The aim of this study was to estimate the prevalence and correlates of erectile dysfunction (ED) in a sample of Chinese type 2 diabetic men. Between October 2016 and April 2017, male patients with type 2 diabetes mellitus treated in our diabetes outpatient clinic were recruited in this study. The participants were asked to complete a short version of the International Index of Erectile Function (IIEF-5), which was a validated and self-administered questionnaire for the diagnosis and grading of ED severity. All patients screened for erectile function also underwent detailed physical examination, and interviewed for demographic and medical history. A total of 550 men were recruited in this study, of whom 20 patients were excluded and 35 did not complete all scheduled study procedures, leaving 495 patients in the final analysis. As determined by IIEF-5 score, 318 (64.2%) patients had ED. Among the 318 patients with ED, mild, mild-to-moderate, moderate, and severe were 37 (11.6%), 65 (20.4%), 95 (29.9%), and 121 (38.1%), respectively. The prevalence of ED in patients with high education, secondary education, and less than secondary education were 83.3%, 60.2%, and 35.4%, respectively (P < 0.0001). The prevalence of ED was 64.2% in Chinese type 2 diabetic men. Increased age, longer duration of diabetes mellitus, and worse glycemic control may promote the progression of ED among Chinese type 2 diabetic men. We also found that the higher education levels may increase the risk of ED in men with type 2 diabetes mellitus.
Erectile dysfunction (ED) due to androgen deficiency is rare in the young population. We retrospectively evaluated in this study men aged 18-40 years presenting with ED from 2015 to 2017. The International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Grade Scores (EHGS) were used to assess erectile function. Total testosterone (TT), sex hormone-binding globulin (SHBG), lipid profile, and glycometabolic indicators were tested in fasting blood sample. TT and SHBG were detected by electrochemiluminescence immunoassay, and free (FT) and bio-available testosterone (BT) were calculated from a validated formula. Linear regression was used to analyze the data. In total, 140 cases (30.56 +/- 4.81 years) with a mean TT levels of 6.15 +/- 2.17 ng/ml were enrolled. Decreased levels of FT were associated with lower IIEF-5 scores(beta = 0.176, P = 0.048) and EHGS (beta = 0.198, P = 0.026) after adjustment for age, body mass index (BMI), smoking, comorbidities, high-sensitive C-reactive protein (hsCRP), uric acid, fructosamine, and quantitative insulin sensitivity check index (QUICKI). TT was only associated with EHGS in the crude model (beta = 0.177, P = 0.037) and some single factor adjustment models, whereas BT and SHBG were not related with erectile function in any model. Low FT level, even in the presence of normal TT, is associated with ED severity in young men. FT levels should be screened in ED patient even with normal total testosterone.
Epalrestat, an aldose reductase inhibitor (ARI), was adopted to improve the function of peripheral nerves in diabetic patients. The aim of this study was to investigate whether epalrestat could restore the erectile function of diabetic erectile dysfunction using a rat model. From June 2016, 24 rats were given streptozocin (STZ) to induce the diabetic rat model, and epalrestat was administered to ten diabetic erectile dysfunction (DED) rats. Intracavernous pressure (ICP) and mean systemic arterial pressure (MAP), levels of aldose reductase (AR), nerve growth factor (NGF), neuronal nitric oxide synthase (nNOS), alpha-smooth muscle antigen (alpha-SMA), and von Willebrand factor (vWF) in the corpus cavernosum were analyzed. We discovered that epalrestat acted on cavernous tissue and partly restored erectile function. NGF and nNOS levels in the corpora were increased after treatment with epalrestat. We also found that the content of alpha-SMA-positive smooth muscle cells and vWF-positive endothelial cells in the corpora cavernosum were declined. Accordingly, epalrestat might improve erectile function by increasing the upregulation of NGF and nNOS to restore the function of the dorsal nerve of the penis.
Psoriasis is a common skin disease with the global prevalence of about 2%. Mounting evidence has emerged indicating that there was an association between psoriasis and increased susceptibility to erectile dysfunction (ED). We aimed to assess whether psoriasis was a risk factor for ED through a comprehensive literature review and meta-analysis. The MEDLINE (PubMed), EMBASE, and the Cochrane Library were systematically searched for all studies investigating the erectile function in psoriatic patients. The association between psoriasis and risk of ED was summarized using the odds ratios (OR) with a 95% confidence interval (CI). The protocol for this meta-analysis is available from PROSPERO (CRD42018093025). Overall, 1829449 participants (the mean age ranged from 44 years to 56.3 years) were included from 8 studies (6 cross-sectional, 1 cohort, and 1 case-control study); 39490 of whom were patients with psoriasis, with the mean disease duration from 6 months to 19.9 years. The methodological quality of the 8 included studies was considered to be either moderate or high quality. Synthesis results from the included studies revealed that psoriasis was significantly associated with an increased risk of ED in psoriatic patients (OR = 1.62, 95% CI: 1.37-1.91, P < 0.001; heterogeneity: I-2 = 62.6%, P = 0.009). The results were consistent after multivariable adjustment (6 studies; combined OR = 1.5, 95% CI: 1.31-1.72, P < 0.001; heterogeneity: I-2 = 53.5%, P = 0.056). Evidence from this meta-analysis indicates that patients with psoriasis have a significantly elevated risk of ED.
Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a form of energy transfer that is of lower intensity (<0.2mJ/mm(2)) relative to traditional Extracorporeal Shock Wave Lithotripsy (ESWL) used for management of urinary stones. At this intensity and at appropriate dosing energy transfer is thought to induce beneficial effects in human tissues. The proposed therapeutic mechanisms of action for Li-ESWT include neovascularization, tissue regeneration, and reduction of inflammation. These effects are thought to be mediated by enhanced expression of vascular endothelial growth factor, endothelial nitric oxide synthase, and proliferating cell nuclear antigen. Upregulation of chemoattractant factors and recruitment/activation of stem/progenitor cells may also play a role. Li-ESWT has been studied for management of musculoskeletal disease, ischemic cardiovascular disorders, Peyronie's Disease, and more recently erectile dysfunction (ED). The underlying mechanism of Li-ESWT for treatment of ED is incompletely understood. We summarize the current evidence basis by which Li-ESWT is thought to enhance penile hemodynamics with an intention of outlining the fundamental mechanisms by which this therapy may help manage ED.
Although previous studies have investigated the safety and efficacy characteristics of oral drugs in patients with premature ejaculation (PE), the available results remained inconsistent. Hence, this article was conducted to comprehensively compare the effectiveness of oral drugs and several relevant complications in patients with PE. Relevant researches were comprehensively searching from the databases PubMed, EMBASE, and Web of Science, up to May 1st, 2018. The pooled standard mean difference (SMD) or odds ratios (ORs) with 95% Credible interval (CrI) was respectively utilized to evaluate the safety and efficacy of oral drugs in PE. A total of 25 relevant research were ultimately included in this network metaanalysis. PE oral drugs mainly included serotonin reuptake inhibitors (SSRIs) and phosphodiesterase type 5 inhibitors (PDE5i). Our results successfully shed light on the efficacy differences of oral drugs for the treatment of PE. The cumulative rank probability of IELT at 4-6 weeks from best to worst was SSRIs + PDE5i, PDE5i, and other SSRIs alone. In addition, this meta-analysis also showed fluoxetine 20 mg, dapoxetine 60 mg, PDE5i, and SSRIs + PDE5i had a higher, whereas other SSRIs alone had a relatively lower incidence rate of clinically relevant complications. In summary, our results showed that the usage of PDE5i only or in combination with SSRIs might be stronger than SSRIs alone in the efficacy of PE oral drugs. Nevertheless, it also has a problem about the side effects of PDE5i including gastrointestinal or central nervous systems complications, which prevents it as the first-line treatment drug. Despite the development of some promising new therapeutic options, SSRIs remained as the first line of therapeutic PE oral drug through a synthetical consideration at present.
As lifelong premature ejaculation (PE) and subjective PE are two different PE subtypes, the measurement of their characteristic features requires different objective measures. In this article, we address the differences between lifelong PE and subjective PE, in terms of the extent of variation of sexual performance and propose a new objective measure for research of subjective PE. By considering lifelong PE as a mainly "male" sex disorder and subjective PE as a mainly "man" sex disorder, we show that stopwatch-mediated intravaginal ejaculation latency time (IELT) measurement is most adequate for research of lifelong PE, but inadequate for research of subjective PE. Subjective PE needs another objective measure to capture its key characteristics. Arguments are provided to show that the characteristics of subjective PE are different from the key features of lifelong PE. The core issue in lifelong PE is the very short IELT with a very small variation in sexual performance. Subjective PE is characterized by a higher variation of sexual performance. Stopwatch-mediated IELT measurement is essential in case of small variation of sexual performance. In contrast, measurement of various parameters of penile intravaginal thrusting is suggested to be more appropriate in case of high variation of sexual performance observed in subjective PE. In conclusion, research of lifelong PE should be performed by stopwatch measurement of the IELT whereas research of subjective PE should be performed by movement tracker devices, designed to be bound to the males body and/or inserted into the women's vagina with robust software to measure intravaginal thrusting variation performance. Future studies are warranted to provide scientific data to support this hypothesis.
Recently, the ICD-11 for Mortality and Morbidity Statistics (ICD-11-MMS, 2018 Version) has been published with a new definition of premature ejaculation (PE), including a third PE subtype. This definition differs from Diagnostic and Statistical Manual of Mental Disorders (DSM-5) definition of PE. We hereby address the similarities and differences between ICD-11-MMS and DSM-5 definition of PE and call attention to the illogical policy of some European (EU) National Regulatory Agencies to remain with a 1-min cut-off point of ejaculation time for Lifelong, Acquired and Subjective PE. The advantage of ICD-11-MMS is the inclusion of a third PE subtype, which is congruent with Subjective PE. A serious disadvantage of DSM-5 is that a 1-min criterion is used for both Lifelong and Acquired PE, and that a third PE subtype is not mentioned. Despite the incomplete DSM-5 definition of PE, some EU regulatory agencies adhere to a definition of PE which relies only on the 1-min ejaculation time cut-off point of DSM-5, and do not recognize the more recent PE definitions of ICD-11-MMS and International Society for Sexual Medicine. There is no scientific evidence for this illogical position. The continued use of a 1-min cut-off point for all subgroups of PE ignores the existence of Acquired PE (Intravaginal Ejaculation Latency Time (IELT) <3 min) and Subjective PE (IELT <approx. 6 min), both of which have been shown to be clinically and psychologically important. In conclusion, some EU regulatory agencies are not recognizing ongoing developments in the definition of three different subgroups of PE. We propose combining the DSM-5 and ICD-11 MMS definitions to optimize the whole PE spectrum for future registered drug treatment studies, so that it properly reflects patient needs.
Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel treatment for erectile dysfunction (ED). Its ability to improve erectile function has been shown in patients with vasculogenic ED by many randomized-controlled trials against sham procedures. However, the role of LI-ESWT in ED caused by radical prostatectomy (RP) is still questionable because this type of ED was excluded from nearly all clinical studies; it has been investigated in only a few small single-arm trials. This review summarizes preclinical studies on mechanisms of action of LI-ESWT for ED and neurological diseases to explore the potential of this treatment for nerve-impaired ED after RP.
The purpose of the present study was to conduct a meta-analysis of cross-sectional studies assessing the relationship between alcohol consumption and the risk of erectile dysfunction (ED). To identify relevant studies, databases such as Pubmed, Medline, Embase, and the Cochrane Library were searched from the inception of the present study to March 2016. Finally, 24 studies (154,295 patients) were included. We combined a study-specific odds ratio (OR) estimated by using a random effects meta-analysis. The results of our meta-analysis indicated that light to moderate alcohol consumption (<21 drinks/ week) was correlated with a decreased risk of erectile dysfunction (OR = 0.71; 95% CI: 0.59-0.86; P = 0.000). However, regular (ever vs. never) and high alcohol consumption (>21 drinks/week) had no significant influence on the prevalence of ED (regular: OR = 0.87; 95% CI: 0.75-1.07; P = 0.062; high: OR = 0.99; 95% CI: 0.80-1.22; P = 0 .893) . In a dose-response meta-analysis, a non-linear relationship was observed between alcohol consumption and risk of ED (P for non-linearity = 0.0000). In conclusion, moderate intake of alcohol exhibited a beneficial effect on the risk of ED, whereas regular and high consumption did not.
Erectile dysfunction (ED) is a wide spread and troublesome problem in aging men. Many analyses of hypertensive patients suggest that the prevalence of ED in hypertensive populations is even higher. The purpose of this meta-analysis was to evaluate the relation between hypertension and ED. A literature review was performed to identify all cross-section studies about hypertension and erectile dysfunction. Sources included MEDLINE and EMBASE from 1966 to 2015. The reference lists of the retrieved studies were also investigated, and a meta-analysis were conducted. Eighteen cross-section studies involving a total of 41,943 participants and 10,151 cases of ED were used in this analysis. We found that risk of ED was increased with hypertension (summary OR = 1.84, 95% CI: 1.58-2.14, p < 0.000001). Adjusting for obesity, unfavorable lipid levels, alcohol abuse, physical activity, cigarette smoking, educational level and other lifestyle factors, hypertension was also associated with increased risk of ED (summary OR = 1.58, 95% CI: 1.35-1.86, p < 0.00001). The results of this meta-analysis support that hypertension is associated with an increased risk of ED. Further high-quality prospective studies are needed to confirm this observation.
Over the past decades, sleep-related erection and rigidity monitoring has been used to differentiate psychogenic from organic erectile dysfunction (ED), due to the involuntary nature of erections in sleep. This study retrospectively reviewed all available literature focusing on sleep-related erection and rigidity monitoring through a systematic PubMed search. To date, there are mainly seven methods and their modifications, including: sleep laboratory testing, the mercury strain gauge, the stamp test, the erectometer, the Snap gauge, the RigiScan, and nocturnal electrobioimpedance volumetric assessment. This study analyzes and summarizes the advantages and limitations of seven monitoring methods. This study indicates that both of the above methods possess the capacity to assess erectile quality and provide guidance to the diagnosis, etiology, and differential diagnosis of ED. However, some limitations still exist for the application. New devices which can continuously monitor kinds of variables, including sleep-related erection, axial and radial rigidity, and oxygen saturation are needed.
The objective of this study is to evaluate the association between chronic periodontitis (CP) and the risk of erectile dysfunction (ED). Electronic search using PubMed, Embase and the Cochrane Library was carried out for observational studies, longitudinal, cohort, case control and epidemiological studies on humans, published up to December 2015. Manual searches were also performed. Odds ratios (ORs) and corresponding 95% confidence intervals (Cls) were used to estimate the association between CP and the risk of ED. Methodological quality assessment was carried out using the Newcastle-Ottawa Quality Assessment Scale. Four case control studies and one cross-sectional studies involving 213, 006 participants were included. Based on the random-effects model, analyses of all studies showed that CP was associated with an increased risk of ED (OR=2.28, 95% CI: 1.50-3.48). There was heterogeneity among the studies (P < 0.001, I-2=97.8%). Estimates of total effects were generally consistent with the sensitivity and subgroup analyses. In conclusion, our meta-analysis suggested that there was a significant association between CP and the risk of ED. Further epidemiological studies are needed to better estimate the key risk factors for periodontitis and their interaction effects.