Liver transplantation improves erectile function in patients with end-stage liver disease: a systematic review and meta-analysis.

Background: Liver transplantation (LT) has been recognized as the most effective therapy for end-stage liver disease (ESLD). However, the question of whether LT can improve erectile function in patients with ESLD remains controversial. Therefore, we conducted this meta-analysis to evaluate the association between LT and erectile dysfunction (ED). Methods: According to the PRISMA guidelines, studies were included after conducting searches in four databases from March 2024 onwards. These databases included PubMed, Cochrane Library, Web of Science, and Embase. The primary outcome of interest was to compare the International Index of Erectile Function (IIEF) scores between patients after and before LT. Standardized mean differences (SMDs) and their corresponding 95% confidence intervals (CIs) were utilized to assess the relationship between LT and ED. Results: The results showed that the LT group had higher IIEF-5 domain scores for erectile function compared to the control group (SMD =-0.31, 95% CI: -0.53 to -0.09), P=0.007). No heterogeneity or publication bias was detected in the results. Additionally, the IIEF-15 domain score was also found to be improved after LT. Specifically, the LT group had higher domain scores for erectile function (SMD =-0.77, 95% CI: -1.07 to -0.48, P<0.001), orgasmic function (SMD =-0.82, 95% CI: -1.12 to -0.52, P<0.001), sexual desire (SMD =-0.89, 95% CI: -1.19 to -0.59, P<0.001), intercourse satisfaction (SMD =-0.92, 95% CI: -1.22 to -0.62, P<0.001), and overall satisfaction (SMD =-0.87, 95% CI: -1.17 to -0.57, P<0.001). Conclusions: It is suggested by our meta-analysis that LT may contribute to improvements in erectile function among men with ESLD. This improvement may be related to the remarkable improvement in endocrine hormone disorders observed after LT. However, future studies with better designs and larger sample sizes are still needed to confirm our conclusions. Additionally, attention to erectile function before and after surgery in patients with liver failure is crucial.

Efficacy and safety of low-intensity pulsed ultrasound (LIPUS) combined with tadalafil in the treatment of severe erectile dysfunction: a retrospective cohort study.

Background: Low-intensity pulsed ultrasound (LIPUS) is an effective and safe treatment for mild to moderate erectile dysfunction (ED). This study aimed to investigate the efficacy and safety of combining LIPUS with tadalafil in treating severe ED. Methods: The data from 27 patients treated with LIPUS alone (group A) and 21 patients treated with a combination of LIPUS and daily 10 mg tadalafil (group B) were retrospectively analyzed. The LIPUS regimen consisted of twice-weekly treatments for 4 consecutive weeks. The treatment was considered effective if the change in International Index of Erectile Function-Erectile Function Domain (IIEF-EF) score after treatment was greater than or equal to the minimal clinically important difference (MCID) (the MCID for severe ED is 7 points). The effectiveness, IIEF-EF score, erectile hardness score (EHS), peak systolic velocity (PSV), end diastolic velocity (EDV), and adverse events were evaluated before treatment, 4 weeks after treatment, and 12 weeks after treatment. Results: Compared to pre-treatment, both groups showed significant improvement in IIEF-EF score and EHS at 4 and 12 weeks after treatment (P<0.001), with no statistically significant difference between the two time points (P>0.05). The effective rate did not significantly differ between group A (9/27, 33.3%) and group B (10/21, 47.62%) at 4 weeks or between group A (9/27, 33.3%) and group B (12/21, 57.14%) at 12 weeks after treatment (P=0.32, P=0.10). However, in patients without comorbidities, the effective rate of group B (12/18, 66.67%) was higher than that of group A (9/25, 36.00%) at 12 weeks after treatment (P=0.047). After LIPUS treatment, the PSV level significantly increased and the EDV level significantly decreased compared with before treatment (P<0.05). No adverse events were reported. Conclusions: The study suggests that LIPUS has a therapeutic effect on severe ED patients, especially those without comorbidities. It may have a synergistic or overlapping effect with phosphodiesterase type 5 inhibitors (PDE5Is) on severe ED patients without comorbidities.

Exploring the link between comorbid insomnia and sleep apnea (COMISA) and erectile dysfunction: implications for male sexual health.

INTRODUCTION: This review explores the interplay between comorbid insomnia and sleep apnea (COMISA) and erectile dysfunction (ED), 2 conditions that significantly impact men's health. COMISA, a recently recognized condition characterized by the coexistence of insomnia and obstructive sleep apnea, has been shown to disrupt sleep architecture and cause intermittent hypoxia. These disturbances are increasingly linked to the exacerbation of ED, a prevalent issue among men. Understanding the connection between COMISA and ED is crucial for developing integrated treatment approaches that address both sleep and sexual health. OBJECTIVES: We aim to explore the epidemiological, physiological, and potential therapeutic intersections of COMISA and ED. This review sets out to develop a better understanding of the relationship between these conditions and to emphasize the need for an integrated diagnostic and therapeutic approach that addresses both sleep and sexual health. METHODS: Through a comprehensive analysis, including a detailed examination of extant studies, we address the hormonal imbalances and alterations in neural pathways that collectively contribute to the complex pathophysiology of ED and how these are particularly susceptible to the concurrent presence of COMISA. RESULTS: Our analysis indicates that disruptions in sleep architecture and intermittent hypoxia associated with COMISA can exacerbate ED. Hormonal imbalances, endothelial dysfunction, autonomic imbalance, and increased inflammation and oxidative stress are key mechanisms through which COMISA influences ED. These factors collectively impair vascular health, reduce testosterone levels, disrupt neural control of erections, and contribute to the severity of ED. CONCLUSIONS: This review underscores the necessity for an integrated approach to diagnosis and therapy that considers both sleep and sexual health to improve overall outcomes. These insights should foster a deeper understanding of the relationship between COMISA and ED, encourage further research in this area, and potentially lead to the development of innovative treatment strategies to manage these closely intertwined health concerns.

Exploring You-gui Pill for the Treatment of Diabetic Erectile Dysfunction: Data Mining Analysis, Network Pharmacology and Experiments In Vitro.

INTRODUCTION: The You-gui pill (YGP) is a classical compound used for treating antidiabetic erectile dysfunction (DMED). However, the specific active ingredients responsible for its effects on DMED and their mechanisms remain unclear. METHODS: In this paper, we used data mining techniques to analyze high-frequency herbs and herb combinations used in Chinese medicine for the treatment of DMED based on existing literature. Using network pharmacology to study the active components and mechanism of action of YGP against DMED, molecular docking was used to analyze the interactions of the active components with major structural proteins, nonstructural proteins, and mutants. Also, the therapeutic effect of YGP on hyperglycemic modelling and its underlying mechanisms were experimentally validated in CCEC cells by analyzing the expression of its relevant target mRNAs. RESULTS: Network pharmacological analysis identified the three core components of YGP as quercetin, kaempferol, and ß-sitosterol, and constructed a PPI network map of common targets of YGP and DMED, which included HIF-1α, ALB, Bcl-2, INS, IL-1ß, IL-6, TNF-α, CASP3, and TP53. Combined with molecular docking results, these targets had a strong binding affinity between them and the active ingredient compounds, with the highest affinity for HIF-1α and TNF-α. During the in vitro cellular assay validation, the HIF-1α, ALB, Bcl-2, TNF-α, and IL-6 mRNA in CCECs cells showed positive regulation after YGP intervention. CONCLUSION: The combination of "data mining - network pharmacology - molecular docking - experimental validation" provides a powerful methodological basis for the study of the main active components and mechanism of action of YGP against DMED, as well as the development and application of the drug.

Evaluation of efficacy and safety of low-intensity pulsed ultrasound in patients with concurrent erectile dysfunction and chronic prostatitis/chronic pelvic pain syndrome: a prospective, randomized controlled study.

OBJECTIVE: The primary objective of this clinical trial is to investigate the effect of low-intensity pulsed ultrasound (LIPUS) on patients suffering from comorbid erectile dysfunction (ED) and chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS). METHODS: The clinical trial was conducted in the andrology outpatient treatment room of the Department of Urology, Xiangya Hospital, Central South University from August to November 2022 A total of 60 patients who met the research criteria for comorbid ED combined with CP/CPPS were recruited and randomly assigned to three treatment groups. They were treated with LIPUS (Group A), drug therapy(Group B), and LIPUS combined with drug therapy (Group C), respectively. Each group comprised 20 patients. Statistical analysis was performed on the five-item version of International Index of Erectile Function (IIEF-5), Erection Hardness Score (EHS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the nine-item Patient Health Questionnaire (PHQ-9), the seven-item Generalized Anxiety Disorder Scale (GAD-7), and the incidence of adverse events to comprehensively evaluate the efficacy and safety of LIPUS. RESULTS: The positive response rate of ED and CP/CPPS treatment in Group A is 40%(8/20) and 45%(9/20), while those in Group B is 55%(11/20) and 60%(12/20), and those in Group C is 85%(17/20) and 85%(17/20). A notable increase in IIEF-5 scores was observed across the three groups post-treatment (10.45 ± 2.50 vs. 13.65 ± 3.03, P = 0.008; 11.80 ± 3.21 vs. 16.40 ± 3.20, P = 0.011; 12.90 ± 3.92 vs. 19.40 ± 2.35, P = 0.042) with a concomitant significant decrease in NIH-CPSI scores (16.75 ± 4.53 vs. 14.65 ± 4.51, P = 0.016; 16.35 ± 4.32 vs. 12.20 ± 4.74, P = 0.007; 16.00 ± 4.40 vs. 8.15 ± 4.28, P = 0.021). Notably, the most pronounced changes were seen in the group receiving LIPUS combined with tadalafil and doxazosin. Additionally, all groups exhibited marked improvements in anxiety and depression symptoms post-treatment. No adverse events were observed during treatment. CONCLUSION: LIPUS can improve erectile function and CP/CPPS symptoms with good safety, and LIPUS combined with tadalafil and doxazosin is more effective during the treatment. However, its long-term efficacy remains to be seen. TRIAL REGISTRATION: Chinese Clinical Trial Registry; approval number: ChiCTR2200063038 ( https://www.chictr.org.cn/ ) on August 29, 2022.

Potential genetic association between coffee/caffeine consumption and erectile dysfunction: a Mendelian randomization study and meta-analysis.

Background: Coffee is a widely consumed beverage with potential benefits for various chronic diseases. Its effect on reducing erectile dysfunction (ED) risk is unclear. This Mendelian randomization (MR) study investigates the impact of coffee/caffeine consumption on ED. Methods: Two sets of coffee consumption-associated genetic variants at the genome-wide significance level were obtained from recent studies of coffee consumption. Taking into account other sources of caffeine, genetic variants associated with caffeine consumption from tea were also obtained. The inverse variance weighted (IVW) method was utilized as the primary analysis. Sensitivity analysis methods and meta-analysis methods were performed to confirm the robustness of the results, while the genetic variants associated with confounders, e.g., diabetes and hypertension, were excluded. Results: Genetically predicted coffee/caffeine consumption was unlikely to be associated with the risk of ED in the Bovijn datasets, with similar directional associations observed in the FinnGen datasets. The combined odds ratio for ED was 1.011 (95% CI 0.841-1.216, p=0.906) for coffee consumption from the genome-wide meta-analysis, 1.049 (95% CI 0.487-2.260, p=0.903) for coffee consumption from the genome-wide association study, and 1.061 (95% CI 0.682-1.651, p=0.793) for caffeine from tea. Conclusion: Using genetic data, this study found no association between coffee/caffeine consumption and the risk of ED.

Twisting of Inflatable Penile Prosthesis Tubing Leading to Device Malfunction and Required Explantation: A Rare Complication.

Erectile dysfunction (ED), the impairment of achieving and maintaining an erection for satisfactory sexual intercourse, is a common pathology that men experience for a variety of different factors. Conservative treatment for ED includes changing medications, lifestyle modifications, and psychotherapy. Pharmaceutical and nonsurgical interventions include phosphodiesterase-5 inhibitors(PDE-5i), intracavernosal medication injections, and vacuum devices. Surgical treatment options for ED have evolved over time and currently include the use of inflatable penile prosthesis (IPP) and malleable penile prosthesis. IPP insertion is usually met with good patient satisfaction. However, complications of device insertion can include corporal perforation, urethral injury, cylinder erosion or extrusion, infection, and mechanical failure, to name a few. Our patient presented with device malfunction and intraoperative assessment showed the IPP tubing twisted at the levels of the reservoir on the first operation and the level of the cylinder and scrotal pump on the second operation. The twisting of the tubing resulted in a nonfunctioning IPP as the fluid was unable to fill the cylinders resulting in an erection. The patient was managed with complete device explanation and reinsertion of a new three-piece IPP per the patient and partner's request. This is the first case report highlighting this specific complication, and we hope to provide clinicians with the resources to recognize this rare complication.

Regenerative therapies for erectile dysfunction: a systematic review, Bayesian network meta-analysis, and meta-regression.

BACKGROUND: Current guidelines advocate a shared decision-making process approach to erectile dysfunction management, and while there is growing interest in regenerative therapies such as stem cell therapy, platelet-rich plasma injections, and low-intensity shockwave therapy for erectile dysfunction, comparative data on the efficacy of these modalities are limited. AIM: This systematic review and network meta-analysis aims to compare stem cell therapy, platelet-rich plasma injections, and low-intensity shockwave therapy for managing erectile dysfunction and quantify their impact on the International Index of Erectile Function (IIEF). METHODS: In January 2024, a systematic search of online databases was performed to identify randomized clinical trials related to stem cell therapy, platelet-rich plasma injections, and low-intensity shockwave therapy in erectile dysfunction. Eligible articles reported outcomes using the IIEF score. Data were inputted into Review Manager 5.4 for pairwise meta-analysis. Data were then used to build a network in R Studio. These networks were used to model 200 000 Markov Chains via MonteCarlo sampling. The results are expressed as standardized mean difference (SMD) with 95% credible intervals (CrI). Meta-regression was used to adjust for PDE5is use. OUTCOMES: Impact on the International Index of Erectile Function. RESULTS: A total of 16 studies involving 907 patients were analyzed. The standardized mean difference (SMD) vs control for stem cell therapy was 0.92 [95% CrI -0.49, 2.3]. For platelet-rich plasma, the SMD vs control was 0.83 [95% CrI 0.15, 1.5], and for low-intensity shockwave therapy, the SMD vs control was 0.84 [95% CrI 0.49, 1.2]. When stratifying low-intensity shockwave therapy by dose, the SMD vs control at 0.15 mJ/mm2 was 1.1 [95% CrI 0.36, 1.9], while at 0.09 mJ/mm2, it was 0.75 [95% CrI 0.26, 1.2]. Meta-regression adjusting for the administration of PDE5 inhibitors yielded non-significant results. CLINICAL IMPLICATIONS: The findings suggest that stem cells, platelet-rich plasma, and low intensity shockwave therapy, particularly at 0.15 and 0.09 mJ/mm2, may offer improvements in erectile function. STRENGTHS AND LIMITATIONS: The strength is the robust statistical methods. Limitations are in heterogeneity in control groups and follow-up durations among included studies. CONCLUSION: Shockwave therapy and platelet-rich plasma demonstrated statistically significant improvements, though the clinical relevance and extent of their impact remain questionable. Further research is necessary to determine the efficacy of stem cell therapies for erectile function.

Perceptions of prostate cancer patients undergoing definitive radiotherapy on the impact of prostate cancer and radiation therapy on male sexuality.

Introduction: Male sexual function is an important aspect of the life of prostate cancer patients and plays a significant role in the long-term quality of life of prostate cancer survivors. However, there is a paucity of published literature on the perceived impact of prostate cancer and its treatment on the sexual function of patients in Ghana and West Africa in general. The purpose of this study was to explore the perceptions of prostate cancer patients on the effects of the disease and radiation therapy on male sexual function. The study also examined the changes in sexuality experienced by men with prostate cancer. Methods: This research was a descriptive longitudinal study conducted at the third largest hospital in Africa. The study included Ghanaian prostate cancer patients of all ages who were treated with definitive radiotherapy at the study site between October 2021 and May 2022. Quantitative data were collected and analysed using the Statistical Package for Social Sciences version 26.0 and Microsoft Excel 2019. Descriptive statistics were used to determine frequencies and percentages of the demographic characteristics. Results: The mean age of the participants was 65.7 years (SD 6.7) ranging from 50 to 81 years. Patients had different ideas about the potential adverse effects of prostate cancer (86%) and radiotherapy (70%) on male sexual function. A decrease in sexual desire (54%) was the commonest perceived effect of prostate cancer on male sexual function followed by premature ejaculation (49%) and a decrease in sexual activity (48%). On the other hand, erectile dysfunction (49%) was the commonest perceived effect of radiotherapy for prostate cancer on male sexual function followed by a decrease in sexual desire (38%) and premature ejaculation (37%). Health professionals were the major source of information regarding the perceptions of the patients on the effects of both prostate cancer (46%) and radiation therapy (43%) on male sexual function. Conclusion: There should be enhancement of awareness measures to educate Ghanaian cancer patients on the side effects and implications of treatment on their sexuality. Comprehensive sexual health assessment should be incorporated in the routine care of patients with cancers that have the potential to impact the sexual function of patients.

Sexual effects and long-term outcomes of endoscopic lumbar sympathectomy for plantar hyperhidrosis in men: a cross-sectional study.

Background: Plantar hyperhidrosis (PHH) is a disease with high psychosocial impact, and endoscopic lumbar sympathectomy (ELS) has been shown to be the best choice for treatment, but with some concerns such as compensatory sweating (CS) and sexual effects (SE), particularly in men. Objectives: The aim of this study is to evaluate the long-term effectiveness of ELS for controlling PHH in men, its side effects, and perceived sexual modifications. Methods: A cross-sectional study including only male patients operated for PHH with ELS between 2014-2022 at a private practice. During remote interviews, patients were asked about symptoms before and after ELS and about the postoperative effects on PHH. They were also objectively asked about any SE during the postoperative period. Validated quality of life for hyperhidrosis and erectile function questionnaires were also administered. Results: 10 male patients averaging 4.26±2.86 years post-ELS were interviewed. Eight of them (80%) achieved complete response (≥80% of sweat reduction) in the first month after surgery and this response was maintained up to the interview date. Two patients had partial response. In six patients, CS occurred, with 5 reporting it as non-troublesome. Six patients reported some type of SE, but none reported erectile dysfunction. Regarding the functional results, all patients rated ELS from good (10%) to very good (30%) or excellent (60%). Conclusions: Endoscopic lumbar sympathectomy was effective for treatment of plantar hyperhidrosis in these patients, improving their quality of life and providing lasting PHH control, with some transient sexual dysfunctions that did not impair their sexual life.

Contexto: A hiperidrose plantar (HHP) é uma doença de alto impacto psicossocial, e a simpatectomia lombar endoscópica (SLE) tem se mostrado a melhor escolha de tratamento. Porém, há algumas preocupações como suor compensatório (SC) e efeitos sexuais (ES), particularmente em homens. Objetivos: O objetivo deste estudo foi avaliar a eficácia a longo prazo da SLE para controlar a HHP em homens, seus efeitos colaterais e as modificações sexuais percebidas. Métodos: Tratou-se de um estudo transversal incluindo apenas pacientes do sexo masculino operados de HHP por meio de SLE entre 2014 e 2022 em consultório particular. Por meio de entrevistas remotas, os pacientes foram questionados sobre os sintomas antes e depois da SLE e sobre a evolução pós-operatória da HHP, assim como foram questionados objetivamente sobre qualquer ES percebido durante o pós-operatório. Também foram aplicados questionários validados de qualidade de vida para hiperidrose e função erétil. Resultados: Foram entrevistados 10 pacientes do sexo masculino com média de 4,26±2,86 anos pós-SLE. Oito deles (80%) obtiveram resposta completa (≥80% de redução do suor) no primeiro mês após a cirurgia e mantiveram a resposta na entrevista. Dois pacientes tiveram resposta parcial. Em seis pacientes, ocorreu SC, com cinco relatando-a como não problemática. Seis pacientes relataram algum tipo de ES, mas nenhum apresentou disfunção erétil. Todos os pacientes avaliaram o resultado funcional da SLE como bom (10%), muito bom (30%) ou excelente (60%). Conclusões: A SLE pode tratar de forma eficaz a HHP nesses pacientes, melhorando a qualidade de vida e proporcionando efeitos duradouros no controle da HHP, com algumas disfunções sexuais transitórias que não prejudicam a vida sexual.

Nanotechnology-based drug delivery platforms for erectile dysfunction: addressing efficacy, safety, and bioavailability concerns.

Erectile dysfunction (ED), is a common and multidimensional sexual disorder, which comprises changes among any of the processes of the erectile response such as organic, relational, and psychological. However, both endocrine and nonendocrine causes of ED produce substantial health implications including depression and anxiety due to poor sexual performance, eventually affecting man's life eminence. Marginally invasive interventions following ED consist of lifestyle modifications, oral drugs, injections, vacuum erection devices, etc. Nevertheless, these conventional treatment regimens follow certain drawbacks such as efficacy and safety issues, and navigate to the development of novel therapeutic approaches such as nanomedicine for ED management. Nanotechnology-centred drug delivery platforms are being explored to minimize these limitations with better in vitro and in vivo effectiveness. Moreover, nanomedicine and nanocarrier-linked approaches are rapidly developing science in the nanoscale range, which contributes to site-specific delivery in a controlled manner and has generated considerable interest prominent to their potential to enhance bioavailability, decrease side effects, and avoidance of first-pass metabolism. This review provides an overview of recent discoveries regarding various nanocarriers and nano-delivery methods, along with current trends in the clinical aspects of ED. Additionally, strategies for clinical translation have been incorporated.

Development of a Risk Predictive Model for Erectile Dysfunction at 12 Months after COVID-19 Recovery: A Prospective Observational Study.

Objectives: To develop a risk prediction model for the identification of features involved in the prediction of erectile dysfunction (ED) at 12 months following COVID-19 recovery. Methods: We performed an observational prospective multicentre study. Participants were classified according to their history of COVID-19: (I) patients with a past history of COVID-19 and (II) patients without a previous microbiological diagnosis of COVID-19. A total of 361 patients (past history of COVID-19, n = 166; no past history of COVID-19, n = 195) were assessed from January 2022 to March 2023. Patients with a past history of COVID-19 were assessed at 12 months following COVID-19 recovery. The primary outcome measure was ED, assessed through the 5-item International Index of Erectile Function (IIEF-5). Data concerning epidemiologic variables, comorbidities and active treatment were also collected. We performed a binary logistic regression to develop a risk predictive model. Among the models developed, we selected the one with the higher Area Under the Curve (AUC). Results: The median age was 55 years in both groups. The ED prevalence was 55.9% in patients with past history of COVID-19 and 44.1% in those with no past history of COVID-19. The best predictive model developed for ED comprised 40 variables and had an AUC of 0.8. Conclusions: We developed a regression model for the prediction of ED 12 months after COVID-19 recovery. The application of our predictive tool in a community setting could eventually prevent the adverse effects of ED on cardiovascular health and the associated unfavourable economic impact.

Influence of Mediterranean Diet on Sexual Function in People with Metabolic Syndrome: A Narrative Review.

Metabolic syndrome (MS), a cluster of cardiometabolic disorders, and sexual dysfunction are two conditions that impact a large proportion of the general population. Although they can occur independently, they are frequently linked and significantly affect people's quality of life. In recent years, research has increasingly focused on the importance of diet, particularly the Mediterranean diet (MD), in modulating sexual function due to its anti-inflammatory, antioxidant, and vasodilatory properties. In this narrative review, we examined the relationship between MS and sexual function in both men and women, with a special emphasis on the MD's therapeutic efficacy in improving sexual dysfunction. In men, MD has been shown to ameliorate erectile dysfunction, as well as several sperm parameters, perhaps leading to improved fertility. On the other hand, adherence to MD has been demonstrated to partially recover several sexual dysfunctions in women, such as those related to their menstrual cycle, menopause, endometriosis, and polycystic ovary syndrome. These favorable effects of MD have been demonstrated in both sexes also among people affected by MS. However, more targeted studies are needed to validate these data for different dietary approaches as well.

A Case Report on 46,XX Male Difference of Sex Development.

The 46,XX male syndrome is a very rare disorder/difference of sex development (DSD). Characterized by a 46,XX karyotype with a male phenotype and various abnormalities, including virilized external genitalia, small testes, hypergonadotropic hypogonadism, and azoospermia. Primarily described in small population studies and clinical reports, much remains to be understood about the prevalence of clinical manifestations, treatment outcomes, and long-term follow-up in this disorder. Here we describe a 24-year-old male who sought medical attention due to a history of erectile dysfunction, associated with a loss of libido, impaired concentration, difficulty sleeping, and bilateral gynecomastia. He and his family had no relevant medical history. On physical examination, the patient had a normal development of secondary sexual characteristics but presented with bilateral testicular atrophy with a volume of 6 ml per testis. A testicular and abdominal ultrasound were performed confirming testicular atrophy and finding no other abnormalities. Laboratory analysis revealed a hypergonadotropic hypogonadism with normal prolactin, thyroid stimulating hormone, hemoglobin, hematocrit, and kidney and liver function. The spermiogram, performed twice, revealed azoospermia. A bone densitometry was also performed, reporting osteopenia in the lumbar spine and left hip. A karyotype test was performed revealing a 46,XX (SRY-positive) DSD. The patient started on therapeutic supplementation with testosterone showing marked improvement of his libido, erectile dysfunction, and return of testosterone to levels within range. The patient and his partner were referred to infertility outpatient care and subsequently opted for in vitro fertilization using a sperm donor. This case report highlights the need for clinical practical awareness of this rare disorder and its wide phenotypical spectrum while also focusing on important aspects of the current literature regarding its approach and treatment. The limited data on long-term management suggest that there is a need for specialized multicenter follow-up not only to ensure a better understanding of this disorder but also to provide a better care on the quality of life and healthy well-being of this patients.

Safety and efficacy of platelet-rich plasma injection for treatment of erectile dysfunction: a prospective randomized controlled study.

BACKGROUND: Affected sexual relationships affect both the quality of life of men and women. Platelet-derived therapies are becoming increasingly popular in various medical and surgical fields because of their ability to aid in tissue healing and vascular remodeling. This study aimed to assess the safety and effectiveness of platelet-rich plasma (PRP) injections in treating patients with erectile dysfunction (ED). RESULTS: Fifty-two participants with mild to moderate ED were divided into two groups: group A, who received three PRP penile injections, and group B, who received three saline injections (5 ml for each injection site). The International Index of Erectile Function (IIEF) was used to evaluate all participants. A month after the last injection, the PRP group's IIEF was 16.12 ± 1.25, while the placebo group's was 15.99 ± 1.21 (p = 0.683). Following a 3-month period, the IIEF for the PRP group was 16.44 ± 1.17, while the placebo group's was 16.31 ± 1.06 (p value = 0.653). Following a 6-month period, the IIEF for the PRP group was 16.35 ± 1.45, while that for the placebo group's was 16.23 ± 1.19 (p = 0.727). In terms of IIEF, there was no significant difference between the two groups after one, three, and six months of treatment. CONCLUSION: In brief, our research revealed no data to support the application of PRP injections in the management of mild-to-moderate ED.

RéSUMé: CONTEXTE: Une altération des relations sexuelles affecte à la fois la qualité de vie des hommes et des femmes. Les thérapies dérivées des plaquettes deviennent de plus en plus populaires dans divers domaines médicaux et chirurgicaux, en raison de leur capacité à aider à la guérison des tissus et au remodelage vasculaire. La présente étude visait à évaluer l'innocuité et l'efficacité d'injections de plasma riche en plaquettes (PRP) dans le traitement des patients atteints de dysfonction érectile (DE). RéSULTATS: Fifty-two participants atteints de dysfonction érectile légère à modérée ont été divisés en deux groupes: le groupe A, qui a reçu trois injections de PRP dans le pénis, et le groupe B, qui a reçu trois injections de solution saline (5 ml pour chaque site d'injection). L'indice international de la fonction érectile (IIEF) a été utilisé pour évaluer tous les participants. Un mois après la dernière injection, l'IIEF du groupe PRP était de 16,12 ± 1,25, tandis que celui du groupe placebo était de 15,99 ± 1,21 (p = 0,68). Trois mois après la dernière injection, l'IIEF pour le groupe PRP était de 16,44 ± 1,17, tandis que celui du groupe placebo était de 16,31 ± 1,06 (valeur p = 0,65). Enfin, 6 mois après la dernière injection, l'IIEF pour le groupe PRP était de 16,35 ± 1,45, tandis que celui du groupe placebo était de 16,23 ± 1,19 (p = 0,73). En ce qui concerne l'IIEF, il n'y avait pas de différence significative entre les deux groupes après un, trois et six mois de traitement. CONCLUSION: En bref, notre recherche n'a révélé aucune donnée en faveur de l'application des injections de PRP dans la prise en charge de la dysfonction érectile légère à modérée.

Age-Dependent Effects of Homocysteine on Erectile Dysfunction Risk Among U.S. Males: A NHANES Analysis.

Erectile dysfunction (ED) is a common problem that seriously impacts men's quality of life and mental health. Earlier studies have indicated that homocysteine (HCY) levels might be linked to the risk of ED, although these studies are limited by small sample sizes and insufficient correction for confounding factors. This study uses data from the 2001-2004 National Health and Nutrition Examination Survey (NHANES) to evaluate the relationship between HCY levels and ED risk in U.S. adult males. The analysis involved using a weighted generalized linear model to assess main effects and restricted cubic splines (RCS) to explore nonlinear relationships. Results showed that the association between HCY and ED was not statistically significant after adjusting for covariates. However, interaction analyses between age and the HCY-ED relationship showed that as age increases, the impact of HCY on ED strengthens. Based on this, subgroup analysis by age was carried out, revealing that in people aged 50 and above, HCY levels were significantly positively correlated with ED, especially when HCY levels exceeded 9.22 µmol/L, significantly increasing the risk of ED. Sensitivity analysis further confirmed the robustness of these findings. This study indicates that controlling HCY levels, especially in middle-aged and older men, might help prevent and treat ED, providing a foundation for future preventive strategies.

The Intersection of Artificial Intelligence, Wearable Devices, and Sexual Medicine.

PURPOSE OF REVIEW: The aim of our review paper is to provide a comprehensive overview of the current technologies in artificial intelligence and wearable devices dedicated to sexual health. RECENT FINDINGS: Currently, AI-powered technologies are enhancing our understanding of reproductive health and sexually transmitted infections, and facilitating empathetic education and outreach to diverse populations. Additionally, innovative wearable devices are providing insights into men's erectile health, addressing ejaculatory concerns, and exploring women's orgasms in relation to pelvic floor muscles and clitoral blood flow. The field of sexual health technology is rapidly expanding, with recent innovations transforming our understanding of sexual health. As technology progresses, it is crucial to address significant ethical considerations to protect users, particularly due to the sensitive nature of the data involved.

NLRP3 inhibitor combined with Yimusake improves erectile dysfunction in rats with diabetes mellitus through the attenuation of pyroptosis.

Erectile dysfunction (ED) is a prevalent complication associated with diabetes mellitus (DM), yet pharmacological treatments for diabetes-related erectile dysfunction (DMED) continue to be inadequate in clinical settings. Our previous studies have indicated that there is a close correlation between ED and pyroptosis, but the specific mechanism remains unclear. In this study, we sought to explore the therapeutic effects of DMED through the modulation of NLRP3, aiming to elucidate its potential molecular mechanisms. The DMED rat model was established via intraperitoneal injection of streptozotocin. The rats were randomly assigned to the control group, the DMED group, the Yimusake group, the MCC950 (NLRP3 inhibitor) group, and the MCC950+Yimusake group. Erectile function of rats was observed by measuring intracavernosal pressure (ICP) and mean arterial pressure (MAP). HE staining was performed to observe the histopathological changes in penile; immunofluorescence was performed to measure the level of CD31 (Platelet endothelial cell adhesion molecule-1) in penile. Besides, immunohistochemistry, RT-qPCR and Western blot were performed to demonstrate the expression of NLRP3, caspase-1, IL-1ß and eNOS. After treatment with the MCC950 and Yimusake, the number of blood sinusoids and small vessels significantly reduced in penile tissue; NLRP3, caspase-1, IL-1ß proteins and mRNA expression decreased, eNOS protein and mRNA expression increased. Compare with the Y group and the MCC950 group, MCC950+Yimusake group had a more significant effect. MCC950 and Yimusake might potentially suppress pyroptosis in the penile tissue of DMED rats by modulating the NLRP3/caspase-1 pathway, thus enhancing erectile function. This discovery could offer a promising therapeutic approach for individuals with DMED.

Microsurgical penile revascularization for ischemic erectile dysfunction:Cumulative effective rate over time and factors affecting surgical outcomes.

OBJECTIVES: This study aimed to clarify the cumulative effectiveness of microsurgical penile revascularization over time and factors that affect surgical outcomes. SUBJECTS AND METHODS: This study analyzed 114 men with a median age of 30.5 years. They had localized arterial lesions on the internal pudendal artery by angiography. They underwent the anastomosis of the distal end of the inferior epigastric artery to the dorsal artery of the penis with 11-0 sutures. RESULTS: The final cumulative effectiveness rate calculated by the Kaplan-Meier method was 92.5%. The 1- and 3-year cumulative effectiveness rates were 58.0% and 92.5%, respectively. Twenty-one patients were not cured during the study. Age was a factor significantly affecting the surgical outcomes (p=0.018), and the peak systolic and end-diastolic velocities on Doppler ultrasound, corporal veno-occlusive dysfunction, and venous ligation were less significant (p=0.290, p=0.559, p=0.054, and p=0.732, respectively). CONCLUSION: The final cumulative effectiveness rate of penile revascularization was 92.5%. Latency was observed until cure, half of the cases were cured in approximately 10 months. Cavernous function appears to be reversible and cavernous dysfunction was not a significant factor in surgical outcome. J. Med. Invest. 71 : 219-224, August, 2024.