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PubMedDate not supplied

Use of an assessment tool to enhance diabetes educators' ability to identify erectile dysfunction.

An assessment tool to identify erectile dysfunction is useful to diabetes educators in recognizing patients with sexual dysfunction requiring further counseling, education, and treatment. Use of an assessment tool serves as a first step in creating dialogue between diabetes educators and patients living with undiagnosed erectile dysfunction. The assessment tool helps identify underlying causes of erectile dysfunction, its impact on psychological well-being, and identification of treatment and referral needs. The purpose of this article is to discuss the value of assessing erectile dysfunction as a component of comprehensive diabetes care. An example of an erectile dysfunction assessment tool developed in 1991 is presented.

Diabetes Mellitus↗

PubMed2000

Importance of asking questions about erectile dysfunction.

Cardiovascular disease and erectile dysfunction share many common risk factors. In fact, recent studies have demonstrated evidence of occult coronary artery disease, undiagnosed hyperlipidemia, and hypertension in men presenting with erectile dysfunction. It is therefore incumbent upon all physicians, especially cardiologists, to query their patients about their erectile function.

Adolescent↗

PubMed1986

[Corpus cavernosum autoinjection therapy: initial experiences in erectile dysfunction].

The cause of erectile dysfunction was evaluated by a multidisciplinary approach in 120 impotent patients. Out of these, the CCAT was proposed to 20 patients with vasculogenic erectile dysfunction, 19 of them accepted this therapy. The dosage of phentolamine mesylate-papaverin hydrochloride injection required was determined in each patient individually. Usually we injected initially 1 cc in one corpus cavernosum. Eighteen patients followed the regimen successfully at home. In 2 patients prolonged erections were observed, which were successfully relieved by simple corpus puncture, however, discontinuation of therapy was not necessary. CCAT failed in 1/19 patients with a severe venous leak. Follow up was carried out weekly.

Drug Therapy, Combination↗

PubMed2001

The development of erectile dysfunction in men treated for prostate cancer.

PURPOSE: Erectile dysfunction is a common side effect in men treated for prostate cancer. Previously published studies document the incidence of erectile dysfunction in men treated for prostate cancer to be between 20% and 88%. To our knowledge a prospective evaluation focused on the development of erectile dysfunction in men treated for prostate cancer has not elucidated components of its chronology or risk factors. MATERIALS AND METHODS: A centralized prospective database of 2,956 patients diagnosed with prostate cancer at a single institution was studied in regard to pretreatment and posttreatment erectile dysfunction. Of these 2,956 patients 802 had sufficient information regarding erectile function and comprise our study population. Factors analyzed in regard to treatment and erectile dysfunction include treatment modality, that is radical prostatectomy, external beam radiation therapy and watchful waiting, and ethnicity, patient age, clinical stage and tumor histological grade. RESULTS: No significant difference was noted in the posttreatment erectile function between patients treated with radical prostatectomy or external beam radiation (10% versus 15%). Patients selecting watchful waiting had the lowest risk of erectile dysfunction. Clinical stage and race were significant predictors for the development of erectile dysfunction in the watchful waiting and external beam radiation treatment groups. CONCLUSIONS: Erectile dysfunction develops in greater than 80% of patients treated for prostate cancer. External beam radiation has the same risk for erectile dysfunction as radical prostatectomy.

Adult↗

PubMed2004

The psychological and interpersonal relationship scales: assessing psychological and relationship outcomes associated with erectile dysfunction and its treatment.

Erectile dysfunction (ED) is associated with complex psychological and interpersonal issues. A new measure of treatment outcome, the Psychological and Interpersonal Relationship Scales (PAIRS), was developed to evaluate the broader psychological and interpersonal outcomes associated with erectile dysfunction and its treatment. Initial items were generated based on literature review, focus groups and market research, interviews with patients and partners, and consultation with expert clinicians. Domains of Sexual Self-Confidence, Spontaneity, and Time Concerns were identified and subsequently confirmed by factor analysis. A series of validation studies was performed with four separate samples, including assessment of internal consistency and test-retest reliability, convergent and discriminant validity, and treatment responsiveness. Samples for these studies included men recruited from clinical trials for ED in several countries ( N =413) and a community sample ( N =801). Findings from these studies indicate that PAIRS demonstrates adequate psychometric properties and appears well suited for use in further clinical studies of treatments for ED. It provides a broader assessment of treatment outcome than current measures of erectile function.

Adult↗

PubMedDate not supplied

[Unilateral intracavernous phalloprosthetics of erectile dysfunction].

258 patients with erectile dysfunction have undergone incomplete intracavernous phalloprosthetic operation (ICFPO) to maximally preserve unaffected cavernous tissue. Indications for this procedure are formulated. Adequate axial stability of the phallus after ICFPO was ensured by improved design of the monolithic polyethylene rod. Changes were also made in the operative technique of ICFPO to reduce the scope of surgical intervention and operative trauma. Outcomes of the surgery and results of postoperative examinations showed ICFPO to promote recovery or improvement of erection in most of the patients. Minimal traumatism, functional effectiveness and outpatient setting say in favor of this method for surgical treatment of some forms of erectile dysfunction.

Adult↗

PubMed2006

Arterial elasticity and erectile dysfunction in hypertensive men.

Erectile dysfunction is a common symptom among hypertensive patients that impairs quality of life and adherence to antihypertensive pharmacologic therapy. It is also associated with cardiovascular risk factors and disease. The Sexual Health Inventory in Men (SHIM) was administered to 105 ambulatory hypertensive patients, and large and small artery elasticity indices were measured. Each variable was examined in a simple linear regression model or 1-way analysis of variance model to determine each variable's relationship with the SHIM score. Variables that were significantly associated with the SHIM score in the univariate models included age, duration of hypertension, peripheral vascular disease, and small artery elasticity. Large artery elasticity was not significantly associated with the SHIM score. In the multivariate model, age, hypertension duration, and peripheral vascular disease were associated with a lower SHIM score. This study demonstrates a relationship between erectile dysfunction and reduced artery elasticity.

Blood Pressure↗

PubMed1998

[Rational diagnosis of erectile dysfunction].

In diagnostics of erectile dysfunction there are different simple or large-scale procedures available. Referring to a three-step-scheme that makes difference in the diagnostics in I. non-invasive, II. semi-invasive and III. invasive procedures the current diagnostic measures will be explained. To the non-invasive measures do account the extensive patients history taking including the sexual history and the psychological diagnostics, the physical examination and laboratory screenings. The semi-invasive procedures include the intracavernous injection test with vasoactice substances, the doppler sonography and duplex or color duplex sonography, the corpus-cavernosum-electromyogram (CC-EMG) and other neurophysiological examinations. The third invasive step contains the dynamic infusion pharmacological cavernosography and cavernosometry (DICC) and the selective pharmacological phallo-arteriography. The procedures of this step are essentially limited to patients with erectile dysfunction who are planned for surgical interventions.

Diagnosis, Differential↗

PubMed2004

Nutrients and botanicals for erectile dysfunction: examining the evidence.

Erectile dysfunction affects 50 percent of men ages 40-70 in the United States and is considered an important public health problem by the National Institutes of Health. Consumers are exposed to a plethora of natural products claiming to restore erection and sexual vitality. A review of the available empirical evidence reveals most naturally occurring compounds lack adequate clinical trials to support efficacy. However, arginine, yohimbine, Panax ginseng, Maca, and Ginkgo biloba all have some degree of evidence they may be helpful for erectile dysfunction. Improvements in penile endothelial L-arginine-nitric oxide activity appear to be a unifying explanation for the actions of these naturally occurring agents.

Arginine↗

PubMed2007

The natural progression and remission of erectile dysfunction: results from the Massachusetts Male Aging Study.

PURPOSE: Erectile dysfunction affects more than 150 million men and is strongly associated with cardiovascular disease. A 1992 National Institutes of Health consensus development panel identified erectile dysfunction progression and spontaneous remission as priorities for investigation, but there are few data describing the natural course of the disorder following its initial presentation. This analysis estimates the frequency of erectile dysfunction progression and remission among aging men, and assesses the relation of progression/remission to demographics, socioeconomic factors, comorbidities and modifiable lifestyle characteristics. MATERIALS AND METHODS: Data from the Massachusetts Male Aging Study, a longitudinal study of men (401) 40 to 70 years old, were analyzed to assess erectile dysfunction severity following initial presentation of symptoms. Logistic regression was used to estimate the odds of erectile dysfunction progression/remission as a function of covariates. RESULTS: A total of 141 subjects (35%) exhibited erectile dysfunction remission (95% CI: 30%, 40%). Of 323 subjects with minimal or moderate baseline erectile dysfunction 107 (33%) exhibited erectile dysfunction progression (95% CI: 28%, 38%). The 78 subjects with complete erectile dysfunction were considered ineligible for progression and 45 (58%) of these exhibited complete erectile dysfunction at followup. Age and body mass index were associated with progression and remission, while smoking and self-assessed health status were associated with progression only. CONCLUSIONS: Natural remission and progression occur in a substantial number of men with erectile dysfunction. The association of body mass index with remission and progression, and the association of smoking and health status with progression, offer potential avenues for facilitating remission and delaying progression using nonpharmacological intervention. The benefits of such interventions for overall men's health may be far-reaching.

Aged↗

PubMed2003

Erectile dysfunction after surgical treatment.

Erectile dysfunction is a recognized complication of prostate and bladder radical surgery, although there is significant variation in the reported risk, much of this variability is related to the retrospective nature of most previous studies. Undoubtedly, the quality of life of bladder and prostate cancer patients would be much improved if both normal micturition and potency are preserved, which is the subject of this article. Quality of life studies can delineate sexual function after radical prostatectomy, including the use of sexual aids. Penile erection is a neurovascular event modulated by neurotransmitters and hormonal status. The penis is innervated by autonomic and somatic nerves. Both surgery and radiation therapy appear to affect such a mechanism. Radiation is thought to produce Erectile Dysfunction (ED) by accelerating microvascular angiopathy causing cavernosal fibrosis or stenosis of the pelvic arteries and by accelerating existing arteriosclerosis, leading to vascular impotence. Years may elapse before clinically significant ED occurs. Criteria that influence recovery of erections after surgery include younger patient age, stronger erections before operation, preservation of the neurovascular bundles, and attention to fine details in the surgical technique. Recovery of erections occurs in 68% of preoperatively potent men treated with bilateral nerve-sparing surgery and in 47% of those treated with unilateral nerve-sparing surgery.

Erectile Dysfunction↗

PubMed2001

Socioeconomic considerations in erectile dysfunction treatment.

The socioeconomics of erectile dysfunction have been changed greatly by the introduction of the successful oral therapy, sildenafil. The population of patients presenting for treatment of erectile dysfunction has expanded significantly and rapidly. This article addresses the descriptive and analytic economic implications of erectile dysfunction treatment.

Cost of Illness↗

PubMed2004

Erectile dysfunction is strongly linked with decreased libido in diabetic men.

Erectile dysfunction frequently occurs with diabetes mellitus. A survey of diabetic men was conducted by anonymous questionnaire to investigate the associations of erectile dysfunction with various predictive factors. A total of 112 diabetic males without an obvious history of erectile dysfunction were available for analyses. The mean age and duration of diabetes were 53.7 +/- 12.2 years and 10.2 +/- 8.6 years (mean +/- standard deviation), respectively. The questionnaire included questions on the presence or absence of smoking, hypertension, libido and subjective symptoms of diabetic neuropathy that may be associated with erectile dysfunction. Analysis of the answers to the questionnaire revealed that 40% of the patients complained of erectile dysfunction (erection 'always insufficient'). Erectile dysfunction was significantly correlated with age (p = 0.005), but not with duration of diabetes (p = 0.25), adjusted for age. Erectile dysfunction was also associated with sensory neuropathy and reduced libido, independently of age. The logistic regression analysis revealed that erectile dysfunction was positively associated with reduced libido and age. The odds ratio of erectile dysfunction for reduced compared to unreduced libido was 18.21, suggesting that psychogenic factors have a marked influence on erectile dysfunction. It is concluded that the presence of erectile dysfunction should be considered when symptoms related to diabetic neuropathy are observed; psychological approaches, such as sexual counseling, could be applied for the treatment of erectile dysfunction.

Adult↗

PubMed1999

Erectile dysfunction in patients with diabetes.

Erectile dysfunction, which is common among men with diabetes, leads to significant reduction in quality of life, and as with other complications of diabetes deserves to be treated on the NHS. This article explores the problem of erectile dysfunction and diabetes and the role of sildenafil, which is likely to be the first choice treatment of patients presenting with erectile dysfunction.

Diabetes Complications↗

PubMed1999

Differential gene expression of growth factors in young and old rat penile tissues is associated with erectile dysfunction.

The molecular mechanisms of erectile dysfunction with aging are unclear. Recent studies have suggested that growth factors may play a role in the etiology of erectile dysfunction. This present study was designed to test the hypothesis that gene expression of various growth factors such as TGF alpha, TGF beta 1, TGF beta 2, TGF beta 3, IGF and NGF modulate with aging in rat penile tissues. For this purpose, total RNA was extracted from young and old rat penile tissues and the gene expression for these growth factors was determined by differential reverse-transcriptase-polymerase chain reaction (RT-PCR) using specific oligonucleotide primers. mRNA levels of growth factors were quantified by using beta-actin as an internal standard. The results of these experiments suggest that: (1) young and old rat penile tissues expressed mRNA transcripts for TGF alpha, TGF beta 1, TGF beta 2, TGF beta 3, IGF and NGF; (2) TGF beta 1 gene expression was significantly increased in old rat penile tissues as compared to young; (3) mRNA transcripts for NGF and TGF beta 3 were significantly lower in old rat penile tissues as compared to young; and (4) TGF alpha, TGF beta 2 and IGF mRNA expression did not change in young and old rat penile tissues. These results suggest that the differential gene expression for various growth factors in young and old rat penile tissues may be important in understanding the pathophysiology of erectile dysfunction associated with aging.

Aging↗

PubMed2004

Effect of testosterone supplementation on sexual function in hypogonadal men with erectile dysfunction.

OBJECTIVES: To evaluate the impact of normalization of testosterone levels in men with documented hypogonadism and erectile dysfunction on erectile function and sexual satisfaction. Although the data support the role of testosterone in the preservation of libido and nocturnal erectile function, the evidence supporting the use of testosterone supplementation in hypogonadal men with erectile dysfunction is weak. METHODS: This analysis used two validated questionnaires, the International Index of Erectile Function and the Erectile Dysfunction Inventory of Treatment Satisfaction, in a serial fashion at baseline (before treatment) and 1, 3, and 6 months after the achievement of a therapeutic testosterone level. RESULTS: A total of 32 men met all inclusion criteria; 69% of men achieved therapeutic testosterone levels using transdermal testosterone gel, 19% required a transdermal patch, and 12% required intramuscular delivery. Statistical significance was reached for the difference between the baseline and 1-month International Index of Erectile Function erectile function domain score and all post-treatment International Index of Erectile Function libido scores. A steady decrease occurred in the Erectile Dysfunction Inventory of Treatment Satisfaction scores from the 1 to 6-month values that reached statistical significance. CONCLUSIONS: In men with documented hypogonadism and erectile dysfunction, normalization of serum testosterone levels was associated with only short-term improvement in erectile function and sexual satisfaction. The use of testosterone supplementation in this population for the treatment of erectile dysfunction is questionable.

Administration, Cutaneous↗

PubMed2006

Erectile dysfunction--an observable marker of diabetes mellitus? A large national epidemiological study.

PURPOSE: We examined whether men with erectile dysfunction are more likely to have diabetes mellitus than men without erectile dysfunction, and whether erectile dysfunction can be used as an observable early marker of diabetes mellitus. MATERIALS AND METHODS: Using a nationally representative managed care claims database from 51 health plans and 28 million members in the United States, we conducted a retrospective cohort study to compare the prevalence rates of diabetes mellitus between men with erectile dysfunction (285,436) and men without erectile dysfunction (1,584,230) during 1995 to 2001. Logistic regression models were used to isolate the effect of erectile dysfunction on the likelihood of having diabetes mellitus with adjustment for age, region and 7 concurrent diseases. RESULTS: The diabetes mellitus prevalence rates were 20.0% in men with erectile dysfunction and 7.5% in men without erectile dysfunction. With adjustment for age, region and concurrent diseases, the odds ratio of having diabetes mellitus between men with erectile dysfunction and without erectile dysfunction was 1.60 (p <0.0001). With adjustment for regions and concurrent diseases, the age specific odds ratios ranged from 2.94 (p <0.0001, age 26 to 35) to 1.05 (p = 0.1717, age 76 to 85). CONCLUSIONS: Men with erectile dysfunction were more than twice as likely to have diabetes mellitus as men without erectile dysfunction. Erectile dysfunction is an observable marker of diabetes mellitus, strongly so for men 45 years old or younger and likely for men 46 to 65 years old, but it is not a marker for men older than 66 years.

Adolescent↗

PubMed2001

[Erectile dysfunction].

Diagnostics and therapy of erectile dysfunction are currently one of the main issues dealt with by urologists. The Androcheck--the recommended annual medical checkup for men above 50 years of age--has taken this fact into account. Nearly 10% of all men suffer from persistent erectile malfunction. In addition to age, typical risk factors are diabetes, hypertonia, chronic nicotine abuse, other chronic illnesses as well as operations in the pelvis. Modern diagnostics work in three steps and take into consideration from the beginning the therapeutical requests by both the patient and his partner. The more invasive the therapy, the more extensive as well as comprehensive the preliminary diagnostics must be. After the obligatory basic examination, a Sildenafiltest may already present a satisfactory solution for therapy. With the introduction of this first potent oral drug for the therapy of erectile dysfunction, the status of all other therapy options has changed as a consequence. The indication for semi-invasive therapies such as intraurethral applications of prostaglandin E 1 or invasive methods such as the auto-injection therapy have become far more rare. On the other hand, patients who have been dissatisfied with these methods or other oral drugs may sometimes be successfully treated with Sildenafil. The diversity of therapeutical options should, however, be used for combining methods in order to successfully treat all patients suffering from erectile dysfunction. It goes without saying that primary or concomitant psychotherapy or couple therapy should not be left out.

Aged↗