Association between erectile dysfunction and the severity of obstruction to airflow in patients with chronic obstructive pulmonary disease / Asociación entre disfunción eréctil y la severidad de la obstrucción al flujo aéreo en pacientes con enfermedad pulmonar obstructiva crónica

Objectives: The objective of this study was to explore a possible association between ED and the severity of airflow obstruction in patients with COPD. Materials and methods: A cross-sectional study was conducted using the International Index Erectile Function (IIEF), a scale validated and translated to Spanish. Bivariate analyses between subgroups were made for quantitative variables using a t-test for means and Mann­Whitney U for medians; qualitative variables were compared using the χ2 test or Fisher's test, depending on distribution. Confusion bias in the association between ED and airflow obstruction was controlled using a logistic regression model. Results: The Spanish version of the IIEF-15 scale was valid and applicable to the Colombian population. The prevalence of ED in COPD patients living at high altitudes was similar to that found at sea level. Such prevalence is higher than in general population. Beta-blockers increased 7 times the risk of ED, but we found no association between the degree of airflow obstruction and ED. Conclusion: Although the severity of COPD is not associated with ED, the prevalence of ED in COPD is higher than in general population. Therefore, ED screening in COPD patients using the IIEF could be justified. The strong association between beta-blockers and ED had not been previously described in patients with COPD but must be considered in their clinical management.

Objetivos: Explorar una posible asociación entre DE y severidad de la obstrucción al flujo aéreo en pacientes con EPOC. Materiales y métodos: Estudio de corte transversal aplicando el Índice Internacional de Función Eréctil (IIFE), validado y traducido al español. Se realizó análisis bivariado para variables cuantitativas usando prueba-t para medias y U de Mann Whitney para medianas; las variables cualitativas fueron comparadas usando prueba de Chi2 o test de Fisher, según distribución. Los sesgos de confusión en la asociación entre DE y obstrucción al flujo aéreo fueron controlados usando un modelo de regresión logística. Resultados: La versión en español de la escala IIFE-15 fue aplicable en población colombiana. La prevalencia de DE en pacientes con EPOC viviendo a gran altura fue similar a lo encontrado a nivel del mar. Esta prevalencia es mayor que en población general. El uso de beta-bloqueadores aumentó hasta siete veces el riesgo de DE, pero no se encontró asociación entre el grado de obstrucción y la DE. Conclusiones: Aunque la severidad de la EPOC no está asociada con DE, la prevalencia de DE en EPOC es mayor que en población general. Está justificada la realización de tamizaje usando el IIFE. La asociación fuerte entre beta-bloqueadores y DE no se ha descrito previamente en pacientes con EPOC, pero debe considerarse en su manejo.

An Insight into the Role of Periodontitis as a Potential Risk Factor for Development of Erectile Dysfunction

ABSTRACT@#Erectile dysfunction (ED) is one of the common sexual disorders affecting many men worldwide. Owing to shared common risk factors, periodontitis is related to ED. However, the prevalence of periodontitis among Malaysian patients with ED is currently unknown. This study aimed to investigate the prevalence of periodontitis in patients with ED in Malaysia and the factors associated with this relationship. Forty-one subjects aged 27–59 years old were recruited to participate in this study. The International Index of Erectile Function (IIEF-5) was used in assessing the presence of ED. Their periodontal health was assessed through comprehensive periodontal examination including plaque index, bleeding on probing and clinical attachment level. The subjects were categorised according to the severity of their periodontal health and ED. A questionnaire on general health and oral habits was administered. The prevalence of periodontitis (95.5%) among subjects with ED was significantly higher than those without ED (52.6%). Subjects with ED had the worst periodontal health, as indicated by the mean clinical attachment loss and percentage of sites with bleeding on probing. No differences in oral hygiene habits were found between subjects with and without ED. The prevalence of periodontal disease among Malaysian patients with ED was high. Periodontitis was positively associated with the severity of ED, supporting a dose-dependent association between the two diseases. Oral hygiene habits were not significantly related to any periodontitis parameters nor were significantly different between subjects with and without ED.

Prevalence of Periodontitis in Erectile Dysfunction Patients

ABSTRACT@#Erectile dysfunction (ED) and periodontitis have common risk factors, such as diabetes mellitus and tobacco smoking. Multiple reports are available in regard to the association between ED and chronic periodontitis (CP). The study aimed to determine the association of ED and CP in selected Malaysian population. In this study, 74 patients (mean age = 52.4 ± 10.9 years old) diagnosed with ED, from scores via the International Index of Erectile Function (IIEF-5) questionnaire, were included. ED severity was classified as mild, mild to moderate, moderate, and severe. Periodontal condition was recorded using basic periodontal examination (BPE) method, of which scores of 0, 1, 2, and 3 were associated with having no periodontitis while a score of 4 was considered to have periodontitis. There are 40 (54.1%) subjects found to have periodontitis and the association of ED and periodontitis showed a moderate positive degree of correlation, ρ = 0.487 (p < 0.001). The percentage of subjects having periodontitis indicated an increasing trend with the severity of ED; from 19.0% (mild ED), 54.2% (mild to moderate ED), 75.0% (moderate ED), to 84.6% (severe ED). A greater degree of correlation was noted between dental scaling experience and ED, ρ = 0.635 (p < 0.001). Binomial logistic regression had shown no other co-morbidities and factors were affecting this relation. There seemed to be an association between ED and periodontitis existing in these selected Malaysian populations.

The efficacy of non-transecting uerthroplasty in the management of bulbar urethral stricture / 中华泌尿外科杂志

Objective:To compare efficacy and erectile function outcome of Non-transecting Urethroplasty (NTU)with excision and primary anastomotic urethroplasty(EPA) in the management of bulbar urethral stricture.Method:A retrospective analysis of the case data of 73 patients with bulbar urethral stricture admitted to Shanghai Sixth People's Hospital from January 2016 to December 2019. The patients are 18 to 60 years old, because of the stenosis of the bulbous urethra, the length of the stenosis is less than 2 cm, and there is no history of urethral surgery, no multiple urethral stricture, and no obvious ED before surgery. According to the operation method, the patients were divided into 25 cases in NTU group and 48 cases in EPA group. The ages of the NTU group and the EPA group were (39.2±9.4) years and (42.1±9.3) years, respectively. The course of the disease was 6.0(3.0-14.0) months and 6.5(3.0-11.0) months, respectively, and the body mass index was (23.7±3.2) kg/m 2 and (24.5±2.7) kg/m 2, the preoperative maximum urine flow rate (Q max) was (8.7±4.3) ml/s and (7.9±4.6) ml/s, respectively, and the length of the stenosis was respectively (1.7±0.4) cm and (1.8±0.2) cm, the preoperative International Erectile Function Questionnaire (IIEF-5) was (20.9±1.9) points and (21.3±2.1) points, respectively, the difference was not statistically significant ( P>0.05). The etiology of NTU group and EPA group were 8 cases (32.0%) and 31 cases (64.6%) of trauma, 11 cases (44.0%) and 9 cases (18.8%) of iatrogenic injury, and 6 cases (24.0%) and 8 cases (16.7%), the difference was statistically significant ( P=0.023). All operations were performed by the same team of doctors. The urethral scar was assessed during the operation. If the scar tissue can be completely removed without breaking the urethra, NTU is performed. The distal end of the urethra is cut at the dorsal side of the narrow segment of the urethra, and the urethral scar is removed in a transverse wedge shape. The urethra is sutured; otherwise, EPA is performed, the urethra is completely cut off, the stricture of the urethra and surrounding scar tissue is completely removed, and the urethra end-to-end anastomosis is performed. Record the operation time and intraoperative bleeding. Difficulty urinating after surgery, urethral microscopy and urethral angiography showed that the urethral stricture at the surgical site was defined as a failure of the operation. The urinary catheter was removed 3 weeks after surgery, urine flow rate was measured at 3 weeks, 6 months, and 12 months after surgery, erectile function was evaluated 12 months after surgery, and urethral angiography was performed 1 to 2 years after surgery. Result:All 73 operations in this study were successfully completed. The operation time of NTU group and EPA group were (67.6±11.3) min and (62.7±10.1) min, respectively, and the difference was not statistically significant ( P=0.063); intraoperative blood loss was (71.6±16.2) ml and (86.0±20.8) ml, the difference was statistically significant ( P=0.004). The postoperative median follow-up time was 18.0 months (13-38 months). The surgical success rates of the NTU group and EPA group were 92.0%(23/25) and 93.8%(45/48), respectively. The Q max of the NTU group and the EPA group were (26.7±3.6) ml/s and (28.1±8.7) ml/s, (25.2±3.5) ml/s and (26.7±8.1) ml/s, (25.0±4.3) ml/s and (26.2±7.2) ml/s; the IIEF-5 scores were (21.8±1.6) and (20.6±2.9) points respectively at 12 months after operation, the difference was both No statistical significance ( P>0.05). There was a statistically significant difference in IIEF-5 between NTU group and preoperative ( P=0.023). Conclusion:NTU can achieve the same outcomes as EPA in the management of bulbar urethral stricture. More importantly, the continuance of bulbar urethra is attained and avoiding rupture of bulbar cavernous artery, so as to protect the blood supply of penile and erectile function. NTU is a minimally invasive, feasible surgical method, which is advised for the patients with shorter stricture segment and fewer fibrosis.

The efficiacy and safety of refined extroperitoneal intrafascial laparoscopic radical prostatectomy in localized prostate cancer / 中华泌尿外科杂志

Objective:This paper intends to explore the clinical efficacy and safety of the refined extroperitoneal intrafascial laparoscopic radical prostatectomy in patients with localized prostate cancer.Methods:The data of 107 patients with localized prostate cancer who were underwent laparoscopic radical prostatectomy in our hospital from July 2013 to January 2020 were analyzed retrospectively. According to the operation methods, the patients were divided into two groups: the refined intra fascial resection group (59 cases) and the conventional interfascial neurovascular bundle reservation group(48 cases). There was no significant different comparing the age [(61.8±8.9) years vs. (62.2±8.1) years, P=0.71], body mass index (BMI) [(24.8±1.3) kg/m 2 vs.(24.3±1.4) kg/m 2, P=0.89], preoperative total prostate specific antigen (PSA) [(6.8±0.9) ng/ml vs. (7.2±1.1) ng/ml, P=0.44], prostate volume [(47.9±18.4) ml vs. (48.3±17.9) ml, P=0.67] between the modified group and the conventional group. The clinical stage of the two groups was both in cT 1-T 2aN 0M 0, and the preoperative Gleason score was less than or equal to 7 ( P=0.76). In the improved group, the bilateral pelvic floor fascia was not dissected, the dorsal deep vein complex was not sutured, the denonvillier fascia was kept intact, the prostate was dissected by intrafascial technique, and the bilateral vascular and nerve bundles were completely preserved. After anastomosing the urethra and bladder neck, the bilateral prostate fascia, the pubic bladder-prostate ligament, DVC and the anterior wall of bladder neck were continuously sutured with 3-0 barbed wire in order to anatomically reconstructe the anterior suspension system. The preoperative data, intraoperative condition, postoperative pathological stage, positive margin rate and postoperative 6-month's follow-up, especially incontinence and erectile function were compared between the two groups. Results:There was no significant difference between the two groups in the basic clinical data, intraoperative bleeding volume[(90.6±26.4)ml vs.(105.3±34.1)ml, P>0.05], prostate-specific antigen 6 weeks after operation[(0.08±0.06)ng/ml vs.(0.09±0.07) ng/ml, P>0.05], postoperative pathological stage and positive margin rate(12.5% vs. 11.9%, P>0.05). In the early postoperative stage, patients performed a significantly better continence. Continence rate in 1 week: 16.7%(8/48) vs. 52.5%(31/59)( P<0.05), in 1 month: 29.2%(14/48)vs. 64.4%(38/59)( P<0.05), and in 3 month 52.1%(25/48) vs. 77.9%(46/59)( P<0.05). And also a better erectile function recovery rate in 1 month: 8.3%(4/48) vs. 23.7%(14/59)( P<0.05), in 3 month: 27.1%(13/48) vs. 49.2%(29/59)( P<0.05), in refined intrafascial group, but that was not significant different between the two groups 6 months after operation. Conclusion:The refined intrafascial laparoscopic radical prostatectomy can completely reconstruct the anatomic structure adjacent to urethra, and preserve utmostly the pelvic floor muscle, prostate fascia and neurovascular bundle, which are supposed to facilitate the revovery of urinary incontinence and erectile dysfunction in the early postoperative period.

Relationship of preoperative androgen levels and metabolic syndrome with quality of life and erectile function in patients who are to undergo radical prostatectomy / 亚洲男科学杂志(英文版)

This study aims to investigate whether clinical and biological preoperative characteristics of patients who were to undergo radical prostatectomy were associated with impairment in patient-reported quality of life (QoL) and erectile dysfunction immediately before intervention. We evaluated patient-reported outcomes among 1019 patients (out of 1343) of the AndroCan study, willing to score the Aging Male Symptom (AMS) and the International Index of Erectile Function 5-item (IIEF-5) auto-questionnaires. Univariate linear regression and robust multiple regression were used to ascertain the relationship between demographic, clinical, and hormonal parameters and global AMS or IIEF-5 scores. As a result, most patients (85.1') of the Androcan cohort agreed to complete questionnaires. Significantly higher IIEF-5 global scores were found in non-Caucasian and obese patients, with larger waist circumference, metabolic syndrome, diabetes mellitus, cardiovascular disease, hypertension, high blood sugar, concomitant medications, and hypogonadism, while the AMS global score was significantly higher in patients with larger waist circumference, metabolic syndrome, high blood pressure, raised glycemia, and concomitant medication. The IIEF-5 global score was correlated to age, dehydroepiandrosterone (DHEA), fat mass percentage, and androstenediol (D5). The AMS global score was significantly correlated to DHEA, D5, and DHEA sulfate. Finally, the multivariate models showed that QoL and erectile function were significantly affected, before surgery, by symptoms and signs that are usually considered as pertaining to the metabolic syndrome, while sexual hormones are essentially correlated to erectile dysfunction.

Periprostatic fat thickness measured on MRI correlates with lower urinary tract symptoms, erectile function, and benign prostatic hyperplasia progression / 亚洲男科学杂志(英文版)

This study investigated the correlation between periprostatic fat thickness (PPFT) measured on magnetic resonance imaging and lower urinary tract symptoms, erectile function, and benign prostatic hyperplasia (BPH) progression. A total of 286 treatment-naive men diagnosed with BPH in our department between March 2017 and February 2019 were included. Patients were divided into two groups according to the median value of PPFT: high (PPFT >4.35 mm) PPFT group and low (PPFT <4.35 mm) PPFT group. After the initial evaluation, all patients received a combination drug treatment of tamsulosin and finasteride for 12 months. Of the 286 enrolled patients, 244 completed the drug treatment course. Patients with high PPFT had larger prostate volume (PV; P = 0.013), higher International Prostate Symptom Score (IPSS; P = 0.008), and lower five-item version of the International Index of Erectile Function (IIEF-5) score (P = 0.002) than those with low PPFT. Both high and low PPFT groups showed significant improvements in PV, maximum flow rate, IPSS, and quality of life score and a decrease of IIEF-5 score after the combination drug treatment. The decrease of IIEF-5 score was more obvious in the high PPFT group than that in the low PPFT group. In addition, more patients in the high PPFT group underwent prostate surgery than those in the low PPFT group. Moreover, Pearson's correlation coefficient analysis indicated that PPFT was positively correlated with age, PV, and IPSS and negatively correlated with IIEF-5 score; however, body mass index was only negatively correlated with IIEF-5 score.

Effect of modified holmium laser enucleation of the prostate on sexual function in the treatment of benign prostatic hyperplasia / 上海交通大学学报（医学版）

Objective : To study the effect of modified holmium laser enucleation of the prostate (HoLEP) on sexual function in patients with benign prostatic hyperplasia (BPH). Methods ¡¤ The clinical data of 167 middle-aged and elderly patients with BPH treated by modified HoLEP from Feb. 2017 to Oct. 2018 were retrospectively analyzed. According to the status of sexual activity after operation, the patients were divided into study group who had sex (65 cases) and control group who had no sex (102 cases). The risk factors of sexual activity after operation in the two groups were analyzed. The changes of erectile function and ejaculatory function in the study group before and after operation were recorded and analyzed by international index of erectile function (IIEF-5) score, erection hardness score (EHS) model and ejaculatory function question-naire. Results ¡¤ There were no significant differences between the two groups in the stress urinary incontinence, postoperative hospitalization time, weight of enucleated prostate, crush time, total prostate specific antigen, preoperative urinary retention and enucleation time. The patients in the study group were younger than those in the control group (P=0.000). There were no significant differences in IIEF-5 score and EHS in the study group before and 1, 3, 6 months after operation. There were no significant differences in shorten ejaculation latency, ejaculation pain and ejaculation with or without semen in the study group before and after operation, but the patients of decreased semen volume increased from 41.82% (23/55) to 92.73% (51/55) (P=0.000). Conclusion ¡¤ Age is a risk factor in BPH patients, whether there is sexual activity after modified HoLEP or not. The modified HoLEP has no significant effect on erectile function, but the effect on ejaculatory function is the decrease of ejacu-lated semen volume.

Prevalence of and risk factors for erectile dysfunction in young nondiabetic obese men: Results from a regional study / 亚洲男科学杂志(英文版)

Erectile dysfunction (ED), a condition closely related to cardiovascular morbidity and mortality, is frequently associated with obesity. In this study, we aimed to determine the prevalence of ED and evaluate the associated risk factors in a cohort of 254 young (18-49 years) nondiabetic obese (body mass index [BMI] ≥ 30 kg m-2) men from primary care. Erectile function (International Index of Erectile Function [IIEF-5] questionnaire), quality of life (Aging Males' Symptoms [AMS scale]), and body composition analysis (Tanita MC-180MA) were determined. Total testosterone was determined using high-performance liquid chromatography-mass spectrometry. Multivariate logistic regression analysis was used to study the factors associated with ED. ED prevalence was 42.1%. Subjects with ED presented higher BMI, waist circumference, number of components of the metabolic syndrome, AMS score, insulin resistance, and a more unfavorable body composition than those without ED. Multivariate logistic regression analysis showed that a pathological AMS score (odds ratio [OR]: 4.238, P 40% of subjects. A pathological AMS score, the degree of obesity, and age were positively associated with ED, while elevated HDL-cholesterol levels were inversely associated with the odds of presenting ED. Further prospective studies are needed to evaluate the long-term consequences of ED in this population.

Erectile function after WST11 vascular-targeted photodynamic therapy for low-risk prostate cancer treatment / 亚洲男科学杂志(英文版)

Vascular-targeted photodynamic therapy (VTP) using padeliporfin is currently assessed as a low-risk prostate cancer (LRPCa) treatment. The aim of this study was to assess erectile function outcomes of VTP for LRPCa treatment. We prospectively included all patients treated with VTP for LRPCa. The primary endpoint was the post-treatment International Index of Erectile Function score (IIEF5 score) evolution (at 6 months, 12 months, and then every year for 5 years). Secondary endpoints were the need of erectile dysfunction (ED) treatment and its efficacy. Eighty-two men were included. The median follow-up was 68 (range: 6-89) months. There was a 3-point significant decrease in the median IIEF5 score between baseline and at 6 months post-VTP (23 [range: 1-25] vs 20 [range: 1-25], P = 0.005). There was a 1-point decrease at 1 year and 2 years post-VTP compared to baseline (22 [range: 2-25] and 22 [range: 0-25], P < 0.005). There was no significant difference at 3, 4, and 5 years compared to baseline. Twenty-seven (32.9%) patients received ED treatment: phosphodiesterase type-5 inhibitors (PDEI5; n = 18), intracavernous injections (ICI; n = 9), and intra-urethral gel (n = 1). The median IIEF5 score statistically significantly increased after ED treatment (7 [range: 0-24] vs 21 [range: 1-25], P < 0.001). ED treatment was efficient for 75% of the patients. There was no statistically significant difference between IIEF5 score at baseline and after ED treatment (P = 0.443). Forty-six patients were totally potent before VTP and among them, 13 needed ED treatment post-VTP with a success rate of 69.2%. VTP induced minimal changes in erectile function with a 3-point and a 1-point reduction in the IIEF5 score at 6 months and at 1 year, respectively. When required, ED treatment was efficient.

Human tissue kallikrein-1 protects against the development of erectile dysfunction in a rat model of hyperhomocysteinemia / 亚洲男科学杂志(英文版)

The aim of this study was to investigate the mechanism by which a diet inducing high hyperhomocysteinemia (HHcy) leads to the deterioration of erectile function in rats and whether this is inhibited by expression of the human tissue kallikrein-1 (hKLK1) gene. We established a rat model of HHcy by feeding methionine (Met)-rich diets to male Sprague-Dawley (SD) rats. Male wild-type SD rats (WTRs) and transgenic rats harboring the hKLK1 gene (TGRs) were fed a normal diet until 10 weeks of age. Then, 30 WTRs were randomly divided into three groups as follows: the control (n = 10) group, the low-dose (4% Met, n = 10) group, and the high-dose (7% Met, n = 10) group. Another 10 age-matched TGRs were fed the high-dose diet and designated as the TGR+7% Met group. After 30 days, in all four groups, erectile function was measured and penile tissues were harvested to determine oxidative stress, endothelial cell content, and penis fibrosis. Compared with the 7% Met group, the TGR+7% Met group showed diminished HHcy-induced erectile dysfunction (ED), indicating the improvement caused by hKLK1. Regarding corpus cavernosum endothelial cells, hKLK1 preserved endothelial cell-cell junctions and endothelial cell content, and activated protein kinase B/endothelial nitric oxide synthase (Akt/eNOS) signaling. Fibrosis assessment indicated that hKLK1 preserved normal penis structure by inhibiting apoptosis in the corpus cavernosum smooth muscle cells. Taken together, these findings showed that oxidative stress, impaired corpus cavernosum endothelial cells, and severe penis fibrosis were involved in the induction of ED by HHcy in rats, whereas hKLK1 preserved erectile function by inhibiting these pathophysiological changes.

Brain magnetic resonance imaging in exploring the central neurophysiological mechanisms of penile erection: Progress in studies / 中华男科学杂志

Previous studies have found that penile erection is not only dependent on the peripheral nervous and vascular systems, but also controlled by the central nervous system. Some brain regions are responsible for promoting and suppressing penile erection, respectively. Studies on the brain functions showed both activation and inactivation of the brain regions when receiving sexual stimulation, and those on the brain structure of ED patients revealed atrophy of the gray matter structure and abnormal connection of the white matter fibers. In addition, abnormal connections within emotional, cognitive and default and salience networks were found in patients with psychogenic ED. This article reviews the brain MRI-based studies on the central neurophysiological mechanisms of penile erection, aiming to gain a deeper insight into human neurophysiological mechanisms of the neural circuits controlling erectile function.

Efficacy and safety of low-intensity extracorporeal shock wave therapy in the treatment of ED: A meta-analysis of randomized controlled trials / 中华男科学杂志

Objective@#To evaluate the clinical efficacy and safety of low-intensity extracorporeal shock wave therapy (LI-ESWT) in the treatment of ED based on the available clinical evidence.@*METHODS@#We searched PubMed, MEDLINE, EMBASE, Cochrane Library, CNKI, VIP, CBM and Wanfang Database up to June 2018 for published randomized controlled trials on the treatment of ED by LI-ESWT. We performed literature screening, data extraction and quality evaluation according to inclusion and exclusion criteria, and conducted a meta-analysis of the data obtained using the RevMan 5.3 software.@*RESULTS@#A total of 595 ED cases in 8 double-blind randomized controlled trials (RCT) were included in this study, 362 in the LI-ESWT and 233 in the control group. Compared with the controls, the patients treated by LI-ESWT showed significantly improved IIEF (WMD = 1.70, 95% CI: 0.44－2.96, P = 0.008) and erection hardness score (EHS) (RR = 11.72, 95% CI: 5.13－26.80, P < 0.01). The IIEF scores of the patients were markedly increased at 4 and 24 weeks after LI-ESWT (WMD = 1.43, 95% CI: 0.10－2.75, P = 0.03; WMD = 3.09, 95% CI: 1.49－4.68, P = 0.0002), as well as after the 10th to 12th treatment (WMD = 1.81, 95% CI: 0.31－3.31, P = 0.02) though not after the 5th to 6th (WMD = 1.88, 95% CI: －2.10 to 5.86, P = 0.35). LI-ESWT also significantly increased the IIEF scores in the patients with the baseline IIEF ≥12 (WMD = 2.13, 95% CI: 0.51－3.75, P = 0.01) but not in those with the baseline IIEF ≤11 (WMD = 1.04, 95% CI: －0.96 to 3.03, P = 0.31). No significant adverse events were reported in the 8 RCTs.@*CONCLUSIONS@#As a non-invasive treatment, LI-ESWT is safe and effective and can significantly improve IIEF and EHS in ED patients.

The protective effect of non-transecting urethroplasty on erectile function in patients with posterior urethral stricture / 中华泌尿外科杂志

Objective To explore the erectile function preservational mechanism of Non-transecting urethroplasty(NTU) for posterior urethral stricture.Methods From May 2012 to September 2016,62 patients with posterior urethral stricture,who were treated with NTU,were enrolled in this study.The mean age was 37.5 years old,ranging 18-48 years old.The causes were pelvic fracture urethral injury in 53 cases and iatrogenic injury in 9 cases.Preoperative urethrography and urethroscopy revealed the strictures located in posterior urethra,which was at the distal of verumontanum.The mean length of stricture was 2.1 cm,ranging 0.5-2.5 cm.The average period between trauma and surgery was 6.4 months,ranging 3 months-2 years.All patients had no previous history of urethroplasty.Their sexual hormones were in normal level.Among those patients,the IIEF-5 scores were more than 12 and number of events during NPT test were more than twice.Finally,43 cases were underwent NTU and 19 cases accepted inferior pubectomy (IP)+ NTU.All patients had a general anesthesia.The bulbar urethra was mobilized dorsally from the tunica albuginea of the corpora cavernosa and then extended proximally up toward the perineal membrane.Scar tissue surrounding the urethra was excised and inferior pubectomy (IP) was performed as a supplemental technique to keep the suturing position without tension.The ventral hemi-circumference was then sutured with interrupted 4-0 polyglycolic sutures with tension-free anastomosis.The 18-Fr indwelling catheter was inserted.Result Average follow-up was 20.2 months,ranged from 12 to 36 months.In NTU group,NPT test revealed no significant difference in number of events (2.7 ± 0.7 vs.3.0 ± 1.0,P ＞ 0.05),duration of best episode [(16.4 ± 3.5) min vs.(16.4 ± 3.8) min,P ＞ 0.05)] or tip rigidity [(31.2 ± 4.7) ％ vs.(30.8 ± 3.5) ％,P ＞ 0.05)] between pre-and post-operation,respectively.The IIEF-5 score (19.7 ± 1.9 vs.20.4±2.1,P＜0.05)and Qmax[(8.7 ±4.0)ml/s vs.(25.5 ±4.7)ml/s,P＜0.05)] increased significant pre-and post-operation,respectively.In IP + NTU group,Qmax [(8.4 ± 4.4) ml/s vs.(23.1 ± 3.5)ml/s,P ＜ 0.05)] increased significant pre and post operation.The NPT test revealed slight decrease in number of events(2.3 ± 0.6 vs.1.6 ± 1.0,P ＜ 0.05),duration of best episode [(15.6 ± 2.4) min vs.(14.5±2.4)min,P＜0.05)] or tip rigidity [(29.8±3.0)％ vs.(25.6 ±7.1)％,P＜0.05)] between pre-and post-operation,respectively.However,the IIEF-5 scores (17.3 ± 1.6 vs.16.5 ± 2.1,P ＜ 0.05) didn't show significant difference pre-and post-operation.Stricture recurrence occurred in 3 patients,the success rate was 95.2％ (59/62) during 12 months following.Conclusion NTU is not only a safe and promising procedure for posterior urethral stricture less than 2.5cm,but also a new minimally invasive approach to preserve erectile function.

IcarisideII facilitates the differentiation of ADSCs to SCs via let-7i/STAT3 axis to preserve erectile function

BACKGROUND: IcarisideII (ICAII) could promote the differentiation of adipose tissue-derived stem cells (ADSCs) to Schwann cells (SCs), leading to improvement of erectile function (EF) and providing a realistic therapeutic option for the treatment of erectile dysfunction (ED). However, the underlying molecular mechanisms of ADSCs and ICAII in this process remain largely unclear. METHODS: ADSCs were treated with different concentrations of ICAII. Cell proliferation was determined by MTT assay. qRT-PCR and western blot were performed to detect expressions of SCs markers, signal transducer and activator of transcription-3 (STAT3), and microRNA-let-7i (let-7i). Luciferase reporter assay was conducted to verify the regulatory relationship between let-7i and STAT3. The detection of intracavernosal pressure (ICP) and the ratio of ICP/mean arterial pressure (MAP) were used to evaluate the EF in bilateral cavernous nerve injury (BCNI) rat models. RESULTS: ICAII promoted cell proliferation of ADSCs in a dose-dependent manner. The mRNA and protein levels of SCs markers were increased by ICAII treatment in a dose-dependent manner in ADSCs. Moreover, let-7i was significantly decreased in ICAII-treated ADSCs and upregulation of let-7i attenuated ICAII-induced promotion of SCs markers. In addition, STAT3 was a direct target of let-7i and upregulated in ICAII-treated ADSCs. Interestingly, overexpression of STAT3 abated the let-7i-mediated inhibition effect on differentiation of ADSCs to SCs and rescued the ICAII-mediated promotion effect on it. Besides, combination treatment of ADSCs and ICAII preserved the EF of BCNI rat models, which was undermined by let-7i overexpression. CONCLUSION: ICAII was effective for preserving EF by promoting the differentiation of ADSCs to SCs via modulating let-7i/STAT3 pathway.

Kaempferia parviflora ethanol extract improves self-assessed sexual health in men: a pilot study / 中西医结合学报

<p><b>BACKGROUND</b>Sexual health positively correlates with overall wellbeing. Existing therapeutics to enhance male sexual health are limited by factors that include responsiveness, adherence and adverse effects. As the population ages, safe and effective interventions that preserve male sexual function are needed. Published research suggests that various preparations of Kaempferia parviflora, a plant in the Zingiberaceae (ginger) family, support cardiovascular health and may ameliorate erectile function.</p><p><b>OBJECTIVE</b>The aim of this study was to examine the effects of KaempMax™, an ethanol extract of the K. parviflora rhizome, on erectile function in healthy middle-aged and older men.</p><p><b>DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS</b>We conducted an open-label, one-arm study on 14 generally healthy males aged 50-68 years with self-reported mild erectile dysfunction, who were not using prescription treatments. Participants took 100 mg KaempMax™ daily for 30 days.</p><p><b>MAIN OUTCOME MEASURES</b>Evaluations were conducted at baseline and on the final study assessment. Primary efficacy analyses included the International Index of Erectile Function (IIEF); secondary efficacy analyses included the Global Assessment Question about erectile function.</p><p><b>RESULTS</b>Thirteen participants completed the 30-day study. Supplementation with KaempMax™ resulted in statistically significant improvements in erectile function, intercourse satisfaction and total scores on the IIEF questionnaire. KaempMax™ was well tolerated and exhibited an excellent safety profile.</p><p><b>CONCLUSION</b>Our results suggest that KaempMax™ may improve erectile function in healthy middle-aged and older men. While the effects were not as pronounced as what might be seen with prescription medication, most participants found them satisfactory. Additional, longer and placebo-controlled clinical trials will be needed.</p><p><b>TRIAL REGISTRATION</b>Clinicaltrials.gov identifier NCT03389867.</p>

Validity of premature ejaculation diagnostic tool and its association with International Index of Erectile Function-15 in Chinese men with evidence-based-defined premature ejaculation / 亚洲男科学杂志(英文版)

The premature ejaculation diagnostic tool (PEDT) is a brief diagnostic measure to assess premature ejaculation (PE). However, there is insufficient evidence regarding its validity in the new evidence-based-defined PE. This study was performed to evaluate the validity of PEDT and its association with IIEF-15 in different types of evidence-based-defined PE. From June 2015 to January 2016, a total of 260 men complaining of PE and defined as lifelong PE (LPE)/acquired PE (APE) according to the evidence-based definition from Andrology Clinic of the First Affiliated Hospital of Anhui Medical University, along with 104 male healthy controls without PE from a medical examination center, were enrolled in this study. All individuals completed questionnaires including demographics, medical and sexual history, as well as PEDT and IIEF-15. After statistical analysis, it was found that men with PE reported higher PEDT scores (14.28 ± 3.05) and lower IIEF-15 (41.26 ± 8.20) than men without PE (PEDT: 5.32 ± 3.42, IIEF-15: 52.66 ± 6.86, P < 0.001 for both). It was suggested that a score of ≥9 indicated PE in both LPE and APE by sensitivity and specificity analyses (sensitivity: 0.875, 0.913; specificity: 0.865, 0.865, respectively). In addition, IIEF-15 were higher in men with LPE (42.64 ± 8.11) than APE (39.43 ± 7.84, P < 0.001). After adjusting for age, IIEF-15 was negatively related to PEDT in men with LPE (adjust r =-0.225, P < 0.001) and APE (adjust r =-0.378, P < 0.001). In this study, we concluded that PEDT was valid in the diagnosis of evidenced-based-defined PE. Furthermore, IIEF-15 was negatively related to PEDT in men with different types of PE.

The value of preoperative magnetic resonance imaging in detecting the distribution of neurovascular bundles before the nerve-sparing laproscopic radical prostatectomy / 中华泌尿外科杂志

Objective To investigate the preoperative magnetic resonance imaging (MRI)examination of the distribution of neurovascular bundles (NVB) around the prostatic capsule,and its clinical value in the nerve-sparing laparoscopic radical prostatectomy (NS-LRP).Methods The clinical data of 42 patients with clinically localized prostate cancer who were admitted from January 2008 to January 2017 were retrospectively analyzed.Age ranged from 58 to 74 years,with an average of 68 years.Preoperative serum PSA range from 0.94 to 12.28 ng/dl,with an average of 7.01 ng/dl.Preoperative Gleason score range from 6 to 8,with an average of 6.Clinical stage:T1-T2 37 cases,T3 5 cases.The average preoperative International Erectile Function Index questionnaire-5 (IIEF-5) 21,of which 23 cases had normal erectile function (IIEF-5 ＞ 22).All the 42 patients underwent MRI examination before operation.According to the distribution of NVB around the prostatic capsule,they were divided into 3 groups:17 cases in group A,and no NVB was evident in all cases.In group B,8 cases were visible but not obvious.In group C,17 cases were evident NVB.There was no significant difference in age,preoperative serum PSA and Gleason score between the three groups (P ＞ 0.05).The preoperative IIEF-5 in group A,B,and C were 19.5,22.8,and 21.5,respectively,with no statistically significant difference (P ＞ 0.05).All 42 cases received NS-LRP under general anesthesia.The differences in IIEF-5 before and after surgery were compared between the three groups.Results In this study,42 cases were successfully completed.42 patients were followed up for 12 to 36 months,with an average of 14.1 months.In group A,B,and C,postoperative IIEF-5 was 8.0,14.1,and 15.5,respectively,which was statistically significant compared with preoperative values (P ＜ 0.05).The decrease of IIEF-5 afteroperation in group A was significantly different from that of group Band C (P ＜0.05).Conclusions Compared with patients with visible NVB on MRI examination,patients have no visible NVB observed on MRI with erectile function-related nerves around the prostatic capsule may be walking on both sides of the prostatic capsule and spreading over the entire anterior ventral surface of the prostate.To maxium-preserve NVB and postoperative erectile function to the utmost,NS-LRP surgery should be more accurately dissected on both sides and ventral side of the prostatic capsule.

Adaptación y análisis psicométrico de la versión española del índice internacional de función eréctil (IIEF) en población Chilena / Adaptation and psychometric analysis of the spanish version of the international index of erectile function in Chilean population

Contar con instrumentos validados en Chile para Disfunción Eréctil (DE), motivó el validar la versión española del Índice Internacional de Función Eréctil (IIEF), en población chilena. Se realizó un estudio cuantitativo no experimental transversal, de muestra no probabilística por conveniencia, con 95 varones adultos de tres centros de salud (Concepción, Talcahuano y Santiago), durante Noviembre 2012 y Junio 2013. Expertos ciegos realizaron entrevista clínica utilizando criterios DSM-V y causas médico-quirúrgicas de DE. Luego de aplicación piloto y adaptación del IIEF, se logró la versión IIEF-Ch aplicándola a toda la muestra. Se analizaron los resultados con SPSS 15.0, obteniéndose alta correlación entre variables (X2: 956.533) y alta adecuación muestral (0,893); dos factores que explican el 81.59% de la varianza del instrumento, con alta confiabilidad (.971) y adecuada validez de criterio, alta sensibilidad (84.5%) y especificidad aceptable (91.9%). La IIEF-Ch es un instrumento válido y confiable para estudios sobre DE en Chile.

Having instruments validated in Chile for Erectile Dysfunction (ED), motivated the validation of the Spanish version of the International Index of Erectile Function (IIEF), in Chilean population. A non-experimental quantitative study of non-probabilistic sample was carried out for convenience, with 95 adult males from three health centers (Concepción, Talcahuano and Santiago), during November 2012 and June 2013. Blind experts conducted a clinical interview using DSM-V criteria and medical-surgical causes of ED. After the pilot application and adaptation of the IIEF, version IIEF-Ch was achieved by applying it to the entire sample. The results were analyzed with SPSS 15.0, obtaining high correlation between variables (X2: 956,533) and high sample adequacy (0,893); two factors that explain 81.59% of the variance of the instrument, with high reliability (.971) and adequate criterion validity, high sensitivity (84.5%) and acceptable specificity (91.9%). The IIEF-Ch is a valid and reliable instrument for studies on ED in Chile.

Influence of photoselective vaporization of the prostate on the sexual function of the patient / 中华男科学杂志

n recent years, photoselective vaporization of the prostate (PVP) has gained a wide clinical application in the treatment of benign prostatic hyperplasia (BPH) for its satisfactory effect, high safety, and low incidence of complications. With the improvement of living conditions, BPH patients are paying more attention to their sexual function, especially erectile function and ejaculatory problems instead of just focusing on the alleviation of lower urinary tract symptoms. Few studies of PVP, however, relate to its association with the sexual function of the patient and there is a certain controversy over the influence of PVP on it in the existing literature. Prevailing views hold that the uprated power in PVP does not affect erectile function or increase the risk of retrograde ejaculation (REj) and that PVP is even better than transurethral resection of the prostate (TURP) in avoiding the risk of REj.