The relationship between lipid profile and erectile dysfunction

The objective of this study is to investigate the relation between serum lipids (cholesterol, LDL, HDL, triglyceride (TG)) and erectile dysfunction (ED). The experimental methods involved comparison of 100 patients with organic ED (mean age of 43.59+/-10.51 y), with 100 healthy individuals (mean age of 43.72+/-9.76 y) regarding their lipid profile from January 2000 to June 2003 (cholesterol, TG, HDL, LDL). The results showed that there was a significant difference between mean plasma cholesterol and LDL levels in the individuals suffering from ED and the control group (P=0.04 and 0.02, respectively). The TG and HDL mean plasma level differences were not significant (P=0.583 and 0.299, respectively). Odds ratios for high plasma cholesterol level (>240 mg/dl) and high plasma LDL level (>160 mg/dl) were 1.74 and 1.97. The R2 was 0.04 for both cholesterol and LDL. Applying linear regression, the coefficient for cholesterol and LDL reduced the International Index of Erectile Function questionnaire scores by -0.036 and -0.035. In conclusion, this study, the correlation of cholesterol and LDL levels with ED strongly supports the role of hyperlipidemia treatment in both the prevention and management of ED.     

Significance of hypogonadism in erectile dysfunction

To review the role and significance of hypogonadism, defined as a low testosterone (T) level, in erectile dysfunction (ED). Review of literature. Serum T is below 3 ng/ml in 12% of ED patients, including 4% before and 15% after the age of 50. Replacement studies in men with severe hypogonadism demonstrate that sexual desire and arousal, as well as the frequency of sexual activity and spontaneous erections are clearly T-dependant. Psychic erections are partly T-dependant. The effects of T upon sexual function are dose-dependant up to a threshold level that is consistent within an individual, but markedly variable between individuals, ranging from 2 to 4.5 ng/ml. More evidence is required to confirm a significant impact of T on the intrapenile vascular mechanisms of erections in men as it is the case in animals. No convincing association of T with ED has been found in epidemiological studies. As concerns clinical experience, although a meta-analysis of the randomized controlled trials established that T therapy consistently restores erectile function in young hypogonadal patients with T below 3.46 ng/ml, the effects of this treatment have been mostly disappointing when used alone in older patients consulting for ED who are subsequently diagnosed to have hypogonadism following routine T measurement. These poor results may probably be explained by the high prevalence of co-morbidities, and by the fact that ED itself may induce hypogonadism. Combination therapy with T and PDE5 inhibitor (PDE5I) may be effective in the hypogonadal ED patients when T therapy alone fails. However, more evidence is required to confirm the hypothesis that a minimum level of T is required for a complete effect of PDE5I in certain men, since a PDE5I was able to restore complete erections in severely hypogonadal men. Though a low T level is not always the only cause of ED in hypogonadal ED patients, there are important benefits in screening for hypogonadism in ED. A low T level justifies a 3 month trial of T therapy, before combining a PDE5I if T therapy alone fails     

Bidirectional relationship between depression and erectile dysfunction

PURPOSE: We specified the interrelationship between depressive mood and erectile dysfunction. MATERIALS AND METHODS: The target population consisted of men who were 50, 60 or 70 years old and residing in the study area in Finland in 1994. Questionnaires were mailed to 3,143 men in 1994 and to 2,837 men 5 years later. The followup sample consisted of 1,683 men who responded to the baseline and followup questionnaires. RESULTS: Erectile dysfunction was strongly associated with untreated and treated depressive symptoms. The prevalence OR adjusted for potential confounders was 2.6 (95% CI 1.8-3.8) for untreated and 3.3 (95% CI 1.6-7.1) for treated depressive symptoms at the beginning of followup. The incidence of erectile dysfunction was 59/1,000 person-years (95% CI 39-90) in men with depressive mood and 37/1,000 person-years (95% CI 32-43) in those free of the disorder. Compared with men free of depressive symptoms who did not use medication for psychological disorders at study entry the adjusted incidence density ratio of erectile dysfunction was 4.5 (95% CI 2.2-9.2) in men with treated depressive symptoms and 1.2 (0.7-2.1) in those with untreated depressive symptoms. The incidence of depressive mood was 20/1,000 person-years in men with erectile dysfunction and 11/1,000 person-years in those free of erectile dysfunction. The adjusted incidence density ratio of depressive mood was 1.9 (95% CI 1.1-3.3) in men with erectile dysfunction compared with those free of it at entry. CONCLUSIONS: Moderate or severe depressive mood or antidepressant medication use may cause erectile dysfunction and erectile dysfunction independently may cause or exacerbate depressive mood.     

The relationship between the severity of erectile dysfunction and aortic stiffness

Aortic stiffness increases in patients with erectile dysfunction (ED) but it is not known whether aortic stiffness affects the degree of ED. In the present study, we aimed to determine whether there is any relationship between aortic stiffness and the severity of ED. Patients with ED were divided into 3 groups according to the International Index of Erectile Function (IIEF) scores. Mild ED was named as group 1, moderate ED as group 2 and severe ED as group 3. The values of fasting blood glucose (FBG), serum lipid values, total testosterone (T. tes), and free testosterone (F tes) were recorded. Aortic stiffness was determined by pulse wave velocity (PWV) and augmentation index (AIX) measurements. The mean or median values of the laboratory parameters among the groups were similar (p > .05). No statistical difference was found between the groups in terms of AIX value (p = .386). Mean PWV values were calculated as 7.26, 8.30 and 8.78 in group 1, group 2 and group 3 respectively. PWV values were significantly different between groups (p < .0001). PWV values were found to be increased with increasing severity of erectile dysfunction.     

The relationship between serum irisin levels and erectile dysfunction in diabetic men (irisin and erectile dysfunction in diabetic patients)

Irisin is an exercise-induced myokine that alleviates endothelial dysfunction and reduces insulin resistance in type 2 diabetes mellitus. We conducted this cross-sectional prospective study to determine the association of serum irisin levels and erectile dysfunction in type 2 diabetic patients. We compared 34 diabetic patients with erectile dysfunction with 30 diabetic patients without erectile dysfunction. In our study, serum irisin levels were found to be statistically significantly higher in diabetic patients without erectile dysfunction compared to those with erectile dysfunction (p = .016) and according to correlation analysis, irisin levels had a significantly negative correlation with the serum HbA1C value (r = −.294, p = .018). Based on the results of our study, we think that this molecule can be used in the diagnosis or treatment of erectile dysfunction in diabetic patients, if these findings are supported by larger studies.     

News from andrology. Infertility, erectile dysfunction, and hypogonadism

This contribution discusses new aspects in andrology focusing on infertility, erectile dysfunction (ED), and hypogonadism. Topics such as prostatitis and detection of Chlamydia, idiopathic infertility and PDE5 inhibitors, and ED after GreenLight laser treatment are addressed.     

高血压与勃起功能障碍相互关系研究进展

勃起功能障碍(ED)与高血压之间的关系是男科学研究的重点领域。目前研究认为,这两种疾病拥有相似的病理生理过程,如氧化应激效应造成血管内皮损害以及RhoA/Rho激酶活性上调。两种疾病均为血管功能损害这一病理过程的不同阶段。定期细致而全面评估高血压合并ED患者病情,并予以合理药物治疗显得尤为重要。在高血压患者中,5型磷酸二酯酶抑制剂无论是单用还是联合抗高血压药物使用都取得了令人满意的效果。目前,基因治疗以及脂肪源性干细胞治疗都展现出了良好的前景,通过转化医学方法可使其更好的为临床服务。     

Relationship between smoking and erectile dysfunction

We estimated the effects of smoking on the risk and prognosis of erectile dysfunction (ED), and of ED on smoking behavior. The follow-up sample consisted of the 1442 men aged 50-75 y, who responded to both baseline and follow-up questionnaires. We estimated the effect of smoking on the incidence of ED among the 1130 men free from ED, ED on risk to start smoking in the 502 nonsmokers, smoking on the prognosis of ED among the 312 with ED and ED on quitting smoking among the 292 current smokers at baseline. Risk of ED increased nonsignificantly with smoking (odds ratio (OR)=1.4), while ED recovery reduced (OR=0.6). Therefore, there was the ratio of 2.3 (1.4/0.6) describing the total effect of smoking on the risk of ED. Both quitting (OR=1.7) and starting (OR=1.9) smoking were rare and nonsignificantly higher in men with ED. Most of the OR estimates on smoking-ED relationships were not statistically significant, probably due to small numbers. There are two bidirectional relations between ED and smoking. Those who smoked had a higher risk of ED than nonsmokers. The men with ED were more likely to start smoking than those free from ED. The estimates of effects were not statistically significant, but they were consistent with each other and with the hypothesis that smoking causes ED and ED causes smoking. The recovery from ED was less in smokers than among nonsmokers, and current smokers with ED were more likely to stop smoking than men free from ED. Numbers were few and estimates of effects were not significant, but consistent with the hypothesis of smoking preventing recovery from ED and ED improving the success of smoking cessation. Such transitions in four directions explain indirectly the known positive association between the prevalence of smoking and the prevalence of ED.     

Relationship between metabolic syndrome and erectile dysfunction

AIM: To determine the relationship between metabolic syndrome (MS) and erectile dysfunction (ED) and to see which risk factors correlated the best with ED. METHODS: Seventy-nine cardiology clinic outpatients with coronary artery disease (CAD) and lipid metabolism disorder were recruited. They were categorized as having MS, hypertension (blood pressure greater than 130/85 mmHg) and dyslipidemia. ED was classified based on International Index of Erectile Function scores. Patients were grouped into quartiles based on body mass index (BMI). Chi-square, Pearson's correlation and regression tests were used for statistical analysis. RESULTS: The mean age of the patients was 56.6 years. ED was diagnosed in 59 (74.7 %) of the 79 patients. In the 38 patients with MS, all had ED. ED was not significantly correlated with cholesterol levels (P>0.05), but was found often in patients who had both hypercholesterolemia and HT (P<0.01). Nineteen (76 %) of the 25 patients who had dyslipidemia had ED. However, ED was not significantly correlated with dyslipidemia (P >0.05). Twenty-two of the 23 patients who had BMI greater than 30 had ED, which was significantly more prevalent than that in those who had normal BMI (P<0.01). ED was seen in 38 of 53 smoker patients. Although ED was more prevalent in cigarette smokers, it was not significantly different from non-smokers (P>0.5). Conclusion: ED is present in a high percentage of patients with MS. Among multiple risk factors for ED, MS correlates the most highly. The next most important risk group is the patients with hypertension +hypercholestrolemia and obesity (BMI 30).     

下尿路综合征与勃起功能障碍关系研究进展

大量流行病学资料证实下尿路综合征与勃起功能障碍二者之间关系密切，但二者之间存在这种关系的机制还不完全清楚。如何选择有效治疗受到关注。本文就这些方面的进展作一综述。     

Erectile dysfunction may predict coronary artery disease: relationship between coronary artery calcium scoring and erectile dysfunction severity

Objectives The aim of this prospective study is to evaluate patients with erectile dysfunction (ED) in terms of coronary artery calcium (CAC) levels assessed by multidetector computed tomography (MDCT) and to find out if ED severity may predict coronary heart disease risk. Patients and method Sixty men with a mean age of 55.7 (41–77) years with ED and 23 men with a mean age of 53.2 (39–76) years without ED, who admitted to our clinic between January 2005 and December 2005, were included in the study. All patients answered the standard International Index of Erectile Function (IIEF) forms, and were classified into four groups as mild, moderate, severe ED and no ED. CAC levels were assessed by MDCT protocol. CAC levels and IIEF scores were analyzed within each group. Results Pearson correlation test demonstrated significant negative correlation between IIEF score and CAC score (r = −497; P < 0.0001). CAC scores increased significantly with regard to IIEF scores decrease: IIEF 1–10 (n = 18), mean CAC: 557.7; IIEF 11–16 (n = 13), mean CAC: 541.3; IIEF 17–25 (n = 29), mean CAC: 84.6; and IIEF ≥ 26 [n = 23 (Control group)], mean CAC: 10.1. The difference between the mean CAC scores of these four groups was statistically significant (P < 0.0001). When we took the cut-off value for IIEF score 26 we observed significantly higher CAC scores at the group of IIEF < 26 (mean 325.5 vs 10.1; P < 0.0001). Conclusion We observed positive correlation with ED severity and CAC levels. Therefore, we think that detection and quantification of preclinical coronary artery disease by CAC scoring with a non-invasive method might have a great potential for early cardiac preventive measures.     

Predicting hypogonadism in men based upon age, presence of erectile dysfunction, and depression

Hypogonadism, a disorder associated with aging, can cause significant morbidity. As clinical manifestations of hypogonadism can be subtle, the challenge and the burden of diagnosis remain the responsibility of the clinician. Four different analytic methods were used to predict hypogonadism in men based upon age, the presence of erectile dysfunction (ED) and depression. 218 men were classified by age, serum testosterone level, the presence of ED and depression. Depression was determined by the Center for Epidemiologic Studies Depression Scale (CES-D). ED was assessed by the Sexual Health Inventory for Men (SHIM). Hypogonadism was defined as a serum testosterone level <300 ng/dl. An artificial neural network (ANN) was programmed and trained to predict hypogonadism based upon age, SHIM, and CES-D scores. Subject data was randomly partitioned into a training set of 148 (67.9%) and a test set of 70 (32.1%). The ANN processed the test set only after the training was complete. The discrete predicted binary output was set to (0) if testosterone level was <300 ng/dl or (1) if >300 ng/dl. The data was also analyzed by standard logistic regression (LR), linear and quadratic discriminant function analysis (LDFA and QDFA, respectively). Reverse regression (RR) analysis evaluated the statistical significance of each risk factor. The ANN can accurately predict hypogonadism in men based upon age, the presence of ED, and depression (receiver-operating characteristic=0.725). A four hidden node network was found to have the highest accuracy. RR revealed the depression index score to be most significant variable (P=0.0019), followed by SHIM score (P=0.00602), and then by age (P=0.015). Hypogonadism can be predicated by an ANN using the input factors of age, ED, and depression. This model can help clinicians assess the need for endocrinologic evaluation in men.     

The anocavernosal erectile dysfunction syndrome. II Anal fissure and erectile dysfunction.

A previous study has demonstrated that the bulbocavernosus muscle (BCM) is a part of the external anal sphincter (EAS) [Shafik, Arch Androl, 1999]. It aids erection by compressing the penile bulb and the dorsal penile vein, and acts as a 'suction-ejection' pump in the ejaculatory process. Being a part of the EAS, the BCM is assumed to be involved in the different EAS pathologies. A recent study showed that erectile (ED) and ejaculatory dysfunction in 16 men with fecal incontinence (FI) after an anal fistula operation was cured after sphincteroplasty [Shafik, in press]. This article investigates the erectile and ejaculatory status in patients with anal fissure. The study comprised 32 men with acute anal fissure (mean age 36.7 +/- 8.2 s.d. years), 21 with chronic anal fissure (mean age 38.8 +/- 10.3 s.d. years), and 10 healthy volunteers (mean age 35.2 +/- 7.3 s.d. years). Erectile dysfunction occurred in all men with an acute fissure and in 16 of the chronic fissure patients; erection had been normal before fissure occurrence. The volunteers had normal erection. The anal pain radiated to the penis and was exaggerated on erection and penile thrusting. Erectile dysfunction investigations showed normal results. The electromyographic (EMG) activity of the external and internal (IAS) anal sphincters and the BCM as well as anal, penile bulb and cavernosal pressures were recorded. The acute fissures were treated conservatively and chronic ones by internal anal sphincterotomy. The patients were followed for mean periods of 17.3 +/- 3.6 s.d. months. The bulbocavernosus reflex as well as EMG activity of EAS and BCM were normal, while the resting EMG activity of the IAS was increased. The anal pressure in the acute and chronic anal fissure was increased (P < 0.01, P < 0.05, respectively), while the bulbar and cavernosal pressures showed no significant changes. Fissure treatment effected cure of the fissure and the ED in 30/32 of the acute and in 19/21 of the chronic cases. Erectile dysfunction persisted in the four patients in whom the fissures did not heal. In conclusion, a relationship is suggested to exist between anal fissure and ED. The ED occurred in the presence of anal fissure and was normalized with fissure cure. The BCM and anal pain seem to play a role in the etiology of ED associated with anal fissure.     

Association of hypogonadism and type II diabetes in men attending an outpatient erectile dysfunction clinic

Patients with diabetes mellitus (DM) were more often hypogonadal than normal fasting glucose subjects. The aim of this investigation is the assessment of characteristics and psychobiological correlates of DM associated with hypogonadism (DMAH). The Structured Interview SIEDY was used along with several biochemical, psychological and instrumental investigations in a series of more than 1200 patients with erectile dysfunction (ED); 16% of whom with type II DM. Hypogonadism was defined as circulating total testosterone (T) below 10.4 nmol/l. The prevalence of hypogonadism was 24.5% in DM versus 12.6% in the rest of the sample (P < 0.0001); differences in the prevalence of hypogonadism retained significance after adjustment for age and BMI. DMAH was associated with typical hypogonadism-related symptoms, such as reduction in sexual desire, leading to a decreased number of sexual attempts, and with higher depressive symptomatology. In DMAH, testis size and LH concentrations were significantly reduced, suggesting a central origin of the disease. At penile Duplex ultrasound examination, diabetic patients and in particular hypogonadal type II diabetic patients showed lower levels of basal and dynamic (after PGE1 injection) peak systolic velocity and acceleration, when compared to the rest of the sample, even after adjustment for age and BMI. Our results show that hypogonadism is frequently associated with type II DM, at least in the 6th decade. DMAH might exacerbate sexual dysfunction by reducing libido and mood and further compromising penile vascular reactivity.     

腹型肥胖与男性勃起功能障碍的相关性研究

目的 探讨腹型肥胖与男性勃起功能障碍之间的相关关系.方法 随机选取符合研究条件的男性受试者210例.测量腰围、体重指数、腰臀比.符合标准者于清晨空腹采集外周血标本,使用生化分析仪测定血清总胆固醇(TC)、总甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)的浓度.用勃起功能障碍国际指数问卷表(IIEF-5)评估这些受试者的勃起功能,并用统计学方法分析两者之间的相关关系.结果 腹型肥胖者勃起功能障碍(ED)的发病率为48.6%.腰围、腰臀比、体重指数与勃起功能评分之间呈负相关.结论 腹型肥胖是影响男性勃起功能的一个重要因素.校正年龄因素后,腰围、腰臀比与体重指数越高勃起功能评分越低.     

原发性精索静脉曲张与阴茎勃起功能障碍的相关性探讨

目的 了解原发性精索静脉曲张与阴茎勃起功能障碍的关系.方法 以527例原发性精索静脉曲张患者为研究对象,全部原发性精索静脉曲张患者均接受手术治疗,搜集手术前后精索静脉曲张的临床资料和国际勃起功能指数-5(IIEF-5)问卷调查结果.结果 国际勃起功能指数-5(IIEF-5)分值随原发性精索静脉曲张术后治愈而升高.原发性精索静脉曲张疗效满意,合并的勃起功能障碍病情好转.结论 原发性精索静脉曲张很可能是勃起功能障碍的危险因素,其继发的心理因素,也可以成为勃起功能障碍的心理病因之一.原发性精索静脉曲张的治疗,可以改善阴茎勃起功能障碍的病情.

Abstract：

Objectives To understand the relationship between Varicocele( VC ) and erectile dysfunction (ED). Methods 527 patients with VC were investigated by International Index of Erectile Function - 5 ( IIEF-5) before and 6 months after surgery. All patients were treated with operation for Varicocele. Results The prevalonce of Erectile dysfunction in patients with varicocele decreased after the varicocele been treated. The treatment of varicoeele was satisfying, the state of erectile dysfunction turn for the better. Conclusions Varicocele probably is one of the risk factor in erectile dysfunction. The treatment of varicocele can improve the state of erectile dysfunction.