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PubMed2003

Erectile dysfunction risk factors in noninsulin dependent diabetic Saudi patients.

PURPOSE: We assessed the prevalence of and analyzed risk factors for erectile dysfunction in patients with noninsulin dependent diabetes in Makkah, Saudi Arabia. MATERIALS AND METHODS: A total of 562 male diabetic Saudi patients were enrolled in this study. Patients were screened for erectile dysfunction using the International Index of Erectile Function. At the time of screening patients were also interviewed for sociodemographic data, including age, education, occupation, marital status and smoking. Medical history included diabetes, diabetes related complications, risk factors for diabetes and erectile dysfunction, and current medication. RESULTS: Mean age of the study sample was 53.7 years (range 27 to 84). Of the patients 86.1% had various degrees of erectile dysfunction, including mild in 7.7%, moderate in 29.4% and severe in 49.1%. The prevalence of erectile dysfunction was 25% in patients younger than 50 years, which increased to 75% in those older than 50 years. Of those without erectile dysfunction 70% were younger and 30% were older than 50 years (p = 0.0001). Patients with a history of diabetes of greater than 10 years were 3 times as likely to report erectile dysfunction as those with a history of less than 5 years. Men with poor metabolic control were 12.2 times as likely to report erectile dysfunction as those with good metabolic control. Of diabetic patients with erectile dysfunction 53% had 1 or more diabetic related complications compared with 20.5% with no erectile dysfunction (p = 0.0001). CONCLUSIONS: Erectile dysfunction is common in diabetic Saudi men. This study provides a quantitative estimate of the prevalence of erectile dysfunction and its main risk factors in diabetic Saudi patients.

Adult↗

PubMed2003

Erectile dysfunction in the elderly: epidemiology, etiology and approaches to treatment.

PURPOSE: Erectile dysfunction is experienced at least some of the time by most men who have reached 45 years of age, and it is projected to affect 322 million men worldwide by 2025. The prevalence of erectile dysfunction is high in men of all ages and increases greatly in the elderly. MATERIALS AND METHODS: This paper reviews the epidemiology of erectile dysfunction with an emphasis on the experience of older men, normal age related changes in the structure and function of the penis that may contribute to increased risk with age, how the accumulation of risk factors with age may contribute to the high prevalence of the disease in older men, and established and emerging therapies. The normal aging process and age related risk factor accumulation contribute to the increased prevalence of erectile dysfunction in the elderly. RESULTS: Remarkable progress has been made in the treatment of erectile dysfunction. At present inhibition of phosphodiesterase 5 with oral agents such as sildenafil would appear to be the initial treatment of choice. These drugs have been shown to be safe and effective, and sildenafil has demonstrated efficacy in patients with many of the comorbidities observed in older men with erectile dysfunction. New treatments, in particular transfection with genes for key mediators of erectile function that are known to be down-regulated in elderly men, also hold promise. CONCLUSIONS: Further research into the neural, vascular and molecular mechanisms involved in penile erection will lead to the development of even safer, more effective and more convenient therapies for men with erectile dysfunction.

Aged↗

PubMed1996

Identification of a down-regulated mRNA transcript in corpus cavernosum from diabetic patients with erectile dysfunction.

Fifty per cent of men with diabetes have erectile dysfunction. Previous studies demonstrated that cultured smooth muscle cells from corpus cavernosum display significantly altered K+ channel function, PGE-induced cAMP accumulation, and endothelin-1 induced Ca2+ mobilization that are consistent with the pathophysiology of erectile dysfunction. Since defects in signal transduction frequently lead to altered gene expression, we examined differences in gene expression in corporal tissue excised from three diabetic patients with erectile dysfunction function and one patient with neurogenic erectile dysfunction. Using differential display, we identify a transcript expressed in tissue derived from the patient with impotence secondary to a radical prostectomy, but which was greatly reduced or absent in corporal tissue from all three diabetic patients examined. DNA sequence analysis indicates that this transcript has no significant homology to sequences presently deposited in the GenBank database. This suggests that altered gene expression may play a significant part in the etiology of erectile dysfunction.

Base Sequence↗

PubMed2004

Erectile dysfunction: management update.

Dramatic advances in the management of erectile dysfunction have occurred over the past decade. Oral therapy with vasoactive agents has emerged as first-line treatment and has transformed both the manner in which the public views erectile dysfunction and the way health care providers deliver care. Whereas an extensive investigation was previously common in the management of erectile dysfunction, recent treatment guidelines promote a more minimalist, goal-oriented approach. In this article, we review the physiology of erection, and the pathophysiology, diagnosis and clinical management of erectile dysfunction. We also present the existing evidence for the efficacy of 3 phosphodiesterase inhibitors, the most widely used class of agents for erectile dysfunction.

Erectile Dysfunction↗

PubMed1994

[Which hormone determinations are necessary in the initial assessment of erectile dysfunction?].

The assessment of an erectile dysfunction (ED) includes the history, a clinical examination and blood tests. There is some confusion about which basic hormonal tests are needed at the beginning of clinical evaluation. We feel that with the results from our patients we could help to answer this question. From 1 January 1990 until the December 31 1993 we evaluated 1134 patients for ED. Those who favoured a surgical correction of their ED were fully evaluated by nocturnal penile tumescence testing, penile arteriography, intracavernosal injection of vasoactive agents and dynamic pharmaco-cavernosometry. The results from these tests were correlated with luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone and prolactin. 183 (16.1%) of our patients with a mean age of 45 +/- 14 were fully evaluated. From these patients 76 were excluded because their ED was posttraumatic, undoubtedly psychogenic or could not be proven by the tests mentioned above. From the 107 patients finally included in this study, 90 had normal endocrine parameters. 17 patients had low testosterone. 14 of these patients had otherwise completely normal hormonal tests without evidence of secondary hypogonadism. Three patients had their low testosterone levels confirmed by repeated measurements. In addition, prolactin was significantly increased, and FSH and LH were near or below the lower reference value. When evaluating patients for the first time because of an erectile dysfunction, the measurement of testosterone as a single endocrine test is adequate. If testosterone is low, repeated measurements, combined with LH, FSH and prolactin, will identify patients with an ED due to an endocrine disease.

Adolescent↗

PubMed2000

Effect of erectile dysfunction on frequency of intercourse: a population based prevalence study in Finland.

PURPOSE: We estimate the prevalence of erectile dysfunction in Finland and its effect on frequency of sexual intercourse. MATERIALS AND METHODS: A population based study of 3,143, 50, 60 and 70-year-old men in Tampere and 11 municipalities in the same county was conducted by mailed questionnaire. The definition of erectile dysfunction was based on difficulties in achieving an erection before sexual intercourse and maintaining it. Erectile dysfunction was classified into 4 groups as none, minimal, moderate and complete. To estimate the effect of erectile dysfunction on the frequency of sexual intercourse the men were divided into those who had intercourse at least an average of once weekly and those who did not. RESULTS: A total of 2,198 questionnaires (70%) were returned and 1, 983 men (63%) were included in the study. Of these men 26% had no, 48% minimal, 14% and 12% complete erectile dysfunction, which increased with age (compared with 50-year-old men, the odds ratios for complete erectile dysfunction were 4.5 (95% confidence interval [CI] 2.6-7.5) for 60 and 21 (95% CI 12.5 to 34.7) to 70-year-old men. The effect of erectile dysfunction on the frequency of sexual intercourse could not be accounted for by age or marital status. The adjusted effect was strong among men with moderate (odds ratio 3.5, 95% CI 2.2-5.1) and complete (173, 68-443) erectile dysfunction but minimal erectile dysfunction had no impact (odds ratio 0.9, 95% CI 0. 6-1.3) on the frequency of intercourse. CONCLUSIONS: Erectile difficulties are common and complete erectile dysfunction increases with age. Erectile dysfunction regulates the sex life of men with moderate or complete dysfunction but this association cannot be accounted for by age or marital status. Although mild erectile dysfunction did not completely regulate sex life, its significance is the risk of progression to a more severe sexual life disturbing dysfunction.

Aged↗

PubMed2006

Female sexual dysfunction, voiding symptoms and depression: common findings in partners of men with erectile dysfunction.

The aim of this study was to investigate the prevalence of female sexual dysfunction (FSD), urinary symptoms, and depressive symptoms in female partners of men presenting with erectile dysfunction (ED). A multi-component questionnaire was administered to female partners of men with erectile dysfunction presenting to a urology center. It contained a standardized sexual function component (the Brief Index of Sexual Function for Women), a depression scale (Centers for Epidemiologic Studies-Depression, CES-D), a demographics questionnaire and a general medical questionnaire. A total of 73 consecutive female partners of male patients presenting with ED, were surveyed using the questionnaire at their counterpart's visit. Fifty-two women responded, of whom 50 filled out the questionnaire adequately for proper evaluation. This indicated a response rate of 68% (50/73). The mean age was 44.8 years (range 20.0-83.0). Thirty-eight of the 50 women (76%) reported being sexually active. A variety of sexual behaviors were reported including 40% (20/50) of women engaging in vaginal intercourse. Sexual dysfunction symptoms included: anxiety/inhibition (26%), hypoactive desire (20%), arousal/lubrication difficulty (30%), orgasmic difficulty (24%), dyspareunia (18%), incontinence during intercourse (8%), and sexual dissatisfaction (34%). Eight women (16%) reported difficulty communicating sexual issues with their partners. Forty-one women (82%) rated sexual activity as an important part of their lives. Urinary symptoms of frequency and urgency were reported by 18/50 (36%). Depressive symptoms were present in 22/50 (44%). FSD disorders, urinary symptoms and depressive symptoms are common in partners of men with erectile dysfunction.

Adult↗

PubMed1999

Long-term results of dorsal penile vein ligation for symptomatic treatment of erectile dysfunction.

About 20% of patients with erectile dysfunction do not react to intracavernous pharmacological treatment (SKAT) because of a cavernous leak. The first attempt to treat venous insufficiency goes back as far as the beginning of the century. Ligature and resection of the superficial and deep veins of the penis (DPVL) were performed in 122 patients (nonresponders to SKAT with a maintenance flow of less than 40 ml min-1). Twenty-four patients suffered from primary dysfunction and 98 from secondary dysfunction. The average age of the patients was 49 years, and the average duration of the preoperative erectile dysfunction 4.4 years. Postoperative follow-up was carried out for 70 months. In 98% of the patients, cavernosography revealed a dorsal leak. Twenty-six per cent had ectopic veins, 38% a leakage through the crural veins and 24% a glandular or spongiosal shunt. After the 70-month follow-up, only 14% of the 122 patients were able to achieve an adequate spontaneous erection and 19% also responded to SKAT. Depending upon the time elapsed since the operation, the rate of spontaneous reaction was reduced. It was found that younger patients with a short history of erectile dysfunction, no arterial cofactor, a maintenance flow of less than 100 ml min-1 and a severe dorsal leakage from a DPVL were the most likely to benefit from this procedure. Since degeneration of smooth muscle cells of the cavernosa is in most patients the cause of the venous leakage, penis vein surgery is to be regarded as symptomatic treatment.

Adult↗

PubMed1999

Quantitative sensory and autonomic testing in male diabetic patients with erectile dysfunction.

OBJECTIVE: To correlate abnormalities of nerve fibres in the lower limbs with erectile dysfunction in male diabetic patients, using a range of quantitative sensory and autonomic function tests. PATIENTS AND METHODS: The study included 68 male diabetic patients with symptomatic erectile dysfunction and 11 matched diabetics without erectile dysfunction; none had clinical evidence of peripheral vascular disease or psychological disorder. Patients were evaluated with a symptom questionnaire based on the Michigan Neuropathy Screening Instrument questionnaire and examined clinically. Sural and peroneal nerve-conduction studies, and quantitative sensory and autonomic tests (vibration, thermal, light-touch thresholds, sensory and autonomic cutaneous axon-reflexes) were used to detect nerve abnormalities in the lower limbs, which were correlated with erectile dysfunction. RESULTS: Symptoms of neuropathy were more common in the group with male erectile dysfunction (MED), but statistically significant only for neuropathic pain (53% MED, 18% nonMED, P<0.05, chi-square test) and gastroparesis (44% MED, 0% nonMED, P<0.05). Tests of unmyelinated afferents (warming perception and capsaicin-induced sensory axon-reflex vasodilatation) were most often abnormal, sometimes with no other abnormalities on tests or neurological examination. However, abnormality of warm perception was not significantly different between groups (81% MED, 70% nonMED), suggesting that it is a poorer discriminant than abnormal sensory axon-reflex vasodilatation (89% MED, 22% nonMED, P<0.001). The only other significant test difference was decreased sural nerve action potential (70% MED, 22% non-MED, P<0.01). CONCLUSIONS: There appeared to be preferential involvement of unmyelinated sensory fibres that mediate axon-reflex vasodilatation in the limbs of diabetic patients with erectile dysfunction. This test appears to be a helpful indicator of neurological involvement in erectile dysfunction, and may be used to monitor the effect of new treatments.

Adult↗

PubMed1998

Health-related quality of life in men with erectile dysfunction.

OBJECTIVE: To assess health-related quality of life (HRQOL) in men with erectile dysfunction. DESIGN: Descriptive survey with general and disease-specific measures. The instrument contained three established, validated HRQOL measures, a validated comorbidity checklist, and sociodemographics. The RAND 36-Item Health Survey 1.0 (SF-36) was used to assess general HRQOL. Sexual function and sexual bother were assessed using the UCLA Prostate Cancer Index. The marital interaction scale from the Cancer Rehabilitation Evaluation System Short Form (CARES-SF) was used to assess each patient's relationship with his sexual partner. SETTING: Urology clinics at a university medical center and the affiliated Veterans Affairs (VA) Medical Center. PARTICIPANTS: Thirty-five (67%) of 54 consecutive university patients presenting for erectile dysfunction and 22 (42%) of 52 VA patients who were awaiting a previously prescribed vacuum erection device participated. MAIN RESULTS: The university respondents scored slightly lower than population normals in social function, role limitations due to emotional problems, and emotional well-being. The VA respondents scored lower than expected in all eight domains. Scores for the VA population were significantly lower than those for the university population in physical function, role limitations due to physical problems, bodily pain, and social function. A significant correlation was seen between marital interaction and sexual function (r = -.33, p = .01) but not between marital interaction and sexual bother (r = -.15, p = .26) in the total sample. Sexual function also correlated significantly with general health perceptions (r = .34, p = .01), role limitations due to physical problems (r = .29, p = .03), and role limitations due to emotional problems (r = .30, p = .03). Sexual bother did not correlate with any of the general HRQOL domains. Affluent men reported better sexual function (p = .03). CONCLUSIONS: The emotional domains of the SF-36 are associated with more profound impairment than are the physical domains in men with erectile dysfunction. Erectile dysfunction and the bother it causes are discrete domains of HRQOL and distinct from each other in these patients. With increased attention to patient-centered medical outcomes, greater emphasis has been placed on such variables as HRQOL. This should be particularly true for a patient-driven symptom, such as erectile dysfunction.

Comorbidity↗

PubMed2004

[Growth hormone deficiency and age-related erectile dysfunction].

The incidence of erectile dysfunction (ED) significantly increases in aging men, which may be associated with the decrease of the serum growth hormone (GH) level. GH may play an important role in the maintenance of penile erectile function, perhaps by promotion of the NO-cGMP pathway, stimulation of the regeneration of NOS-containing nerve fibers and the augmentation of androgenic action.

Adult↗

PubMed1999

Pathophysiology of Erectile Dysfunction.

Physiology of erection and pathophysiology erectile dysfunction is reviewed. Analysis is obtained from basic and clinical research including animals studies, anatomical studies, and molecular and cellular research on corporal tissue obtained during penile prosthesis implantation. Supraspinal influences and spinal influence on penile erection has been learned from spinal cord injury patient. Corporal smooth muscle relaxation of penile arteries and corpus cavernosum leads to penile erection, results from parasympathetic/nonadrenergic noncholinergic neural pathway activation and simultaneous inhibition of sympathetic outflow. Anatomical studies taught understanding of the mechanism for restriction of blood outflow from the corpora cavernosa. The change of smooth muscle tone has emerged as a key factor in erection and detumescence. Many independent factors converge on the modulation of corporal smooth muscle tone. Neuronal and local neurotransmitter effects via gap junction, potassium channels, and calcium channel. A nitric oxide/cyclic guanosine monophosphate mechanism as well as cyclic aminomonophosphate has an important role in mediating the corporal smooth muscle relaxation necessary for erectile function. Erectile dysfunction can be due to vasculogenic, neurogenic, hormonal, veno-occlusive, psychogenic and/or pharmacogenic factors as well as alterations in the nitric oxide/cyclic guanosine monophosphate (cGMP) or cyclic aminophosphate (cAMP) pathway or other regulatory mechanisms including gap junction or ionic channel resulting in an imbalance in corporal smooth muscle contraction and relaxation. Our present knowledge of the hemodynamics, functional anatomy, neurophysiology, and neuropharmacology of penile erection and dysfunction at the cellular and molecular level has led to better understanding of physiology and pathophysiology of erectile dysfunction.

Journal Article↗

PubMed2003

Investigations in erectile dysfunction.

PURPOSE OF REVIEW: This is an update of recent developments in the investigation of erectile dysfunction in the period since March 2002. RECENT FINDINGS: Three developments in the field of medical sexology redirected the approach towards the investigation of erectile dysfunction. First, the emergence of oral pharmacological therapy; second, the notion that sexual relationship issues have an important impact on the successful outcome of pharmacological therapy; and finally, the concept that erectile dysfunction is often a sequel or even a sentinel of cardiovascular disease. Consequently, the current evaluation of men with erectile dysfunction may be divided into two steps: a basic diagnostic evaluation for the majority of men, and specific diagnostic procedures for a small minority. The basic evaluation is aimed at the identification of the underlying pathological condition and erectile dysfunction-associated risk factors. Such screening may diagnose reversible causes of erectile dysfunction and also unmask medical and psychological conditions that manifest with erectile dysfunction. The basic evaluation consists of a comprehensive medical, sexual and psychosocial history and a physical examination. Patients who have failed first-line treatment or complicated cases qualify for specific diagnostic procedures, traditionally performed by urologists. SUMMARY: Current research into the investigation of erectile dysfunction emphasizes the notion that erectile dysfunction is often a result of an interplay between medical and psychosexual conditions. Recognition of the underlying conditions and an estimation of their relative contribution to the patient's and his partner's sexual problem are key issues in the current evaluation of the man with erectile dysfunction.

Erectile Dysfunction↗

PubMedDate not supplied

[Necessity for using evidence-based medicine in making clinical decisions based on the example of erectile dysfunction].

The choice of the method to treat erectile dysfunction is often not easy. The evidence-based approach to the critical appraisal of the medical literature could help us to find the best way. All the available information was critically assessed in order to find the answer to the question: Ds sildenafil effective in the treatment of erectile dysfunction in patients with diabetes mellitus? All sources of information have been analysed including medical text books and the sources from the university of Cochrane library. The result of the analysis was the following: sildenafil is effective with a B degree of significance in the treatment of erectile dysfunction in patients with diabetes mellitus. This allows us to recommend sildenafil for treatment of erectile dysfunction in men with diabetes mellitus. The above algorithm of the critical assessment of the primary medical literature can be used for preparing standards of urological diseases treatment.

Erectile Dysfunction↗

PubMed1997

Running an erectile dysfunction clinic.

Men experiencing erectile dysfunction may appreciate attending a clinic where staff deal specifically with this problem. Several treatments are available for impotence, including hormone replacement, penile injections and vacuum therapy.

Erectile Dysfunction↗

PubMed2006

Prevalence of erectile dysfunction in kidney transplant recipients.

Prevalence and severity of erectile dysfunction increase with advancing age. Patients with end-stage renal disease (ESRD) experience disturbances in erectile function related to organic factors including as uremia, hypertension, endocrine, and nonorganic factors like depression. Recipients of kidney transplants show a high prevalence of erectile dysfunction, 32.2% to 50.7%. We conducted a study of the prevalence of erectile dysfunction among male renal transplant recipients using the International Index of Erectile Function. Among 182 men with kidney transplantations, there were 89 recipients (48.9%) with erectile dysfunction; 60 recipients had normal sexual function (32.9%); and whereas 33 recipients had no sexual activity.

Adult↗

PubMed2001

Preliminary observations of sildenafil treatment for erectile dysfunction in dialysis patients.

Erectile dysfunction is common in dialysis patients. We report our experience with sildenafil citrate in patients undergoing dialysis therapy. Male subjects attending the Outpatient Dialysis Unit at the University of Pennsylvania (Philadelphia, PA) who were prescribed sildenafil by their primary physician or nephrologist were asked to complete the International Index of Erectile Function before their first dose of sildenafil and after at least 4 weeks of therapy. Subjects' mean age was 50.3 +/- 14.63 (SD) years. Ninety-three percent of the subjects were black. Based on a global efficacy question, 66.7% of the subjects believed that treatment had improved their erections. Subjects reported no increase in the sexual desire domain despite experiencing a significant increase in erectile function, orgasmic function, and satisfaction with intercourse. Sildenafil was well tolerated in a selected group of patients who reported improved sexual function with no major adverse effects.

Adult↗

PubMedDate not supplied

Erectile dysfunction.

With phosphodiesterase inhibitors, a safe and effective oral therapy has emerged for erectile dysfunction. Increasing awareness, particularly through the media, is inducing more men to seek help for this condition. Erectile dysfunction is defined as the persistent inability to achieve or maintain an erection adequate for satisfactory sexual activity. The prevalence increases with age. Basic and clinical research is identifying the neurovascular and humoral control of the mechanisms. The initial evaluation should differentiate erectile dysfunction from premature ejaculation and loss of libido. Myocardial insufficiency, hypogonadism and peripheral neuropathy should be looked for. Initial laboratory investigations should be restricted to identifying previously undetected medical illness that may directly contribute to erectile dysfunction. Discussing the available options with the couple is an important aspect. If erectile dysfunction is secondary to other treatable disorders these should be treated simultaneously. When other diseases that require intervention are ruled out and if there are no contraindications, therapy may be initiated with a phosphodiesterase inhibitor. In selected cases, psychosexual therapy may be beneficial. If phosphodiesterase inhibitors are contraindicated, vacuum constriction devices may be tried. Further options include intracavemosal injection, intraurethral instillation, penile revascularization and prosthesis. The availability of effective and well-tolerated oral medications has dramatically changed the clinical approach to erectile dysfunction. Pharmacotherapy is the preferred cost-effective first-line therapy in the vast majority of patients. A stepped-care approach is followed in the primary care and family practice settings. Appropriate urological, endocrine and psychiatric referrals, and shared decision-making with the couple will enable effective treatment of men with erectile dysfunction.

Erectile Dysfunction↗