Handgrip strength, and erectile dysfunction among men with metabolic syndrome attending an institutional primary care clinic in Malaysia: A cross-sectional study.

Background: Erectile dysfunction (ED) is an independent predictor for cardiovascular diseases (CVD). The prevalence increases with age, but little is known about the relationship between handgrip strength (HGS) and ED, especially among men with a high risk of CVD. This study aimed to determine the prevalence of ED among men aged ≥40 years with metabolic syndrome (MetS) and its association with HGS. Materials and Methods: A cross-sectional study at an institutional primary care clinic in Malaysia was conducted between June 2021 and October 2021. HGS and erectile function were assessed using a hand dynamometer and International Index of Erectile Function (IIEF-5) questionnaire, respectively. Multiple logistic regression analyses were performed to determine the association between sociodemographics, clinical characteristics, and HGS with ED. Results: A total of 334 participants were recruited. The prevalence of ED was 79% (95% confidence interval [CI]: 0.75-0.84). ED was associated with elderly aged ≥60 years (odds ratio [OR] 3.27, 95%CI: 1.60-6.69), low HGS (OR 15.34, 95%CI: 5.64-41.81) and high total cholesterol (OR 0.36, 95%CI: 0.16-0.78). Conclusion: In conclusion, age above 60 years and those with low HGS are at higher risk of ED. Thus, robust screening of ED among men with MetS and improving muscle strength and physical fitness may be warranted.

Gap in Sexual Dysfunction Management Between Male and Female Patients Seen in Primary Care: An Observational Study.

BACKGROUND: Female sexual dysfunction (FSD), defined as clinically distressing problems with desire, arousal, orgasm, or pain, affects 12% of US women. Despite availability of medications for FSD, primary care physicians (PCPs) report feeling underprepared to manage it. In contrast, erectile dysfunction (ED) is frequently treated in primary care. OBJECTIVE: To describe differences in patterns of FSD and ED diagnosis and management in primary care patients. DESIGN: Retrospective observational study. SUBJECTS: Primary care patients with an incident diagnosis of FSD or ED seen at a large, integrated health system between 2016 and 2022. MAIN MEASURES: Sexual dysfunction management (referral or prescription of a guideline-concordant medication within 3 days of diagnosis), patient characteristics (age, race, insurance type, marital status), and specialty of physician who diagnosed sexual dysfunction. We estimated the odds of FSD and ED management using mixed effects logistic regression in separate models. KEY RESULTS: The sample included 6540 female patients newly diagnosed with FSD and 16,591 male patients newly diagnosed with ED. Twenty-two percent of FSD diagnoses were made by PCPs, and 38% by OB/GYNs. Forty percent of ED diagnoses were made by PCPs and 20% by urologists. Patients with FSD were managed less frequently (33%) than ED patients (41%). The majority of FSD and ED patients who were managed received a medication (96% and 97%, respectively). In the multivariable models, compared to diagnosis by a specialist, diagnosis by a PCP was associated with lower odds of management for FSD patients (aOR, 0.59; 95% CI, 0.51-0.69) and higher odds of management (aOR, 1.52; 95% CI, 1.36-1.64) for ED patients. CONCLUSIONS: Primary care patients with FSD are less likely to receive management if they are diagnosed by a PCP than by an OB/GYN. The opposite was true of ED patients, exposing a gap in the quality of care female patients receive.

Transcriptomic analysis reveals the mechanism of isorhamnetin in the treatment of Diabetes Mellitus Erectile Dysfunction.

PURPOSE: Exploring the therapeutic effect and mechanism of isorhamnetin in the treatment of DMED. METHODS: Using a high glucose environment to induce endothelial cells damage in the corpus cavernosum, and combining with intervention agents such as ferroptosis inhibitors to observe the process of cell damage and repair, evaluating cell status through CCK-8 and DAPI; To establish the STZ-induced diabetes rat model and detect the erectile function and tissue changes; Perform transcriptome sequencing on rat models and samples treated with isorhamnetin to analyze differentially expressed genes and their GO functions; Identify critical pathways by combining with the ferroptosis database; Flow cytometry was used to detect ROS and mitochondrial membrane potential, and RT-PCR was used to verify gene expression, Seahorse detects mitochondrial oxygen consumption rate, revealing the mechanism of action of isorhamnetin. RESULTS: Ferroptosis inhibitors and isorhamnetin can effectively reverse the damage of corpus cavernosum endothelial cells induced by high glucose and ferroptosis agonists. Isorhamnetin has the ability to reinstate the erectile function of diabetic rats, while enhancing the quantity of endothelial cells and refining the morphology of collagen fibers. Immunohistochemistry revealed that ferroptosis existed in the penis tissue of diabetes rats. Transcriptomic analysis showed that isorhamnetin improves gene expression in DM rats by regulating genes such as GFER, IGHM, GPX4 and HMOX1, involving multiple pathways and biological processes. Flow cytometry and RT-PCR confirmed that isorhamnetin can reduce reactive oxygen species levels, restore essential gene expression, improve mitochondrial membrane potential, and alleviate oxidative stress and ferroptosis. Seahorse detection found that isorhamnetin can restore mitochondrial oxygen consumption rate CONCLUSION: Isorhamnetin attenuates high glucose damage to cavernous endothelial cells by inhibiting ferroptosis and oxidative stress, restores erectile function and improves tissue morphology in diabetic rats, and its multi-pathway and multi-targeting regulatory mechanism suggests that it is promising to be an effective drug for the treatment of DMED.

Interaction of smoking and spicy habits modifies the risk of erectile dysfunction.

Background: Having a spicy diet and smoking habit may be important factors causing erectile dysfunction (ED). The aim of this study is to investigate the impact of spicy diet and smoking habits on the risk of ED in men, with a focus on the interaction between these lifestyle factors. Methods: Our investigation was conducted as a retrospective analysis spanning from June 2017 to June 2023. Participants underwent interviews utilizing the Structured Interview on Erectile Dysfunction (SIEDY) to evaluate the degree of pathological factors. The International Index of Erectile Function-5 (IIEF-5) was employed as a metric for assessing ED. Additionally, the subjects were comprehensively questioned about their smoking history and dietary preferences, which included an inquiry into how often they consumed spicy meals. Results: Our research involved 373 participants, with 67.6% being individuals with ED. Among the participants, 50.7% were non-smokers and 49.3% were smokers, totaling 188 and 185, respectively. There was no significant difference in the spicy food frequency consumption among smokers with ED. However, non-smokers who consumed spicy food more frequently experienced more severe ED (P=0.02). ED patients showed significant differences in body mass index (BMI), blood glucose and testosterone, which were linked to vascular damage (P=0.03, P=0.02, P=0.04, respectively). Additionally, non-smokers who consumed more spicy food had higher scores on the SIEDY 2 scale, indicating marital factors (P=0.004). In non-smoking participant, a high spicy ratio indicated an even higher risk of ED [odds ratio 2.58, 95% confidence interval: 1.27-5.26; P=0.008], while there was no significant impact on ED in smoking participants (data not shown). Conclusions: This retrospective study suggests that a considerable consumption of spicy foods is independently correlated with an elevated risk of ED, particularly among non-smoking men.

Association between erectile dysfunction and subjective well-being in primary care patients with type 2 diabetes.

Objectives: To assess the association between erectile dysfunction and subjective well-being among primary care patients with type 2 diabetes mellitus. Methods: This cross-sectional study included 340 men with type 2 diabetes treated in primary health care settings in the Ismailia governorate between April 2021 and April 2022. A multistage random cluster sampling technique was used. Sociodemographic data, disease characteristics, lifestyle, surgical and sexual history, and the Arabic translations of the abridged 5-item version of the International Index of Erectile Function (IIEF-5) Questionnaire, and the 5-item World Health Organization Well-Being Index (WHO-5) were gathered. Results: Erectile dysfunction was identified in 72.94% of diabetic patients, with 55% mild or mild-to-moderate (ED I), and 17.9% moderate or severe (ED II). Twenty percent had Poor subjective well-being, with a mean WHO-5 index of 63.4 (± 15.4). Binary logistic regression analysis showed that education, diabetes duration, insufficient income, dyslipidemia, benign prostate hyperplasia, and IIEF-5 score were significantly associated with poor subjective well-being. Increasing IIEF-5 score was significantly associated with a 22% decrease in the odds of poor subjective well-being (OR: 0.78; 95% CI 0.66-0.93). Multinomial regression analysis showed that increasing score of the WHO-5 well-being index was associated with a 11% and 14% reduction in the odds of ED I and II, respectively (OR: 0.89 (95% CI 0.86-0.93), and 0.86 (95% CI 0.81-0.92), respectively). Conclusion: Erectile dysfunction and subjective well-being were interrelated. Early detection of erectile dysfunction is essential for improving the positive mental health of men with type 2 diabetes in primary care.

An overview of conventional and investigational phosphodiesterase 5 inhibitors for treating erectile dysfunction and other conditions.

INTRODUCTION: There is a rising concern about developing innovative, efficacious PDE5I molecules that provide better safety, efficacy, and tolerability with less adverse effects. Innovative PDE5I with dual targets have also been defined in the literature. Additionally, some of PDE5I are able to selectively inhibit other enzymes such as histone deacetylase, acetylcholine esterase, and cyclooxygenase or act as nitric oxide donors. This review presents knowledge concerning the advanced trends and perspectives in using PDE5I in treatment of ED and other conditions. AREAS COVERED: Pre-clinical and early clinical trials that investigated the safety, efficacy, and tolerability of novel PDE5I such as Udenafil, Mirodenafil, Lodenafil, Youkenafil, Celecoxib, and TPN729 in treatment of ED and other conditions. EXPERT OPINION: Preclinical and limited early clinical studies of the new molecules of PDE5I have demonstrated encouraging results; however, safety, efficacy, and tolerability are still issues that necessitate further long-term multicenter clinical studies to ensure justification of their uses in treatment of ED and other conditions. Progress in molecular delivery techniques and tailored patient-specific management and additional therapeutic technology will dramatically improve care for ED and other conditions. The dream of ED and many other conditions becoming more effectively managed may be feasible in the near future.

Genetically predicted allergic rhinitis causally increases the risk of erectile dysfunction.

Objective: Evidence shows that allergic rhinitis (AR) may increase the risk of erectile dysfunction (ED). This study aims to investigate whether there is a causal relationship between AAR and ED by Mendelian randomization (MR) analysis. Methods: We performed a two-sample MR analysis using genome-wide association studies (GWAS) summary data. Single nucleotide polymorphisms (SNPs) associated with AR and ED were obtained from the GWAS database. The MR analysis primarily employed the inverse variance weighted (IVW), MR Egger, and weighted median (WM) methods. We assessed pleiotropy using the MR-PRESSO global test and MR-Egger regression. Cochran's Q test was used to evaluate heterogeneity, and a leave-one-out analysis was performed to verify the robustness and reliability of the results. Results: The IVW analysis demonstrated a positive association between genetic susceptibility to AR and an elevated relative risk of ED (IVW OR = 1.40, p = 0.01, 95% CI 1.08-1.80). The results obtained from MR-Egger regression and WM methods exhibited a consistent trend with the results of the IVW method. Sensitivity analyses showed no evidence of heterogeneity nor horizontal pleiotropy. The leave-one-out analysis showed that the findings remained robust and were unaffected by any instrumental variables. Conclusion: This study presents genetic evidence that indicates a causal association between AR and ED.

Changing trends in penile prosthesis implantation in China and an overview of postoperative outcomes from a single center.

BACKGROUND: Surgical penile prosthesis implantation (PPI) procedures have only recently been introduced to mainland China, with the overall number of such procedures having been conducted to date remaining relatively low. Accordingly, relatively little remains known with respect to the annual trends in PPI. Accordingly, this study was developed with the goal of clarifying these trends across different hospitals in mainland China, while also providing a single-center overview of post-PPI patient outcomes. RESULTS: To identify males in mainland China who had undergone PPI, a retrospective review of data from January 2019 - October 2023 was conducted. This approach revealed an increase in the total PPI caseload from 120 in 2019 to 413 within the first 10 months of 2023. Over this same interval, the number of surgeons performing PPI rose from 33 to 74. A retrospective review of the 112 patients who had undergone PPI at Shanghai General Hospital from 2019-2023 revealed that these patients had a median age of 39 [27-63] years, and PPI treatment led to a significant increase in median International Index of Erectile Function-5 (IIEF-5) scores from a baseline value of 10.23 ± 1.26 to a post-treatment value of 22.6 ± 2.73. The underlying causes of erectile dysfunction for these patients included vasculogenic factors (58/112; 51.8%), diabetes mellitus (21/112; 18.8%), and injuries to the spinal cord or pelvis (14/112; 12.5%). The overall rates of satisfaction with the PPI reported by patients and their partners were 93.0% and 90.4%, respectively, and the 3-year PPI survival rate for this cohort was 87%. CONCLUSION: These data highlight a rising trend in the number of PPI being performed in China, with these steadily increasing rates since 2019 emphasizing the increasingly high levels of acceptance of this procedure by patients and clinicians as a means of treating erectile dysfunction. However, the expertise is restricted to a small number of surgeons. Even so, it is a safe and efficacious approach to managing severe erectile dysfunction for patients in China, and when performed by experienced surgeons based on standardized protocols, low complication rates can be achieved while providing patients and their sexual partners with high levels of satisfaction.

RéSUMé: CONTEXTE: Les procédures chirurgicales d'implantation de prothèses péniennes (IPP) n'ont été que récemment introduites en Chine continentale, le nombre total de procédures de ce type ayant été effectuées à ce jour restant relativement faible. On ne sait donc encore que relativement peu de choses sur les tendances annuelles de l'IPP. La présente étude a été développée dans le but de clarifier ces tendances dans différents hôpitaux de Chine continentale, tout en fournissant une vue d'ensemble des résultats des patients post-IPP dans un seul centre. RéSULTATS: Afin d'identifier les hommes de Chine continentale qui avaient subi un IPP, une recherche rétrospective des données a été effectuée de janvier 2019 à octobre 2023. Cette approche a révélé une augmentation du nombre total de cas d'IPP de 120 en 2019 à 413 au cours des 10 premiers mois de 2023. Au cours de cette même période, le nombre de chirurgiens pratiquant des IPP est passé de 33 à 74. L'étude rétrospective des 112 patients qui avaient subi un IPP à l'hôpital général de Shanghai de 2019 à 2023 a révélé qu' ils avaient un âge médian de 39 [27­63] ans, et que le traitement par IPP a entraîné une augmentation significative des scores médians de l'indice international de la fonction érectile-5, qui sont passés d'une valeur de base de 10,2 ± 1,3 à une valeur post-traitement de 22,6 ± 2,7. Les causes sous-jacentes de la dysfonction érectile chez ces patients comprenaient des facteurs vasculogéniques (58/112; 51,8%), un diabète (21/112; 18,8%) et des lésions de la moelle épinière ou du bassin (14/112; 12,5%). Les taux globaux de satisfaction à l'égard de l'IPP, rapportés par les patients et leurs partenaires, étaient respectivement de 93,0% et 90,4%, et le taux de survie à 3 ans de l'IPP dans cette cohorte était de 87%. CONCLUSION: Ces données mettent en évidence une tendance à la hausse du nombre d'IPP pratiquées en Chine; ces taux en constante augmentation depuis 2019 soulignent les niveaux de plus en plus élevés d'acceptation de cette procédure par les patients et les cliniciens comme moyen de traitement de la dysfonction érectile. Cependant, l'expertise est limitée à un petit nombre de chirurgiens. Malgré cela, il s'agit d'une approche sûre et efficace pour gérer la dysfonction érectile sévère pour les patients en Chine, et lorsqu'elle est effectuée par des chirurgiens expérimentés sur la base de protocoles standardisés, de faibles taux de complications peuvent être atteints tout en offrant aux patients et à leurs partenaires sexuels des niveaux élevés de satisfaction.

Efficient use of penile Doppler ultrasound for investigating men with erectile dysfunction.

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.

Unveiling the science behind erectile dysfunction topical therapy: investigating transdermal papaverine as a novel treatment approach.

INTRODUCTION: Erectile dysfunction is among the most prevalent urologic issues affecting men globally and is characterized by a high incidence rate. This condition significantly affects the quality of life of patients and their sexual partners. OBJECTIVES: Due to the interactions, contraindications, and side effects associated with systemic drugs, recent research has increasingly focused on topical and transdermal medications for the treatment of erectile dysfunction. METHODS: Based on previous studies, this article examines papaverine in terms of local effectiveness, methods of increasing therapeutic efficiency, possible local side effects, and evaluation of its various formulations. RESULTS: Among these approaches, notable strategies include using novel formulations and nanoformulations as compared with classic ones, employing permeation enhancers, and combining treatments with other oral and topical drugs with synergistic mechanisms. These methods aim to improve transdermal papaverine's bioavailability and therapeutic efficacy while minimizing side effects and enhancing patient compliance. CONCLUSION: Transdermal papaverine may not be as effective as its injectable form, but the treatment path is more pleasant, with less pain and fewer side effects for patients. For this reason, using solutions that remove the penile skin and fascial absorption barrier can be very effective.

[Incidence of comorbid ED with LUTS and its risk factors in patients with BPH].

OBJECTIVE: To investigate the incidence of comorbid ED with lower urinary tract symptoms (LUTS) and its risk factors in BPH patients. METHODS: Based on inclusion and exclusion criteria, we selected BPH patients visiting the outpatient department of the Second Xiangya Hospital of Central South University from January 2020 to January 2023. We collected the general and clinical data from the patients, including age, height, body weight, abdominal circumference, hip circumference, blood pressure, blood routine, liver function, kidney function, blood lipids and fasting blood glucose, obtained their IPSS, quality of life (QOL) scores, and IIEF-5 scores by questionnaire investigation, and performed data processing and analysis with the SPSS 22.0 software. RESULTS: The incidence rate of comorbid ED with LUTS in the BPH patients rose with the increase of age, 36.46% in the 45－49-year group, 43.72% in the 50－54-year group, 53.66% in the 55－59-year group, 69.23% in the 60－64-year group, and 78.74% in the 65－70-year group. The lipid accumulation product (LAP), visceral adiposity index (VAI), triglycerides and glucose (TyG), hepatic steatosis index (HSI), body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) were correlated positively with IPSS scores and negatively with IIEF-5 scores, while LDL-C and total cholesterol (TC) negatively with IPSS scores and positively with IIEF-5 scores. CONCLUSION: The incidence of comorbid ED with LUTS in BPH patients increases with age. The risk factors for this comorbidity include hypertension, dyslipidemia, diabetes, BMI, and lifestyle, and the risk of the condition can be effectively assessed by LAP, VAI, TYG, HSI, BMI, WHtR, WHR, TG and HDL-C.

[Treatment of hypoxia-induced ED in high-altitude areas by transcutaneous low-frequency electrical stimulation based on the parameters obtained from visualized precision electrophysiological diagnosis].

OBJECTIVE: To investigate the effects of visualized precision electrophysiological diagnosis and transcutaneous low-frequency electrical stimulation (TES) on hypoxia-induced ED in high-altitude areas. METHODS: This study included 152 ED patients from high-altitude hypoxic areas treated by TES based on the parameters obtained from visualized precision electrophysiological diagnosis. We followed up the patients for 1 to 3 months and compared their IIEF-5 scores, nocturnal penile tumescence and rigidity (NPTR) and infrared thermal metabolic technology (TMT)-based temperature of the whole body and diseased parts before and after treatment. RESULTS: All the patients successfully completed 1 to 3 courses of TES. There were no statistically significant differences in the IIEF-5 scores (P<0.05) and penile tip optimal erection rigidity and duration (P<0.01) of the patients before and after treatment. TMT images indicated a temperature change of >1.5 ℃ in the penis and bilateral inguinal regions after treatment, suggesting the effectiveness of electrical stimulation. No recurrence was observed during the follow-up. CONCLUSION: TES based on the parameters obtained from visualized precision electrophysiological diagnosis has a definite effect on hypoxia-induced ED by enhancing oxygen supply to the penile corpus cavernosum and improving its function and structure.

[Action mechanism of Huotu Jiji Pellets in the treatment of erectile dysfunction: An exploration based on network pharmacology and molecular docking].

OBJECTIVE: To explore the potential action mechanism of Huotu Jiji Pellets (HJP) in the treatment of erectile dysfunction (ED) based on network pharmacology and molecular docking. METHODS: We identified the main effective compounds and active molecular targets of HJP from the database of Traditional Chinese Medicine Systems Pharmacology (TCMSP) and Integrative Pharmacology-Based Research Platform of Traditional Chinese Medicine (TCMIP) and the therapeutic target genes of ED from the databases of Genecards. Then we obtained the common targets of HJP and ED using the Venny software, constructed a protein-protein interaction (PPI) network of HJP acting on ED, and screened out the core targets with the Cytoscape software. Lastly we performed GO functional enrichment and KEGG pathway enrichment analyses of the core targets followed by molecular docking of HJP and the core targets using Chem3D and AutoDock Tools and QuickVina-W software. RESULTS: A total of 64 effective compounds, 822 drug-related targets, 1 783 disease-related targets and 320 common targets were obtained in this study. PPI network analysis showed that the core targets of HJP for ED included ESR1, HSP90AA1, SRC, and STAT3. GO functional enrichment analysis indicated the involvement of the core targets in such biological processes as response to xenobiotic stimulus, positive regulation of kinase activity, and positive regulation of MAPK cascade. KEGG pathway enrichment analysis suggested that PI3K-Akt, apoptosis, MAPK, HIF-1, VEGF, autophagy and other signaling pathways may be related to the mechanism of HJP acting on ED. Molecular docking prediction exhibited a good docking activity of the key active molecules of HJP with the core targets. CONCLUSION: This study showed that HJP acted on ED through multi-components, multi-targets and multi-pathways, which has provided some evidence and reference for the clinical treatment and subsequent studies of the disease.

[Comprehensive therapy of traditional Chinese medicine for erectile dysfunction with damp-heat stasis: A clinical observation of 103 cases].

OBJECTIVE: To assess the clinical effect and safety of comprehensive therapy of traditional Chinese medicine (TCM) in the treatment of erectile dysfunction (ED) with damp-heat stasis. METHODS: We selected 108 cases of ED with damp-heat stasis meeting the inclusion criteria and treated with tadalafil (the control group, n = 54) or tadalafil + comprehensive TCM therapy (the trial group, n = 54) in the First Affiliated Hospital of Henan University of Chinese Medicine in the same period. After 8 weeks of treatment, we recorded the patients' scores on IIEF-5, TCM syndrome, erectile quality (EQS), 9-Item Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Scale 7 (GAD-7). At 16 weeks of our study, we collected the efficacy parameters, safety indicators and adverse reactions by telephone follow-up and compared the data obtained between the two groups of patients. RESULTS: Totally, 103 of the patients completed the study, 51 in the control and 52 in the trial group. Compared with the baseline, the IIEF-5 and EQS scores were both markedly increased after 8 weeks of treatment in the trial group (12.35±3.00 vs 18.36±2.82, P< 0.05; 39.5 ï¼»30.25－43ï¼½ vs 67.5 ï¼»54.5－76.75ï¼½, P< 0.05) and the control (11.96±2.79 vs 15.88±3.86, P< 0.05; 38.0 ï¼»29－42ï¼½ vs 56 ï¼»49－64ï¼½, P< 0.05), even more significantly in the former than in the latter (P< 0.05); the TCM syndrome and GAD-7 scores were remarkably decreased in the trial (9.5 ï¼»8－12ï¼½ vs 4.0 ï¼»2.25－5ï¼½, P< 0.05; 5 ï¼»2.25－6.75ï¼½ vs 2.5 ï¼»1－4.75ï¼½, P< 0.05) and the control group (10.0 ï¼»8－12ï¼½ vs 5.0 ï¼»3－6ï¼½, P< 0.05; 5.0 ï¼»3－6ï¼½ vs 4.0 ï¼»2－5ï¼½, P< 0.05), even more significantly in the former than in the latter (P< 0.05), so were the PHQ-9 scores (P< 0.05), but with no statistically significant difference between the two groups (P > 0.05). The IIEF-5 scores of the two groups remained significantly higher than the baseline during the follow-up (P< 0.05), even higher in the trial than in the control group (17.04±2.60 vs 14.16±3.34, P< 0.05). No obvious abnormal safety indicators or adverse events were observed during the study. CONCLUSION: Comprehensive TCM therapy combined with tadalafil is superior to tadalafil alone in the treatment of ED with damp-heat stasis, and has a better long-term efficacy and a higher safety.

[Digital health applications in urology]. / Digitale Gesundheitsanwendungen in der Urologie.

BACKGROUND: Digital health applications (DiGA) were included in the German healthcare system in 2020. They are available for prescription and reimbursed by public and private insurance companies. For the specialty of urology, there are currently two DiGA available: for the treatment of erectile dysfunction and benign prostatic hyperplasia/overactive bladder (BPH/OAB). The legal basis, clinical results and practical implementation are presented. METHODS: Evaluation of websites and publications to show the regulatory requirements, mode of action, results of clinical trials and prescribing practice with DiGA. RESULTS: Since 2020, 63 DiGA have been listed in the register of the Federal Office for Drugs and Medical Devices (BfArM), 35 of them definitively. Two urological DiGA aim to treat erectile dysfunction and BPH/OAB. Randomized, controlled studies have shown a significant and clinically relevant patient benefit for both DiGA. Further urological DiGA are in clinical development. CONCLUSIONS: DiGAs offer multimodal therapy combinations that have not yet been used in clinical practice and show a multidimensional benefit for the patient.

Mesenchymal stem cell secretome: A promising therapeutic strategy for erectile dysfunction?

Objective: The secretome, comprising bioactive chemicals released by mesenchymal stem cells (MSCs), holds therapeutic promise in regenerative medicine. This review aimed to explore the therapeutic potential of the MSC secretome in regenerative urology, particularly for treating erectile dysfunction (ED), and to provide an overview of preclinical and clinical research on MSCs in ED treatment and subsequently to highlight the rationales, mechanisms, preclinical investigations, and therapeutic potential of the MSC secretome in this context. Methods: The review incorporated an analysis of preclinical and clinical research involving MSCs in the treatment of ED. Subsequently, it delved into the existing knowledge regarding the MSC secretome, exploring its therapeutic potential. The methods included a comprehensive examination of relevant literature to discern the processes underlying the therapeutic efficacy of the MSC secretome. Results: Preclinical research indicated the effectiveness of the MSC secretome in treating various models of ED. However, the precise mechanisms of its therapeutic efficacy remain unknown. The review provided insights into the anti-inflammatory, pro-angiogenic, and trophic properties of the MSC secretome. It also discussed potential advantages, such as avoiding issues related to cellular therapy, including immunogenicity, neoplastic transformation, and cost. Conclusion: This review underscores the significant therapeutic potential of the MSC secretome in regenerative urology, particularly for ED treatment. While preclinical studies demonstrate promising outcomes, further research is essential to elucidate the specific mechanisms underlying the therapeutic efficacy before clinical application. The review concludes by discussing future perspectives and highlighting the challenges associated with the clinical translation of the MSC secretome in regenerative urology.

Prenatal exposure to dibutyl phthalate contributes to erectile dysfunction in offspring male rats by activating the RhoA/ROCK signalling pathway.

Prenatal exposure to dibutyl phthalate (DBP) has been reported to cause erectile dysfunction (ED) in adult offspring rats. However, its underlying mechanisms are not fully understood. Previously, we found that DBP activates the RhoA/ROCK pathway in the male reproductive system. This study investigated how prenatal exposure to DBP activates the RhoA/ROCK signalling pathway, leading to ED in male rat offspring. Pregnant rats were stratified into DBP-exposed and NC groups, with the exposed group receiving 750 milligrams per kilogram per day (mg/kg/day) of DBP through gavage from days 14-18 of gestation. DBP exposure activated the RhoA/ROCK pathway in the penile corpus cavernosum (CC) of descendants, causing smooth muscle cell contraction, fibrosis, and apoptosis, all of which contribute to ED. In vitro experiments confirmed that DBP induces apoptosis and RhoA/ROCK pathway activation in CC smooth muscle cells. Treatment of DBP-exposed offspring with the ROCK inhibitor Y-27632 for 8 weeks significantly improved smooth muscle cell condition, erectile function, and reduced fibrosis. Thus, prenatal DBP exposure induces ED in offspring through RhoA/ROCK pathway activation, and the ROCK inhibitor Y-27632 shows potential as an effective treatment for DBP-induced ED.

Contemporary management of ischemic priapism: A 12-year population-based analysis from a large US database.

BACKGROUND: Priapism is a urological condition characterized by a persistent erection. The management varies based on its subclassifications. Despite established clinical guidelines for ischemic priapism, there is a lack of large-scale research focused on patient characteristics and management strategies. OBJECTIVES: To analyze the contemporary management of ischemic priapism in the US, exploring patient demographics and clinical characteristics, as well as predictors of erectile dysfunction (ED) and penile prosthesis implantation (PPI). MATERIALS AND METHODS: We performed a retrospective analysis of the PearlDiver Mariner database, reviewing records from 2010-2021. Adult males diagnosed with ischemic priapism were included. Data analysis covered demographic, clinical variables, and management strategies. Predictors of de novo ED and PPI were evaluated using multivariable logistic regression analysis. RESULTS: Of 36,120 patients, most (93%) received only medical management, and a minority underwent surgical interventions (penile shunt surgery [PSS], PPI or both). Medical management was typically effective, as 67.08% of the patients in this group experienced only one episode of priapism. However, de novo ED occurred in 16.57% of these patients. The majority of patients undergoing PPI had an inflatable prosthesis (81%). Older age (odds ratio, OR 1.02), the presence of metabolic diseases (OR 1.39), neurogenic disorders (OR 1.72), solid pelvic malignancies (OR 1.09), and multiple episodes of priapism were identified as significant predictors of de novo ED (all p < 0.05). Similarly, age (OR 1.03), the presence of metabolic diseases (OR 1.23), solid pelvic malignancies (OR 1.99), and multiple episodes of priapism were associated with higher likelihood of PPI (all p < 0.05). CONCLUSION: Most cases of ischemic priapism are managed with the medical therapy. Less than 3% of patients with ischemic priapism receive PPI, and when this occurs an inflatable prosthesis is favored. Age, specific comorbidities, and multiple episodes of priapism appear to be significant predictors of ED and PPI.

Association between the systemic immune-inflammation index and erectile dysfunction: A cross-sectional study.

BACKGROUND: Erectile dysfunction (ED) is associated with inflammation. The systematic immune-inflammation index (SII), as a new inflammation marker, was applied to predict the risk of diseases. However, no research explores the relationship between SII and ED. Hence, the purpose of this study was to investigate the association between SII and ED. METHODS: Related data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2001-2004. Based on self-report, all participants were classified into ED and non-ED group. Weighted multivariate regression analysis the relationship between categorical SII and ED in unadjusted and adjusted models. Restricted cubic spline (RCS) was used to examine the association of continuous SII and ED risk. Furthermore, the association between categorical SII and the risk of ED was evaluated among subgroups of age, body mass index, hypertension, diabetes and cardiovascular disease. Finally, weighted multivariate regression analysis and RCS were performed to assessed the connection between SII and the risk of severe ED. RESULTS: Initially, data on 21,161 participants were obtained. After implementing the inclusion and exclusion criteria, 3436 participants were included in analyses. Weighted multivariate regression analysis demonstrated that Q4 group SII was associated with an increased risk of ED (OR = 1.03, 95% confidence intervals: 1.00-1.05, p = .03). RCS showed SII was nonlinearly associated with the risk of ED, and the inflection point of SII was at 485.530. In addition, subgroup analyses demonstrated that participants in the SII > 485.530 group had a higher ED risk than SII ≤ 485.530 group among subgroups of age ≥50, hypertension, and non-diabetes. Weighted multivariate regression analysis and RCS found no relationship of SII and the risk of severe ED. CONCLUSION: In US adults, SII > 485.530 was correlated with an increased risk of ED. While, no significant association between SII and severe ED risk. Additional studies are required to support our results.