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PubMed2004

[The use of color Doppler in the diagnosis of erectile dysfunction].

The technology of color Doppler ultrasonography (CDU) was more and more popularly applied to the clinical diagnosis of erectile dysfunction (ED) in recent years since its introduction into this domain by Lue et al. CDU is preferable as a diagnostic means for its advantages of being convenient, non-impairing and easily repeatable. Nowadays, CDU is becoming a hotpoint of research. However, CDU still has some defects that have limited its application. This article reviews its mechanism, usage, research development and application combined with other diagnostic means, and introduces a new type of power-Doppler imaging.

Erectile Dysfunction↗

PubMed1995

Psychology's role in the assessment of erectile dysfunction: historical precedents, current knowledge, and methods.

This article describes the role of the psychologist in the evaluation of erectile dysfunction. It begins by reviewing current diagnostic criteria and providing a historical overview. Next, current epidemiologic knowledge is summarized, including data on prevalence and recent research examining cognitive, affective, dyadic, and lifestyle etiologic risk factors. This is followed by a state-of-the-science discussion of assessment procedures. Recent psychophysiologic methods are highlighted, including RigiScan monitoring, waking arousal, and diurnal tumescence. It concludes by emphasizing the necessity of continued collaboration between psychology and medicine for both evaluation and treatment.

Erectile Dysfunction↗

PubMed2006

Pathophysiology and treatment of diabetic erectile dysfunction.

The pathophysiology of diabetes is multifactorial and no single etiology is at the forefront. The proposed mechanisms of erectile dysfunction (ED) in diabetic patients includes elevated advanced glycation end-products (AGEs) and increased levels of oxygen free radicals, impaired nitric oxide (NO) synthesis, increased endothelin B receptor binding sites and ultrastructural changes, upregulated RhoA/Rho-kinase pathway, NO-dependent selective nitrergic nerve degeneration and impaired cyclic guanosine monophosphate (cGMP)-dependent kinase-1 (PKG-1). The treatment of diabetic ED is multimodal. Treatment of the underlying hyperglycemia and comorbidities is of utmost importance to prevent or halt the progression of the disease. The peripherally acting oral phosphodiesterase type 5 (PDE5) inhibitors are the mainstay of oral medical treatment of ED in diabetics. Vacuum erection devices are an additional treatment as a non-invasive treatment option. Local administration of vasoactive medication via urethral suppository or intracorporal injection can be effective with minimal side-effects. Patients with irreversible damage of the erectile mechanism are candidates for penile implantation. Future strategies in the evolution of the treatment of ED are aimed at correcting or treating the underlying mechanisms of ED. With an appropriate vector, researchers have been able to transfect diabetic animals with agents such as neurotrophic factors and nitric oxide synthase (NOS). Further studies in gene therapy are needed to fully ascertain its safety and utility in humans.

Alprostadil↗

PubMed2005

Recognizing the risk of erectile dysfunction in a urology clinic practice.

OBJECTIVE: To determine the utility of simple patient-reported information in signalling erectile dysfunction (ED), as a challenge for the clinical urologist or related specialist is to quickly recognize risk factors for sexual dysfunction within the time constraints of an office visit. PATIENTS AND METHODS: In a sample of men visiting a urology clinic, we determined the utility of simple patient-reported information in signalling ED. RESULTS: Information readily obtained through a patient's self-report (that typically obtained in the office setting) can be very useful in understanding and predicting the likelihood of ED. Risk factors identified largely paralleled those identified in men generally, and included age, specific urological and non-urological somatic conditions, and tobacco use. Furthermore, knowing about even moderate levels of patient-reported psychological or relationship stress was useful in assessing the risk of ED. CONCLUSION: Understanding the relationship of such risk factors to ED among men visiting a urology clinic might be particularly useful in clinical situations where the patient, for whatever reason, is reluctant to disclose an erectile problem when scheduling an appointment or even during the consultation.

Ambulatory Care↗

PubMed1999

Transcutaneous nitroglycerine in the treatment of erectile dysfunction: a placebo controlled clinical trial.

Transcutaneous nitroglycerine has previously been reported to be effective in the treatment of erectile dysfunction. We present our results with the drug in a randomised, placebo controlled, double-blind crossover study. The effect of the drug has been evaluated both under laboratory conditions and in a home study. Eighteen men were included in the study. No effect of nitroglycerine could be demonstrated under laboratory conditions by application of the Rigiscan Monitor. In the home study there was no statistical significant effect of transcutaneous nitroglycerine compared to placebo (P= 0.2813).

Administration, Cutaneous↗

PubMed2001

Efficacy and safety of oral sildenafil in men with erectile dysfunction and spinal cord injury.

OBJECTIVE: To assess the efficacy of sildenafil in men with spinal cord injury (SCI) and erectile dysfunction (ED). METHODS: Seventeen men with SCI were selected from February to September 1998 for sildenafil treatment of ED. The initial dose of 25 mg was increased by 25-mg increments as needed. Patients underwent baseline physical examination and answered questions from the abridged International Index of Erectile Function before and during therapy. RESULTS: Sixteen patients tolerated therapy; 1 developed hypotension and discontinued therapy. There was significant improvement in erectile function (P < .05) after 5.3 +/- 2.2 months when compared with baseline or previous therapies (P < .05). Of the 17 patients, 94% recommended sildenafil to others. Six of these 16 patients were available for long-term follow-up. There was further significant improvement in quality of erection (P < .05), but no change in satisfaction. CONCLUSION: Sildenafil is effective and well tolerated in men with SCI and ED.

Administration, Oral↗

PubMed2005

Gene therapy for erectile dysfunction.

The past decade has seen an explosion of new information on the physiology of penile erection, pathophysiology of erectile dysfunction (ED), and development of new oral agents (e.g., three PDE5 inhibitors) to manage ED. Although all three selective PDE5 inhibitors are effective in the majority of ED cases, these oral medications have failed in certain disease states, such as diabetic ED, postprostatectomy ED, and severe veno-occlusive dysfunction. Only about 50% to 60% of these cases benefit from PDE5 inhibitor therapy, prompting the development of new approaches, including gene-based therapies for the treatment of ED. The penis is a convenient tissue target for gene therapy because of its external location and accessibility, the ubiquity of endothelial lined spaces, and low level of blood flow, especially in the flaccid state. Initially, gene therapy has been reserved for the treatment of life-threatening disorders including cancer, hereditary and acquired diseases. However, gene therapy is an attractive therapeutic possibility for the treatment of ED. Evolution of nitric oxide (NO), a small gaseous, lipophilic signaling molecule that is produced by nitric oxide synthase (NOS) activates guanylate cyclase (GC), resulting in increased cyclic guanosine monophosphate (cGMP) production, plays a significant role in our understanding of cavernosal smooth muscle physiology. Many gene therapy strategies have focused on the NO/GS/cGMP pathway. All three NOS isoforms, endothelial NOS (eNOS), neuronal NOS (nNOS), and iNOS have been used for gene therapy in order to modulate erectile response. Various viral and nonviral vectors have been used to date for the transfer of genetic material to the target cell or tissues with various degrees of success. Recently, second generation or "gutless" (helper-dependent) adenovirus vectors have been developed in order to reduce cellular toxicity and immune response, while increasing efficient gene therapy. Varieties of other gene therapy trials have also been undertaken for the treatment of ED and are the focus of this review.

Brain-Derived Neurotrophic Factor↗

PubMed2004

Vardenafil improves patient satisfaction with erection hardness, orgasmic function, and overall sexual experience, while improving quality of life in men with erectile dysfunction.

PURPOSE: The North American Pivotal Trial was designed to investigate the efficacy and safety of vardenafil in males with erectile dysfunction (ED). MATERIALS AND METHODS: In this randomized, double-blind, placebo-controlled, multicenter, fixed-dose, parallel group, 6-month study, vardenafil at three doses (5 mg, 10 mg, and 20 mg) was compared to placebo with the primary efficacy variables being the International Index of Erectile Function (IIEF) Erectile Function (EF) domain score and per patient diary response success rates for penetration and maintenance of erection through completion of intercourse. Additional efficacy variables included IIEF domain scores measuring intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction. Diary entries for overall per patient satisfaction rates for hardness and sexual experience were also measured. Improvements in quality of sexual life were assessed using the Fugl-Meyer quality of life (QoL) questionnaire. RESULTS: Compared to placebo, patients taking 10 mg and 20 mg doses of vardenafil showed statistically significantly greater improvement in IIEF domain scores measuring intercourse satisfaction (10.3 and 10.3 vs. 7.7), orgasmic function (7.1 and 6.9 vs. 5.3), overall satisfaction. (7.1 and 7.1 vs. 5.2) for vardenafil 10 mg and 20 mg vs. placebo, respectively, at last observation carried forward (LOCF). Vardenafil 5 mg was statistically significantly better than placebo for the secondary IIEF domain variables of intercourse satisfaction (8.9 vs. 7.7) and overall satisfaction (6.3 vs. 5.2) for vardenafil vs. placebo, respectively, at LOCF. Per patient satisfaction rates for the secondary diary variables measuring erection hardness (38%, 52%, 58% and 18%) and overall satisfaction (45%, 58%, 62% and 23%) were dose dependent and statistically significantly superior for vardenafil at 5 mg, 10 mg and 20 mg compared with placebo, respectively. Patients' answers to the Fugl-Meyer QoL questionnaire assessing improvement in sexual life also indicated statistically significant superiority for all doses of vardenafil vs. placebo treatment. The most frequent adverse events (AE) in the 5 mg, 10 mg, and 20 mg of vardenafil and placebo groups, respectively, were: headache (10%, 22%, 21% and 4%), flushing (5%, 10%, 13% and 0%), dyspepsia (1%, 4%, 6% and < 1%), and rhinitis (9%, 14%, 17% and 5%). Most AEs were mild or moderate in severity and transient in nature. CONCLUSION: Vardenafil was superior to placebo for IIEF domain scores, per patient success rates for diary questions, and assessment of quality of sexual life, in a broad range of patients with ED irrespective of etiology or severity. Vardenafil was generally well tolerated, with most AEs being mild or moderate in severity and transient in nature.

Adult↗

PubMed2025

A cross-species multi-omics analyze uncovers conserved molecular mechanisms underlying age-related erectile dysfunction.

BACKGROUND: The urgent need for new treatments is driven by the challenging clinical situation of age-related erectile dysfunction (ARED). AIM: To clarify the conserved molecular mechanisms of ARED across species using multi-omics. METHODS: Rat and mouse models with ARED were developed to facilitate the extraction of mRNA and proteins from the corpus cavernosum for high-throughput sequencing. Bioinformatics techniques were employed to analyze differentially expressed genes and to conduct analyses using the Kyoto Encyclopedia of Genes and Genomes, Gene Ontology, and protein-protein interaction networks. Verification of the results was carried out using immunofluorescence, hematoxylin-eosin staining, and Masson staining. OUTCOMES: The multi-omics profiles of ARED rats and mice were analyzed and validated across species. RESULTS: In both species, Kyoto Encyclopedia of Genes and Genomes and Gene Ontology analyses of transcriptomic and proteomic data revealed that differentially expressed genes were predominantly enriched in pathways associated with alterations in extracellular matrix composition, downregulation of mitochondrial activity, and disruption of protein homeostasis. Immunofluorescence analysis demonstrated an upregulation of reactive oxygen species expression, coupled with a downregulation of Aldh18a1, collagen, and collagen I expression in the corpus cavernosum of mice and rats with ARED. CLINICAL IMPLICATIONS: To offer a novel approach for enhancing the erectile function in patients with ARED. STRENGTHS AND LIMITATIONS: The primary strength of this study lies in its utilization of cross-species multi-omics sequencing, which has elucidated the conserved molecular mechanisms underlying ARED. However, a significant limitation is the absence of subsequent validation in patients with ARED. CONCLUSIONS: Cross-species multi-omics comparisons present a potentially innovative approach for elucidating the underlying mechanisms and identifying preventive and therapeutic targets for ARED.

aging↗

PubMed1995

A prospective long-term follow-up study of patients evaluated for erectile dysfunction: outcome and associated factors.

The aim of this study was to investigate the long-term outcome of erectile dysfunction (ED) assessed in a routine clinical setting. The original population consisted of 209 patients who were consecutively referred to either the Urology Clinic or the Sexual Dysfunction Clinic of a University Hospital. At follow-up, 22 patients had died and 32 could not be found. Of the remaining 155, 107 (69%) patients participated in the study. The mean follow-up period was 4.1 years. Of these, 21 had had a prosthesis implanted, 34 had received self-injection therapy. 31 had sex therapy and 28 patients had not received any treatment. Overall, the rate of penetration increased, whereas coital frequency did not change. Despite the fact that sexual functioning in terms of penetration rate improved, more than of the patients reported that they were dissatisfied with the overall quality of their sex-lives.

Coitus↗

PubMed2006

The prevalence of Peyronie's disease in diabetic patients with erectile dysfunction.

We attempted in this study to investigate the prevalence of Peyronie's disease (PD) among diabetic patients with erectile dysfunction (ED). Two-hundred and six diabetic patients were further evaluated in this study. Forty-two (20.3%) patients had PD. There were significant associations between PD and risk factors of age, obesity and smoking. All patients with PD had also ED. Penile curvature was present in 82.1% of all patients with PD. Of the patients with PD, 25.4% had pain with or without erection. Significant associations between PD and ED and ED duration were detected. This study confirmed the high prevalence of PD among diabetic patients with ED. Further work is needed probing the mechanisms through which diabetes affects the pathogenesis of ED and PD.

Adult↗

PubMed1989

[Erectile dysfunction. Review and current status of diagnosis and therapy].

A rational concept of the diagnostic evaluation and treatment of erectile dysfunction (ED) is based on the corpus cavernosum drug test (CCDT) employing in combination with penis Doppler sonography. A positive CCDT with erection within 10 minutes indicates psychogenic or neurogenic ED, which is treated with sexual therapy of intracavernous (self)injection (ICI, ICSI). An erection after 10-30 minutes and pathological Doppler sonographic findings document a hemodynamically relevant penile blood flow disturbance which is treated with papaverine administered by ICI or ICSI. A negative CCDT with normal Doppler findings correlates with venous insufficiency as the cause of ED. On the basis of the results of drug cavernosography the indication for venous or penile prosthetic surgery is established. Depending on the pathological Doppler sonographic findings, in negativ CCDT the surgical treatment comprises prosthesis implantation or, in suitable cases, revascularization procedures.

Diagnosis, Differential↗

PubMed2004

Hormonal supplementation and erectile dysfunction.

The role of testosterone on sexual desire is well established. However, the effects of low testosterone levels in the pathophysiology of erectile mechanism in humans remains unclear. Recent evidence indicate that approximately 10-20% of men with erectile dysfunction (ED) have hormonal abnormalities, raising up to 35% over the age of sixty. It is now clear that sexual desire and erectile function in humans are both responsive to androgens, probably at different threshold values. In fact, different degrees of testosterone deficiency may determine a sequence of molecular penile events leading to reduced capacity of penile smooth muscle and endothelial cells of relaxation, without greatly affecting sexual desire. Also, androgens may directly control the expression and activity of phosphodiesterase type-5 in human corpus cavernosum. In some selected men with total testosterone below 10-13nmol/l and/or free testosterone below 200-250pmol/l, androgen supplementation may improve therapeutic efficacy of phosphodiesterase type-5 inhibitors. For ageing men with partial androgen deficiency (PADAM) who fail first-line oral treatments in whom androgens are not contraindicated, a combination of testosterone and phosphodiesterase type-5 inhibitors may be considered to improve erectile function and improve the quality of life.

Androgens↗

PubMed2002

Rat model of erectile dysfunction caused by cavernous nerve ablation.

OBJECTIVE: To identify the rat cavernous nerve and establish a rat model of erectile dysfunction (ED) caused by injury of the cavernous nerve. METHODS: Twenty rats underwent dissections. Cavernous nerves were identified with the aid of an operating microscope and confirmed by electrical stimulation. Then, 42 experimental rats were randomized into 3 groups, including sham-operated controls and unilateral and bilateral cavernous nerve ablation groups. Three weeks after surgery, rat models were evaluated with the Apomorphine test. RESULTS: The major pelvic ganglion lies on either side of the dorsolateral lobes of the prostate.It includes 2 inflows, one called hypogastric nerve and the other, the pelvic nerve. The largest outflow is termed the cavernous nerve. Stimulus parameters which could induce obvious penile erection were 5 volts, a frequency of 20 Hertz and a duration of 5 milliseconds. Three weeks after surgery, apomorphine could induce penile erection of each rat in the controls with a mean of 2.57 +/- 1.40 erections in 30 minutes, while there were no erections (0.00 +/- 0.00) in either the unilateral or bilateral groups. CONCLUSIONS: The rat large ganglion and its cavernous nerve can be easily identified and it produces an obvious response to electrical stimulation. Rats are low cost animals to purchase, easy to house and very available making an ideal animal for developing an ED model caused by cavernous nerve injury. In addition, our study showed that in the early period of cavernous nerve ablation, unilateral and bilateral treated rats lost erectile capacity.

Animals↗

PubMed1995

The clinical assessment of erectile dysfunction: a comparison of nocturnal penile tumescence monitoring and intracavernosal injections.

One hundred and fifty-nine men with erectile dysfunction were assessed with Rigiscan monitoring of nocturnal penile tumescence (NPT) and response to intracavernosal injections (ICI) of papaverine or prostaglandin E1. A satisfactory NPT, suggestive of psychogenic causation, was recorded in 58%, whereas 15% had clearly impaired NPT. There was a significant association between presence of vascular disease, diabetes and impairment of NPT. For ICI, only 32% showed a satisfactory response, with 48% clearly impaired. Of the 92 men with satisfactory NPT, 40% HAD clearly impaired and 41% satisfactory ICI response. Of the 51 men with satisfactory ICI response, 8% had clearly impaired and 74.5% satisfactory NPT. There was no association between ICI response and history of vascular disease. We conclude that monitoring of NPT by Rigiscan, and without sleep monitoring, is a valuable diagnostic procedure. In contrast, because of the high proportion of false negative results. ICI monitoring is of very limited diagnostic value. The explanation for false negative ICI responses, however, could prove to be of considerable theoretical and clinical importance.

Adult↗

PubMed2000

Relative efficacy of sildenafil compared to other treatment options for erectile dysfunction.

OBJECTIVE: We examined and compared the efficacy of sildenafil in patients previously using other agents or devices for erectile dysfunction (ED) treatment. METHODS: We identified 47 patients with organic ED who had tried other therapies (intracavernosal injection therapy [ICIT], intraurethral prostaglandin suppositories [IPS], vacuum erection devices [VEDs], or yohimbine) before using sildenafil. Comparisons of the efficacy of sildenafil to the previously used agent or device were assessed by telephone questionnaire. Responses were compared using nonparametric Wilcoxon rank sum and analysis of variance testing. RESULTS: Sildenafil therapy was no more effective than ICIT or VEDs but was more effective than IPS. No significant difference occurred in response to sildenafil with age. Of 22 patients achieving erections adequate for intercourse with their previous therapy, 14 (63%) achieved equal or improved erections with sildenafil. Of the remaining 18 patients who had erections inadequate for intercourse with previous therapy, 5 (27%) had adequate erections with sildenafil. CONCLUSIONS: Oral sildenafil therapy provides results comparable to those of other available ED treatment modalities. A trial of this drug in this patient population is warranted.

Adult↗

PubMed1997

Psychological subtypes of erectile dysfunction: results of statistically analyses and clinical practice.

In contrast to the impressive advances made in somatic research of erectile dysfunction (ED), psychogenic ED is mostly treated as a monolithic block or is merely defined by exclusion of organic factors. This paper proceeds from the assumption that a classification of psychological subtypes of ED is urgently needed and has to include a categorization of different pathogenetic mechanisms as well as a classification of interaction patterns with somatic risk factors. After a brief review of current approaches, psychological subtypes of ED are examined along two different lines of evidence. First, 236 consecutive patients from an ED outpatient. unit were included in a cluster analysis to identify homogeneous subgroups of cases. Three clusters emerged, whose main characteristics as well as most important discriminating variables were further explored by various statistical procedures. Second, on the basis of clinical experience a four-level model of psychogenic ED is proposed that consists of dispositional, etiologic, pathogenetic, and maintaining factors. In addition, four different pathogenetic modes of psychogenic ED are differentiated, which have been labeled actual-neurotic, psychoneurotic, psychosomatic, and functional. Conclusions concentrate on these modes as well as on the empirical subtypes and their implications for clinical practice and future research. Our results indicate that we are just beginning to understand the complex pathogenic interface between psychological factors and manifest ED.

Erectile Dysfunction↗

PubMed2002

Malaysian cultural differences in knowledge, attitudes and practices related to erectile dysfunction: focus group discussions.

This qualitative study aimed to examine cultural differences in knowledge, attitudes and practices related to erectile dysfunction (ED) utilizing focus group discussion. Six focus groups consisting of 66 men, 45-70-y-old were conducted-two Malay groups (n=18), two Chinese groups (n=25) and two Indian groups (n=23). Participants were purposely recruited from the general public on a voluntary basis with informed consent. Transcripts were analyzed using qualitative data analysis software ATLASti. The Malay and Chinese traditional remedies for preventing or treating ED are commonly recognized among all races. Many have a negative perception of someone with ED. Malay and Chinese men tended to blame their wife for their problem and thought that the problem might lead to extra-marital affairs, unlike the Indian men who attributed their condition to fate. Malays would prefer traditional medicine for the problem. The Chinese felt they would be more comfortable with a male doctor whilst this is not so with the Malays or Indians. Almost all prefer the doctor to initiate discussion on sexual issues related to their medical condition. There is a need for doctors to consider cultural perspectives in a multicultural society as a lack of understanding of this often contributes to an inadequate consultation.

Aged↗