Is Pelvic Floor Dysfunction an Independent Threat to Sexual Function? A Cross-Sectional Study in Women With Pelvic Floor Dysfunction

IntroductionPrior studies have reported an association of sexual dysfunction with pelvic floor dysfunction (PFD), but without defining causation.AimTo investigate predictors of sexual function in women with PFD, including pelvic organ prolapse, stress urinary incontinence, overactive bladder, obstructed defecation, and fecal incontinence.MethodsThis retrospective cross-sectional study included 755 women (mean age = 56 years, 68% postmenopausal) referred for PFD (2008–2013). Subjects underwent standardized history and examination, including demographics and assessment of pelvic floor function and sexual function using validated quality-of-life instruments. The physical examination included body mass index, Pelvic Organ Prolapse Quantification measurements, and pelvic muscle strength (Oxford scale). Proportional odds regression analysis tested patient characteristics, PFD, and other determinants of sexual dysfunction as predictors of sexual function.Main Outcome MeasuresThe Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) to assess PFD and the Short Personal Experiences Questionnaire to assess sexual function.ResultsThe prevalence of PFD included pelvic organ prolapse (72%), stress urinary incontinence (66%), overactive bladder (78%), fecal incontinence (41%), and obstructed defecation (70%). Most subjects (74%) had a sexual partner and most (56%) reported recent sexual intercourse. Participants reported a low level of sexual desire and sexual enjoyment and moderate levels of sexual arousal and orgasm. When stratified by sexual enjoyment, 46% enjoyed sex and this group had lower PFDI and PFIQ scores, reflecting less quality-of-life burden. Pelvic organ prolapse, obstructed defecation, and fecal incontinence were associated with not enjoying sex. However, when adjusted for other determinants of sexual dysfunction (eg, aging, dyspareunia, atrophy, and partner issues), these associations disappeared.ConclusionWomen with PFD also have a large burden of sexual dysfunction, although this appears to be mediated by factors not unique to PFD.     

Double-Dose Desogestrel: Is it Effective in Adolescent Menstrual Dysfunction?

Study ObjectiveAdolescent menstrual dysfunction (AMD) is a common cause of iron deficiency anemia and absences from school. The management of AMD with single- and double-dose desogestrel is largely on the basis of anecdotal evidence. Our aim was to describe the effectiveness and safety of both dosing strategies in our clinic cohort to help guide future management.DesignLocal service evaluation with retrospective analysis of clinic notes.SettingAdolescent gynecology clinic in a tertiary pediatric center in the North West of England.ParticipantsAdolescent girls (10-18 years of age) with AMD (n = 129).InterventionsSingle-dose (75 µg) desogestrel vs double-dose (150 µg) desogestrel.Main Outcome MeasuresPrevalence of amenorrhea and light spotting, side effects, and discontinuation rates of both dosing regimens.ResultsForty-three of 87 (49%) adolescent girls who started treatment with a double dose of desogestrel were amenorrheic/experienced light spotting, compared with 7/40 (18%) of girls who started treatment with a single dose (P = .001). Patients taking a double dose of desogestrel were less likely to discontinue overall (double: 45/89 [51%]; vs single: 35/40 [88%]; P < .001) and there was no evidence of an increase in nonbleeding side effects (double: 30/89 [34%]; vs single: 15/40 [38%]; P = .68).ConclusionOur findings provide evidence that a double dose of desogestrel is associated with a higher prevalence of amenorrhea and light spotting compared with a single dose in adolescent girls with AMD. However, larger studies are needed to further inform clinical guidelines.     

ORIGINAL RESEARCH–EPIDEMIOLOGY: Selective Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction

IntroductionSexual dysfunctions are often present in subjects with mood disturbances; however. antidepressants can induce per se sexual dysfunctions.AimTo explore the relationship between the use of selective serotonin reuptake inhibitors (SSRIs), non-SSRIs antidepressants and benzodiazepines (BDZ), hormonal parameters, and reported sexual dysfunction (as assessed by the Structured Interview on Erectile Dysfunction [SIEDY]) in male subjects with comparable psychopathological symptoms (as assessed by the Middlesex Hospital Questionnaire [MHQ] a self-reported test for the screening of mental disorders in a non-psychiatric setting).MethodsA consecutive series of 2,040 (mean age 51 ± 13 years) male patients with sexual dysfunction was studied.Main Outcome MeasuresSeveral hormonal and biochemical parameters were investigated, along with SIEDY and the MHQ.ResultsHigher prolactin was observed only in patients using SSRIs, whereas no other hormonal difference was found after adjustment for confounders. Use of SSRIs was associated with a twofold risk for patient hypoactive sexual desire and with a higher impairment of reported erectile function. However, no difference in penile blood flow was observed. A very high risk (sevenfold) for delayed ejaculation (DE) was observed in SSRI users. Interestingly, the association with the mild, but not severe, form of DE was observed also in subjects using non-SSRI antidepressants (3.35 [1.48–7.59]; P < 0.005). Different life stressors and relational parameters were also associated with SSRI use. SSRI users reported less enjoyment with masturbation and decreased partner desire and climax. Conversely, a lack of significant association was observed among BDZ or non-SSRI antidepressant users and all the aforementioned life-stressors and relational parameters.ConclusionsSSRIs can negatively affect all the steps of the male sexual response cycle (desire–arousal–excitement–orgasm). SSRI-associated sexual dysfunction has a deleterious effect on both auto- and couple-erotic performances. Conversely, other antidepressants and BDZ are less often associated with sexual impairment. Corona G, Ricca V, Bandini E, Mannucci E, Lotti F, Boddi V, Rastrelli G, Sforza A, Faravelli C, Forti G, and Maggi M. Selective serotonin reuptake inhibitor-induced sexual dysfunction. J Sex Med 2009;6:1259–1269.     

Nitric Oxide‐Releasing Polymeric Microspheres Improve Diabetes‐Related Erectile Dysfunction

IntroductionWe have used a long‐acting nitric oxide (NO)‐releasing polymer to develop injectable biodegradable microspheres capable of localized NO release over prolonged periods of time.AimThe aim of this study was to evaluate the therapeutic potential of these microspheres for diabetes‐related erectile dysfunction (ED) in the rat model.MethodsNO‐releasing microspheres were incubated in physiologic buffer, and in vitro NO release was measured using a Griess assay. To ensure no migration, microspheres were fluorescently tagged and injected into the corpus cavernosum of adult rats, and fluorescent imaging was performed weekly for 4 weeks, at which point rats were sacrificed. To assess physiologic efficacy, diabetes was induced in 40 rats using streptozotocin (STZ), whereas 10 rats were kept as age‐matched controls. Diabetic rats were divided into four groups: no treatment, sildenafil, NO‐releasing microspheres, and combination therapy. For each rat, the cavernosal nerve (CN) was stimulated at various voltages, and intracavernosal pressure (ICP) and mean arterial pressure (MAP) were measured via corpus cavernosum and carotid artery catheterization, respectively. Long‐term efficacy was determined by injecting diabetic rats with microspheres and measuring erectile response at predetermined intervals for up to 5 weeks.Main Outcome MeasuresErectile response was determined via calculation of mean peak ICP/MAP and area under curve (AUC) for each experimental group.ResultsUnder physiologic conditions in vitro, microspheres continued NO release for up to 4 weeks. Fluorescent imaging revealed no detectable signal in tissues besides cavernosal tissue at 4 weeks postinjection. Upon CN stimulation, peak ICP/MAP ratio and AUC of diabetic rats improved significantly (P < 0.05) in microsphere and combination therapy groups compared with no treatment and sildenafil groups. In long‐term efficacy studies, microspheres augmented the effect of sildenafil for 3 weeks following injection (P < 0.05).ConclusionsNO‐releasing microspheres significantly improved erectile response in diabetic rats for 3 weeks and hence offer a promising approach to ED therapy, either as monotherapy or combination therapy. Soni SD, Song W, West JL, and Khera M. Nitric oxide‐releasing polymeric microspheres improve diabetes‐related erectile dysfunction. J Sex Med 2013;10:1915‐1925.     

Is Obesity a Further Cardiovascular Risk Factor in Patients with Erectile Dysfunction?

IntroductionErectile dysfunction (ED) and, in particular, arteriogenic ED have been proposed as new markers of risk for incident major adverse cardiovascular events (MACE). Reduced penile blood flow is more common in obese people than in leaner ED subjects.AimTo explore the interaction of overweight/obesity and penile blood flow in the prediction of incident MACE.MethodsThis is an observational prospective cohort study evaluating a consecutive series of 1,687 patients attending our andrological unit for ED. Different clinical, biochemical, and instrumental (penile flow at color Doppler ultrasound: PCDU) parameters were evaluated.Main Outcomes MeasuresAccording to body mass index (BMI), subjects were divided into three groups: normal weight (BMI = 18.5–24.9 kg/m²), overweight (BMI = 25.0–29.9 kg/m²), and obese (BMI ≥ 30.0 kg/m²). Information on MACE was obtained through the City of Florence Registry Office.ResultsAmong patients studied, 39.8% were normal weight, while 44.1% and 16.1% showed BMI 25–29.9 and 30 kg/m² or higher, respectively. During a mean follow-up of 4.3 ± 2.6 years, 139 MACE, 15 of which were fatal, were observed. Cox regression model, after adjusting for age and Chronic Diseases Score, showed that obesity classes along with the presence of arteriogenic ED (peak systolic velocity at PCDU <25 cm/second) were significantly and independently associated with incident MACE (hazard ratio = 1.47 [1.1–1.95], P < 0.05 and 2.58 [1.28–5.09], P < 0.001, respectively). When a separate analysis was performed for classes of obesity, reduced peak systolic velocity at PCDU (<25 cm/second) was significantly associated with incident MACE in obese (BMI ≥ 30 kg/m²), but not in leaner, subjects.ConclusionsIn obese subjects, more than in leaner ED subjects, impaired penile blood flow is associated with an increased risk of incident cardiovascular disease. The interaction with concomitant risk factors, such as obesity, should be taken into account when assessing the predictive value of penile blood flow for cardiovascular diseases. Corona G, Monami M, Boddi V, Balzi D, Melani C, Federico N, Balzi D, Sforza A, Rotella CM, Forti G, Mannucci E, and Maggi M. Is obesity a further cardiovascular risk factor in patients with erectile dysfunction?     

High Progesterone Levels and Ciliary Dysfunction—A Possible Cause of Ectopic Pregnancy

Objectives: To investigate the effects of different levels ofhormones on the ciliary activity of human oviducts and,consequently, to assess their possible role in tubalimplantation of the fertilized egg. Design: Fallopian tube epithelial samples were incubatedin media with the addition of Estradiol (E₂), progesterone(P), human menopausal gonadotropin (hMG), LH, or pureFSH (Metrodin) in different concentrations. The ciliary beatfrequency (CBF) was measured after 24 h of incubation.Then the media were exchanged to media without theaddition of hormones and the CBF was measured again 24 hlater by using the photoelectric technique. Setting: University teaching hospital, IVF unit. Results: Twenty-four hr after the addition of P to the culturemedium in concentrations of 0.5 or 1 ng/ml a significantdecline of the CBF down to 63% of the control level wasobserved (P < 0.001) and with P in concentration of 2 ng/ml or greater, 50–70% of the cilia were paralyzed. Theseeffects of P were found to be reversible. Incubation with E₂induced a slight increase of 4% in the mean CBF (P =0.002). Twenty-four hr incubation with Metrodin, Pergonal,or LH did not affect ciliary motility. Conclusions: Higher levels of progesterone cause ciliarydysfunction and subsequently may be a possible cause ofectopic pregnancy.     

Erectile Dysfunction and Correlated Factors in Brazilian Men Aged 18–40 years

IntroductionFew population-based studies in erectile dysfunction (ED) included subjects less than 40 years old and analyzed the several factors and consequences potentially associated with this condition.AimEvaluation of the prevalence of erectile dysfunction (ED) and associated factors in a sample of Brazilian men aged 18 to 40 years old.MethodsCross-sectional study in which subjects were contacted in public places of 18 major Brazilian cities and interviewed using an anonymous questionnaire. Survey data were submitted to chi-squared, student's t-test and logistic regression analyses.Main Outcome MeasuresThe data were collected by means of a self-administered questionnaire with 87 questions about sociodemographic variables, general health, habits and lifestyle-related factors, sexual behavior and sexual difficulties, including ED which was assessed by a single question.ResultsPrevalence of ED in 1,947 men was 35.0% (73.7% mild, 26.3% moderate/complete). Greater frequency of ED was seen in subjects that never had information about sex, experienced difficulties in the beginning of sexual life and have never masturbated. ED was associated to lower level of education, but not to race, sexual orientation, employment or marital status. Also, no association was found between ED and smoking, alcoholism, obesity, sedentary life, diabetes, hypertension, cardiovascular disease, hyperlipidemia, depression or anxiety. ED caused negative impact in men's self-esteem, interpersonal relationships, work and leisure activities, and in sexual life satisfaction. Less than 10% of men with ED had received medical treatment for this problem.ConclusionsPrevalence of ED in this young population was high, mostly of mild severity. Low education and psychosocial problems were associated to ED and, due probably to the sample subjects' young age, no association was found with organic problems. Measures in the fields of education and psychosocial difficulties prevention would have a positive impact in the control of erectile dysfunction in the young population. Martins FG, and Abdo CHN. Erectile dysfunction and correlated factors in Brazilian men aged 18–40 years.     

Female Sexual Dysfunction and Diabetes: A Systematic Review and Meta‐Analysis

IntroductionSexual dysfunction is reported in diabetic women (female sexual dysfunction [FSD]).AimTo examine the frequency of FSD in diabetic women, and its clinical or metabolic correlates, through meta‐analysis of available studies.MethodsWe searched in MEDLINE, EMBASE, Cochrane Library, and in reference lists of articles and systematic reviews; we considered human clinical studies published as full articles reporting on FSD in diabetic and control women. In total, we considered 26 studies, including 3,168 diabetic and 2,823 control women.Main Outcome MeasuresFrequency of FSD and score of Female Sexual Function Index (FSFI) as a function of study size, patient details (age, body mass index [BMI], duration of diabetes, metabolic control [HbA1c], chronic complications, Beck Depression Inventory [BDI] score).ResultsFrequency of FSD was higher in type 1 (OR [95%CI] 2.27 [1.23, 4.16]), in type 2 diabetes (2.49 [1.55, 3.99]), and in “any diabetes” (type 1 and 2) women (2.02 [1.49, 2.72]) than in controls for any duration of diabetes. FSFI was lower in type 1 (?0.27 [?0.41, ?0.12]), in type 2 diabetes (?0.65 [?0.75, ?0.54]), and in “any diabetes” women (?0.80 [?0.88, ?0.71]) than in controls. Depression was significantly more frequent in diabetic than in control women. At meta‐regression only BMI was significantly associated with effect size (P = 0.005). At weighed regression, the only significant association was found between age and FSFI (P = 0.059). The limitations were as follows: only studies of observational nature were available, and heterogeneity was seen among studies.ConclusionsFSD is more frequent in diabetic than in control women, but it is still poorly understood; low FSFI is associated with high BMI. Further studies are necessary to better understand risk factors for FSD in diabetic women.     

Nerve‐Sparing Approach Reduces Sexual Dysfunction in Patients Undergoing Laparoscopic Radical Hysterectomy

IntroductionAlthough growing evidence suggests the beneficial effects of a nerve‐sparing (NS) approach to surgery in cervical cancer patients, only limited data on NS laparoscopic radical hysterectomy (LRH) are available, and no studies have investigated the effects of NS‐LRH on sexual function.AimThis study aims to determine whether the implementation of NS‐LRH impacts on sexual function in cervical cancer patients.MethodsSexually active cervical cancer patients undergoing type C (class III) LRH between 2004 and 2013 were enrolled in this prospective study.Main Outcome MeasuresPreoperative and postoperative sexual function were assessed using a validated questionnaire, the Female Sexual Function Index (FSFI). The FSFI evaluates desire, arousal, lubrication, orgasm, satisfaction, and pain.ResultsForty patients undergoing radical hysterectomy (20 conventional LRH vs. 20 NS‐LRH) represented the study group. Baseline characteristics were similar between groups (P > 0.05). No differences in preoperative FSFI scores were recorded (P > 0.05). We observed that both LRH and NS‐LRH worsened postoperative FSFI scores (P < 0.001). However, patients undergoing NS‐LRH had higher postoperative FSFI scores than patients undergoing LRH (21.3 ± 9.4 vs. 14.2 ± 12.5; P = 0.04). Considering postoperative domain scores, we observed that desire, arousal, orgasm, and pain scores were similar between groups (P > 0.05), while patients undergoing NS‐LRH experienced higher lubrication (3.4 ± 2.3 vs. 1.7 ± 2.2; P = 0.02) and satisfaction (4.6 ± 3.9 vs. 2.8 ± 2.2; P = 0.004) scores in comparison with patients undergoing conventional LRH. No between‐group differences in survival outcomes were found.ConclusionsBoth conventional LRH and NS‐LRH impact negatively on patients' sexual function. However, the NS approach impairs sexual function less, minimizing the effects of radical surgery. Bogani G, Serati M, Nappi R, Cromi A, di Naro E, and Ghezzi F. Nerve-sparing approach reduces sexual dysfunction in patients undergoing laparoscopic radical hysterectomy. J Sex Med 2014;11:3012–3020.     

The Management of Erectile Dysfunction with Placebo Only: Does it Work?

IntroductionRandomized clinical trials (RCT) remain the gold standard in providing scientific evidence in medical practice in spite of the significant placebo effect in the treatment of several disorders. Although the first‐line therapy for erectile dysfunction (ED) is oral phosphodiesterase type‐5 inhibitor (iPDE5), the placebo effect in RCT of iPDE5 for ED occurs at a rate as high as 50%.AimsTo evaluate the role of therapeutic illusion in the oral treatment for ED.MethodsA prospective, controlled, single‐blind, parallel‐group study was performed at single‐center. One hundred and twenty‐three patients with ED were randomly assigned into three groups and received different letters: Group 1 (G1) was informed to be receiving a substance for ED treatment; Group 2 (G2) was informed that they could be receiving an active drug or placebo; Group 3 (G3) was conscious to be using placebo. Starch capsules were dispensed to all patients. Median follow up was 12 weeks.Main Outcome MeasuresED improvement was assessed after 8 weeks of the intervention by the erectile function domain of the International Index of Erectile Function (IIEF) and the Quality of Erection Questionnaire. ED severity was classified by the IIEF erectile function (IIEF‐EF) domain score into five categories: no ED (score of 26–30), mild (22–25), mild to moderate (17–21), moderate (11–16), and severe (6–10). Improvement in IIEF‐EF domain was considered as a change in category of severity.ResultsED severity improved in all three groups (G1 = 31.7%, P = 0.039; G2 = 36.8%, P = 0.028; G3 = 36.8%, P = 0.002) and no difference was found among groups (P = 0.857). Improvement of quality of erection score was only significant in G2 (P = 0.005) and G3 (P < 0.001).ConclusionsWritten‐suggested therapeutic illusion for patients with ED has no major influence in the outcomes. However, treatment of ED with oral placebo capsules demonstrates clinical effects, improving erectile function and quality of erection. de Araujo AC, da Silva FG, Salvi F, Awad MC, da Silva EA, and Damião R. The management of erectile dysfunction with placebo only: Does it work?     

Valproic Acid Prevents Penile Fibrosis and Erectile Dysfunction in Cavernous Nerve‐Injured Rats

IntroductionBilateral cavernous nerve injury (BCNI) causes profound penile changes such as apoptosis and fibrosis leading to erectile dysfunction (ED). Histone deacetylase (HDAC) has been implicated in chronic fibrotic diseases.AimsThis study will characterize the molecular changes in penile HDAC after BCNI and determine if HDAC inhibition can prevent BCNI‐induced ED and penile fibrosis.MethodsFive groups of rats (8–10 weeks, n = 10/group) were utilized: (i) sham; (ii and iii) BCNI 14 and 30 days following injury; and (iv and v) BCNI treated with HDAC inhibitor valproic acid (VPA 250 mg/kg; 14 and 30 days). All groups underwent cavernous nerve stimulation (CNS) to determine intracavernosal pressure (ICP). Penile HDAC3, HDAC4, fibronectin, and transforming growth factor‐β1 (TGF‐β1) protein expression (Western blot) were assessed. Trichrome staining and the fractional area of fibrosis were determined in penes from each group. Cavernous smooth muscle content was assessed by immunofluorescence to alpha smooth muscle actin (α‐SMA) antibodies.Main Outcome MeasuresWe measured ICP; HDAC3, HDAC4, fibronectin, and TGF‐β1 protein expression; penile fibrosis; penile α‐SMA content.ResultsThere was a voltage‐dependent decline (P < 0.05) in ICP to CNS 14 and 30 days after BCNI. Penile HDAC3, HDAC4, and fibronectin were significantly increased (P < 0.05) 14 days after BCNI. There was a slight increase in TGF‐β1 protein expression after BCNI. Histological analysis showed increased (P < 0.05) corporal fibrosis after BCNI at both time points. VPA treatment decreased (P < 0.05) penile HDAC3, HDAC4, and fibronectin protein expression as well as corporal fibrosis. There was no change in penile α‐SMA between all groups. Furthermore, VPA‐treated BCNI rats had improved erectile responses to CNS (P < 0.05).ConclusionHDAC‐induced pathological signaling in response to BCNI contributes to penile vascular dysfunction. Pharmacological inhibition of HDAC prevents penile fibrosis, normalizes fibronectin expression, and preserves erectile function. The HDAC pathway may represent a suitable target in preventing the progression of ED occurring post‐radical prostatectomy. Hannan JL, Kutlu O, Stopak BL, Liu X, Castiglione F, Hedlund P, Burnett AL, and Bivalacqua TJ. Valproic acid prevents penile fibrosis and erectile dysfunction in cavernous nerve‐injured rats. J Sex Med 2014;11:1442–1451.     

Association Between Epilepsy and Erectile Dysfunction: Evidence from a Population‐Based Study

IntroductionAlthough the association between epilepsy and sexual disorders has long been known, very few studies have attempted to explore the association between epilepsy and erectile dysfunction (ED).AimThis population‐based case‐control study aimed to investigate the association between ED and a prior diagnosis with epilepsy.MethodsThis study used data from the Longitudinal Health Insurance Database 2000 in Taiwan. The cases comprised 6,427 patients with a diagnosis of ED and 32,135 controls who were frequency matched with cases based on 10‐year age groups and index year. Conditional logistic regression was used to calculate the odds ratios (ORs) for prior epilepsy.Main Outcome MeasureThe prevalence and risk of epilepsy between cases and controls.ResultsOf the sampled patients, 3,861 (14%) were diagnosed before the index date: 1,358 individuals (19.7%) were cases and 2,503 (12.1%) were controls. After adjusting for hypertension, diabetes, hyperlipidemia, renal disease, coronary heart disease, obesity, alcohol abuse/alcohol dependence syndrome, and socioeconomic status, conditional logistic regression analysis revealed that patients with ED were more likely to have been diagnosed with prior epilepsy than controls (OR = 1.83, 95% CI = 1.51–2.21). Compared with controls, the adjusted ORs for prior generalized epilepsy and partial epilepsy for cases were 2.13 (95% CI = 1.52–3.00) and 1.64 (95% CI = 1.31–2.06), respectively. The most pronounced associations were detected in ED cases aged between 30 and 39 who were 3.04 (95% CI = 1.67–5.50) times more likely than controls to have been previously diagnosed with epilepsy.ConclusionsOur findings suggest a positive correlation between ED and a prior diagnosis with epilepsy. Keller J, Chen Y‐K, and Lin H‐C. Association between epilepsy and erectile dysfunction: Evidence from a population‐based study. J Sex Med 2012;9:2248–2255.     

Is the Deep Endometriosis or the Surgery the Cause of Postoperative Bladder Dysfunction?

Study ObjectiveTo assess whether deep endometriosis surgery affects the bladder function.DesignProspective multicenter observational study (Canadian Task Force classification II-2).SettingAcademic research centers.PatientsThirty-two patients with diagnosis of deep endometriosis requiring surgery.InterventionsWomen were evaluated with urodynamic studies, International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form, and International Consultation on Incontinence Questionnaire Overactive Bladder Module questionnaires before and 3 months after surgery.Measurements and Main ResultsThe main outcome measure was the impact of deep endometriosis surgery on urodynamic parameters. All cystomanometric parameters showed an improvement postoperatively: in particular, the first desire to void (120 vs 204 mL; p <.001) and the bladder capacity (358 vs 409 mL; p = .011) increased significantly after surgery. Of the uroflow parameters, the maximal voiding flow improved significantly postoperatively (19 vs 25 mL/s; p = .026). The International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (2.5 vs 0; p = .0005) and International Consultation on Incontinence Questionnaire Overactive Bladder Module (4.3 vs 1.2; p <.001) questionnaires showed a significant postoperative improvement too.ConclusionOur data show that in a selected population of patients with deep infiltrating endometriosis (not requiring bowel or ureteral resection), the bladder function improves after surgery, both during filling and on voiding urodynamic phases. Postoperatively, patients with deep infiltrating endometriosis become aware of bladder filling later, have a higher bladder capacity, and have a higher maximal flow. The postoperative urodynamic results are corroborated by the improved scores on the bladder questionnaires.     

ORIGINAL RESEARCH—ERECTILE DYSFUNCTION: Evaluation of Microalbuminuria in Patients with Erectile Dysfunction

IntroductionThe recent sophisticated diagnostic procedures aimed at identifying the exact cause of erectile dysfunction (ED) are often complicated in clinical application, invasive, or highly expensive. Microalbuminuria, a test easy to perform and of low cost, is a marker of extensive endothelial dysfunction, and it has been suggested to be linked to ED.AimThe aim of this study was to investigate the eventual role of microalbuminuria in differentiating patients with arteriogenic and non arteriogenic ED.MethodsThe diagnosis of ED was based on the International Index of Erectile Function 5-questionnaire, and patients were classified as arteriogenic (N = 29) and non-arteriogenic (N = 49) in relation to the results of echo-color-doppler examination of cavernosal arteries in basal conditions and after intracavernous injection of 10 µg prostaglandin E₁.Main Outcome MeasuresThe microalbuminuria of 78 males without the most common atheriosclerotic risks and with ED was measured.ResultsMicroalbuminuria, defined as urinary albumin/creatinine ratio, was not significantly (P > 0.05) different between patients of the two groups.ConclusionsOur data show that in ED patients the cavernosal arteries damage, as assessed by dynamic echo-color-doppler, may be independent on or precede extensive endothelial dysfunction, and that microalbuminuria cannot be predictive of penile arteriogenic etiology. Barassi A, Pezzilli R, Morselli-Labate AM, Porreca W, Piediferro G, Ciociola F, Colpi G, and Melzi d'Eril G. Evaluation of microalbuminuria in patients with erectile dysfunction.     

Interplay Between Premature Ejaculation and Erectile Dysfunction: A Systematic Review and Meta‐Analysis

IntroductionThe specific determinants and underlying factors linking erectile dysfunction (ED) and premature ejaculation (PE) have yet to be clearly identified.AimThe aim of this study was to review and meta‐analyze all available data regarding the link between ED and PE.MethodsAn extensive Medline Embase and Cochrane search was performed including the following words: “premature ejaculation” and “erectile dysfunction”.Main Outcome MeasuresAll observational trials comparing the risk of ED in relation to PE were included. Data extraction was performed independently by two of the authors (G.R, G.C.), and conflicts resolved by the third investigator (M.M.).ResultsOut of 474 retrieved articles, 18 were included in the study for a total of 57,229 patients, of which 12,144 (21.2%) had PE. The presence of PE, however defined, was associated with a significant increase in ED risk (odds ratio: 3.68[2.61;5.18]; P < 0.0001). Meta‐regression analysis showed that the risk of ED in PE subjects was higher in older individuals as well as in those with a lower level of education and in those who reported a stable relationship less frequently. In addition, subjects with PE and ED more often reported anxiety and depressive symptoms and a lower prevalence of organic associated morbidities, including diabetes mellitus, hypertension and dyslipidemia. All the latter associations were confirmed even after adjustment for age. Finally the risk of PE‐related ED increased with the increased proportion of acquired ejaculatory problems (adj r = 0.414; P < 0.0001 after the adjustment for age).ConclusionsIn conclusion, the present data showed that ED and PE are not distinctly separate entities, but should be considered from a dimensional point of view. Understanding this dimensional perspective might help sexual health care professionals in providing the most appropriate therapeutic approach to realistically increase patient related outcomes in sexual medicine. Corona G, Rastrelli G, Limoncin E, Sforza A, Jannini EA, and Maggi M. The interplay between premature ejaculation and erectile dysfunction: A systematic review and meta‐analysis. J Sex Med 2015;12:2291–2300.