Association between serum fetuin‐A level and erectile function

Recent studies have shown that ED is an early symptom of atherosclerosis. Fetuin‐A, a glycoprotein secreted by the liver, kidneys and choroid plexus, has been linked to systemic fibrosis and calcification in human and rat studies. Deficiency of this compound may play a role in atherosclerosis and cardiovascular disease progression. The aim of the study was to examine whether serum fetuin‐A level is related to erectile function or severity of ED. Sixty ED patients without cardiovascular disease were assigned to one of the three groups (mild, moderate or severe ED) depending on ED severity. Twenty healthy volunteers were included as the control group. The International Index of Erectile Function‐5 questionnaire was used to measure erection quality in all four groups. Mean age, body mass index, total testosterone, low‐ and high‐density lipoprotein cholesterol, and triglyceride levels did not significantly differ between the three erectile dysfunction and control groups (P > 0.05). The group with severe ED had a significantly lower mean fetuin‐A level than the mild ED and control groups. For both mild and moderate ED groups, the mean serum fetuin‐A level was significantly lower in comparison with the control group (P < 0.001). Serum fetuin‐A level may be used as a supplemental biochemical parameter in preliminary evaluation of ED.     

Serum testosterone levels in diabetic men with and without erectile dysfunction

Diabetes mellitus is a common chronic disease, affecting 0.5–2% worldwide. The Massachusetts Male Aging Study reported that up to 75% of men with diabetes have a lifetime risk of developing ED. Type 2 diabetes is associated with low total serum testosterone (TT) identified in several cross‐sectional studies and systemic analyses. There is a lack of consensus regarding what constitutes the lowest level of testosterone within the boundaries of normality. In this retrospective study, we sought to evaluate the effect of associated co‐morbidities on serum total testosterone (TT) level in men with type 2 diabetes DM, either with or without erectile dysfunction (ED). Three hundred and ninety‐one patients were evaluated for erectile function using an abridged, five‐item version of the International Index of Erectile Function‐5. Measurements of TT, fasting lipid profile, blood sugar and glycated haemoglobin (HbA1c) were conducted. Penile hemodynamics was assessed using intracavernosal injection and penile duplex study. Hypogonadism was found in 126 cases (33.2%), and normal TT was observed in 254 (66.8%). ED was detected in 119 cases in the hypogonadal group (94.4%) as compared to 155/254 (61.0%) in eugonadal group, P = 0.0001. TT was lower in diabetic men with ED as compared to those with normal erectile function (EF), 392.4 ± 314.9 versus 524.3 ± 140.2 ng dl^?1, respectively, P < 0.0001. After exclusion of patients with hypertension and dyslipidaemia, 185 men were evaluated, and there was no difference in the mean TT level among men with ED 490.6 ± 498.2 ng dl^?1 versus normal EF 540.6 ± 133.4 ng dl^?1 although, HbA1c remained lower in men with normal erectile function. Receiver operating characteristic (ROC) curve of TT in men without associated co‐morbidities showed that EF was compromised at TT = 403.5 ng dl^?1 or less. Sensitivity of 63.3% and a specificity of 94.0% were detected. At this level, ED was found in 33/38 (86.8%) men with TT 403.5 ng dl^?1, whereas ED was observed in 57/147 (38.8%) men with TT ≥ 403.5 ng dl^?1 (P < 0.0001). We propose a cut‐off value of 403.5 ng dl^?1 of TT blood levels as an indicator for initiation of testosterone replacement therapy in diabetic men with ED. Further prospective controlled trials are recommended.     

Novel predictive risk factor of erectile dysfunction: Serum 25-hydroxy vitamin D

The present study aimed to investigate the association between the severity of erectile dysfunction (ED) and serum 25-hydroxy vitamin D. It also sought to determine the cut-off level of serum 25-hydroxy vitamin D for ED. This study included 130 men who had ED between 2018 and 2019. Patients were divided into three groups according to their scores on the international index of erectile function-5 (IIEF-5) Turkish validated short form questionnaire. The serum 25-hydroxy vitamin D results were compared between the groups. The mean age of the patients was 49.28 ± 13.62 years. Groups 1, 2 and 3 included 44 (33.8%) patients with severe ED, 56 (43.1%) patients with moderate ED and 30 (23.1%) patients with mild ED, respectively. Statistical significance was observed between the groups and serum 25-hydroxy vitamin D levels. A positive correlation was detected between the IIEF-5 scores, serum testosterone and serum 25-hydroxy vitamin D levels. A cut-off level for serum 25-hydroxy vitamin D was calculated as 27.32 ng/ml. During multivariate analysis, we found that serum 25-hydroxy vitamin D levels were independent prognostic risk factors for decreased IIEF-5 scores. Decreased serum 25-hydroxy vitamin D levels were associated with decreased IIEF-5 scores. Therefore, vitamin D replacement therapy may improve symptoms.     

肾移植与血液透析治疗对尿毒症患者阴茎勃起功能影响的临床对照研究

目的:研究对比男性尿毒症患者接受肾移植与接受血液透析治疗勃起功能的变化及与生殖激素水平变化的关系。方法:收集2009年5月至2012年1月在我院门诊进行随访的肾移植男性患者35例、血液透析治疗的尿毒症患者30例,应用国际勃起功能指数(IIEF-5)调查表、夜间勃起功能(NEVA)测定仪评估阴茎勃起功能,同时测定生殖激素水平。结果:接受肾移植手术者勃起功能障碍(ED)患病率为51.4%,血液透析者ED患病率为73.3%(P<0.05);肾移植后的ED患者发病情况要明显轻于单纯血液透析的ED患者;肾移植中重度ED患者(25.7%)要明显少于单纯血液透析者(46.6%);肾移植组中ED患者夜间阴茎勃起次数、勃起强度及持续时间均强于单纯血液透析组ED患者(P<0.05);接受肾移植患者较单纯血液透析血清睾酮水平上升[(4.32±1.37)vs(2.53±1.12)ng/ml,P<0.05],雌二醇[(19.57±2.29)vs(43.38±5.58)pg/m)]和催乳激素[(8.59±1.19)vs(17.22±3.31)mIu/ml]明显下降(P均<0.05)。结论:肾移植受者肾功能良好时其总体勃起功能要优于单纯血液透析的尿毒症患者。     

Endocan is markedly overexpressed in severe erectile dysfunction

This study aimed to measure the serum endocan level of patients with erectile dysfunction (ED) and to investigate the possible association between this and vasculogenic severe ED. We performed a prospective analysis of 86 consecutive patients affected by ED. Patients were divided into severe ED (IIEF‐5 score < 7) and mild or moderate ED (IIEF‐5 score > 7). A strong negative correlation was found between serum endocan levels and peak systolic velocity (p < .001 and r = ?.665) in men with severe ED. Univariate logistic regression analysis demonstrated that tobacco consumption (p < .05), serum total 25‐hydroxyvitamin D (p < .01), serum endocan levels (p < .01), peak systolic velocity (p < .01), hypertension (p < .001), dyslipidaemia (p < .001), metabolic syndrome (p = .026) and a history of a cardiovascular event (p < .001) significantly increase the risk of severe ED. In the multivariate logistic regression model, we also found that age, hypertension, metabolic syndrome, cardiovascular events and higher serum endocan levels were independently associated with severe ED. Circulating endocan may be used in daily practice as a new marker that correlates with cardiovascular risks and the severity of ED disease.     

Lipoprotein‐associated phospholipase A2 levels are associated with erectile dysfunction in patients without known coronary artery disease

Endothelial dysfunction and microvascular damage play a crucial role in the pathogenesis of erectile dysfunction (ED). Lp‐PLA2 is a calcium‐independent member of the phospholipase A2 family and hydrolyses oxidised phospholipids on low‐density lipoprotein (LDL) particles that plays a pivotal role in ox‐LDL‐induced endothelial dysfunction. The purpose of the current study was to determine the association between Lp‐PLA2 levels and ED in patients without known coronary artery disease (CAD). All patients were evaluated for ED and divided into two groups: 88 patients suffering from ED for >1 year were enrolled as an experimental group and 88 patients without ED were enrolled as a control group in this study. Diagnosis of ED was based on the International Index of Erectile Function Score‐5. Levels of Lp‐PLA2 were measured in serum by colorimetric assay. The relationship between Lp‐PLA2 levels and ED in patients was evaluated statistically. The mean age of patients with ED group was 59.4 ± 11.32 and 55.8 ± 9.67 in the control group. Plasma Lp‐PLA2 levels were significantly higher in ED than in the control group (220.3 ± 66.90 and 174.8 ± 58.83 pg ml^?1, respectively, P < 0.001). The Lp‐PLA2 levels were negatively correlated with score of ED (r = ?0.482, P < 0.05). In logistic regression analysis, enhanced plasma Lp‐PLA2 levels result in approximately 1.2‐fold increase in ED [1.22 (1.25–2.76)]. In this study, serum Lp‐PLA2 levels were found to be associated with endothelial dysfunction predictive of ED. Serum Lp‐PLA2 level appears to be a specific predictor of ED, and it may be used in early prediction of ED in the male population.     

Effects of taking tadalafil 5 mg once daily on erectile function and total testosterone levels in patients with metabolic syndrome

We aimed to evaluate the efficacy of tadalafil 5 mg once‐daily treatment on testosterone levels in patients with erectile dysfunction (ED) accompanied by the metabolic syndrome. A total of 40 men with metabolic syndrome were evaluated for ED in this study. All the patients received 5 mg tadalafil once a day for 3 months. Erectile function was assessed using the five‐item version of the International Index of Erectile Function (IIEF) questionnaire. Serum testosterone, follicle‐stimulating hormone and luteinising hormone levels were also evaluated, and blood samples were taken between 08.00 and 10.00 in the fasting state. All participants have three or more criteria of metabolic syndrome. At the end of 3 months, mean testosterone values and IIEF scores showed an improvement from baseline values (from 3.6 ± 0.5 to 5.2 ± 0.3, from 11.3 ± 1.9 to 19 ± 0.8 respectively). After the treatment, serum LH levels were decreased (from 5.6 ± 0.6 to 4.6 ± 0.5). There was significantly difference in terms of baseline testosterone and luteinising hormone values and IIEF scores (p < .05). Based on our findings, we recommend tadalafil 5 mg once daily in those men with erectile dysfunction especially low testosterone levels accompanied by metabolic syndrome.     

复方玄驹胶囊联合溴隐亭治疗高泌乳素血症导致的勃起功能障碍的疗效观察

目的:观察复方玄驹胶囊联合溴隐亭治疗高泌乳素血症导致的勃起功能障碍的疗效。方法:46例高泌乳素血症导致勃起功能障碍患者,随机平均分为治疗组和对照组,治疗组同时口服复方玄驹胶囊(3粒,3次/d)和溴隐亭进行治疗,对照组单用溴隐亭进行治疗,治疗至病情稳定后观察勃起功能、血清泌乳素水平、血清睾酮水平变化并对疗效进行评估。结果:治疗组、对照组经治疗12周后国际勃起功能指数(IIEF-5)分别为(13.7±3.5)、(16.4±3.7),两组病例经治疗12周后勃起功能较治疗前均明显改善(P<0.05),治疗组病例勃起功能较对照组改善更显著(P<0.05),治疗组、对照组病例治疗后血清泌乳素水平分别为(156.07±26.31)mIU/L、(164.73±28.58)mIU/L,较治疗前均有显著下降(P<0.05),两组间治疗后血清泌乳素水平无显著差异(P>0.05),治疗组、对照组病例治疗后血清睾酮水平分别为(15.34±5.27)nmol/L、(12.02±2.36)nmol/L,较治疗前均有升高(P<0.05),治疗组血清睾酮水平较对照组显著升高(P<0.05),治疗组、对照组治疗后勃起功能改善有效率分别为86.96%(20/23)、65.22%(15/23),治疗组明显高于对照组(P<0.05)。结论:复方玄驹胶囊联合溴隐亭能有效治疗男性高泌乳素血症导致的勃起功能障碍,联合用药较单用溴隐亭疗效更为显著。     

The prevalence of erectile dysfunction among Brazilian men screened for prostate cancer

OBJECTIVE

To determine the prevalence of erectile dysfunction (ED) in a large cohort of Brazilian men who were screened for prostate cancer, and to determine risk factors in this population, as there are large cultural differences among countries in reporting the frequency of ED, and it is likely that the prevalence of ED among men screened for prostate cancer cannot be generally applied across countries.

SUBJECTS AND METHODS

The analysis focused on the baseline characteristics of 1008 consecutive South American men from Brazil with no known prostate disease who had routine screening for prostate cancer by urologists. The variables analysed were patient age, urinary symptoms, patient health‐related quality of life (HRQL), prostate‐specific antigen (PSA) levels, prostate volume and erectile function. To assess lower urinary tract symptoms (LUTS) and HRQL, we used the American Urological Association symptom score and its appended eighth question, respectively. Benign prostatic hyperplasia was defined as a prostate volume of >30 g. Sexual function was assessed using the five‐item version of the International Index of Erectile Function questionnaire. Thus, ED was considered to absent for scores of 22–25, mild for 17–21, mild to moderate for 12–16, moderate for 8–11, or severe for 5–7. Obesity was defined by calculating the body mass index (BMI), and categorized as underweight (<18.5 kg/m²), normal weight (18.5–24.9 kg/m²), overweight (25–29.9 kg/m²) or obese (= 30 kg/m²). The mean (sd ) PSA level was 4.3 (6.7) ng/mL and the mean prostate volume 37.8 (21.8) mL. The correlation of ED with these variables was estimated using unconditional logistic regression models.

RESULTS

Information about erectile function was available for 908 patients. ED was considered to be absent, mild, mild to moderate, moderate and severe in 169 (18.6%), 210 (23.1%), 169 (18.6%), 138 (15.2%) and 222 (24.5%) patients, respectively. The ED was severe in 18.4%, 25.7% and 43.4% of patients with mild, moderate and severe LUTS, respectively (P < 0.001). The answer to the HRQL question was also significantly associated with ED; ED was severe in 16.5% of patients feeling delighted/pleased and in 35.8% of patients feeling unhappy/terrible (P < 0.001). The prostate volume was significantly related to ED. The BMI category showed that normal weight, overweight and obese patients had similar rates of ED (P = 0.415); ED was severe in about a quarter of the patients in each of these categories, and 50% and 24% of patients in the underweight and greater BMI groups had severe ED, respectively.

CONCLUSIONS

Of men screened for prostate cancer in Brazil, ≈40% have moderate or severe ED. Severe LUTS, higher HRQL scores, a large prostate volume, a low BMI and higher PSA levels might be associated with higher rates of ED. These variables should be considered when analysing the erectile function of patients screened for prostate cancer.     

Erectile function and gonadal hormones levels in men with end‐stage renal disease: It's relevance to duration of haemodialysis

In this study, we evaluated the relationship between haemodialysis (HD) duration and erectile function status and gonadal hormones serum levels in adult men with end‐stage renal disease (ESRD). A total of 118 men with ESRD on chronic HD were eligible for analysis. The erectile dysfunction (ED) was defined and graded according to the international index of erectile function (IIEF‐5) score. The serum levels of follicle stimulating hormones (FSH), luteinising hormone (LH), testosterone (TST), prolactin (PRL) and estradiol (E2) were measured using the standard laboratory technique. The mean age was 48.97 ± 14.68 years and mean duration of HD was 4.58 ± 3.03 years. The overall prevalence of ED was 78.8%; from them 31.2% had severe grade. The prevalence of ED was comparable in HD duration categories [≤5 years (79.7%), 5–10 years (76.5%), >10 years (80.0%); p > 0.05]. The percentage of abnormal serum levels of FSH, LH, TST, PRL, E2 were 5.1%, 1.6%, 18.6%, 90.7% and 0.0% respectively. No significant relationships were observed between HD duration and IIEF‐5 score or gonadal hormones serum levels (p < 0.05). We concluded that HD duration has no effect on erectile function status and gonadal hormones serum levels. Other factors may be relevant to these conditions in this particular group of patients.     

Visceral adiposity index is useful for evaluating obesity effect on erectile dysfunction

Studies show that erectile dysfunction (ED) is associated with obesity, and it has been shown that the possibility of developing sexual dysfunction in obese men is 30% higher compared to those with normal weight. Obesity is measured using various methods, for example waist circumference (WC) measurement or body mass index (BMI), but recently, visceral adiposity index (VAI) has also been utilised to better assess obesity and metabolic syndrome. In our study, the potential link between VAI and ED was investigated. The data of 176 patients who presented to the urology outpatient clinic with erection complaints were retrospectively screened. A control group was also established with 122 men without complaints of erectile dysfunction. The erectile functions of all participants were determined using the International Erectile Function Index‐5 (IIEF‐5) scoring. In addition, their serum fasting blood glucose, total testosterone (TT), triglyceride (TG), low‐density lipoprotein (LDL) cholesterol and high‐density lipoprotein (HDL) cholesterol levels were measured. The physical examination comprised the measurement of WC, height and weight, and BMI. The mean age of the participants was 58.7 ± 8.4 for the ED group and 57.1 ± 7.5 for the control group. The mean VAI was statistically significantly higher in the ED group (5.32 ± 2.77) compared to the control group (4.11 ± 1.93) (p < 0.001). Since VAI contains both physical and metabolic parameters, our findings suggest that it discloses the effects of WC, BMI, HDL and TG more clearly. VAI is considered useful for the assessment of the effect of obesity on ED patients.     

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.     

Significance of platelet distribution width as a severity marker of erectile dysfunction

Mean platelet volume (MPV) and Platelet distribution width (PDW) are potential markers in platelet activation. In present study, we aimed to evaluate MPV and PDW as potential severity markers for those patients who are complaining erectile dysfunction (ED). A total of 358 participants were enrolled in this study. The whole cohort was asked to complete the International Index of Erectile Function‐5 (IIEF‐5) questionnaire. The participants were classified into 3 groups: control group (n = 120), mild ED (n = 118) and severe ED (n = 120). We found in our cohort MPV and PDW were significantly higher in both mild ED group and severe ED group than control group (9.24 ± 0.70 and 9.71 ± 0.80 versus 8.56 ± 0.62 for MPV; 14.48 ± 1.29 and 14.98 ± 1.60 versus 12.86 ± 1.13 for PDW respectively). The MPV and PDW increased as the disease progressed. In the mild and severe ED groups, a significant inverse correlation was detected between the mean values of IIEF‐5 score and PDW. Furthermore, in the receiver operating characteristic curve analysis, the area under the curve of the MPV and PDW to predict severe ED was 0.818 and 0.848 respectively. Our study establishes a dose‐dependent association between the PDW and ED. Therefore, the PDW can serve as a potential marker for predicting the severity of ED.     

Can testosterone level be a good predictor of late‐onset hypogonadism?

Androgens are essential for the development and growth of the genitalia. They regulate the erectile physiology by multiple mechanisms. Several studies have examined associations among sex hormones' serum levels, erectile function and sex drive. We sought to identify a protocol for using testosterone in men with erectile dysfunction and late‐onset hypogonadism (LOH). During a 16‐month period, men with erectile dysfunction who presented to the andrology clinic were selected. They underwent a complete physical examination and filled out the International Index of Erectile Function‐5 questionnaire. Serum luteinising hormone (LH) and testosterone levels were evaluated. Patients received a single intramuscular injection of 250 mg testosterone. Thereafter, serum levels of LH and testosterone were measured 3 weeks later. The mean age was 53 years old. After treating patients with testosterone, 45 (94%) showed improvement in LOH symptoms including libido, loss of energy, irritability and quality of life. The mean International Index of Erectile Function was 9 and 13.1, prior to and after treatment respectively. Mean serum testosterone levels before and after treatment were 4.2 and 4.1 ng ml^?1 respectively (P = 0.849). Mean serum LH revealed a significant decrease after the study (P = 0.004) (6.12 and 5.1 ng ml^?1, before and after the study respectively). Our findings suggested that testosterone replacement therapy improves libido and LOH symptoms in individuals with almost normal or lower limit normal value of serum testosterone levels.     

Is the plasma endocan level a reliable predictor for the severity of erectile dysfunction?

Purpose

The aim of our study was to assess the correlation between serum endocan level and erectile dysfunction (ED).

Methods

A total of 92 patients were reviewed in this study after institutional review board approval. The patients’ characteristics were recorded, including age, body mass index, blood pressure, smoking history, serum creatinine, glucose, lipid profile, total testosterone, and Beck Depression Inventory scores. ED was evaluated with the Sexual Health Inventory for Men (SHIM) questionnaire and classified as severe, moderate, or mild. Scores of >?18 indicate normal erectile function and were recruited for the control group.

Results

Sixty-three patients with a median age of 56 years in the ED group and 29 patients with a median age of 55 years in the control group were compared. ED was classified as severe in 20, moderate in 25, and mild in 18 patients. A significant difference was determined between the severe ED group and the control group for serum endocan levels (p?<?0.001). A significant negative correlation between the SHIM score and endocan levels (rho ? 0.65; p?<?0.01), age and SHIM score (rho ? 0.32; p?=?0.04), BMI and SHIM score (rho ? 0.25; p?=?0.03), and BMI and total testosterone (rho ? 0.16; p?=?0.04) was determined upon Spearman’s correlation analysis. A positive correlation was also determined between total testosterone and SHIM score (rho 0.50; p?=?0.04). Patients’ age (p?=?0.037) and serum endocan level (p?=?0.029) were determined as significant in the multivariate analysis.

Conclusion

This study demonstrated the presence of an association between plasma endocan levels and ED. Endocan may be used as a new diagnostic marker for the severity of ED.

     

El peso de la comorbilidad del paciente se correlaciona con la gravedad de la disfunción eréctil

Objective

To explore the potential relationship between erectile dysfunction (ED), low testosterone levels, and the Charlson Comorbidity Index (CCI).

Assessment of the relationship between asymmetric dimethylarginine and severity of erectile dysfunction and coronary artery disease

The plasma concentration of asymmetrical dimethylarginine (ADMA), an inhibitor of nitric oxide synthase, has been linked to endothelial dysfunction. We investigated the relation between plasma ADMA concentration and severity of erectile dysfunction (ED) and coronary artery disease (CAD). We measured plasma levels of ADMA in 92 male patients. Patients were divided into three groups: group 1 (n = 41), patients with ED and without CAD; group 2 (n = 29), patients with stable CAD; group 3 (n = 22), control group (patients without CAD or ED). Erectile function was evaluated by the erectile function domain of the international index of erectile function (IIEF-EFD) a validated 15-item self-administered questionnaire. Erectile function is specifically addressed by six questions that form the so-called erectile function domain of the questionnaire. Each question is scored 0–5. ED is defined as any value <26. Patients with CAD who have stable angina pectoris were selected after coronary angiography. ADMA was analyzed by ELISA method. Group 1 had significantly higher concentrations of plasma ADMA than groups 2 and 3 (respectively, 0.75 ± 0.40 vs. 0.50 ± 0.30, P = 0.013; 0.75 ± 0.40 vs. 0.50 ± 0.25, P = 0.021). There was negative correlation between ADMA and IIEF-EFD score in all groups (n = 92) (r = −0.322, P = 0.002). In a multiple logistic regression analysis adjusting for age, hyperlipidemia, ADMA remained independent predictor for severe ED. Odds ratio for plasma ADMA was 14.151 (1.101–181.940; P = 0.042). First of all, this study provides that ADMA concentrations are significantly higher in patients who have ED when compared to patients with CAD and controls. Second, there was a negative correlation between ADMA and severity of ED. Elevating levels of circulating ADMA is an independent risk factor for severe of ED, and ADMA may be a link between CAD and ED.     

Is there any relation between serum levels of total testosterone and the severity of erectile dysfunction?

The objective of this study was to correlate the severity of erectile dysfunction (ED) with the total testosterone serum levels (TT) in a normal population. During a screening program for the early diagnosis of prostate cancer, 1071 men aged from 40 to 90 y, were invited to answer the questionnaire of the Simplified International Index of Erectile Function (IIEF-5) as a method to diagnose and classify ED. The IIEF-5 scores ranged from 1 to 25 and the ED was classified into five groups according to the scores: severe (1-7), moderate (8-11), mild-moderate (12-16), mild (17-21) and no ED (22-25). Besides the questionnaire, all subjects had their TT serum levels determined based on the blood sample obtained between 08:00 and 10:00. The analysis of the relationship between the different degrees of ED and TT levels was then studied. Of the 1071 men, 965 were included in the study (90.1%). Eighty-eight percent of these were Caucasian and 12% black. The mean age of the population was 60.7 y. The prevalence of all degrees of ED was 53.9%. The degree of ED was mild in 21.5%, mild to moderate in 14.3%, moderate in 6.3% and severe in 11.9%. The variation of TT serum concentrations was similar (P>0.05) in the different age groups. Furthermore, the TT serum levels were not different for individuals with and without ED (P>0.05) and similar concentrations of TT was observed in the different severity degrees of ED (P>0.05). Only one (0.7%) man in the group of individual with maximal score had subnormal levels of TT. ED presented a clear association with the subjects' aging, but neither correlation between TT levels and ED, nor with its severity, could be demonstrated in the present study.     

Apoptosis of corpus cavernosum in patients with organic erectile dysfunction

Objectives  It has been reported that apoptosis of penile erectile tissue occurs after penile denervation, castration, and diabetes mellitus in animal studies. Aim of this study was to investigate apoptosis in corpora cavernosa of patients with organic erectile dysfunction (ED). Methods  Cavernous biopsies were obtained from 38 patients with erectile dysfunction and 10 patients with normal erectile function. Apoptosis of tissues were determined via terminal deoxyuridine nucleotide end labeling method by using flow cytometry. Results  The mean ages of patients with ED and control patients were 50.65 ± 2.27, and 32.43 ± 2.90 years, respectively (P = 0.0001). Patients with ED were set in two groups as more than 50 years old and less than 50 years old for further analysis of age factor on apoptosis. The mean % apoptosis of ED patients was 26.22 ± 2.79 and control group was 11.26 ± 3.79, (P = 0.032). Mean fluorescence intensity (MFI) values were also 17.41 ± 3.21 and 6.59 ± 2.28, respectively (P = 0.039). MFI and % apoptosis values were not statistically significant different neither between the patients groups nor between the control and patients ≤50 years old (P > 0.05). Conclusions  We did not find any statistically significant difference with respect to apoptosis rates when we compared neither control group with ≤50 years old patients nor patients groups of ED. Because of this we did not have enough data to say that apoptosis has a prominent role on the development of ED independently from other factors. However, further studies are necessary to clarify the role of apoptosis in erectile dysfunction.     

Second to fourth digit ratio, adult testosterone level and testosterone deficiency

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? 2D/4D digit ratio is inversely related to intrauterus exposure to androgens. Our experience suggests that 2D/4D digit ratio inversely predicts adult testosterone levels and is directly related to hypogonadism.

OBJECTIVES

? The ratio of the second and fourth finger lengths (2D/4D) is related to intrauterine exposure to testosterone. The relationship between 2D/4D and adult hormonal pattern is controversial. ? The aim of our study was to determine if there was a relationship between adult serum testosterone levels and the 2D/4D ratio.

PATIENTS AND METHODS

? We prospectively recruited 204 consecutive patients referred for transrectal prostate biopsy between January 2008 and June 2009. The same physician performed clinical examinations, 2D/4D measurements and the transrectal biopsy in all cases. ? Cut‐off points of 231 and 346 ng/dL testosterone (8 and 12 nmol/L) were used. 2D/4D determination was done with a vernier calliper on the left hand. ? The hormonal profile (testosterone and sexual hormone binding globulin) of the patients was determined between 7.00 am and 11.00 am. ? Age, weight, height, body mass index, toxic habits, digital rectal examination, prostate‐specific antigen and 2D and 4D measurements were recorded prospectively.

RESULTS

? The mean age was 67 ± 7 years and the mean testosterone level was 413 ± 18 ng/dL (14.33 ± 0.62 nmol/L). ? The percentages of patients with testosterone <231 ng/dL (8 nmol/L) and testosterone <346 ng/dL (12 nmol/L) were 6.1 and 30.6 respectively. ? Univariate analysis showed that low 2D/4D ratios were related to higher levels of testosterone (B=?741.98; β=?0.165, P= 0.045) and also with low prevalence of biochemical hypogonadism (testosterone <346 ng/dL). ? Mean 2D/4D ratio in patients with testosterone >346 ng/dL was lower than in patients with testosterone <346 ng/dL (2D/4D 0.97 ± 0.037 vs 0.99 ± 0.043 depending on their hormonal status, P= 0.05). High 2D/4D ratio was associated with low testosterone serum levels (P= 0.046).

CONCLUSIONS

? The 2D/4D ratio is related to adult testosterone levels and the presence of testosterone deficiency syndrome. ? Patients with high 2D/4D ratios have lower testosterone levels and higher risk of testosterone deficiency syndrome.