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PubMed2006

Infection induced inflammation is associated with erectile dysfunction in men with diabetes.

BACKGROUND: In diabetic patients with erectile dysfunction, endothelial dysfunction is a major underlying cause. Infection-induced inflammation may be associated with endothelial dysfunction. The goal of this study was to determine whether erectile dysfunction in patients with diabetes is associated with infections of Chlamydia pneumoniae or cytomegalovirus and/or with low-grade inflammation. MATERIALS AND METHODS: Diabetic patients, 57 with and 33 without erectile dysfunction, were enrolled in a case-control study. Both groups of patients consists of type 1 and type 2 diabetics. Serum antibodies against cytomegalovirus and C. pneumoniae and markers of inflammation, including high-sensitivity C-reactive protein and fibrinogen, were measured. RESULTS: Adjusted odds ratios for erectile dysfunction in cytomegalovirus IgG, C. pneumoniae IgG and C. pneumoniae IgA seropositive men were 2.4 (95%CI; 1.0-6.0), 3.0 (95%CI; 1.2-8.1) and 1.8 (95%CI; 0.7-4.6), respectively. Odds ratios for the highest tertiles of high-sensitivity C-reactive protein and fibrinogen concentrations compared to the lowest tertile were 4.3 (95%CI; 1.4-13.1) and 6.6 (95%CI; 2.1-21.2), respectively. CONCLUSION: Elevated high-sensitivity C-reactive protein or fibrinogen serum levels and infection with cytomegalovirus or C. pneumoniae were associated with erectile dysfunction in diabetes. The relation between cytomegalovirus and erectile dysfunction is markedly present in patients with elevated high-sensitivity C-reactive protein and fibrinogen levels, suggesting a modifying effect by the inflammation.

Antibodies, Bacterial↗
PubMed2005

[Erectile dysfunction after traumatic pelvic injury].

UNLABELLED: Erectile dysfunction is a serious consequence of pelvic injuries. The aim of the study was to review and assess erectile dysfunction rates in mono and polytraumatized males with the pelvic injury, and to highlight the impotence-type of the pelvic injury relation and to evaluate the therapeutic response of the patients. METHODS: In total, 231 mono- or polytraumatized males with the pelvic injury were mailed a private letter including the HEF-5 International Index of Erectile Function questionnaire. The AO classification was used to assess the relation of the pelvic injury type and the onset of the erectile dysfunctin. The c2 test was used to assess the statistical significance. The peroral treatment with the phosphodiesterase 5 (PDE5) inhibitors was the therapeutical method of first choice. The therapeutical effect was assessed using the IIEF 5 questionnaire. RESULTS: We concluded that the erectile dysfunction affects nearly a third (31.5%) of the males who suffered pelvic injuries. The fact, whether the patient suffered an isolated pelvic injury or a pelvic injury in a polytrauma, has no influence on the erectile dysfuntion onset (p = 0.218), however, the onset of impotence has a significant connection to the type of the pelvic injury. We confirmed a statistically significant increase in the erectile dysfuncion rates in patients with the pelvic ring injury type B and C (p = 0.023). The mean IIEF-5 score prior to the treatment initiation was 11.5. In 85% of the patients the peroral treatment of the erectile dysfunctin using the PDES inhibitors was successful and resulted in achievement of the pair sexual satisfaction. The score of the IIEF-5 questionnaire reached physiological values 23 (22-25) following the treatment. Based on the findings, the authors recommend, during their hospitalization, to inform the males who suffered the type B and C pelvic ring injury about a possibility of their sexual dysfunction, and to advise them to contact a sexual disorders specialist.

Aged↗
PubMed2006

Is there a relationship between sex hormones and erectile dysfunction? Results from the Massachusetts Male Aging Study.

PURPOSE: The prevalence of erectile dysfunction increases as men age. Simultaneously, age related changes occur in male endocrine functioning. We examined the association between erectile dysfunction and total testosterone, bioavailable testosterone, sex hormone-binding globulin and luteinizing hormone. MATERIALS AND METHODS: Data were obtained from the Massachusetts Male Aging Study, a population based cohort study of 1,709 men. Self-reported erectile dysfunction was dichotomized as moderate or severe vs none or mild. Odds ratios and 95% CI were used to assess the association between sex hormone levels and erectile dysfunction. Multiple logistic regression models were used to adjust for potential confounders including age, body mass index, partner availability, phosphodiesterase type 5 inhibitor use, depression, diabetes and heart disease. RESULTS: Using data from the most recent followup, analyses were conducted on 625 men with complete data. A moderate decrease in erectile dysfunction risk was observed with increasing total testosterone and bioavailable testosterone levels. However, this effect was not apparent after controlling for potential confounders. Increased luteinizing hormone levels (8 IU/l or greater) were associated with a higher risk of erectile dysfunction (adjusted OR 2.91, 95% CI 1.55-5.48) compared to luteinizing hormone levels less than 6 IU/l. A significant interaction between luteinizing hormone and total testosterone levels showed that increased testosterone levels were associated with a decrease in risk of erectile dysfunction among men with luteinizing hormone levels greater than 6 IU/l. CONCLUSIONS: In this large population based cohort of older men we found no association among total testosterone, bioavailable testosterone, sex hormone-binding globulin and erectile dysfunction. Testosterone levels were associated with a decrease in risk of erectile dysfunction only in men with increased luteinizing hormone levels.

Age Factors↗
PubMed2005

Pharmacotherapy of erectile dysfunction: focus on cardiovascular safety.

Therapy of erectile dysfunction has been revolutionised in recent years, as specific pharmacological inhibitors of phosphodiesterase 5 (PDE5), such as sildenafil, tadalafil, or vardenafil, were shown to be highly effective in the treatment of erectile dysfunction. They dilate arterial smooth muscle cells of the corpora cavernosa, which express PDE5 abundantly, by inhibiting the breakdown of 3'5'-cyclic guanosine monophosphate. Despite theoretical concerns of a reduced myocardial tolerance to ischaemia or promoting cardiac arrhythmias, randomised trials and retrospective analyses do not support an increased cardiac risk with oral treatment. Therapeutic doses of PDE 5 inhibitors exhibit slight blood pressure lowering effects, and do not appear to compromise coronary blood flow in coronary artery disease. However, the combination of PDE5 inhibitors with any nitric oxide donor is absolutely contraindicated because of potentially life-threatening hypotension. Before prescribing medication for erectile dysfunction, any patient with cardiovascular disease should be evaluated for a potential risk of a cardiovascular event during sexual activity according to the Princeton Consensus Panel. When a stable cardiac condition can be achieved (low risk group), oral treatment for erectile dysfunction may be appropriate.

Administration, Oral↗
PubMed2005

Management of erectile dysfunction by the primary care physician.

Erectile dysfunction is common and closely associated with age and risk factors for cardiovascular disease. The oral selective inhibitors of phosphodiesterase type 5 (PDE5) have become the treatments of choice, owing to their convenience, general safety, and broad-spectrum effectiveness. For the same reasons, they have greatly simplified the workup. Thus, the general practitioner has gradually replaced the urologist for the initial management of erectile dysfunction and the proper evaluation of cardiac status before starting treatment with the PDE5 inhibitors. The following review provides a practical approach for the management of erectile dysfunction in primary care.

Cardiovascular Agents↗
PubMed2007

Circulating monocyte oxidative activity is increased in patients with type 2 diabetes and erectile dysfunction.

PURPOSE: We investigated the relationship between oxidative stress and diabetic erectile dysfunction. MATERIALS AND METHODS: A total of 23 patients with a mean +/- SD age of 56.7 +/- 5.6 years, a history of type 2 diabetes for 10.0 +/- 8.3 years and erectile dysfunction, as tested by the International Index of Erectile Function questionnaire, but without vascular and neurological complications, and 15 age matched patients with diabetes without erectile dysfunction were recruited. Circulating monocyte oxidative activity by cytofluorometry, and endothelin-1, intercellular adhesion molecule-1, plasminogen activator inhibitor-1 by enzyme linked immunosorbent assay were evaluated in all patients in the study. RESULTS: Monocyte free radical production, and total and low density lipoprotein cholesterol were higher in patients with than in those without erectile dysfunction (p <0.03, <0.02 and <0.05, respectively). In all patients the International Index of Erectile Function score inversely correlated with low density lipoprotein (p <0.05), while in patients with erectile dysfunction it negatively correlated with age (p <0.03), body mass index (p <0.02), endothelin-1 (p <0.02) and intercellular adhesion molecule-1 (p <0.05). Endothelin-1, intercellular adhesion molecule-1 and plasminogen activator inhibitor-1 were not different in patients with diabetes with and without erectile dysfunction. CONCLUSIONS: In men with type 2 diabetes who have erectile dysfunction but are asymptomatic for cardiovascular disease oxidative activation of monocytes is increased and it is related to other risk factors of endothelial dysfunction.

Diabetes Complications↗
PubMed2003

Identifying patients with type 2 diabetes with a higher likelihood of erectile dysfunction: the role of the interaction between clinical and psychological factors.

PURPOSE: We estimated the prevalence of erectile dysfunction in patients with type 2 diabetes and identified subgroups of patients in which the interaction among clinical, psychological and sociodemographic characteristics determined an increased likelihood of erectile dysfunction. MATERIALS AND METHODS: The presence of erectile dysfunction was based on patient self-reporting. Clinical information was collected by participating physicians. The severity of depressive symptoms was investigated using the Center for Epidemiological Studies Depression scale. To evaluate interactions among the variables investigated and identify distinct, homogeneous subgroups of patients with different odds ratios for erectile dysfunction a tree growing technique was used. RESULTS: In the 1,460 patients studied the prevalence of severe and mild-moderate erectile dysfunction was 34% and 24%, respectively. While severe erectile dysfunction was mainly related to the severity of diabetes, mild-moderate dysfunction was independent of clinical variables and only associated with the severity of depressive symptoms. The tree growing technique led to the identification of 6 classes characterized by a marked difference in the prevalence of severe erectile dysfunction of between 19% and 65%. Patients on diet alone showed the lowest prevalence of erectile dysfunction and were considered the reference category, while patients treated with insulin who had neuropathy represented the subgroup with the highest likelihood of erectile dysfunction (OR = 7.2, 95% CI 3.9 to 13.2). In patients treated with oral agents the odds ratio for erectile dysfunction was 2.7 (95% CI 1.8 to 3.9) for those with severe depressive symptoms and 1.9 (95% CI 1.3 to 2.7) for current/former smokers with low depressive symptoms. Patient age, retinopathy and cardiac-cerebrovascular disease were globally predictive variables associated with an increased likelihood of erectile dysfunction. CONCLUSIONS: Our data illustrate the interplay of clinical and psychological factors in determining the risk of erectile dysfunction in type 2 diabetes and can help identify those for whom much greater attention is needed to detect erectile problems.

Aged↗
PubMed2007

Clinical and psychological predictors of incidence of self-reported erectile dysfunction in patients with type 2 diabetes.

PURPOSE: We evaluated the predictors of the incidence of erectile dysfunction in patients with type 2 diabetes mellitus and identified subgroups of patients in whom the interaction between clinical and psychological characteristics determined an increase in the risk of erectile dysfunction. MATERIALS AND METHODS: The study was based on 670 individuals. The presence of erectile dysfunction and the severity of depressive symptoms were investigated with a questionnaire filled in every 6 months for 3 years. Poisson regression was used to calculate incidence rates. To evaluate interactions among the different variables and identify distinct and homogeneous subgroups in terms of incidence of erectile dysfunction, RECursive Partitioning and AMalgamation method was used. RESULTS: Overall erectile dysfunction developed in 192 men with type 2 diabetes, with an incidence rate of 166.3 per 1,000 person-years. Age, insulin treatment, hemoglobin A1c greater than 8.0%, total cholesterol greater than 3.88 mmol/l and severity of depressive symptoms represented independent predictors of erectile dysfunction. RECursive Partitioning and AMalgamation analysis identified 5 classes with a marked variation in the risk of erectile dysfunction. Patients with low levels of depressive symptoms and hemoglobin A1c 8.0% or less showed the lowest risk of erectile dysfunction. Compared with this subgroup patients with higher levels of depressive symptoms and treated with insulin had a 3-fold risk of erectile dysfunction. Age, smoking, high cholesterol levels and neuropathy were globally predictive variables associated with an increased risk of erectile dysfunction. CONCLUSIONS: The incidence of erectile dysfunction is predicted by modifiable risk factors. Even in diabetes, psychological problems can contribute to the pathogenesis of erectile dysfunction, in addition to organic causes.

Diabetes Complications↗
PubMed2001

[Postprostatectomy erectile dysfunction].

BACKGROUND: To evaluate the frequency of erectile dysfunction in patients submitted to radical prostatectomy due to prostate carcinoma and to the possibility, with appropriate treatment, of restoring adequate erections for a satisfactory sexual activity. METHODS: Between 1996 and 2000, thirty-eight patients with prostate carcinoma have been submitted to radical prostatectomy. According to TNM classification upon diagnosis, thirty-three patients (87%) were stage pT2N0M0 and five patients (13%) stage pT3N0M0. Mean age of patients was 62.4 years (range 55-76). Mean follow-up was two years and seven months. Diagnosis of erectile dysfunction was made from personal history as well as that of the patient plus partner, and from nocturnal penile tumescence evaluation with Rigiscan. RESULTS: Eighteen patients (47%) presented erectile dysfunction as a complication 16 (89%) of whom showed no nocturnal reaction at the Rigiscan test, while in the remaining two (1%), one-two nocturnal erections of less than five minutes were obtained. Of the eighteen patients, 14 (78%) showed a positive response to treatment with intracavernous drug infusion (papaverine+Phentolamine+Alprostadil), whilst only one patient benefited from treatment with oral Sildenafil. CONCLUSIONS: This study showed the high frequency (47%) of erectile dysfunction in patients submitted to radical prostatectomy as well as the need to perform radical nerve-sparing surgery (particularly in the neoplastic forms not involving the prostate capsule) which is useful not only for preserving erectile function but also on account of better response to oral Sildenafil treatment following the use of this technique.

Aged↗
PubMed1999

[Transurethral alprostadil (MUSE) in erectile dysfunction].

The ideal therapy for erectile dysfunction should be easy, non invasive, painless, with a high success and a low side effects rate. Alternative methods of delivery drugs to the erectile body, instead of intracavernosal injection of vasoactive drugs such as prostaglandin, have been evaluated. Vasoactive agents can be administered topically into the urethral mucosa for absorption into the corpus spongiosum and transfer into the corpora cavernosa via small communicating veins. We report data from the literature and our experience with MUSE (Medicated Urethral System for Erection) for the treatment of erectile dysfunction. Penile pain or discomfort is the common adverse effect reported, while no priapism of fibrotic complication is reported. But local discomfort, limited efficacy, and cost are to be considered.

Administration, Topical↗
PubMed2004

Common grounds for erectile dysfunction and coronary artery disease.

PURPOSE OF REVIEW: Evidence is accumulating to consider erectile dysfunction as a vascular problem. This review focuses on background, pathophysiological mechanisms and clinical evidence of the link between erectile dysfunction and coronary artery disease. RECENT FINDINGS: The link between erectile dysfunction and coronary artery disease is suggested by the following. (1) Common risk factors for atherosclerosis are frequently found in erectile dysfunction. (2) Erectile dysfunction is frequently found in vascular syndromes such as coronary artery disease, hypertension, cerebrovascular disease, peripheral arterial disease and diabetes. (3) A similar pathogenic involvement of the NO pathway leading to impairment of endothelium-dependent vasodilatation and late structural vascular abnormalities is shared by erectile dysfunction and vascular disorders. Given this background, the "artery-size hypothesis" is a recently proposed pathophysiological mechanism to explain the link between sexual dysfunction and myocardial ischemia. SUMMARY: Erectile dysfunction and coronary artery disease appear to be linked tightly each other.

Coronary Artery Disease↗
PubMed1998

Oral phentolamine as treatment for erectile dysfunction.

PURPOSE: For most patients with erectile dysfunction oral agents are a preferred treatment option. Oral or buccal phentolamine has been shown to produce full erections in impotent subsets of study populations. We evaluate the efficacy of oral phentolamine. MATERIALS AND METHODS: After a comprehensive evaluation 44 patients with recent onset (less than 3 years) of erectile dysfunction and a high likelihood of organogenic etiology underwent a prospective, double-blind and placebo controlled trial with oral phentolamine after placebo. RESULTS: After placebo 4 of the 44 patients who reported full erections were excluded from study. Of the 40 patients in the double-blind phase full erections were achieved by 2 of 10 with placebo, and 3 of 10 with 20 mg., 5 of 10 with 40 mg. and 4 of 10 with 60 mg. phentolamine. There were no serious complications observed during the study, and only a single minor side effect occurred in 1 patient after 60 mg. phentolamine. CONCLUSIONS: Our results indicate that oral phentolamine may be of benefit for the treatment of erectile dysfunction. Further studies are required to corroborate our findings.

Administration, Oral↗
PubMed2007

Is the metabolic syndrome an independent risk factor for erectile dysfunction?

PURPOSE: We determined the role of the metabolic syndrome as an independent risk factor for erectile dysfunction. MATERIALS AND METHODS: Men participating in a health screening project completed the International Index of Erectile Function-5. The metabolic syndrome was defined according to the 2005 International Diabetes Federation consensus definition. Multiple linear regression, ANOVA and chi-square tests were used to investigate the impact of the metabolic syndrome on erectile dysfunction. RESULTS: A total of 2,371 men with a mean age of 46.1 years (SD 9.9, range 30 to 69) were analyzed. Of the men 33.4% (652) had no erectile dysfunction (International Index of Erectile Function-5 score 22 to 25), 59.7% (1,166) had mild erectile dysfunction (International Index of Erectile Function-5 score 17 to 21) and 6.9% (134) had moderate to severe erectile dysfunction (International Index of Erectile Function-5 score 5 to 16). The metabolic syndrome was present in 33.8% (794). In a multiple linear regression analysis an increased waist-to-hip ratio (p = 0.01) and metabolic syndrome (p = 0.01) turned out to be independently associated with a decreased International Index of Erectile Function-5 score. When stratified according to age, the metabolic syndrome was correlated to erectile dysfunction only in men 50 years old or older with an increase of severe erectile dysfunction by 48% (p = 0.01). CONCLUSIONS: The metabolic syndrome and an increased waist-to-hip ratio are independently associated with a decreased International Index of Erectile Function-5 score. The metabolic syndrome in men older than 50 years is significantly associated with a higher proportion of moderate to severe erectile dysfunction.

Adult↗
PubMed2001

Smoking and erectile dysfunction: evidence based analysis.

PURPOSE: We examined available evidence concerning the role of smoking in the development of erectile dysfunction. This task involved a complete review of the smoking literature as it pertained to erectile dysfunction and select endothelial diseases. MATERIALS AND METHODS: We comprehensively reviewed the literature, including PubMed and recent abstract proceedings from national meetings relevant to smoking, erectile dysfunction and endothelial diseases. The quality of the evidence was assessed by methods used to develop clinical practice guidelines. Our review involved an objective evaluation of the basic science literature and clinical studies. When necessary, we examined studies of endothelial diseases other than erectile dysfunction because of obvious gaps in the literature. RESULTS: There are strong parallels and shared risks among smoking, coronary artery disease, atherosclerosis and erectile dysfunction. Clinical and basic science studies provide strong indirect evidence that smoking may affect penile erection by the impairment of endothelium dependent smooth muscle relaxation. The association of erectile dysfunction with risk factors such as coronary artery disease and hypertension appears to be amplified by cigarette smoking. Smoking may increase the likelihood of moderate or complete erectile dysfunction 2-fold. The prevalence of erectile dysfunction in former smokers was no different from that in individuals who had never smoked, implying that smoking cessation may decrease the risk of erectile dysfunction. Case studies and retrospective series have shown an association of smoking with erectile dysfunction. CONCLUSIONS: Available evidence on the association of smoking with erectile dysfunction is not complete insofar as association linking factors are concerned. However, the evidence of such an association is likely due to the consistency of the relationship of smoking and endothelial disease, and the strength of the association of erectile dysfunction with other endothelial diseases.

Animals↗
PubMed2005

Factors affecting the increased prevalence of erectile dysfunction in Greek hypertensive compared with normotensive subjects.

Arterial hypertension is considered a risk factor for erectile dysfunction. The aim of the study was to evaluate the prevalence of erectile dysfunction in hypertensive compared with normotensive individuals of similar demographic characteristics in Greece. Furthermore, the effect of age, hypertension severity, hypertension duration, and antihypertension medication on erectile function of these subjects was investigated. The study population consisted of 634 consecutive young and middle-aged men (31-65 years) that visited our outpatient clinic. From them, 358 patients had arterial hypertension and 276 were normotensive. Erectile dysfunction was evaluated with the International Index for Erectile Function questionnaire. Erectile dysfunction was found in 35.2% of patients with essential hypertension compared with 14.1% of normotensive subjects (chi(2) = 35.92, P < .001). Patients with essential hypertension had more severe erectile dysfunction than their normotensive counterparts (chi(2) = 17.1, P < .001). Hypertension duration, hypertension severity, antihypertension medication, and age were positively correlated with erectile dysfunction. The prevalence of erectile dysfunction is higher in patients with essential hypertension compared with normotensive subjects of similar demographic characteristics. Erectile dysfunction is related to age in both groups, whereas duration and severity of hypertension as well as antihypertension drugs affect erectile function of hypertensive patients. Erectile dysfunction affects patient quality of life, underlining the need for vigorous research of this condition and appropriate management.

Adrenergic beta-Antagonists↗
PubMed2000

Prostaglandin E1 versus sex therapy in the management of psychogenic erectile dysfunction.

The treatment for psychogenic erectile dysfunction has been previously managed by non-medical methods consisting of counseling with a psychiatrist, psychologist or sex therapist. The success rate for treatment with counseling has not been uniformly successful. This paper compares the treatment of psychogenic erectile dysfunction using standard sex therapy and self-injection therapy using low-dose PGE1. Fifty men with psychogenic impotence were divided into two groups: standard sex therapy for twelve weeks or treatment using low-dose (2.5 - 5.0 microg) of PGE1. The results showed that men treated with low-dose PGE1 had a 47% improvement of obtaining an unaided erection compared to 58% improvement rate with sex therapy. 69% of patients in the PGE1 group were satisfied with their treatment compared to 75% receiving sex therapy. The frequency of intercourse reported in patient diaries for the two groups was similar (20.5 per month for PGE1 vs 20.0 per month for sex therapy. The reported duration of erection by patients receiving PGE1 therapy was longer than that reported by those receiving sex therapy (35 min vs 10 min). The comparison of the cost of treatment of the two treatment groups reveals that the sex therapy is approximately 25% more expensive than the PGE1 treatment. This pilot study demonstrates that the efficacy of PGE1 was numerically, though not statistically, less than sex therapy in the treatment of psychogenic impotence. The cost per positive outcome with PGE1 treatment is lower than that of sex therapy treatment making PGE1 more cost-effective.

Alprostadil↗
PubMedDate not supplied

Is routine hormonal measurement necessary in initial evaluation of men with erectile dysfunction?

To prospectively compare serum hormone levels and the incidence of hormonal pathologies between men with and without erectile dysfunction, and investigate risk factors that might predict hormonal pathologies in men complaining of erectile dysfunction. The study included 262 men with erectile dysfunction and 53 healthy men with no erectile dysfunction as a control group. All men enrolled in the study were evaluated with a detailed history, physical examination, international index of erectile function (IIEF-5), and serum hormone measurement. Hypotestosteronemia was considered as serum total testosterone value of < 3 ng/mL, and hyperprolactinemia was considered as serum prolactin level of > 18 ng/mL. Serum hormone levels and the incidence of hormonal abnormalities were compared between the two groups. In addition, risk factors for hormonal abnormalities were investigated. There were no significant differences in the mean serum FSH (p = 0.212), LH (p = 0.623), testosterone (p = 0.332) and prolactin values (p = 0.351) between the men with and without erectile dysfunction. Hypotestosteronemia was detected in 29 (11%) of the erectile dysfunction group and in 2 (3.7%) of the control group, revealing no significant difference (p = 0.104). Hyperprolactinemia was detected in 25 (9.5%) of the erectile dysfunction group and in 2 (3.7%) of the control group, revealing no significant difference (p = 0.171). To investigate risk factors that might predict hormonal pathologies, there were no significant differences in the patient age, duration of the sexual dysfunction, smoking history and duration, the presence of chronic disease and the type of erectile dysfunction. Our findings suggest that hormonal measurement should not be routinely performed in the initial evaluation of men presenting with erectile dysfunction, and may be necessary based only on the findings obtained with a careful history and physical examination.

Adult↗