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Objectives: To examine post-operative urinary and sexual functional outcomes for men with high-risk prostate cancer (HRPCa) who underwent radical prostatectomy (RP) within the Michigan Urological Surgery Improvement Collaborative (MUSIC)., Methods: We identified patients who underwent RP for HRPCa in MUSIC between 2014 and 2023. HRPCa was defined according to American Urological Association criteria. Patients completed Expanded Prostate Cancer Index Composite (EPIC-26) pre-RP and 3-, 6-, 12-, and 24-months postoperatively. Primary outcomes included social continence, defined as 0-1 pads used daily; and recovery of sexual function, defined as the ability to achieve erections firm enough for intercourse. Multivariable and bivariate analyses were performed to identify factors associated with recovery of social continence and sexual function., Results: Around 1323 patients were included in the post-RP urinary continence analysis and 422 men in the sexual function analysis. Fifty-eight percent and 86% of patients achieved social continence at 3- and 12-months post-RP, respectively. Continence recovery was associated with higher baseline EPIC-26 urinary continence scores (OR 1.10, per 5 points, 95% CI 1.06-1.15, P <.001), and negatively associated with increasing age (OR 0.78 per 5-year increase, 95% CI 0.71-0.85 P <.001). Fifteen percent of patients had recovery of sexual function at 12-month post-RP. On bivariate analysis, recovery of sexual function was associated with nerve-sparing at time of RP, lower pre-operative PSA, and not receiving post-RP ADT/RT., Conclusion: RP for HRPCa has acceptable rates of postoperative social continence. However, post-RP recovery of sexual function remains a challenge. This information has important implications for pre-operative counseling and post-operative follow-up for patients with HRPCa., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To explore the association between systemic inflammation response index (SIRI) and erectile dysfunction (ED) in American men., Methods: Data from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2004 were used. Multivariate logistic regression and restricted cubic spline were used to evaluate the relationship between SIRI and ED. Interaction analysis was performed for subgroups to verify the results. Meanwhile, 1:1 propensity score matching was performed to adjust for potential confounding factors for data reanalysis to confirm the reliability of the results., Results: A total of 3543 US adults aged 20years or older were included in the study, of whom 955 participants were considered to have ED. After adjusting for potential confounding factors, we found that compared with the lowest tertiles, the highest tertiles of SIRI showed a positive association with ED, which odd ratio was 1.70 (95%CI: 1.16-2.50). Dose-response curve analysis showed a positive linear correlation between SIRI and ED prevalence. And in the subgroup analysis, the interaction analysis showed that the results were consistent. Meanwhile, the matching of propensity scores further confirmed the validity of the results., Conclusion: In conclusion, in this cross-sectional study, we found a positive relationship between SIRI and the prevalence of ED. Further experimental studies are needed to explore the underlying mechanism in the future., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To understand the relationship between hypogonadism and penile prosthesis infection risk., Methods: We performed a retrospective analysis using IBM MarketScan Commercial Claims and Encounters database. We identified men with ED diagnosis who underwent penile prosthesis placement from 1/1/2008 to 12/31/2017. Comorbidities and risk factors were identified along with a diagnosis of hypogonadism. After placement of penile prosthesis, men were followed until date of surgery of penile prosthesis explant due to infection. Cox proportional hazards models from time of penile prosthesis surgery to date of infection adjusting for various known confounding factors were run., Results: We identified 16,660 men who had received penile prosthesis during the study period. 4,832 (29.0%) men had a hypogonadism diagnosis at the time of their initial surgery date. There were 421 (2.5%) device infections requiring explanation. Descriptively, a higher percentage of infections were noted for removal and replacement surgeries compared to primary implants. Hypogonadism was independently associated with a 25.8% higher risk of penile prosthesis infection (HR: 1.258, 95% CI: 1.024-1.546). Among those men who received testosterone therapy for hypogonadism (prescription data within 0-30 days and within 0-90 days of their initial implant surgery), the effect of hypogonadism on infection risk was no longer significant., Conclusions: Untreated hypogonadism was associated with a 26% higher risk of penile prosthesis infection. This association was most pronounced in men undergoing removal and replacement surgery, which likely drives this association. This suggests a possible benefit to testosterone therapy in testosterone deficient men prior to penile implant, specifically in men undergoing revision., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To investigate the association between the plant-based content of diet and erectile dysfunction in men from the National Health and Nutrition Examination Survey (NHANES)., Methods: We collected de-identified information from the NHANES database on demographics, comorbidities, diet, and erectile dysfunction (ED). Exclusion criteria were age <20 or >70 years, incomplete plant-based diet index information, history of prostate cancer, or other missing information. Using the food frequency questionnaire, an overall plant-based diet index (PDI) and healthful plant-based diet index (hPDI) were developed. A higher score on the PDI and hPDI is indicative of greater consumption of plant-based foods., Results: A total of 2549 men were analyzed, of those 1085 (42.6%) have good erectile function and 1464 (57.4%) have some degree of ED [usually have erections 521 (20.4%), sometimes have erection 690 (27.1%), or never have erections 253 (9.9%)]. The median age and BMI were 54 [41-64] years and 28.8 [25.5-32.6] kg/m 2 , respectively. The median PDI and hPDI were 50 [46-54] and 50 [45-56], respectively. In multivariable adjusted logistic regression analysis, hPDI was negatively associated with ED (OR = 0.98, 95% CI: 0.96-0.99; P = .001). There was no association between PDI and ED., Conclusion: In a well characterized national database, we showed that a healthful plant-based diet is associated with less chance of having erectile dysfunction. Whether interventions with a plant-based diet will improve erectile function remains to be studied., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Smoking is independently associated with erectile dysfunction and cardiovascular disease. Given existing similarities in the constituents of e-cigarettes or ENDS and cigarettes, this study examines the association between ENDS use and erectile dysfunction., Methods: Data from Wave 4 (2016-2018) of the Population Assessment of Tobacco and Health study were analyzed in 2020. Male participants aged ≥20 years who responded to the erectile dysfunction question were included. Multivariable logistic regression models examined the association of ENDS use with erectile dysfunction within the full sample and in a restricted sample (adults aged 20-65 years with no previous cardiovascular disease diagnosis) while adjusting for multiple risk factors., Results: The proportion of erectile dysfunction varied from 20.7% (full sample) to 10.2% (restricted sample). The prevalence of current ENDS use within the full and restricted samples was 4.8% and 5.6%, respectively, with 2.1% and 2.5%, respectively, reporting daily use. Current daily ENDS users were more likely to report erectile dysfunction than never users in both the full (AOR=2.24, 95% CI=1.50, 3.34) and restricted (AOR=2.41, 95% CI=1.55, 3.74) samples. In the full sample, cardiovascular disease history (versus not present) and age ≥65 years (versus age 20-24 years) were associated with erectile dysfunction (AOR=1.39, 95% CI=1.10, 1.77; AOR= 17.4, 95% CI=12.15, 24.91), whereas physical activity was associated with lower odds of erectile dysfunction in both samples (AOR range=0.44-0.58)., Conclusions: The use of ENDS seems to be associated with erectile dysfunction independent of age, cardiovascular disease, and other risk factors. While ENDS remain under evaluation for harm reduction and smoking-cessation potential, ENDS users should be informed about the possible association between ENDS use and erectile dysfunction., (Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: To estimate the association between an erectile dysfunction (ED) diagnosis and other chronic health conditions, as well as, the association between receiving ED treatment and these conditions., Methods: Data was reviewed from the IBM MarketScan Claims and Encounters database between 2008-2017 for men ≥18 years. Of this cohort, common chronic health conditions were identified and the associations of receiving ED treatment and having a chronic health condition was then analyzed., Results: We identified 954 512 (38.3%) of the 2 489 069 men ≥18 years with at least one recorded diagnosis of ED, who also had at least one chronic health condition. Eighteen conditions were observed to be positively associated with ED, while eleven conditions were negatively associated. Depression (OR 2.875: 95% CI 2.866, 2.884; P<.001) had the strongest association, while ischemic heart disease (IHD) had the weakest (OR 0.76: 95% CI 0.755, 0.773; P<.001)., Conclusion: Our study found that a diagnosis of ED was strongly associated with concomitant diagnoses of depression, hypertension, diabetes and several autoimmune diseases. Receiving treatment for ED varied between chronic health conditions., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: To review medical malpractice trends and to identify the most common claims filed against medical providers for the management of patients with priapism., Methods: Using the Westlaw legal database, a search was done for the keyword "priapism" between July 1, 1980 and July 1, 2020. Cases were evaluated for plaintiff demographics, reasons for filing claims, management outcomes, legal verdicts and awards and further categorized based upon the timing of the alleged malpractice., Results: Alleged negligence during the pre-management period was cited in 30 cases. Administration of psychotropic medications was the most common reasons for filing pre-management claims 22/56 (39.3%). Delay in care accounted for 18/56 (32.1%) and complications of surgery were 5/56 (8.9%) of claims. The majority of the completed cases were in favor of the defendants (39/47; 83.0%). There was no association between type of health care provider or timing of alleged malpractice and ultimate verdict., Conclusions: Prescribing psychoactive medications without warning of the adverse effect profile is the most common reason for claims filed against providers with trazodone as the leading medication. Medical providers should ensure that patients are well informed of this adverse effect prior to prescription. Regardless, the majority of medical malpractice cases carry a verdict in favor of the defendant., (Copyright © 2021. Published by Elsevier Inc.)

Objective: To investigate the annual erectile dysfunction (ED) prevalence among men enrolled in an employer-sponsored health insurance (ESHI) plan and evaluate ED treatment profiles among those with an ED diagnosis., Methods: A cross-sectional claims analysis was conducted using the IBM MarketScan Commercial Database, a nationally representative sample of US workers enrolled in ESHI plans. Patients aged 18-64 with at least one ED medical diagnosis claim and continuous enrollment in a given year between 2009 and 2017 were included. Among those with an ED diagnosis, utilization rates of the following ED treatments were determined: phosphodiesterase type 5 inhibitors (PDE5I), penile prosthesis implantation, other ED treatments (eg, vacuum pump, intraurethral suppositories), combination treatment, and no insurer-paid treatments., Results: Between 2009 and 2017, the annual prevalence of men with ESHI suffering from ED increased by 116%. However, in 2017, only 23% of men with an ED diagnosis received an ED therapy paid for by their ESHI plans. The proportion of men taking PDE5Is ranged from 18% in 2012 to 26% in 2015. The proportion of men with ED undergoing penile prosthesis implantation has declined in recent years (0.23% in 2009 to 0.11% in 2017). Similarly, the rate of men who received other ED treatments or combination treatment has decreased from 2009 to 2017 (0.94%-0.30% and 0.65%-0.19%, respectively)., Conclusion: ED prevalence among men insured by an ESHI plan has notably increased, yet approximately three-quarters of these men had no claims for ED treatments, indicating substantial access gaps to treatment., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the extent to which erectile dysfunction (ED) is managed by urologists versus non-urologists. We sought to characterize the epidemiology, diagnosis, and outpatient treatment of ED using a nationally representative cohort., Methods: We examined all male patient visits between 2006 and 2016 in the National Ambulatory Medical Care Survey, a survey designed to provide a nationally representative estimate of ambulatory visits in the United States. Distribution of ED diagnoses among physician specialties was determined. Demographic, clinical, and treatment characteristics of men with ED seeing urologists versus non-urologists were compared using chi-squared tests., Results: Among the 170,499 patient visits analyzed, 1.2% were associated with a diagnosis of ED, which translated into 3,409,244 weighted visits annually. Visits for ED were predominantly seen by urologists (58.0%) and family practitioners (26.2%). Men visiting non-urologists for ED were more likely to be younger than 65 (77.4% vs 52.9%, P < .05). Men seeing urologists for ED more frequently had an active cancer diagnosis (24.2% vs 2.8%, P < .05). Non-urologists more readily ordered or reordered phosphodiesterase-5 inhibitors for men with ED (66.62% vs 50.77%, P < .05). Advanced therapies such as intracavernosal injections and intra-urethral agents were almost exclusively ordered by urologists compared to non-urologists (2.72% vs 0.25%, P < .05)., Conclusion: Almost half of all ED visits were seen by non-urologist providers, who were much less likely than urologists to order advanced pharmacologic therapies. This difference in prescribing patterns presents an opportunity for interdisciplinary collaboration and education to ensure that all patients seeking treatment for ED are receiving guideline-based care., (Published by Elsevier Inc.)

Objective: To determine comorbidities in young men with erectile dysfunction (ED) who are increasingly targeted by direct-to-consumer (DTC) internet platforms that sell phosphodiesterase-5 (PDE-5) inhibitors without comprehensive clinical evaluation; and, further, to characterize the portrayal of DTC platforms by popular news media., Methods: We retrospectively reviewed all men age ≤40 evaluated for ED at an andrology clinic during January 2016-March 2019 to obtain demographics, exam and lab findings, and treatments. Five news sources were analyzed during the study period to characterize whether articles about DTC platforms were positive, critical, or balanced/neutral., Results: We identified 388 patients, with age 29.5 ± 5.0 years, 15% rate of obesity, 20% prediabetes or diabetes, 54% dyslipidemia, and 20% hypogonadism. Serum lab findings associated with subfertility were found in 11%. Semen analysis was conducted in 64 men, of whom 40% were abnormal. Varicoceles were found in 35%. PDE-5 inhibitor was prescribed to 328 men (88%). Off-label empiric therapies included clomiphene (32.9%) or aromatase inhibitor (12.1%). Testosterone replacement was initiated in 9.7%. Analysis of news coverage revealed 18 articles, of which 61% portrayed DTC platforms exclusively in a positive light., Conclusion: Office consultation identified young men with significant comorbidities that would be missed by DTC platforms, which employ only questionnaires for health screening. DTC platforms present themselves as medical authorities without following AUA Guidelines, yet garner mostly positive press coverage. Patients engaging these platforms may falsely believe they are receiving adequate medical assessment. Urologists may do well to incorporate telemedicine to enfranchise young men with evidence-based evaluation., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To characterize themes of discussion and specific concerns expressed by users of an internet erectile dysfunction (ED) community using a mixed-methodology approach involving quantitative natural language processing (NLP) and qualitative annotation of content., Methods: We extracted posts and responses from the Reddit community r/ErectileDysfunction (3100 members) during June 2018 to May 2019. We applied an NLP technique called the meaning extraction method with principal component analysis to computationally identify themes of discussion. We manually annotated a subset (30%) of posts based on NLP-derived themes to evaluate specific content., Results: We analyzed 329 posts and 1702 responses. Meaning extraction method with principal component analysis identified key themes: hypogonadism symptoms, masturbation/sex, evaluation/treatment, alternative therapies, and partner factors (posts); and performance anxiety, hypogonadism evaluation, pornography, and pharmacotherapy (responses). Subset annotation of 100 posts revealed a median author age of 24 years (Interquartile Range (IQR): 20-31). 48% of discussants believed their ED was psychogenic, 38% reported depressive symptoms, and 2% mentioned self-harm/suicidality either attributed to or associated with their ED. 28% of discussants reported seeing a health care professional for ED, and 20% attempted abstinence from pornography/masturbation as a self-prescribed intervention., Conclusion: Social media platforms like Reddit empower young men to discuss ED concerns. Fewer than one-third reported seeing a doctor for ED, suggesting that men turn to peers on the internet first, despite risk of misinformation. A majority attributed symptoms to psychological etiologies and excess pornography/masturbation. Depression, self-harm, and suicide emerged as potent concerns. These data underscore the importance of engaging proactively with young men, both in the consultation room and online., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Prostate cancer incidence, treatment, and survival rates vary throughout the UK, but little is known about regional differences in quality of survival., Objective: To investigate variations in patient-reported outcomes between UK countries and English Cancer Alliances., Design, Setting, and Participants: A cross-sectional postal survey of prostate cancer survivors diagnosed 18-42mo previously., Outcome Measurements and Statistical Analysis: Urinary, bowel, and sexual problems and vitality were patient reported using the Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. General health was also self-assessed. Regional variations were identified using multivariable log-linear regression., Results and Limitations: A total of 35823 men responded, 60.8% of those invited. Self-assessed health was significantly lower than the UK average in Wales and Scotland. Respondents reported more urinary incontinence in Scotland, more urinary irritation/obstruction in Scotland and Northern Ireland (NI), poorer bowel function in Scotland and NI, worse sexual function in Scotland, and reduced vitality/hormonal function in Scotland, Wales, and NI. Self-assessed health was poorer than the English average in South Yorkshire and North-East and Cumbria, with more urinary incontinence in North-East and Cumbria and Peninsula, greater sexual problems in West Midlands, and poorer vitality in North-East and Cumbria and West Midlands. Limitations include difficulty identifying clinically significant differences and limited information on pretreatment conditions., Conclusions: Despite adjustment for treatment, and clinical and sociodemographic factors, quality of survival among prostate cancer survivors varied by area of residence. Adoption of best practice from areas performing well could support enhanced survival quality in poorer performing areas, particularly with regard to bowel problems and vitality, where clinically relevant differences were reported., Patient Summary: We conducted a UK-wide survey of patient's quality of life after treatment for prostate cancer. Outcomes were found to vary depending upon where patients live. Different service providers need to ensure that all prostate cancer patients receive the same follow-up care., (Copyright © 2019 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: Erectile dysfunction (ED) is highly prevalent in obstructive sleep apnea (OSA), however, the effect of continuous positive airway pressure (CPAP) therapy on erectile function has not yet been thoroughly investigated in these patients., Methods: Ninety-four men with severe OSA (ie, with an apnea-hypopnea-index ≥ 30/h of sleep) were prospectively evaluated for the presence and severity of ED before and after 6-12 months of CPAP therapy. The abbreviated version of the International Index of Erectile Function, (the IIEF-5) was used to rate erectile function. Furthermore, all study participants responded to standard questionnaires of daytime sleepiness (Epworth Sleepiness Scale), quality of life (WHO Wellbeing 5 questionnaire) and depression (Major Depression Inventory)., Results: ED as defined by an IIEF-5 score of ≤21 was present in 64 patients (68.1%). CPAP treatment significantly improved erectile function in those patients suffering from moderate and severe ED. Additionally, a trend for a correlation between the improvement of erectile function under CPAP and the hours of its use was observed. Finally, this effect was associated with larger improvements of quality of life in affected patients., Conclusions: ED is very frequent in men with severe OSA and can at least partly be reversed by long-term CPAP therapy in most seriously affected patients. The beneficial effect on erectile function may depend on CPAP compliance and is accompanied by improvements of quality of life. Randomized controlled trials are needed to confirm these findings., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: To report long term outcomes of selective arterial embolization for nonischemic priapism on erectile function utilizing validated outcome questionnaires after selective arterial embolization., Materials and Methods: Twenty men, mean age of 36 years (range: 8-58 years), underwent selective penile embolization for nonischemic priapism between December 1997 and February 2016 (218 months). Each identified case of nonischemic priapism was embolized using gelatin sponge, autologous blood clot, platinum microcoils, polyvinyl alcohol particles, or a combination of these. A variety of procedural details, immediate complications, recurrence of nonischemic priapism, post-procedure performance on Sexual Health Inventory for Men and International Index of Erectile Function Questionnaires, and follow-up duration were recorded., Results: Mean time from development of symptoms until treatment was 117 days (range: 1-1,042 days). After selective arterial embolization, nonischemic priapism resolved in 18 (90%) patients. No patients with successful treatment of their nonischemic priapism developed a recurrence of nonischemic priapism during the study period following the initial treatment. Eight (40%) patients experienced ischemic priapism following embolization with 4 (50%) resolving after treatment. Mean post-procedure Sexual Health Inventory for Men score was 22.1 (range: 16-25). Mean post-embolization erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction domains on the International Index of Erectile Function were 25.8 (range: 16-30), 7.8 (range: 6-10), 7.4 (range: 5-10), 10.9 (range: 6-14), and 7.9 (range: 6-10), respectively. Mean follow-up was 4,601 days (range: 970-6,711 days)., Conclusion: Resolution of nonischemic priapism following selective arterial embolization occurred in 90% of the patients. Two validated questionnaires showed no erectile dysfunction following treatment. Mild orgasmic dysfunction, sexual desire dysfunction, intercourse dissatisfaction, and overall satisfaction dysfunction were noted following treatment., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To compare outcomes with early vs delayed reconstruction following pelvic fracture urethral injury (PFUI) to determine if a traditional 3-month delay is necessary. This delay has been advocated to allow resolution of traumatic inflammation and hematoma but has never been validated. We proceed to reconstruction at 3-6 weeks if the associated injuries are stable, the perineum is soft on rectal palpation, and the fracture is stable for lithotomy positioning., Methods: PFUI patients treated with a suprapubic tube and delayed urethroplasty from October 1991 to August 2016 were included. Patients with initial catheter realignment were excluded. We compared reconstruction failure, incontinence, and erectile dysfunction rates in patients reconstructed within 6 weeks after injury with those reconstructed after the traditional ≥12 weeks., Results: Thirty-nine patients were identified with a median age of 32 years (17 to 69). Overall, the median urethral gap was 2 cm (1-4.5) and median follow-up was 64 months (12-277). Stricture failure occurrence was 5.1%, incontinence rate was 7.7%, and erectile dysfunction rate was 56.4%. The 22 patients with urethroplasty ≤6 weeks post-injury were no more likely to experience erectile dysfunction (13 vs 9, P = .70), urinary incontinence (1 vs 2, P = .40) or reconstruction failure (2 vs 0, P = .20) than the 17 patients delayed ≥12 weeks., Conclusion: We report similar outcomes following urethral reconstruction for PFUI patients repaired ≤6 weeks after injury compared with those delayed ≥12 weeks. This suggests that in selected cases reconstruction at 3-6 weeks is feasible, minimizing the morbidity of a suprapubic tube., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To develop a clinically relevant men's health phenotype and investigate the correlation between severity of urologic symptoms and systemic health conditions METHODS: Retrospective chart review was performed for men seeking care for benign prostatic hypertrophy, erectile dysfunction or chronic prostatitis or chronic pelvic pain syndrome. Urologic symptoms were assessed with the International Prostate Symptom Score, Sexual Health Inventory for Men, and National Institute of Health Chronic Prostatitis Symptom Score. Each was graded as absent or mild (0), moderate (1), or severe (2) and totaled for a urologic score (US). Seven comorbidities with known impact on urologic symptoms were similarly graded (0-2 for each) and totaled for a systemic score (SS). These domains were anxiety, cardiovascular, testosterone deficiency, insulin (diabetes), obesity, neurologic, and sleep apnea., Results: The study included 415 men with median age of 53.8 (range 19-92). Mean total US was 2.1 (range 0-6) and mean SS was 4.1 (0-12). There was a strong correlation between US and SS (Spearman Rho = 0.37, P < .00001) which was consistent regardless of age. The hierarchy of systemic condition impact on US was cardiovascular> neurologic> diabetes> anxiety> sleep apnea> obesity> testosterone. By cluster analysis the tightest correlations were age with cardiovascular, anxiety with CPPS, and diabetes with erectile dysfunction., Conclusion: Systemic health conditions correlate strongly with urologic symptoms in men who present for urologic care. Phenotyping with ACTIONS (anxiety, cardiovascular, testosterone deficiency, insulin, obesity, neurologic, sleep apnea) can identify modifiable conditions that may impact urologic symptoms and outcome of interventions. Future validation in the general population is needed., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To evaluate the relationship between metabolic syndrome (MetS) and ejaculatory dysfunction (EjD) in patients with lower urinary tract symptoms and benign prostatic enlargement., Materials and Methods: From 2012 to 2016, a consecutive series of men with lower urinary tract symptoms and benign prostatic enlargement who were attending our prostate clinic were evaluated using the International Prostate Symptom Score (IPSS) and were subsequently enrolled into a prospective database. All patients were assessed using the short form of the International Index of Erectile Function (IIEF-SF) and the Male Sexual Health Questionnaire ejaculatory dysfunction short form (MSHQ-EjD-SF) that evaluates the ability to ejaculate, the ejaculation force, the ejaculation volume, and subjective bother associated with EjD. MetS was defined according to the Adult Treatment Panel III criteria., Results: A total of 220 patients were enrolled; 48 of 220 patients (22%) presented a MetS. Mean age was 70 ± 8 years, mean IPSS was 8.3 ± 6.2, mean IIEF score was 17.3 ± 7.9, and mean MSHQ-EjD-SF was 9.9 ± 4.7. Overall, 109 of 220 patients (50%) were affected by a moderate or severe EjD. On multivariate analysis, age (odds ratio [OR]: 1.058, 95% confidence interval [CI]: 1.016-1.123; P = .007), IIEF score (OR: 0.899, 95% CI: 0.856-0.943; P = .000), and IPSS (OR: 1.065, 95% CI: 1.011-1.123; P = .018) were found to be predictors of EjD. In our series MetS was not found to be predictive of EjD., Conclusion: In our single-center study, MetS has no influence on the EjD evaluated with the MSHQ-EjD-SF., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Context: Prostate biopsy (PB) represents the gold standard method to confirm the presence of cancer. In addition to traditional random or systematic approaches, a magnetic resonance imaging (MRI)-guided technique has been introduced recently., Objective: To perform a systematic review of complications after transrectal ultrasound (TRUS)-guided, transperineal, and MRI-guided PB., Evidence Acquisition: We performed a systematic literature search of Web of Science, Embase, and Scopus databases up to October 2015, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Complications and mortality following random, systematic, and image-guided PBs were reviewed. Eighty-five references were included., Evidence Synthesis: The most frequent complication after PB was minor and self-limiting bleeding (hematuria and hematospermia), regardless of the biopsy approach. Occurrence of rectal bleeding was comparable for traditional TRUS-guided and image-guided PBs. Almost 25% of patients experienced lower urinary tract symptoms, but only a few had urinary retention, with higher rates after a transperineal approach. Temporary erectile dysfunction was not negligible, with a return to baseline after 1-6 mo. The incidence of infective complications is increasing, with higher rates among men with medical comorbidities and older age. Transperineal and in-bore MRI-targeted biopsy may reduce the risk of severe infectious complications. Mortality after PB is uncommon, regardless of biopsy technique., Conclusions: Complications after PB are frequent but often self-limiting. The incidence of hospitalization due to severe infections is continuously increasing. The patient's general health status, risk factors, and likelihood of antimicrobial resistance should be carefully appraised before scheduling a PB., Patient Summary: We reviewed the variety and incidence of complications after prostate biopsy. Even if frequent, complications seldom represent a problem for the patient. The most troublesome complications are infections. To minimize this risk, the patient's medical condition should be carefully evaluated before biopsy., (Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Phosphodiesterase type 5 inhibitor (PDE5i) use is common for management of erectile dysfunction. Single-institution studies have reported conflicting data on the relationship between PDE5i use and biochemical recurrence of prostate cancer (BCR) after radical prostatectomy., Objective: To evaluate the association between PDE5i use and BCR after radical prostatectomy and radiation therapy in a nationwide population-based cohort., Design, Setting, and Participants: This was a nested case-control study using the National Prostate Cancer Register of Sweden linked to the Prescribed Drug Register. Among men with localized prostate cancer who underwent primary radical prostatectomy or radiation therapy during 2006-2007 with 5 yr of follow-up, 293 had BCR after treatment (cases). For each case we identified 20 BCR-free controls (n=5767) using incidence density sampling., Outcome Measurements and Statistical Analysis: Multivariable conditional logistic regression was used to examine the association between PDE5i use and BCR risk. Separate multivariable models including clinical variables for men undergoing prostatectomy or radiotherapy and including surgical pathology after prostatectomy were also analyzed., Results and Limitations: PDE5i use was not associated with BCR after radical prostatectomy (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.59-1.03) or radiation therapy (OR 0.98, 95% CI 0.49-1.97) after adjusting for marital status, education, income, prostate-specific antigen, clinical stage, Gleason score, and proportion of positive biopsies. Results were similar after additional adjustment for surgical pathology (OR 0.86, 95% CI 0.64-1.16). Men whose cumulative number of PDE5i pills was above the median had a slightly lower BCR risk after prostatectomy in the clinical model, and no difference in BCR risk after adjustment for pathologic tumor features., Conclusions: Our results from a population-based cohort suggest that BCR risk is not higher among men using PDE5i after prostate cancer treatment., Patient Summary: Erectile dysfunction medications are not associated with a higher risk of disease recurrence after prostate cancer treatment., (Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Diabetes mellitus and heavy alcohol consumption are both associated with vascular disease, a category that includes erectile dysfunction (ED). However, the association between alcohol consumption and ED among patients with type 2 diabetes mellitus remains unclear. The aim of the present multicenter cross-sectional study was to investigate the relationship between drinking frequency, weekly alcohol consumption, daily alcohol consumption, and ED among Japanese patients with type 2 diabetes mellitus. Study subjects were 340 male Japanese patients with type 2 diabetes mellitus, aged 19-70 years, who had undergone blood tests at our institutions. A self-administered questionnaire was used to collect information on the variables under study. ED was defined as present when a subject had a Sexual Health Inventory for Men score <8. Adjustment was made for age, body mass index, duration of type 2 diabetes mellitus, current smoking, hypertension, dyslipidemia, glycated hemoglobin, stroke, coronary artery disease, diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. The prevalence of ED was 43.2% (147/340). The frequency of alcohol consumption and weekly alcohol consumption were independently inversely associated with ED (p for trend p = 0.001 and 0.004, respectively). The relationship between daily alcohol consumption and ED was an inverted J-shaped curve: alcohol consumption of less than 60 g, but not 60 g or more, per day was independently related to a lower prevalence of ED (p for quadratic trend = 0.003). In Japanese men with type 2 diabetes mellitus, an inverted J-shaped relationship between daily alcohol consumption and ED was observed, while frequency of alcohol consumption and weekly alcohol consumption were significantly inversely associated with ED., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To determine the prevalence of erectile dysfunction (ED) following burn injury., Materials and Methods: A cross-sectional study was conducted in 2013, recruiting 125 male patients with thermal and electrical burn injury. Using the simplified and validated Persian translation of the abridged, 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire, the patients were evaluated for the presence and severity of the ED following burn injury., Results: ED was detected in 66 patients (53%). There was a significant association between the total body surface area (TBSA) and severity of ED, in which by increase in the TBSA, the severity of ED increased. There was a significant negative correlation between IIEF-5 score and age (r = -0.247, P = .005) and TBSA (r = -0.481, P < .001). The logistic regression analysis revealed that TBSA was significantly associated with ED (P < .001)., Conclusion: Our study estimated the prevalence of ED among burn survivors to be higher than the general population. We found that TBSA is a significant risk factor of ED., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Sleep disorders (SD) and erectile dysfunction (ED) both play crucial roles in quality of life and have received increasing attention in the general population and among physicians., Methods: This study investigated the risk of ED in people diagnosed with SD compared with that in age- and sex-matched unaffected people. This longitudinal, nationwide, population-based cohort study was conducted using data in the Taiwan National Health Insurance Research Database (NHIRD) from January 1998 to December 2011. The sample consisted of 603 people with sleep apnea, 17,182 people with non-apnea SD, and 35,570 matched comparisons as controls. A Cox proportional hazard regression was used to compute the risk of ED in people with SD relative to that in people without SD., Results: The ED incidences were 9.44-fold higher (95% CI 6.49-13.7) in the sleep apnea cohort and 3.72-fold higher (95% CI 3.13-4.41) in the non-apnea SD cohort than in the control cohort, respectively, after age, sex, and comorbidities were adjusted for. The incidence of ED was higher in younger adults (adjusted hazard ratio (HR), 10.4 (95% CI 5.93-18.4) in the sleep apnea cohort and adjusted HR, 4.20 (95% CI 3.07-5.76) in non-apnea SD cohort) and those using benzodiazepine (adjusted HR, 9.69 (95% CI 5.48-10.6) in the sleep apnea cohort and adjusted HR, and 3.83 (95% CI 3.20-4.59) in the non-apnea SD cohort)., Conclusion: This nationwide population-based cohort study provides evidence that people with SD, particularly those with sleep apnea, exhibit an increased risk of subsequent ED., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Gout is a deposition disease with an inflammatory response that can increase the risk of cardiovascular disease. Gout is stressful for affected individuals, and can cause erectile dysfunction (ED). The objective of this study was to identify the association between gout and psychogenic ED (PED) and organic ED (OED)., Method: We analyzed 35,265 patients from the National Health Insurance Research Database who had been diagnosed with gout between 2000 and 2011. A total of 70,529 matched controls were included in the study as a comparison. Patients with a history of PED and OED occurring before the index date, aged less than 20 years, or with incomplete demographic information were excluded. Control patients were selected from the population of people without a history of gout, PED, or OED. The following risk factors for PED and OED were included as covariates in the multivariable models: age, comorbidities of coronary artery disease (CAD), peripheral arterial disease, chronic kidney disease (CKD), hypertension, diabetes, hyperlipidemia, depression and anxiety., Result: Men with gout were more likely to have an increased risk (1.21 times) of ED than were those without gout. Patients with gout were 1.52 times more likely to develop OED and 1.18 times more likely to develop PED than patients in the control group. The risk of developing ED was greater for patients with comorbidities of CKD, diabetes, hyperlipidemia, depression and anxiety., Conclusion: Gout is associated with organic and psychogenic ED. Clinical physicians should consider this association when treating patients with gout., (Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Objective: To establish a descriptive profile of men with coexistent erectile dysfunction (ED) and/or benign prostatic hyperplasia (BPH), ED only or BPH only compared to those with neither condition and to identify the determinants of coexisting disease., Materials and Methods: Self-report and/or medication use measures defining ED and BPH were assessed in men aged ≥40 years (N = 2142) between 2001 and 2004 using the National Health and Nutrition Examination Surveys. Descriptive analyses examined the ED and/or BPH covariate distribution. Logistic regressions calculated odds ratios (ORs, 95% confidence interval) comparing men with ED and/or BPH, BPH only, or ED only to men with neither condition., Results: Of 393 men with BPH, 57.8% had coexistent ED, confirming the moderately strong co-occurrence of the conditions (P <.0001). Coexisting ED and/or BPH occurred in 10.6% of participants, whereas 24.4% and 7.7% reported ED and BPH. After age 60, the odds of reporting ED, BPH, or ED/BPH vs neither almost tripled per decade of increasing age, corresponding to prevalence increases. The unadjusted odds of ED and/or BPH vs no disease increased 1.3 times per prostate-specific antigen unit (ng/mL) increase and 1.1 times per C-reactive protein unit (mg/dL) increase. Other predisposing factors for ED and/or BPH included higher body mass index (OR = 2.5), increased antidiabetic (OR = 2.9) or proton pump inhibitor use (OR = 2.3), increased healthcare visits (≥4; OR = 3.5), and more frequent urinary voiding difficulties (OR = 9.7)., Conclusion: Co-occurring ED and/or BPH is evident in ~10% of men ≥40 years old and is associated with significant clinical correlates. Clinicians need to pay greater attention to this clinically important syndrome in aging men., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: National Health Service England recently oversaw a whole-scale reconfiguration of cancer services in London, UK, for a number of different cancer pathways. Centralisation of cancer surgery has occurred with prostate cancer (PCa) surgery only being commissioned at a single designated pelvic cancer surgical centre. This process has required surgeons to work in teams providing a hub-and-spoke model of care., Objective: To report the extent to which the initiation of a quality assurance programme (QAP) can improve the quality of PCa surgical care during reorganisation of cancer services in London., Design, Setting, and Participants: A pre- and postintervention study was initiated with 732 men undergoing robot-assisted radical PCa surgery over a 3-yr period, 396 men before the introduction of the QAP and 336 afterwards., Intervention: Image-based surgical planning of cancer surgery and monthly peer review of individual surgeon outcomes incorporating rating and assessment of edited surgical video clips., Outcome Measurements and Statistical Analysis: We observed margin status (positive/negative), complication rate of surgery, 3-mo urinary continence, use of nerve-sparing surgery, and potency at 12 mo after surgery. Multivariable logistic regression modelling was used to compare outcomes before and after initiation of the QAP. Cox regression analysis was used to evaluate the return of potency over time., Results and Limitations: Demographics of patients undergoing surgery did not change following the reorganisation of cancer services. Patient-reported 3-mo urinary continence improved following the initiation of the QAP, both in terms of requirement for incontinence pads (57% continent vs 67% continent; odds ratio [OR]: 2.19; 95% confidence interval [CI], 1.08-4.46; p=0.02) and International Consultation on Incontinence Questionnaire score (5.6 vs 4.2; OR: 0.82; 95% CI, 0.70-0.95; p=0.009). Concurrently, use of nerve-sparing surgery increased significantly (OR: 2.99; 95% CI, 2.14-4.20; p<0.001) while margin status remained static. Potency at 12 mo increased significantly from 21% to 61% in those patients undergoing bilateral nerve-sparing surgery (hazard ratio: 3.58; 95% CI, 1.29-9.87; p=0.04). Interaction was noted between surgeon and 3-mo urinary continence. On regression analysis, incontinence scores improved significantly for all but one surgeon who had low incontinence rates at study initiation., Conclusions: The implementation of a QAP improved quality of care in terms of consistency of patient selection and outcomes of surgery during a period of major reorganisation of cancer services in London. The QAP framework presented could be adopted by other organisations providing complex surgical care across a large network of referring hospitals., Patient Summary: The introduction of a quality assurance programme improved the quality of prostate cancer care in terms of consistency of patient selection and outcomes of surgery during a period of major reorganisation of cancer services., (Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Despite the paramount importance of patient-reported outcomes, little is known about the evolution of patient-reported urinary and sexual function over time., Objective: To evaluate differences in pretreatment urinary and sexual function in two population-based cohorts of men with prostate cancer enrolled nearly 20 yr apart., Design, Setting, and Participants: Patients were enrolled in the Prostate Cancer Outcomes Study (PCOS) or the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study, two population-based cohorts that enrolled patients with incident prostate cancer from 1994 to 1995 and from 2011 to 2012, respectively. Participants completed surveys at baseline and various time points thereafter., Outcome Measurements and Statistical Analysis: We performed multivariable logistic and linear regression analysis to investigate differences in pretreatment function between studies., Results and Limitations: The study comprised 5469 men of whom 2334 (43%) were enrolled in PCOS and 3135 (57%) were enrolled in CEASAR. Self-reported urinary incontinence was higher in CEASAR compared with PCOS (7.7% vs 4.7%; adjusted odds ratio [OR]: 1.83; 95% confidence interval [CI], 1.39-2.43). Similarly, self-reported erectile dysfunction was more common among CEASAR participants (44.7% vs 24.0%) with an adjusted OR of 3.12 (95% CI, 2.68-3.64). Multivariable linear regression models revealed less favorable self-reported baseline function among CEASAR participants in the urinary incontinence and sexual function domains. The study is limited by its observational design and possibility of unmeasured confounding., Conclusions: Reporting of pretreatment urinary incontinence and erectile dysfunction has increased over the past two decades. These findings may reflect sociological changes including heightened media attention and direct-to-consumer marketing, among other potential explanations., Patient Summary: Patient reporting of urinary and sexual function has evolved and is likely contingent on continually changing societal norms. Recognizing the evolving nature of patient reporting is essential in efforts to conduct high-quality, impactful comparative effectiveness research., (Copyright © 2014 European Association of Urology. All rights reserved.)

This study aims to systematically review existing literature on the association between erectile dysfunction (ED) and bicycling. Furthermore, it wants to suggest preventive measures to minimize the risk of ED associated with bicycle riding. It was revealed that to date, no sufficient evidence exists to either attribute a simple causal relationship between bicycle riding and ED, nor to refute this relationship. There is need for further research to determine if bicycling is an independent risk factor for the development of ED., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To learn the incidence of erectile dysfunction (ED) after pelvic fracture urethral injury (PFUI) and to identify the related risk factors., Methods: Patients who had sustained a PFUI from 1984 to 2010 were identified from database and invited to participate in the study. All responders were queried after a minimum of 2 years from the time of trauma to assess their erectile function (EF) using the EF domain of the International Index of Erectile Function (IIEF). Medical records and imaging studies were reviewed with a focus on 6 variables that may predict ED. Univariate and multivariate analyses were used to identify parameters predictive of ED., Results: Overall, 90 patients participated in the study, among whom 40 (44%) had ED. On univariate analysis, 4 variables were significant factors for prediction of ED, whereas on multivariate analysis only 3 factors remained strong and independent predictors, namely diastasis of pubic symphysis, lateral displacement of prostate, and long urethral gap. The results of analyses showed that these 3 variables were significant at odds ratios (ORs) of 15.9, 6.9, and 2.0, respectively., Conclusion: The development of ED after PFUI can be predicted by 3 factors, namely diastasis of pubic symphysis, lateral prostatic displacement, and long urethral gap. Pubic diastasis has the highest predictive accuracy. A tendency for higher risk of ED could be observed after bilateral rami and Malgaigne's fractures, but they failed to reach the level of significant predictors on multivariate analysis. No relationship was evidenced between ED and age at traumatism., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To determine the potential effect of metabolic syndrome (MetS) and its components on erectile dysfunction (ED) in Chinese men., Materials and Methods: Data were collected from the Fangchenggang Area Male Healthy and Examination Survey from September 2009 to December 2009, and 3197 men were finally included. The MetS was defined using the updated National Cholesterol Education Program Adult Treatment Panel III for Asian Americans. ED was assessed using the 5-item International Index Erectile Function. The association between MetS and ED is presented as the odds ratios (ORs), with 95% confidence intervals (CIs) estimated using a logistic regression model., Results: After adjustments for age, smoking, alcohol drinking, physical activity, education, and body mass index, our results showed that subjects with MetS had a significantly greater risk of ED (OR 1.34, 95% CI 1.04-1.72; P = .02), especially in middle-age (40-59 years) men (OR 2.43, 95% CI 1.71-3.47; P <.001). Of the MetS components, abnormal fasting blood glucose was the most significantly independent factor of MetS for ED (OR 1.31, 95% CI 1.11-1.55; P = .002)., Conclusion: Our data have shown that MetS is a potential and independent risk factor for ED in Chinese men, especially in middle-age men, MetS can be recognized as a warning signal for ED. Abnormal fasting blood glucose was the most significantly independent factor of MetS for ED in Chinese men., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To assess the pathophysiologic composition and age structure of erectile dysfunction (ED) in men visiting outpatient clinics in China., Methods: We studied 3327 consecutive ED outpatients (median age 39 years) from 2006 to 2010 in the 5 training hospitals in China. Every patient was independently evaluated by an experienced urologist/andrologist using comprehensive diagnostic procedures. The simplified International Index of Erectile Function was used to assess the severity of ED., Results: Most patients (95.0%) were <60 years old, and none were >70 years old. The psychogenic patients were younger and had greater percentage than any other patients. Vasculogenic factors were a major etiology of organic ED. A significant difference was found in the age distribution between the patients with psychogenic ED and those with organic ED (P = .000). Diabetes, hypertension, coronary artery disease, and hyperlipidemia played significant roles in affecting the severity of ED in a statistical model, including age. The International Index of Erectile Function scores decreased with age (rs = -0.199, P = .000). Moreover, the percentage of severe and moderate cases increased with age (P = .003 and P = .002, respectively). However, the constituent ratio of patients sharply declined from 30.3% to 4.5% with age., Conclusion: The number of men visiting outpatient clinics with psychological ED is greater than the number with organic causes in China. The age of the Chinese patients with ED who seek medical help is young and this is mainly because of inadequate sex education to young men and because most older patients are reluctant to visit the hospital just for the loss of erectile function., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To evaluate the incidence and probability of recovery of erectile dysfunction after different types of one-stage urethroplasties for anterior urethral stricture disease., Methods: Seventy-eight men undergoing single-stage anterior urethroplasty from January 1, 2008 to March 31, 2010 were followed prospectively. Patients were divided into 3 groups: group 1 (n=25)-penile substitution urethroplasty; group 2 (n=32)--primary excision anastomotic bulbar urethroplasty; and group 3 (n=21)--bulbar substitution urethroplasty. Patients willing to participate completed the International Index of Erectile Function (IIEF) preoperatively and then on subsequent follow-up visits at 3, 6, 9, 12, and 15 months after urethroplasty. Pre- and post-urethroplasty erectile functions were compared., Results: Our mean follow-up period was 15.50+2.389 months. The mean age (years) was similar among groups. The mean stricture length (cm) was 4.78±0.747, 2.95±0.658, and 6.13±0.981 in-groups 1, 2, and 3, respectively (P=.001). Mean preoperative IIEF score was 24.60±2.365 (similar among groups). Erectile dysfunction (ED) was found in 15 (20%) patients: 4/25 (16%), 9/32 (28%), and 2/21 (10%) in groups 1, 2, and 3, respectively. Mean postoperative decline (3 months) in IIEF score was 22.54±4.823. Overall, the decline was not significant among groups (P=.502.) Recovery of erectile function was seen in 75/78 (96%) men at a mean follow-up time of 5.63±2.59 months., Conclusions: Anterior urethroplasty has a probability of causing ED in as much as 20% of patients. The type of urethroplasty has no significant effect on ED. Recovery of erectile function occurs within 6 months of urethroplasty., (Copyright © 2011. Published by Elsevier Inc.)

Objective: To determine the effect of urethroplasty for urethral stricture disease on both voiding symptoms and sexual function through the use of validated patient questionnaires., Methods: Pre- and post-operative scores for the American Urological Association Symptom Index (AUASI), Incontinence Symptom Index (ISI), and Sexual Health Inventory for Men (SHIM) were obtained and compared for adult male patients undergoing urethroplasty. Score differences were then stratified by age. Relevant clinical and demographic characteristics were also examined., Results: Over the 15-year study period, 183 patients underwent 222 urethroplasties. Median age at the time of surgery was 45 years. Urethroplasties were performed for 207 anterior and 15 posterior urethral strictures. The most common approaches were primary anastomotic (36.5%), staged (23.9%), and buccal graft augmented (21.6%). Overall, 63% of men had a clinically meaningful (≥4 point) improvement in AUASI total score and 69% had improvement in their quality of life (QOL) score after urethroplasty. In aggregate, AUASI total scores improved by 7 points (P<.001), and QOL scores improved by 2 points (P<.001). There was no significant difference in ISI or SHIM scores before and after urethroplasty. AUASI total scores improved more dramatically in younger patients. Half of patients with improved AUASI QOL scores did not have a corollary improvement in their total score., Conclusions: As measured by validated questionnaires, patients of all ages can expect a meaningful improvement in bothersome voiding symptoms after urethroplasty for urethral stricture disease, with minimal impact on continence or erectile function., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: Erectile dysfunction (ED) and retinopathy are prevalent in diabetic men. However, the association between ED and diabetic retinopathy (DR) with relation to DR severity levels has never been studied., Materials and Methods: For this cross-sectional study, data were obtained prospectively at the retina clinic of a tertiary medical center. The study group included men with proliferative diabetic retinopathy (PDR) or with severe nonproliferative diabetic retinopathy (NPDR). The control group included diabetic men without retinopathy or with mild NPDR. All men had type 2 diabetes mellitus. All men filled in the Sexual Health Inventory for Males questionnaire (SHIM) to detect significant ED. Significant ED was defined as SHIM questionnaire score <17., Results: The cohort included 102 diabetic men: 64 (62.7%) men in the study group and 38 (37.3%) men in the control group. Mean age for the entire cohort was 64.0 ± 8.2 years, and mean diabetes duration was 14.5 ± 8.9 years. Mean SHIM score for the entire cohort was 11.4 ± 6.5, and 75 (73.5%) men had significant ED. Men in the study group had higher prevalence of significant ED compared with men in the control group (87.5% vs 50.0%; P <.0001), as well as lower mean SHIM questionnaire scores (9.5 ± 5.4 vs 14.7 ± 6.9; P <.0001). Binary logistic regression analysis and linear regression analysis showed that significant ED and SHIM scores, respectively, were associated with DR severity (P = .001 for both), independent of age, diabetes duration, ischemic heart disease, cerebrovascular disease, hypertension, hyperlipidemia, and smoking., Conclusions: Significant ED is associated with DR severity independent of age, diabetes duration, macrovascular comorbidities, and cardiovascular risk factors., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Previous studies have shown that complications and biochemical recurrence rates after radical prostatectomy (RP) vary between different surgeons to a greater extent than might be expected by chance. Data on urinary and erectile outcomes, however, are lacking., Objective: In this study, we examined whether between-surgeon variation, known as heterogeneity, exists for urinary and erectile outcomes after RP., Design, Setting, and Participants: Our study consisted of 1910 RP patients who were treated by 1 of 11 surgeons between January 1999 and July 2007., Intervention: All patients underwent RP at Memorial Sloan-Kettering Cancer Center., Measurements: Patients were evaluated for functional outcome 1 yr after surgery. Multivariable random effects models were used to evaluate the heterogeneity in erectile or urinary outcome between surgeons, after adjustment for case mix (age, prostate-specific antigen, pathologic stage and grade, comorbidities) and year of surgery., Results and Limitations: We found significant heterogeneity in functional outcomes after RP (p<0.001 for both urinary and erectile function). Four surgeons had adjusted rates of full continence <75%, whereas three had rates >85%. For erectile function, two surgeons in our series had adjusted rates <20%; another two had rates >45%. We found some evidence suggesting that surgeons' erectile and urinary outcomes were correlated. Contrary to the hypothesis that surgeons "trade off" functional outcomes and cancer control, better rates of functional preservation were associated with lower biochemical recurrence rates., Conclusions: A patient's likelihood of recovering erectile and urinary function may differ depending on which of two surgeons performs his RP. Functional preservation does not appear to come at the expense of cancer control; rather, both are related to surgical quality., (Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Introduction: The aims of this study were to estimate the prevalence of erectile dysfunction (ED) complaints in a population-based sample from Sao Paulo and to determine the associations of ED prevalence with sleep disturbances, testosterone levels, age, body mass index (BMI), socioeconomic factors and selected medical history indicators., Methods: The Epidemiologic Sleep Study (EPISONO) is a population-based study of sleep and risk factors for sleep disturbances in Brazil's largest city, Sao Paolo. This study adopted a probabilistic three-stage cluster sampling approach for the city of Sao Paulo. Questionnaires that covered medical conditions and sexual and erection complaints were administered and polysomnographies and fasting blood samples were collected. The patient cohort of the current study of ED consisted of 467 men, aged 20-80 years at the time of their enrollment in EPISONO. The percentage of men who participated in EPISONO but refused to participate in our study was 2.3%., Results: The prevalence of ED complaints in the study cohort was 17.08% overall. ED complaints ranged from 7.3% in younger men (20-29 years old) to 63.25% in older men (>50years old) (adjusted odds ratio [OR]=21.65). The logistic regression model showed that both reduced time spent in REM sleep and fragmented sleep had significant effects as risk factors for ED complaints. Obesity (OR=1.8), low testosterone levels (OR=4.28), low quality of life (OR=4.4), an apnea-hypopnea index over 15 (OR=2.75), and obstructive sleep apnea syndrome (OR=2.13) were also significantly associated with a higher risk of ED complaints., Conclusion: EPISONO study indicates that ED complaints are relatively common phenomena, especially among older men. Adequate sleep patterns and normal or high levels of testosterone, which serve as markers for sexual motivation, may be protective against ED. The prevalence of sleep apnea showed a strong impact on erectile function and subsequently negatively affects sexual activity., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Objectives: To investigate the prevalence of erectile dysfunction (ED) in living donors before and after nephrectomy in China., Methods: From January 2006 to December 2008, erectile function of 94 living donors was evaluated before and after nephrectomy by International Index of Erectile Function, version 5 (IIEF-5). A subanalysis was performed by splitting the total cohort into 2 age groups: those <40 years of age (group 1, n = 21) and those >or=40 years of age (group 2, n = 73)., Results: Before and after nephrectomy, the prevalence of ED in group 1 was 9.5% and 19.0% respectively, and in group 2 was 38.4% and 56.2%. The difference between groups was statistically significant at the stage of preoperation (9.5% vs 38.4%, P = .012) and 12 months postoperation (19.0% vs 56.2% P = .003). Compared with the stage of preoperation, the prevalence of ED at the stage of postoperation was significantly increased at group 2 (38.4% vs 56.2%, P = .031), but not in group 1 (9.5% vs 19.0%, P = .663)., Conclusions: The prevalence of ED increased in living donors aged more than 40 years after nephrectomy in China. The change in sexual function of these living donors after nephrectomy should cause clinicians' attention., (Copyright 2010 Elsevier Inc. All rights reserved.)

Objectives: To determine the responsiveness of the University of California-Los Angeles Prostate Cancer Index (UCLA-PCI) by studying its sensitivity to clinically perceptible changes in health over time in men treated for localized prostate cancer., Methods: All subjects underwent radical prostatectomy (n=253), external beam radiotherapy (n=66), or interstitial seed brachytherapy (n=73). We assessed health-related quality of life (HRQOL) outcomes using the UCLA-PCI to capture disease-specific outcomes and the Medical Outcomes Study Short Form-36 to study general HRQOL. We assessed the UCLA-PCI's responsiveness to change by comparison with the health change item of the Medical Outcomes Study Short Form-36. We measured responsiveness by calculating effect sizes and Guyatt statistics when comparing UCLA-PCI scores between baseline and 1 year and between 1 and 2 years., Results: Of the 475 men who completed all baseline questionnaires, 392 (83%) completed all surveys at 12-month follow-up. Although sexual function decreased from baseline to 12 months in all groups, the magnitude of the negative change was inversely proportional to general health. For those whose general health worsened, effect sizes were >0.50 across all 6 domains. Effect sizes and Guyatt statistics were lowest (<0.25) for urinary bother, bowel function, and bowel bother in the groups demonstrating either no change or improvement in general health. Responsiveness of the UCLA-PCI in the short-term recovery period (12 months post-treatment) was better than in the chronic recovery phase (12-24 months) across almost all domains., Conclusions: The UCLA-PCI is responsive to change in assessing HRQOL in men treated for prostate cancer.

Objectives: To determine the prevalence of erectile dysfunction (ED) in human T-cell lymphotropic virus type I (HTLV-I)-infected patients, and its association with overactive bladder (OB)., Methods: In a cross-sectional study, 111 male patients with positive serology for HTLV-I (by enzyme-linked immunosorbent assay and Western blot) were examined between October 2003 and December 2006. Exclusion criteria were age <18 and >80 years, other neurological diseases, penile prosthesis, neoplasm, and psychological and mental disease. Patients were evaluated by a urologist and neurologist. ED was determined by application of the abridged form of 5-item International Index of Erectile Function (IIEF-5). ED was defined as IIEF-5 0 e 2). Diagnosis of HAM/TSP was performed according to World Health Organization recommendations., Results: Of the total of 111 patients, 6 were excluded and 105 were analyzed. The mean age was 48 +/- 10.7 years. ED was observed in 55.2%. ED was documented in all patients who had HAM/TSP, in 79% of the group with EDSS > 0 and

Objectives: To analyze erectile dysfunction (ED) in patients with left ventricular systolic dysfunction (LVSD)., Methods: A consecutive series of men aged 50-65 years undergoing an echocardiography (EC) at the Danube hospital in Vienna was analyzed. All patients completed the International Index of Erectile Function-5 (IIEF-5). LVSD was defined by EC as an ejection fraction (EF) below 55%., Results: A total of 85 men (age, 58.5 years; standard deviation, 4.3) entered the analysis. Mean EF was 60.9% and mean IIEF-5 score 16.8. No ED (IIEF-5, 22-25) was present in 32 men (37.6%), mild ED (IIEF-5, 17-21) in 17 (20%), and 36 (42.4%) had moderate to severe ED (IIEF-5, 5-16). An EF below 55% was seen in 26 men (30.6%). Mean IIEF-5 in men with LVSD was 13.6 compared with 18.2 in those without LVSD (P = .005); the proportion of men with ED (IIEF-5 <22) was 76% in men with LVSD compared with 56.6% in those without LVSD (relative risk, 1.37; P = .05). In a logistic regression analysis adjusted for body mass index and age a declined IIEF-5 score was independently associated with a low EF (

Objectives: To study the association between erectile dysfunction (ED) and depressive symptoms in men with coronary artery disease (CAD). A cross-sectional analysis of data obtained during a prospective study was carried out., Methods: A cohort of men undergoing coronary angiography filled-out the sexual health inventory for males (SHIM) and the mental health inventory 5 (MHI5) questionnaires for detection and severity assessment of both ED and depressive symptoms. CAD documented by coronary angiography was defined as > or = 50% stenosis in at least one of the major epicardial coronary arteries., Results: Overall, 242 men, with a mean age of 63.7 +/- 12.0 years, were included in the study. ED and depressive symptoms were found in 76% and 47.9% of men, respectively, whereas 94 (38.8%) men suffered from both. The prevalence of diabetes mellitus and the mean age were significantly higher, whereas the mean MHI5 scores were significantly lower, in the group with ED than that without. ED was associated independently with age (P <.0001) and depressive symptoms (P = .007), but not with the number of obstructed coronary arteries, history of diabetes mellitus, hypertension, or smoking. After controlling for age and diabetes mellitus, the scores of SHIM were positively correlated with MHI5 scores (r = .14; P = .03)., Conclusions: These results validate the high prevalence of both ED and depressive symptoms in men with CAD. ED in men with CAD might be associated with age and depressive symptoms., (2010 Elsevier Inc. All rights reserved.)

Background: Effects of renal transplantation (RT) on erectile dysfunction (ED) is a controversial issue., Objective: To verify the efficacy of RT in restoring erectile function (EF) in hemodialysed patients., Design, Setting, and Participants: We conducted a prospective, interventional, nonrandomised study from September 2001 to September 2005 on 78 hemodialysed male patients undergoing RT. EF was evaluated during the baseline visit and 1 yr after RT, using the International Index of Erectile Function (IIEF) questionnaire. A subanalysis was performed by splitting the total cohort into two age groups: <45 yr and ≥45 yr., Intervention: RT was performed., Measurements: EF was evaluated using the IIEF scoring system., Results and Limitations: Before RT, 68 patients with a mean total IIEF score of 42.46 complained about ED. One year after RT, 71 patients reported ED, and the mean total IIEF score had decreased to 39.97. The mean pre-RT IIEF EF domain score was 18.48, and it decreased to 17.55 after RT. Patients aged≥45 yr reported no significant variations in any IIEF domain, while patients aged<45 yr reported a significant decrease in mean total IIEF score due to variations in domain scores for erectile function, sexual desire, and overall satisfaction. In the younger age group, we found significant differences between baseline and post-RT IIEF scores in dyslipidaemic patients and in those patients using immunosuppressive (methylprednisolone and cyclosporin) or antihypertensive (ACE-inhibitors, β-blockers, and Ca-antagonists) drugs. The main limitations were the absence of any aetiological characterisation of ED and the small number of patients., Conclusions: After RT, EF worsens in patients<45 yr but is not modified in patients≥45 yr.

Objectives: The Sexual Health Inventory for Men (SHIM) is a widely used scale for the screening and diagnosis of erectile dysfunction (ED). Our objective was to incorporate the SHIM into our prostate cancer screening program to estimate the prevalence of ED among men screened for prostate cancer., Methods: During September 2006, men younger than 75 years of age living in the Washington, DC area were invited to participate in the George Washington University Prostate Cancer Screening Program. The SHIM questionnaire was administered to all participants. Information regarding primary care physician use, phosphodiesterase-5 inhibitor use, serum prostate-specific antigen levels, and digital rectal examination findings was also obtained. Those who registered SHIM scores of 17 or less or who were taking a phosphodiesterase-5 inhibitor were considered to have ED., Results: Overall, 333 men attended the program. Of the 328 men, 123 (37.5%) met our definition of ED; 30 (9%) were using a phosphodiesterase-5 inhibitor and 93 (28%) had an SHIM score of 17 or less. Univariate analysis suggested a significant difference in the prevalence of ED between African-American men and non-African-American men, with 25% and 41%, respectively, found to have a SHIM score of 17 or less (P < .01); however, this difference was not significant once we controlled for age (P > .05). Among our participants, 33% lacked a primary care physician. Of these, 22% had a SHIM score of 17 or less., Conclusions: The results of our study have shown that ED increases in a nonlinear fashion with age, consistent with the findings of previous reports. Of greater concern, however, given the strong association between ED and cardiovascular disease, was the number of those with ED who lacked a primary care physician.