ED had significantly lower mean FMD values (5.1 ± 1.1%) compared to those not having ED (10.9 ± 3.3%). CONCLUSION: The findings of the present study showed that there is a significant association between ED and MS. We observed that the increase in components of MS increased the prevalence of ED in MS. Endothelial dysfunction measured by FMD was correlated with ED.
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Endotelio Vascular , Disfunción Eréctil , Síndrome Metabólico , Humanos , Masculino , Síndrome Metabólico/epidemiología , Síndrome Metabólico/fisiopatología , Síndrome Metabólico/complicaciones , Endotelio Vascular/fisiopatología , Adulto , Disfunción Eréctil/epidemiología , Disfunción Eréctil/fisiopatología , Disfunción Eréctil/etiología , Estudios de Casos y Controles , India/epidemiología , Persona de Mediana Edad , PrevalenciaRESUMEN
INTRODUCTION: Although previous studies have linked obesity and erectile dysfunction, the novel surrogate indicators of adipose accumulation are more essential and dependable factors to consider. Therefore, the primary objective of the current investigation was to examine and clarify the association between metabolic score for visceral fat (METS-VF) and erectile dysfunction. METHODS: Firstly, multivariate logistic regression analysis, smoothed curve fitting, and threshold effect analysis were employed to investigate the association between METS-VF and erectile dysfunction. Mediation analysis was also performed to evaluate the mediating role of homocysteine and inflammation. After that, subgroup analysis was carried out to examine the stability of the correlation of METS-VF with erectile dysfunction in various population settings. Furthermore, the area under the receiver operating characteristic (ROC) curve and eXtreme Gradient Boosting (XGBoost) algorithm were utilized to assess the capability of identifying METS-VF in comparison to the other four obesity-related indicators in identifying erectile dysfunction. RESULTS: After adjusting for all confounding factors, METS-VF was strongly and favourablely correlated with erectile dysfunction. With each additional unit rise in METS-VF, the prevalence of erectile dysfunction increased by 141%. A J-shaped relationship between METS-VF and erectile dysfunction was discovered through smoothed curve fitting. Marital status, physical activity, and smoking status can potentially modify this association. This finding of the ROC curve suggests that METS-VF had a powerful identifying capacity for erectile dysfunction (AUC = 0.7351). Homocysteine and inflammation mediated 4.24% and 2.81%, respectively. CONCLUSION: The findings of the current investigation suggest that METS-VF can be considered a dependable identifying indicator of erectile dysfunction.
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Disfunción Eréctil , Curva ROC , Masculino , Disfunción Eréctil/metabolismo , Disfunción Eréctil/fisiopatología , Humanos , Persona de Mediana Edad , Grasa Intraabdominal/metabolismo , Grasa Intraabdominal/patología , Biomarcadores/metabolismo , Adulto , Homocisteína/sangre , Homocisteína/metabolismo , Obesidad/complicaciones , Obesidad/metabolismo , Anciano , Factores de Riesgo , Síndrome Metabólico/complicaciones , Síndrome Metabólico/metabolismo , Modelos LogísticosRESUMEN
INTRODUCTION: Androgens play important roles in regulating the growth and development of the male reproductive system and maintaining libido and erectile function. The specific mechanisms by which androgen deficiency leads to erectile dysfunction (ED) are not yet fully understood. OBJECTIVES: To understand the mechanisms and treatment of androgen deficiency-related ED. METHODS: A literature search in the past 10 years was conducted in PubMed and Google Scholar to determine the effects of androgen deficiency on erectile function and the treatment of androgen deficiency. RESULTS: Androgen deficiency can be caused by hypothalamic-pituitary lesions and injuries, testicular-related diseases and injuries, endocrine and metabolic disorders, the side effects of medication, and age. Androgen deficiency can lead to ED by inhibiting the NOS/NO/cGMP pathway (nitric oxide synthase/nitric oxide/cyclic guanosine monophosphate) and altering the expression of ion channel proteins, as well as by inducing oxidative stress, death, and fibrosis in penile corpus cavernosum cells. Testosterone replacement therapy is effective at improving the serum testosterone levels and erectile function in patients with androgen deficiency. For patients who need to maintain a low androgenic state, erectile function can be improved by lifestyle changes, treatment with phosphodiesterase type 5 inhibitors, low-intensity extracorporeal shock wave therapy, and stem cell therapy. CONCLUSIONS: Androgen deficiency can affect the structure and function of the penile corpus cavernosum, leading to ED. Areas of further study include how androgen replacement therapy can improve erectile function and how to improve the maintenance of erectile function in patients with hypoandrogenic status.
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Andrógenos , Disfunción Eréctil , Terapia de Reemplazo de Hormonas , Humanos , Disfunción Eréctil/etiología , Disfunción Eréctil/terapia , Disfunción Eréctil/tratamiento farmacológico , Disfunción Eréctil/fisiopatología , Masculino , Andrógenos/uso terapéutico , Andrógenos/deficiencia , Testosterona/deficiencia , Testosterona/uso terapéutico , Inhibidores de Fosfodiesterasa 5/uso terapéuticoRESUMEN
PURPOSE: Holmium laser enucleation of the prostate (HoLEP) is a surgical treatment option for benign prostatic hyperplasia (BPH). Many men develop retrograde ejaculation postprocedure, but there is conflicting evidence regarding sexual function outcomes post-HoLEP. We sought to examine significant variations in patient-reported erectile and ejaculatory function within 12 months post-HoLEP. MATERIALS AND METHODS: We conducted a retrospective study for patients who underwent HoLEP between Nov 2018 and Feb 2022. Of the reviewed patients, 277 patients met inclusion criteria and completed pre and postoperative questionnaires, which included the Male Sexual Health Questionnaire- Ejaculatory Dysfunction (MSHQ-EJD) and the International Index of Erectile Function/Sexual Health Inventory for Men (IIEF-5/SHIM). Surveys were provided to patients up to 12 months postprocedure. Demographics and comorbidities associated with sexual dysfunction were collected. Responses to each question were analyzed to detect sub-categorical variations in sexual function as the secondary objective. Data was analyzed by using a linear mixed model. RESULTS: There was a significant decline in total scores for the MSHQ-EJD (8.70 pre-HoLEP vs. 6.58 post HoLEP, p ≤ 0.001) including a significant decline (p < 0.005) in questions 1-3 which assess ejaculatory ability, strength, and volume. There was not a significant decline in question 4 which assesses bother (2.552 pre-HoLEP vs. 3.119 post-HoLEP, p = 0.526). There was not a significant decline in the IIEF-5/SHIM postoperatively (11.51 pre-HoLEP vs. 13.327 post-HoLEP, p = 0.498). CONCLUSIONS: Patients undergoing HoLEP do not experience a decline in erectile function. Patients do experience a decline in ejaculatory function but did not find this bothersome.
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Eyaculación , Disfunción Eréctil , Láseres de Estado Sólido , Prostatectomía , Hiperplasia Prostática , Humanos , Masculino , Láseres de Estado Sólido/uso terapéutico , Láseres de Estado Sólido/efectos adversos , Hiperplasia Prostática/cirugía , Anciano , Eyaculación/fisiología , Estudios Retrospectivos , Disfunción Eréctil/etiología , Disfunción Eréctil/fisiopatología , Persona de Mediana Edad , Prostatectomía/efectos adversos , Prostatectomía/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Encuestas y Cuestionarios , Resultado del Tratamiento , Erección Peniana/fisiología , Terapia por Láser/métodos , Terapia por Láser/efectos adversosRESUMEN
PURPOSE: To validate and culturally adapt the Sexual Health Inventory for Men (IIEF-5) and the Premature Ejaculation Diagnostic Tool (PEDT), to compare the frequency and severity of erectile dysfunction (ED) and premature ejaculation (PE) in male individuals with MS (mwMS) in comparison with healthy controls (HC) and to investigate predictors of the severity of ED and PE in mwMS. METHODS: 216 consecutive mwMS and 37 HC completed IIEF-5 and PEDT. Additionally, 114 mwMS completed the Modified Fatigue Impact Scale (MFIS), Beck Depression Inventory (BDI-2), Composite Autonomic System Score-31 (COMPASS-31), and the 5-level EQ-5D questionnaire. RESULTS: The test-retest reliability was satisfactory for both questionnaires, with acceptable reliability for both questionnaires. mwMS scored less on IIEF-5 compared to HC (23, IQR 18.25-25 vs 24, IQR 20.25-25, p = 0.028). ED was present in 39.4 % of mwMS and 27.8 % of HC (p = 0.198). Definite PE was present in 12.1 %, and possible PE in 7.8 % of mwMS; and 5.6 % and 11.1 % of HC respectively (p = 0.496). An increase in EDSS was a positive predictor (Exp(B) 1.455, 95 %CI 1.135-1.886, p = 0.003) and the presence of cremasteric reflex was a negative predictor (Exp(B) 0.381, 95 %CI 0.183-0.790, p = 0.010) for the presence of ED. For the PE, disease duration was the only positive predictor in a univariable logistic regression (Exp(B) 1.084, 95 %CI 1.019-1.153, p = 0.070). CONCLUSION: SD is frequent in mwMS with EDSS being a positive and the presence of cremasteric reflex a negative predictor of ED and disease duration a positive predictor of PE symptoms.
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Disfunción Eréctil , Esclerosis Múltiple , Eyaculación Prematura , Humanos , Masculino , Adulto , Eyaculación Prematura/etiología , Eyaculación Prematura/diagnóstico , Eyaculación Prematura/fisiopatología , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/fisiopatología , Disfunción Eréctil/etiología , Disfunción Eréctil/diagnóstico , Disfunción Eréctil/fisiopatología , Persona de Mediana Edad , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Fisiológicas/diagnóstico , Encuestas y CuestionariosRESUMEN
Male fertility and metabolic disorders, including obesity and diabetes, are closely connected. Since hyperuricemia and metabolic syndrome are strongly related, male fertility and hyperuricemia may, to some degree, be associated. According to recent studies, hyperuricemia imposes various effects on sex hormones, semen quality, and male erectile dysfunction. Some researchers claim that uric acid worsens male semen and raises the risk of erectile dysfunction (ED), while others state that it safeguards both penile erection and male semen. Additionally, it has been shown that gout and metabolic syndrome also raise the risk of ED. To clarify this controversy, the influence and potential mechanisms of hyperuricemia on ED, semen quality, sex hormone levels, and the effects of hyperuricemia-related disorders on ED will be comprehensively summarized.
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Disfunción Eréctil , Hiperuricemia , Infertilidad Masculina , Humanos , Masculino , Disfunción Eréctil/etiología , Disfunción Eréctil/fisiopatología , Infertilidad Masculina/etiología , Infertilidad Masculina/fisiopatología , Infertilidad Masculina/metabolismo , Síndrome Metabólico/metabolismo , Síndrome Metabólico/fisiopatología , Reproducción/fisiología , Análisis de Semen , Animales , Hormonas Esteroides Gonadales/metabolismo , Ácido Úrico/sangre , Ácido Úrico/metabolismo , GotaRESUMEN
BACKGROUND: Multiple sclerosis (MS) is a chronic neuroinflammatory disease with highest incidence during the period of optimal reproductive health. This scoping review aimed to identify and summarize available data on sexual/reproductive health in males with MS (MwMS). METHODS: This review was based on PRISMA extension for Scoping Review. PubMed database was searched for keyword "multiple sclerosis" alongside keywords "sexual health", "reproductive health", "family planning", "male fertility", "male infertility", "sexual dysfunction", and "erectile dysfunction", iteratively using the "AND" logical operator. Descriptive analysis was performed on the included articles. RESULTS: Thirty-four studies were included, and four topics emerged: sexual dysfunction, erectile dysfunction, fertility, and family planning. Sexual dysfunction is common in MwMS (35-72%), yet only a minority of MwMS discuss their sexual health with their treatment teams. Both MS disability and depression were associated with sexual dysfunction in MwMS, with erectile dysfunction and decreased libido as the most prevalent aspects of sexual dysfunction. Positively, phosphodiesterase-5 inhibitors appear effective for treating erectile dysfunction and improving sexual quality of life in MwMS. There may also be a relationship between MS and male infertility, though changes in sexual behavior may underlie this association. Finally, a prominent knowledge gap was observed for disease-modifying therapy use and family planning in MwMS. CONCLUSION: Sexual dysfunction is common, impacted by MS severity, and associates with decreased quality of life in MwMS. Communication barriers regarding sexual and reproductive health appear to exist between MwMS and providers, as do literature gaps related to MS therapeutics and sexual/reproductive health.
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Esclerosis Múltiple , Salud Reproductiva , Disfunciones Sexuales Fisiológicas , Humanos , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/fisiopatología , Esclerosis Múltiple/epidemiología , Masculino , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Fisiológicas/epidemiología , Salud Sexual , Disfunción Eréctil/etiología , Disfunción Eréctil/fisiopatologíaRESUMEN
BACKGROUND: The relationship between erectile dysfunction (ED) and type 1 diabetes mellitus (T1DM) is currently a hot topic of medical research. It has been reported that autophagy plays a crucial role in causing erectile dysfunction in T1DM. Recent research has shown that mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase 2 (HMGCS2) is strongly linked to the development of T1DM. However, the specific mechanism by which it regulates the erectile function is not yet fully understood. OBJECTIVES: To investigate whether HMGCS2 affects erectile function in type 1 diabetic rats by regulating autophagy in corpus cavernosum endothelial cells (CCECs). MATERIALS AND METHODS: First, the rat model of T1DM was established. Then, the ratio of maximum penile intracavernous pressure (ICPmax) and mean arterial pressure (MAP) was detected to assess the erectile function in various groups, and the protein expression of HMGCS2, mTOR and p-mTOR was evaluated by western blot (WB) and immunohistochemistry (IHC). To explore the relationship between HMGCS2 and the mTOR signaling pathway in T1DM ED rats, we silenced the expression of HMGCS2 and activated the mTOR signaling pathway with MHY1485 in CCECs and then assessed the expression of beclin1, P62, LC3, autophagosome, endothelial nitric oxide synthase (eNOS), phosphorylation of eNOS (p-eNOS), and nitric oxide (NO) to evaluate autophagy and the erectile function by reverse transcription quantitative polymerase chain reaction and western blot. RESULTS: The study conducted on T1DM ED rats showed that the expression of HMGCS2 was significantly increased, while the autophagy was suppressed. Additionally, the mTOR signaling pathway was highly activated. In contrast, when HMGCS2 was silenced in vitro, p-mTOR/mTOR was reduced, and autophagy was improved. These effects were accompanied by the enhanced activity of eNOS. Furthermore, when HMGCS2 was silenced and the mTOR signaling pathway was simultaneously activated, the results revealed a decrease in autophagy as well as a reduction in activity of eNOS in comparison to just silencing HMGCS2 alone. DISCUSSION AND CONCLUSION: HMGCS2 upregulation in T1DM rats inhibited autophagy and eNOS activity by activating the mTOR pathway and led to a decrease in the erectile function.
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Autofagia , Diabetes Mellitus Experimental , Diabetes Mellitus Tipo 1 , Disfunción Eréctil , Hidroximetilglutaril-CoA Sintasa , Ratas Sprague-Dawley , Transducción de Señal , Serina-Treonina Quinasas TOR , Animales , Masculino , Disfunción Eréctil/metabolismo , Disfunción Eréctil/fisiopatología , Serina-Treonina Quinasas TOR/metabolismo , Ratas , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/complicaciones , Hidroximetilglutaril-CoA Sintasa/metabolismo , Hidroximetilglutaril-CoA Sintasa/genética , Pene/metabolismo , Células Endoteliales/metabolismo , Óxido Nítrico Sintasa de Tipo III/metabolismoRESUMEN
Concomitant sexual disorders have progressively shown increased prevalence in men at first outpatient presentation. We sought to i) estimate the prevalence of unreported premature ejaculation (PE) in a homogenous cohort of 1258 men seeking first medical help for erectile dysfunction (ED) as their primary compliant; ii) compare the baseline sociodemographic and clinical characteristics of men with only ED(ED-only) compared to those with ED and PE(ED + PE); and, iii) investigate the likelihood of detecting PE among men self-reporting only ED over a 16-year period at a single tertiary-referral centre. Descriptive statistics compared sociodemographic and clinical characteristics between ED-only patients and those with unreported concomitant primary/secondary PE(ED + PE). Logistic regression models predicted the risk of having ED + PE at baseline. Local polynomial regression models graphically explored the probability of reporting PE among ED men with ≤40 vs. 41-60 vs. >60 years over the analysed timeframe. Of all, 932 (74.1%) were ED-only and 326 (25.9%) ED + PE patients, respectively. ED + PE patients were younger, presented with fewer comorbidities, and lower rates of severe ED (all p ≤ 0.04). At multivariable logistic regression analysis, younger age (OR:0.98) and low sexual desire/interest (OR:1.54) were independently associated with ED + PE at first clinical assessment (all p = 0.03). The likelihood of detecting unreported concomitant primary/secondary PE among patients complaining of only ED at first presentation worrisomely increased among younger and middle-aged men over the last 16 years.
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Disfunción Eréctil , Eyaculación Prematura , Masculino , Persona de Mediana Edad , Humanos , Disfunción Eréctil/fisiopatología , Eyaculación Prematura/complicaciones , Eyaculación Prematura/epidemiología , Eyaculación Prematura/diagnóstico , Estudios Transversales , Conducta Sexual , LibidoAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Hipogonadismo/diagnóstico , Disfunción Eréctil/complicaciones , Disfunción Eréctil/fisiopatología , Testosterona/sangre , Erección Peniana , Citrato de Sildenafil/administración & dosificación , Hipogonadismo/etiología , Disfunción Eréctil/tratamiento farmacológico , Obesidad/complicacionesAsunto(s)
Disfunción Eréctil , Hipertensión , Disfunción Eréctil/tratamiento farmacológico , Disfunción Eréctil/fisiopatología , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Masculino , Satisfacción del Paciente , Tadalafilo/uso terapéutico , Resultado del TratamientoRESUMEN
Lithium has been a mainstay of therapy for patients with bipolar disorders for several decades. However, it may exert a variety of adverse effects that can affect patients' compliance. Sexual and erectile dysfunction has been reported in several studies by patients who take lithium as monotherapy or combined with other psychotherapeutic agents. The exact mechanisms underlying such side effects of lithium are not completely understood. It seems that both central and peripheral mechanisms are involved in the lithium-related sexual dysfunction. Here, we had an overview of the epidemiology of lithium-related sexual and erectile dysfunction in previous clinical studies as well as possible pathologic pathways that could be involved in this adverse effect of lithium based on the previous preclinical studies. Understanding such mechanisms could potentially open a new avenue for therapies that can overcome lithium-related sexual dysfunction and improve patients' adherence to the medication intake.
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Disfunción Eréctil/tratamiento farmacológico , Litio/uso terapéutico , Animales , Modelos Animales de Enfermedad , Disfunción Eréctil/epidemiología , Disfunción Eréctil/patología , Disfunción Eréctil/fisiopatología , Humanos , Masculino , Modelos BiológicosRESUMEN
BACKGROUND: Erectile dysfunction is a disease commonly caused by diabetes mellitus (DMED) and cavernous nerve injury (CNIED). Bioinformatics analyses including differentially expressed genes (DEGs), enriched functions and pathways (EFPs), and protein-protein interaction (PPI) networks were carried out in DMED and CNIED rats in this study. The critical biomarkers that may intervene in nitric oxide synthase (NOS, predominantly nNOS, ancillary eNOS, and iNOS)-cyclic guanosine monophosphate (cGMP)-phosphodiesterase 5 enzyme (PDE5) pathway, an important mechanism in erectile dysfunction treatment, were then explored for potential clinical applications. METHODS: GSE2457 and GSE31247 were downloaded. Their DEGs with a |logFC (fold change)| > 0 were screened out. Database for Annotation, Visualization and Integrated Discovery (DAVID) online database was used to analyze the EFPs in Gene Ontology enrichment and Kyoto Encyclopedia of Genes and Genomes networks based on down-regulated and up-regulated DEGs respectively. PPI analysis of 2 datasets was performed in Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) and Cytoscape. Interactions with an average score greater than 0.9 were chosen as the cutoff for statistical significance. RESULTS: From a total of 1710 DEGs in GSE2457, 772 were down-regulated and 938 were up-regulated, in contrast to the 836 DEGs in GSE31247, from which 508 were down-regulated and 328 were up-regulated. The 25 common EFPs such as aging and response to hormone were identified in both models. PPI results showed that the first 10 hub genes in DMED were all different from those in CNIED. CONCLUSIONS: The intervention of iNOS with the hub gene complement component 3 in DMED and the aging process in both DMED and CNIED deserves attention.
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Biomarcadores/metabolismo , Fosfodiesterasas de Nucleótidos Cíclicos Tipo 5/metabolismo , Disfunción Eréctil/metabolismo , Óxido Nítrico Sintasa/metabolismo , Nucleótidos Cíclicos/metabolismo , Animales , Biología Computacional/métodos , Bases de Datos Genéticas , Complicaciones de la Diabetes/epidemiología , Disfunción Eréctil/epidemiología , Disfunción Eréctil/fisiopatología , Regulación de la Expresión Génica/genética , Ontología de Genes/estadística & datos numéricos , Redes Reguladoras de Genes/genética , Humanos , Masculino , Modelos Animales , Mapas de Interacción de Proteínas/genética , RatasRESUMEN
The science of penile erection, including recent advances in its molecular physiology and neuroanatomic pathways, is described. The pathophysiology of erectile dysfunction is presented, acknowledging associated disease states, and accordingly follows a practical classification scheme: vasculogenic, neurogenic, endocrine, and psychogenic.
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Disfunción Eréctil/fisiopatología , Erección Peniana/fisiología , Disfunción Eréctil/etiología , Humanos , MasculinoRESUMEN
The role of STIM/Orai calcium entry system on vascular ageing has not been elucidated. We aimed to evaluate the influence of ageing on STIM/Orai signalling and its role on ageing-induced alterations of contractile function in rat corpus cavernosum (RCC) and human penile resistance arteries (HPRA) and corpus cavernosum (HCC). RCC was obtained from 3 months-old and 20 months-old animals. HPRA and HCC were obtained from organ donors of varied ages without history of erectile dysfunction. Aging was associated with enhanced norepinephrine (NE)- and thromboxane analogue (U46619)-induced contractions in RCC which were significantly inhibited by the STIM/Orai inhibitor, YM-58483 (20 µM). Other STIM/Orai inhibitor, 2-aminoethyldiphenylborate also reduced NE-induced contractions in RCC from aged rats. YM-58483 significantly reduced neurogenic contractions and potentiated neurogenic relaxations in RCC from aged rats. In HCC and HPRA, NE-induced contractions were significantly enhanced in older subjects (>65 years-old) but YM-58483 completely reversed ageing-related hypercontractility. Ageing did not modify STIM-1 and Orai1 protein expressions but Orai3 was significantly overexpressed in cavernosal tissue from old rats and older subjects. Contribution of STIM/Orai to cavernosal contraction increases with ageing together with increased expression of Orai3. Orai inhibition could be a potential therapeutic strategy to reduce ageing-related impact on vascular/erectile function.