Physical activity and erectile dysfunction: meta-analysis of population-based studies

We searched for population-based cross-sectional studies, cohort studies and randomized controlled trials (RCTs) on erectile dysfunction (ED) through Medline, PubMed, PsychInfo and scanned though reference lists. Studies that did not include adjusted odds ratios (OR) of physical activity were excluded. Seven cross-sectional studies were suitable for meta-analysis, and the results from one cross-section study, two cohort studies and one RCT were summarized. Pooling the ORs using random effects models, we derived summary estimate for adjusted OR of physical activity in those with ED compared with those without ED, which was 0.53 (0.31, 0.91). Moderate and high physical activities were associated with a lower risk of ED, with ORs at 0.63 (0.43, 0.93) and 0.42 (0.22, 0.82), respectively. Funnel plot by visual inspection, and Begg's test and Egger's test did not detect significant publication bias. Sensitivity analyses revealed that the summary estimate from the random effects model was robust to changes in study sample size and level of statistical adjustment, but not so robust to changes in ED definition, although the summary estimate for each ED definition did not differ significantly. Although causality cannot be demonstrated from cross-sectional studies, the apparent 'protective' effect of physical activity on ED should be further investigated using large-scale cohort studies or RCTs.     

Prevalence of erectile dysfunction: a systematic review of population-based studies

A systematic review was conducted on the prevalence of erectile dysfunction (ED) in the general population. Studies were retrieved which reported prevalence rates of ED in the general population. Using a specially developed criteria list, the methodological quality of these studies was assessed and data on prevalence rates were extracted. We identified 23 studies from Europe (15), USA (5), Asia (2) and Australia (1). On our 12-item criteria list, the methodological quality ranged from 5 to 12. The prevalence of ED ranged from 2% in men younger than 40 y to 86% in men 80 y and older. Comparison between prevalence data is hampered by major methodological differences between studies, particularly in the use of various questionnaires and different definitions of ED. We stress the importance of providing all necessary information when reporting on the prevalence of ED. Moreover, international studies should be conducted to establish the true prevalence of ED across countries.     

银屑病与勃起功能障碍相关性的meta分析

目的:系统评价银屑病与勃起功能障碍(ED)的相关性。方法:计算机检索Cochrane Library、EM-base、Pub Med、OVID、Medline、维普、万方、中国知网(CNKI)、中国生物医学文献服务系统(Sino Med)数据库,搜索银屑病与ED相关的文献,检索时间为数据库建立至2016年6月。分别由两名研究人员按照纳入、排除标准提取相关数据,运用Review Manager 5.3软件对银屑病与ED的相关性,IIEF-5评分进行meta分析。结果:总共纳入6篇文献,采用固定效应模型分析,结果显示银屑病与ED[OR=1.92(95%CI 1.53~2.40)]具有相关性,差异具有统计学意义(P<0.01);随机效应模型分析其中3篇的IIEF-5评分,结果显示银屑病患者IIEF-5评分[MD=-3.11(95%CI-4.85~-1.37)]显著低于非银屑病者,差异具有统计学意义(P<0.01)。结论:银屑病与ED存在相关性,银屑病患者可能具有更高的ED发生率,但仍需要更高质量的文献证实。     

Trazodone for erectile dysfunction: a systematic review and meta-analysis

OBJECTIVE: To determine the efficacy and safety of trazodone in the treatment of erectile dysfunction (ED) in a meta-analysis. METHODS: The data sources used were Medline and the Cochrane Library databases (January 1966 to May 2002), bibliographies of retrieved articles and review articles, and conference proceedings and abstracts. Trials were eligible for inclusion in the review if they included men with ED, compared trazodone with a control, were randomized, of > or = 7 days' duration and assessed clinically relevant outcomes. Two reviewers independently evaluated study quality and extracted data in a standardized fashion. RESULTS: Six trials (comprising 396 men) met the inclusion criteria; they consisted of heterogeneous populations, were small, brief and in some cases methodologically weak. Three of the six trials showed an apparently clinically meaningful benefit of trazodone for ED compared with placebo, the differences being statistically significant in two. In pooled results, trazodone monotherapy appeared more likely than placebo to lead to a 'positive treatment response', although this difference was not statistically significant (37% vs 20%; relative benefit increase, 1.6; 95% confidence interval, CI, 0.8-3.3). Subgroup analyses suggested that men with psychogenic ED might be more likely to benefit from trazodone than those with mixed or physiological ED. The efficacy of trazodone also appeared greater at higher doses (150-200 vs 50 mg/day). Men randomized to trazodone were not significantly more likely than those receiving placebo to withdraw for any reason or for an adverse event, or to have specific adverse events, but wide CIs could not exclude a greater risk of these adverse outcomes with trazodone. Specific adverse events with trazodone included dry mouth (19%), sedation (16%), dizziness (16%) and fatigue (15%). CONCLUSION: Trazodone may be helpful in men with ED, possibly more so at higher doses, and in men with psychogenic ED. Future high-quality trials should compare trazodone with placebo and other therapies in men with depression and psychogenic ED.     

Prevalence and correlates of erectile dysfunction in Turkey: a population-based study

OBJECTIVES: Epidemiologic data indicate that erectile dysfunction (ED) is a significant problem among men worldwide. However, data do not exist for Turkish men. This study was conducted to determine the prevalence and sociodemographic, medical, and lifestyle correlates of ED in Turkey. METHODS: Information was gathered via physician-conducted interviews using a validated questionnaire. Respondents self-rated their ED as "none," "minimal," "moderate," or "severe". Bivariate and multivariate analyses were performed on data from a stratified random sample of 1982 men aged > or = 40 years to quantify the associations between ED and potential covariates. RESULTS: The age-adjusted overall prevalence of ED in Turkey was 69.2% (mild 33.2%, moderate 27.5%, severe 8.5%) and increased with age, as did severity of ED. When we consider moderate + severe ED cases, the prevalence is 36%. In a multivariate model, increased prevalence of moderate or severe ED was significantly associated with age, residence in eastern Turkey; low educational level; unemployment; or underlying diabetes, hypertension, depression, prostate problems or lower urinary tract symptoms. Conversely, residence in southern Turkey, alcohol consumption, physical activity, and higher income were significantly associated with decreased prevalence. CONCLUSIONS: ED affects a high proportion of Turkish men aged > or = 40 years, is correlated with a number of serious medical conditions and the frequency increases with age.     

Prevalence of erectile dysfunction in Asian populations: a meta-analysis

We searched for published studies on the prevalence of erectile dysfunction (ED) in Asian populations, through Medline, PubMed, PsychInfo and scanned through reference lists. Data on prevalence rates were obtained and summarized for each Asian region, and were used to calculate pooled prevalence estimates using fixed and random effects models. As significant heterogeneity existed in certain age group categories, the random effects model was preferred. Twenty general population studies were identified. Six studies were eligible to be entered into the pooling of results, and provided 8653 subjects for analysis. The prevalence of ED increased with age. Pooled random effects age-specific prevalence rates were 15.1% (12.2-18.1), 29.6% (19.7-39.6), 40.6% (23.6-57.7), 54.3% (36.0-72.6) and 70.0% (62.3-77.7) for age groups 20-29, 30-39, 40-49, 50-59 and 60-69 years, respectively. Homogeneity of results in age groups 20-29 and 60-69 years suggested equally low and high prevalences of ED across Asian regions in these age groups, respectively. The overall reported prevalence in individual studies ranged from 2 to 81.8%. Prevalence rates and related information were summarized for each Asian region and for each study.     

Testosterone supplementation for erectile dysfunction: results of a meta-analysis

PURPOSE: To our knowledge a causal relationship between altered levels of androgens and erectile dysfunction has not yet been established. We reviewed the literature to assess the usefulness of androgen replacement for erectile dysfunction. MATERIALS AND METHODS: Meta-analysis was chosen as the method of evaluating the literature. Study inclusion criteria were testosterone given as the only therapy for erectile dysfunction and a clearly stated definition of response for evaluating treatment success or failure. RESULTS: We evaluated 73 articles obtained by a MEDLINE search of 1966 to 1998 and included 16 in our study. The overall response rate was 57%. In the 9 series with response rate by etiology patients with primary versus secondary testicular failure had a response rate of 64% versus 44% (p <0.001). Intramuscular and oral methods of delivery were equivalent with a response rate of 51.3% and 53.2%, respectively. However, the response to transdermal therapy was significantly different from that of intramuscular and oral treatment (80.9% versus 51.3% and 53.2%, respectively, p <0.001). The mean confidence level response for testosterone treatment was 16. 7% in the placebo and 65.4% in the treated group (p <0.0001). CONCLUSIONS: Our meta-analysis of the usefulness of androgen replacement therapy for erectile dysfunction indicates that the response rate for a primary etiology was improved over that for a secondary etiology, transdermal testosterone therapy was more effective than intramuscular or oral treatment, and intramuscular and oral treatments were equivalent. In addition, there was a statistically significant difference in favor of testosterone over placebo, implying a role for supplementation in select groups.     

Prevalence of erectile dysfunction and its correlates: a population-based study in Morocco

To obtain data on the prevalence of erectile dysfunction (ED) and its correlates, along with help-seeking behaviour, 655 randomly selected men at least 25 y old, residing in Casablanca, Morocco, were recruited. They responded to a questionnaire administered by five trained sociologist interviewers. Information on demographics, concomitant diseases, drugs, and sexual activity was collected. ED was prevalent in 54%, increased noticeably with age, and was highly prevalent between both the illiterate and those employed. Risk factors were diabetes, hypertension, heart disease, and smoking. Limited sexual satisfaction, low frequency of intercourse, and a disturbed psychological state with depressed mood had negative effects on erectile function. Given its prevalence in our country, ED should be considered an important medical problem with a multifactorial aetiology, making the cooperation of a multidisciplinary management team highly recommended.     

Understanding erectile dysfunction medication preference studies

PURPOSE OF REVIEW: The existence of three phosphodiesterase 5 inhibitors has resulted in an increase in the marketing of the drugs. This has led to a shift in focus from scientifically rigorous endpoints such as efficacy and adverse event profiles to patient preference. RECENT FINDINGS: Although no consensus currently exists as to the correct methodology for preference studies, some basic guidelines should be adhered to, including: (1) the double-blinding of drug administration; (2) non-biased drug administration instructions; (3) an adequately conducted crossover study; (4) comparison of equivalent doses; (5) standardized preference assessment; (6) declaration of patient demographics; and (7) rigorous statistical analysis. These factors are discussed in the light of the three published preference studies. SUMMARY: In the final analysis, it is unclear to this author how preference studies impact upon clinician decision-making when confronted by a patient with erectile dysfunction.     

男性勃起功能障碍的分子生物学研究进展

阴茎勃起功能障碍(ED)是常见的男性疾病,5型磷酸二酯酶(PDE5)抑制剂的问世改善了大部分ED患者的性生活质量,然而其对难治性ED的治疗效果不佳。随着ED分子生物学研究的迅速发展,人们不断地发现新的阴茎勃起相关信号通路,深入阐明各类ED的分子发病机制,并尝试用基因治疗等先进方法,更好地解决甚至从根本上治愈ED。本文将全面综述目前有关ED的分子信号转导通路、常见类型ED的分子发病机制以及ED基因治疗的研究进展。     

缺氧性勃起功能障碍机制的研究进展

缺氧是诱导勃起功能障碍(ED)的重要原因之一.缺氧性ED的发生、发展是神经、血管、内分泌及各类细胞因子等多种因素共同作用的结果.目前关于缺氧性ED机制的研究在阴茎海绵体微结构、重要信号通路、氧化应激、激素水平以及细胞自噬等方面取得了一定的进展,但仍尚未完全明确.本文综述了缺氧性ED机制的研究现状与进展,以期为缺氧性ED...     

Serum folic acid levels and erectile dysfunction: A meta-analysis and systematic review

The aim of this study was to assess the relationship between serum folic acid (FA) levels and erectile dysfunction (ED) through a meta-analysis. A research was conducted in MEDLINE via PubMed, Cochrane Library, EMBASE and Web of Science up to 22 November 2020 to identify studies related to FA and ED. Two authors independently screened the literature, evaluated methodological quality and extracted the data. We used RevMan5.3 and STATA 14.0 for meta-analysis. A total of six studies including 1,842 participants were included, and the results showed that the FA levels in the non-ED group were significantly higher than those in the ED group (MD = 3.37, 95% CI 1.49–5.52, p = 0.004). Subgroup analysis indicated that with the increase in ED severity, the difference in FA levels between groups was more obvious (MD: 1.99 vs. 4.63 vs. 5.63). The differences in FA levels between groups seem more significant in the younger group (MD = 4.87, 95% CI 2.58–6.89, p < 0.001) than in the older group (MD = 3.15, 95% CI 2.21–4.08, p < 0.001). In conclusion, FA deficiency is closely related to ED, and the degree of FA deficiency may reflect the severity of ED. In addition, the association seems to be more pronounced in the younger group.     

Prevalence and correlates of erectile dysfunction in a population-based study in Belgium

OBJECTIVES: This study aims to estimate the prevalence of erectile dysfunction (ED) in the male population of Belgium, and to study its correlation with education, the international prostate symptom scale (IPSS), sexual activity, depression, body mass index, alcohol, smoking, easiness to discuss ED with a doctor, current health index, physical activity, hypertension, diabetes, cardiovascular disease, professional status, residence and whether or not the respondent lives alone. METHODS: An age-stratified random sample of the male population aged 40-70 years of Ghent and Charleroi was interviewed in the home by a trained, experienced male nurse, using a structured interview that included the international index of erectile function (IIEF) and the IPSS. ED was classified by the subjects' self-reported confidence to achieve and maintain an erection. RESULTS: In total, 799 men were interviewed, with a participation rate of 38.0%. The overall age-adjusted prevalence of ED was 10.1% severe, 24.7% moderate, 26.6% mild, and 38.7% reported no ED. Age and the absence of sexual activity over the last 4 weeks were the strongest correlates of ED. Other strong correlates were four or more health complaints, depression, a high score for the IPSS and absence of physical activity. DISCUSSION: The prevalence of ED in Belgium is comparable with the results of other population-based studies for severe and moderate ED. Sexual inactivity over the last four weeks is a strong correlate of ED, and should make the clinician think of a possible problem of ED.     

Sonic hedgehog信号通路与勃起功能障碍的相关研究进展

Sonic hedgehog(Shh)是维持男性勃起功能的重要调节因子,异常的Shh信号可能是导致ED的机制之一。目前关于Shh信号通路与ED的研究主要集中在双侧海绵体神经损伤的神经源性ED,糖尿病导致的内分泌性ED以及老年性ED。本文梳理了不同类型ED中Shh信号通路的改变,阐明了Shh信号通路在ED中的调控机制,以期对今后的相关研究给予启发。     

Prevalence and correlates of erectile dysfunction in Salvador,northeastern Brazil: a population-based study

Our objectives were to determine the prevalence of erectile dysfunction (ED) in Brazil and to explore potential sociodemographic, medical, and lifestyle correlates. A cross-sectional, population-based, household survey was conducted in Salvador, Bahia, Brazil. Cluster samples of representative households were randomly selected for interviews. Of 654 eligible subjects, 602 (92%) participated. A structured questionnaire was administered by trained interviewers. ED was categorized as 'none', 'mild', 'moderate', or 'severe' according to the ability to 'attain and/or maintain an erection satisfactory for sexual intercourse'. All data were obtained by self-report. The age-adjusted prevalence of ED was 39.5% (minimal 25.1%, moderate 13.1%, severe 1.3%). Prevalence and severity increased with age. Having never been married, diabetes, depression, or prostate disease and current depressive or lower urinary tract symptoms were significantly (P<0.05) associated with increased prevalence. Medical, sociodemographic, and lifestyle variables associated with ED may alert physicians to patients at risk for ED and offer insight to its etiology.     

难治性勃起功能障碍的研究进展

勃起功能障碍(ED)是一种常见病、多发病。目前主要是首选PDE5抑制剂(PDE5I)治疗,总有效率可达80%,部分患者尤其是伴有糖尿病﹑心血管疾病及前列腺癌根治术后者,单独应用PDE5I效果不佳,称为难治性ED。除了NO-cGMP通路外,勃起与ED的发生过程还涉及多条信号通路(RhoA/Rho激酶、H2S、CO等),复杂的信号网络构成了难治性ED发生的基础,以PDE5I为主的交替治疗、联合治疗等可提高对难治性ED治疗成功率。本文就对PDE5I治疗无效的难治性ED的研究进展作一综述。     

炎症性肠病男性患者中勃起功能障碍患病率的meta分析

目的:系统评价成年男性炎症性肠病(IBD)患者中ED的患病率。方法:计算机检索PubMed、The Cochrane Library、Embase、万方数据库和中国知网,搜集并筛查关于IBD患者中ED患病率的相关文献。采用Meta-Analyst软件行meta分析。结果:共纳入9篇文献,包括734例男性IBD患者,男性IBD患者中ED的患病率为34.4%(95%CI 30.8%～38.1%)。亚组分析显示:ED在克罗恩病(CD)的患病率(36.3%, 95%CI 30.1%～42.9%)高于溃疡性结肠炎(UC, 26.8%, 94%CI 21.9%～32.3%),活跃期IBD患者中ED的患病率(47.6%, 95%CI 38.3%～57.2%)明显高于缓解期(26.4%, 95%CI 22.0%～31.4%),差异均有统计学意义(P0.05);全结直肠切除并回肠储袋肛管吻合术后的男性UC中患病率最低,为17.2%(95%CI 11.5%～24.9%)。结论:IBD男性患者常伴有ED,疾病活动增加其患病风险,而疾病缓解可降低风险。