Prevalence of erectile dysfunction: need for treatment?

Research examining the occurrence of sexual problems in nonclinical populations tends to be restricted to highly select populations. Recently, several population-based surveys surfaced in the international literature, triggered by the advent of effective pharmacological treatment for erectile dysfunction (ED). ED is a common disorder, especially among elderly men. The annual incidence in men 40-69 y of age is 26 per 1000 men. Although most of the difficulties are mild and do not totally prevent intercourse, about 26% of men experience moderate to complete ED. The impact of this category of ED on sexual activity among men is marked. The incidence of ED increases with age and the presence of concomitant conditions, such as diabetes mellitus, heart disease, hypertension, depression, pelvic surgery, negative mood, lack of self-esteem, problems with relationships, or just inadequate sexual experience. Vascular disease is thought to be the most common cause of organic ED, and it may be an early symptom of cardiac morbidity and mortality. Although one may expect that any man with ED who is motivated to continue sexual activity may seek current highly effective symptomatic medical treatment, only a few men are actually seeking help, and not every man seeking help appears to be a candidate for (symptomatic) medical treatment. The frequent association of sexual and medical problems, especially in the aged, and the high dropout rates for symptomatic ED treatment make counseling, adjustment of lifestyle, and modification of risk factors, such as medication, overweight, smoking, alcohol consumption, and lack of exercise, the primary steps in a holistic approach toward the treatment of ED. It is especially important to educate these men to remain physically and sexually as active as possible for as long as possible. The phrase 'use it or lose it' is particularly appropriate for the genitalia.     

Environmental erectile dysfunction: can the environment really be hazardous to your erectile health?

The proposal that exposures to environmental or occupational substances may affect erection ability is a tenable one and would add to a growing list of pathogenic risk factors associated with erectile dysfunction. Several lines of evidence gained by clinical epidemiologic and biomedical research investigations lend support. Several environmental toxicants to include lead, organic solvents, and pesticides have been implicated as possibly hazardous agents. Effects on the nervous and hormonal systems have been proposed as the leading mechanisms by which environmental toxicants adversely impact erectile function. Synthesis of the current evidence supports a possible risk association between environmental exposures and erectile dysfunction. However, scientific support is lacking to establish a direct causal association at this time. More scientific work is needed to identify specific environmental agents that may harm erectile function and define their exact mechanisms of action in this regard.     

Animal model of high cholesterol atherosclerotic erectile dysfunction and mechanism of atherosclerotic erectile dysfunction

Aim: To establish the animal model of atherosclerotic erectile dysfunction (ED) induced by high cholesterol diet and explore the mechanism of atherosclerotic ED. Methods: Thirty male rabbits were divided at random into two groups: the normal diet (ND)group (n=10) and the high cholesterol (HCH) group fed with 1.5% cholesterol diet (n=20). Serum total cholesterol, plaque areas of the ascending aorta,     

Is quality of life different for men with erectile dysfunction and prostate cancer compared to men with erectile dysfunction due to other causes? Results from the ExCEED data base

PURPOSE: To our knowledge the relationship between the underlying etiology of erectile dysfunction and its impact on health related quality of life has not been studied. Such a study is important for men with prostate cancer, as the potential negative quality of life impact of erectile dysfunction may affect clinical decision making in newly diagnosed disease. We compare health related quality of life in impotent men with prostate cancer to that of impotent men without prostate cancer using the Exploratory and Comprehensive Evaluation of Erectile Dysfunction (ExCEED, TAP Pharmaceutical Products, Inc., Lake Forest, Illinois) data base, which is a multicenter, observational disease registry of men with erectile dysfunction. MATERIALS AND METHODS: The cohort included 168 men in ExCEED who had baseline health related quality of life measurement. Of these men 47 reported a history of prostate cancer while 121 did not. Appropriate univariate and multivariate analyses were performed comparing health related quality of life outcomes between impotent men with and without prostate cancer. RESULTS: Men with erectile dysfunction and prostate cancer had worse sexual self-efficacy, erectile function, intercourse satisfaction and orgasmic function than those with erectile dysfunction without prostate cancer (all p <0.001). However, men with erectile dysfunction and prostate cancer experienced less psychological impact of erectile dysfunction on sexual experience (p = 0.05) and emotional life (p = 0.03) than those with erectile dysfunction without prostate cancer. The findings regarding the psychological impact of erectile dysfunction persisted in multivariate linear regression models. CONCLUSIONS: Men with erectile dysfunction and prostate cancer appear to have better disease specific health related quality of life than those with erectile dysfunction and no history of prostate cancer. This finding has important ramifications for clinicians when counseling patients newly diagnosed with prostate cancer and also when treating patients who present with erectile dysfunction of various etiologies.     

Should patients with erectile dysfunction be evaluated for cardiovascular disease?

The landmark Massachusetts Male Ageing Study shed new light on the prevalence of erectile dysfunction (ED) and drew attention to ED as a disease of ageing. Over the years, ED has been linked to the development of cardiovascular disease (CVD) in some patients. There is clear evidence that ED and CVD share and have a similar risk factor profile. CVD is one of the most recognizable causes of mortality and early detection coupled with prevention of mortality from CVD has been the prime interest of many researchers. Consequently, there has been a multidisciplinary curiosity regarding the proposal to use ED as a marker for future CVD. In fact, there have been several proposals to use ED as a screening tool for future CVD. We performed a comprehensive search of two main databases-PubMed and Cochrane Library using a combination of keywords such as acute myocardial infarction, coronary artery disease (CAD) and ED. Journal articles from January 2000 to June 2011 were reviewed. We included all articles discussing the relationship between ED and CVD in the English language. All the relevant randomized controlled trials, cohort and retrospective studies, and review articles were included in our overall analysis in an attempt to answer the question whether all patients with ED should be clinically evaluated for CVD. The results showed a link between ED and the development of future CVD in some patients, but ED was not shown to be an independent risk predictor that is any better than the traditional Framingham risk factors. Screening for CVD may, however, be rewarding in younger patients with severe ED and in patients with concurrent CVD risk factors.     

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.

     

Are men with erectile dysfunction more likely to have hypertension than men without erectile dysfunction? A naturalistic national cohort study

PURPOSE:: We examined whether men with erectile dysfunction (ED) are more likely to have hypertension than men without ED in a managed care setting. MATERIALS AND METHODS:: We used a naturalistic cohort design to compare hypertension prevalence rates in 285,436 men with ED to that in 1,584,230 men without ED from 1995 through 2001. We also used a logistic regression model to isolate the effect of ED on the likelihood of hypertension after controlling for subject age, census regions and 9 concurrent diseases. The ED and the nonED cohort came from a nationally representative, managed care claims database that covers 51 health plans and 28 million members in the United States. Finally, the prevalence rate difference between members with and without ED, and the OR of having hypertension were calculated. RESULTS:: The hypertension prevalence rate was 41.2% in men with ED and 19.2% in men without ED. After controlling for subject age, census region and 9 concurrent diseases the OR was 1.383 (p <0.0001), which implies that the odds for men with ED to have hypertension were 38.3% higher than the odds for men without ED. CONCLUSIONS:: Men with ED were more likely to have hypertension than men without ED. This evidence supports the hypothesis that ED shares common risk factors with hypertension. It also suggests that men with ED and clinicians could use ED as an alerting signal to detect and treat undiagnosed hypertension earlier.     

The promise of inhibition of smooth muscle tone as a treatment for erectile dysfunction: where are we now?

Ten years ago, the inhibition of Rho kinase by intracavernosal injection of Y-27632 was found to induce an erectile response. This effect did not require activation of nitric oxide-mediated signaling, introducing a novel target pathway for the treatment of erectile dysfunction (ED), with potential added benefit in cases where nitric oxide bioavailability is attenuated (and thus phosphodiesterase type 5 (PDE5) inhibitors are less efficacious). Rho-kinase antagonists are currently being developed and tested for a wide range of potential uses. The inhibition of this calcium-sensitizing pathway results in blood vessel relaxation. It is also possible that blockade of additional smooth muscle contractile signaling mechanisms may have the same effect. In this review, we conducted an extensive search of pertinent literature using PUBMED. We have outlined the various pathways involved in the maintenance of penile smooth muscle tone and discussed the current potential benefit for the pharmacological inhibition of these targets for the treatment of ED.     

Is the metabolic syndrome an independent risk factor for erectile dysfunction?

PURPOSE: We determined the role of the metabolic syndrome as an independent risk factor for erectile dysfunction. MATERIALS AND METHODS: Men participating in a health screening project completed the International Index of Erectile Function-5. The metabolic syndrome was defined according to the 2005 International Diabetes Federation consensus definition. Multiple linear regression, ANOVA and chi-square tests were used to investigate the impact of the metabolic syndrome on erectile dysfunction. RESULTS: A total of 2,371 men with a mean age of 46.1 years (SD 9.9, range 30 to 69) were analyzed. Of the men 33.4% (652) had no erectile dysfunction (International Index of Erectile Function-5 score 22 to 25), 59.7% (1,166) had mild erectile dysfunction (International Index of Erectile Function-5 score 17 to 21) and 6.9% (134) had moderate to severe erectile dysfunction (International Index of Erectile Function-5 score 5 to 16). The metabolic syndrome was present in 33.8% (794). In a multiple linear regression analysis an increased waist-to-hip ratio (p = 0.01) and metabolic syndrome (p = 0.01) turned out to be independently associated with a decreased International Index of Erectile Function-5 score. When stratified according to age, the metabolic syndrome was correlated to erectile dysfunction only in men 50 years old or older with an increase of severe erectile dysfunction by 48% (p = 0.01). CONCLUSIONS: The metabolic syndrome and an increased waist-to-hip ratio are independently associated with a decreased International Index of Erectile Function-5 score. The metabolic syndrome in men older than 50 years is significantly associated with a higher proportion of moderate to severe erectile dysfunction.     

Could a rural lifestyle decrease the prevalence of erectile dysfunction?

OBJECTIVE: To determine the prevalence of erectile dysfunction (ED) in a specific population and explore potential correlates with lifestyle. SUBJECTS AND METHODS: This prospective observational study, covering a population of a very small rural town, included 2000 men aged > or = 20 years from a total population of 121 831 (51% female and 49% male). The International Index of Erectile Function was completed by each of the 2000 men at their homes over a 1-year period. Another questionnaire assessing socio-economic status and health-related determinants of ED were also completed. RESULTS: All 2000 men completed the questionnaires; overall, only 34 reported ED (1.7%). The frequency of mild, mild to moderate, moderate and severe ED was 12%, 29%, 20% and 38%, respectively. Significantly more men aged > 51 years had ED than those aged <41 years (0.05% and 0.45%, respectively; P < 0.001). There was no difference in ED with salary levels. CONCLUSION: The prevalence of ED in this particular rural population of Brazil was very low, at only 1.7%. Although ED increases with age, this association was not apparent for all age groups. It seems that several others factors, e.g. lifestyle, culture and diet, could be important for the onset of ED.     

Do lifestyle changes work for improving erectile dysfunction？

The main cause of erectile dysfunction （ED） is organic in nature, with vascular etiologies being the most common risk factors. Although there have been sufficient data on the relationship between ED and several well-recognized risk factors, including aging, coronary artery disease, atherosclerosis, diabetes mellitus, dyslipidemia, high blood pressure, and pelvic surgeries, little attention has been paid by the urologists to the role of lifestyle factors in ED. However, accumulating data from basic science and clinical studies have determined a link between the occurrence of ED and a number of lifestyle factors, such as smoking, obesity, alcohol consumption, and lack of physical activity. The application of findings from animal and human studies to the clinical practice regarding the modification of lifestyle factors could help improving ED as well as reducing the risks of developing cardiovascular diseases. This communication addresses the impact of lifestyle factors on erectile function and the potential benefits of modifying these factors to improve ED in respect to the current evidence.     

Diagnosis and treatment of trauma-associated arteriogenic erectile dysfunction

Objective: To study the diagnosis and treatment of the trauma-associated arteriogenic erectile dysfunction. Methods: Four patients suffers from arteriogenic erectile dysfunction caused by pelvic fractures trauma. Before operation they were examined using pharmacopenile duplex ultrasonography(PPDU) and internal pudendal arteriogram(IPA). Dorsal artery inferior epigastric artery anastomosis were performed in 3 cases. Results: PPDU and IPA suggested that both cavernous arteries and blood flow were not seen in 1 case in 2 cases both PSV of cavernous artery were less than normal level, and in 1 case the PSV of right cavernous artery was normal, the PSV of left cavernous artery was less than normal level. Injury of left common penile artery was comfirmed. After operation one recovers normal erection spontaneously and two have rigid erection induced by intracavernous injection. Conclusions: Trauma-associated arteriogenic erectile dysfunction may result from common penile artery and internal pudendal artery inj     

Topical agents and erectile dysfunction: is there a place?

Despite the proven efficacy of oral therapy for erectile dysfunction (ED), some patients are unable to take these medications because of drug interactions (ie, sildenafil and nitroglycerin) or a lack of response. Topical agents represent another minimally invasive option for the treatment of ED. This review discusses the impediments to effective topical therapy and examines the developmental status of several candidate drugs. Although still in the investigative stage, topical medications can be another tool in the urologist’s armamentarium against ED.     

Recent advances in the management of erectile dysfunction

RecentadvancesinthemanagementoferectiledysfunctionSKrishnamurti(AndromedaAndrologyCenter,POBox1563,Hyderabad500082,India)overthepasttwodecades,ithasbecomeincreasinglyclearthatphysical(organic)factorspreponderateintheetiopathogenesisofmaleerectiledysfunction(MED).Researchhasfocusedonbothbasicandclinicalaspectsinanendeavortobetterunderstandcausalmechanismsandsubsequentlyevolveeffectivediagnosticandtherapeuticmodalitiesforthemanagementofthiscondition.Thecurrentstatusofourunderstandingofthesu…