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Background: Hyperestrogenism is believed to be harmful to male sexuality. We aimed to investigate the prevalence of and the impact of hyperestrogenism on sexual functioning in a cohort of men seeking medical attention for new‐onset erectile dysfunction. Materials and methods: Data from 547 men seeking first medical help for new‐onset erectile dysfunction at a single andrology center were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson comorbidity index. All patients completed the International index of erectile function; the International index of erectile function‐erectile function domain was categorized according to Cappelleri's criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estradiol levels >42.6 pg/mL (Tan et al., 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and International index of erectile function domains score. Results: Overall, 96 (17.6%) participants had serum estrogen levels suggestive of hyperestrogenism. Men with hyperestrogenism were older (median [interquartile range]: 46 [35–59] vs. 44 [31–56] years; p < 0.001), had a higher rate of comorbidities (Charlson comorbidity index ≥1: 26.0% vs. 7.4%; p < 0.001), and higher serum total testosterone values (5.4 [5.2–8.0] vs. 4.3 [4.1–5.7] ng/mL; p = 0.01) than those with normal estradiol values. A higher prevalence of severe erectile dysfunction (135 [29.9%] vs. 47 [48.9%] men; p = 0.01) and of hypogonadism (22 [4.8%] vs. 6 [6.3%] men; p = 0.004) were found in men with hyperestrogenism. Serum estradiol levels were positively correlated with total testosterone levels (β = 0.26, p < 0.001) but negatively correlated with International index of erectile function‐orgasmic function (β = –0.24, p = 0.002) and International index of erectile function‐erectile function scores (β = –0.03, p < 0.001). When International index of erectile function scores was used to stratify erectile dysfunction patients, hyperestrogenism (odds ratio 2.44, p = 0.02) was associated with severe erectile dysfunction. Conclusions: One out of five men seeking first medical help for erectile dysfunction showed elevated serum estradiol values suggestive of hyperestrogenism. Hyperestrogenism was associated with health‐significant comorbidities, orgasmic function impairment, and erectile dysfunction severity. [ABSTRACT FROM AUTHOR]

Background: The atherosclerotic cardiovascular disease risk score is a validated algorithm predicting an individual's 10‐year risk of developing acute cardiovascular events (cardiovascular disease). Patients who suffer from arteriogenic erectile dysfunction are susceptible to developing cardiovascular disease in the future. Objectives: To apply the atherosclerotic cardiovascular disease score at a homogenous cohort of men with erectile dysfunction undergoing a dynamic penile colour Doppler duplex ultrasound and explore its predictive ability to identify patients with vasculogenic erectile dysfunction at colour Doppler duplex ultrasound. Materials and methods: Complete data of 219 patients undergoing colour Doppler duplex ultrasound were analysed. All patients completed the International Index of Erectile Function. The atherosclerotic cardiovascular disease score and Charlson comorbidity index were applied to the entire cohort. Patients were divided into those with normal vs. pathological parameters at colour Doppler duplex ultrasound. Descriptive statistics were used to explore differences between the two groups. Logistic regression models tested the potential role of atherosclerotic cardiovascular disease to predict arteriogenic and/or venogenic erectile dysfunction. Local polynomial smoothing models graphically displayed the probability of pathological colour Doppler duplex ultrasound parameters at different atherosclerotic cardiovascular disease scores. Results: Overall, arteriogenic erectile dysfunction and venous leakage were diagnosed in 88 (40.2%) and 28 (12.8%) patients respectively. The median (interquartile range) atherosclerotic cardiovascular disease score was 7.7 (3.9–14). Patients with pathologic colour Doppler duplex ultrasound were older (59 vs. 54 years, p < 0.001), had higher Body Mass Index (26.5 vs. 25.6 kg/m2, p = 0.04), more comorbidities (Charlson comorbidity index ≥ 1) (76.5% vs. 54.4%, p = 0.002) and higher median atherosclerotic cardiovascular disease scores (9.95 vs. 7, p = 0.005), respectively. At logistic regression analysis, a higher atherosclerotic cardiovascular disease risk score was independently associated with arteriogenic erectile dysfunction at colour Doppler duplex ultrasound (odds ratio: 1.03, 95% confidence interval: 1.01–1.08, p = 0.02) after adjusting for Body Mass Index, physical activity, alcohol consumption and severe erectile dysfunction. Discussion: As vasculogenic erectile dysfunction may precede by some years the onset of acute cardiovascular diseases, the rigorous identification of patients with deficient cavernosal arterial blood flow, would definitely allow the implementation of earlier and more effective cardiovascular prevention strategies in men with erectile dysfunction. Conclusions: The atherosclerotic cardiovascular disease risk score represents a reliable tool to identify patients with arteriogenic erectile dysfunction in everyday clinical practice. [ABSTRACT FROM AUTHOR]

The aim of this study was to study the retinal vessels in patients affected by vasculogenic erectile dysfunction (ED), using dynamic vessel analyzer (DVA). Patients with vasculogenic ED and control subjects were prospectively enrolled to undergo a complete urological and ophthalmologic evaluation, including DVA and structural optical coherence tomography (OCT). The main outcome measures were: (1) arterial dilation; (2) arterial constriction; (3) reaction amplitude (the difference between arterial dilation and constriction); and, (4) venous dilation. Thirty-five patients with ED and 30 male controls were included in the analysis. Mean ± SD age was 52.0 ± 10.8 years in the ED group and 48.1 ± 16.3 years in the control group (p = 0.317). In the dynamic analysis, the arterial dilation was lower in the ED group (1.88 ± 1.50%), as compared with the control group (3.70 ± 1.56%, p < 0.0001). Neither arterial constriction nor venous dilation differed between groups. The reaction amplitude was decreased in ED patients (2.40 ± 2.02%, p = 0.023), compared to controls (4.25 ± 2.20%). In the Pearson correlation analysis, the ED severity, was directly correlated with both reaction amplitude (R =.701, p = 0.004) and arterial dilation (R =.529, p = 0.042). In conclusion, subjects with vasculogenic ED are featured by a significant dysfunction of the retinal neurovascular coupling, which is inversely correlated with ED severity. [ABSTRACT FROM AUTHOR]

Background: Erectile dysfunction aetiology has been historically identified as organic, psychogenic and mixed. Objectives: To stratify and compare a cohort of patients seeking medical help for erectile dysfunction for the first time according to the newly proposed binary classification of the European Association of Urology guidelines: 'primary organic' versus 'primary psychogenic'. Materials and methods: Complete data from 2009 consecutive patients presenting for erectile dysfunction were analysed. All patients completed the International Index of Erectile Function at baseline. According to the presence of erectile dysfunction‐related risk factors indexed by the European Association of Urology Guidelines on Sexual and Reproductive Health, patients were categorised as having primary organic (≥1 risk factor) or primary psychogenic (0 risk factor) erectile dysfunction. Descriptive statistics compared the two groups. Linear regression analysis tested the association between the number of risk factors and erectile dysfunction severity. Locally estimated scatterplot smoothing method graphically explored the relationship between the number of risk factors for erectile dysfunction and the International Index of Erectile Function domain scores. Results: Median (interquartile range) age at first presentation was 50 (39–61) years. Of all, 1632 (86.2%) and 377 (13.8%) were identified as having primary organic and primary psychogenic erectile dysfunction, respectively. Overall, 1488 (74.1%) patients were >40 years of age; in this subgroup, the most frequent risk factors were age, hypertension (29%), active smoking (42%) and alcohol intake (25.1%). Median (interquartile range) International Index of Erectile Function‐erectile function score was 15 (7–22). Primary organic erectile dysfunction patients depicted lower International Index of Erectile Function‐sexual desire and International Index of Erectile Function‐orgasmic function scores (all p ≤ 0.02), whilst groups did not differ in terms of International Index of Erectile Function‐erectile function, International Index of Erectile Function‐intercourse satisfaction and International Index of Erectile Function‐overall satisfaction scores. Discussion: One out of nine patients complaining of erectile dysfunction depict criteria for primary psychogenic erectile dysfunction. Erectile function severity could be as severe as patients with organic erectile dysfunction. The single‐centre‐based cross‐sectional nature of the study, raising the possibility of selection biases, is our main limitation. Conclusions: One out of nine patients presenting for erectile dysfunction depict criteria suggestive for primary psychogenic erectile dysfunction in the real‐life setting. Patients with primary psychogenic and primary organic erectile dysfunction have comparable erectile dysfunction severity, thus outlining the importance of a comprehensive and tailored management work‐up in every patient seeking medical help for the first time. [ABSTRACT FROM AUTHOR]

Erectile dysfunction (ED) is widely considered as an early manifestation of cardiovascular diseases (CVDs), sharing similar risk factors. Assess rates and predictors of developing CVD and/or hypertension (HTN) over a long-term follow-up period using user-friendly and clinically reliable tools in men presenting with ED but without CVD/HTN or known vascular risk factors at baseline. Data from 108 patients presenting between 2005 and 2011 with ED were analyzed. All patients were free from CVD and/or HTN (CVD/HTN) at baseline. Patients completed the International Index of Erectile Function (IIEF) at baseline and were followed up every 6 months with clinical assessment or phone interview. Kaplan-Meier analyses estimated the probability of developing CVD/HTN over time. Cox-regression models tested the association between patient baseline characteristics (for example, age, Charlson Comorbidity Index, baseline IIEF-EF, ED severity, alcohol intake, smoking), response to phosphodiesterase type-5 inhibitors (PDE5is), and the risk of developing CVD/HTN. Of all, 43 (40%) patients showed IIEF-EF scores suggestive of severe ED; 37 (39%) and 59 (61%) were nonresponders and responders to PDE5i, respectively. Median (interquartile range) age was 51 (41, 61) years. Median (interquartile range) follow-up was 95 (86-106) months. Overall, the estimated risk of developing CVD/HTN was 15% (95% confidence interval [CI]: 9-27) at 10-year assessment. Men with baseline severe ED had a higher risk of developing CVD/HTN (34%; 95% CI: 17-59, P =.03) at 10 years than patients with mild to moderate ED (5% [95% CI: 2-14]). At the Cox regression analysis, severe ED (Hazard ratio [HR], 4.62; 95% CI: 1.43, 8.89; P =.01) and baseline IIEF-EF score (HR, 0.92; 95% CI: 0.86, 0.99; P =.02) were associated to the risk of CVD/HTN overtime. Conversely, age and nonresponders to PDE5is (HR, 0.92; 95% CI: 0.32, 2.68; P =.9) were not associated to a risk of CVD/HTN over time. The use of an easy and user-friendly tool, as the IIEF-EF domain score, would allow to reliably assess which men with ED at first presentation may deserve a different, more specific and detailed cardiologic investigation to prevent inauspicious CV events. A single-center-based, observational longitudinal study, raising the possibility of selection biases are the main limits. Patients with severe ED and lower baseline IIEF-EF but no vascular risk factors at first presentation have more than 30% risk of developing CVD/HTN in 10-year time. Those patients may benefit from medical preventive strategies to lowering the risk of CV events and HTN. Pozzi E, Capogrosso P, Boeri L, et al. Longitudinal Risk of Developing Cardiovascular Diseases in Patients With Erectile Dysfunction—Which Patients Deserve More Attention?. J Sex Med 2020;17:1489–1494. [ABSTRACT FROM AUTHOR]

The ASCVD (Atherosclerotic Cardiovascular Disease) risk score is a validated and standardised algorithm predicting the individual 10-year risk of developing acute cardiovascular events (CVs). Patients with erectile dysfunction (ED) are at greater risk of CVs; we aimed to i) apply the ASCVD score at a homogenous cohort of men undergoing dynamic penile color doppler duplex ultrasound (CDDU) for ED, and ii) explore its predictive ability to identify patients with arteriogenic and venogenic ED at CDDU. Complete data of 188 consecutive patients undergoing CDDU for ED were analysed. Health-significant comorbidities were scored using the Charlson comorbidity index. All patients completed the International Index of Erectile Function (IIEF) at baseline. Serum hormones (total testosterone (tT) and luteinising hormone (LH)) were dosed for every patient. The ASCVD score was applied to the entire cohort. According to the ASCVD, patients were segregated into low (≤7.5%) vs. intermediate/high risk (> 7.5%). Descriptive statistics was used to explore differences between the two groups. Logistic regression models tested the potential predictive role of ASCVD scores to predict pathological CDDU parameters (peak systolic velocity (PSV) < 35 cm/s and/or resistance index (RI) ≤ 0.70). Local polynomial smoothing models graphically displayed the probability of pathological CDDU parameters at different ASCVD scores. Overall, median (IQR) age was 54 (43-60) yr. Of all, 52 (27.7%) patients reported severe ED, as for IIEF-EF ≤ 11. Overall, 80 (42.6%) showed a pure arteriogenic ED and 15 (8%) pure venogenic ED at CDDU. Intermediate/high-risk patients (52.7%) were found to have lower IIEF-EF scores, higher BMI, higher CCI and presented with a greater rate of PDE5i non-responders compared to those with low-risk (47.3%) according to ASCVD (all p<0.005). Conversely, the two groups did not significantly differ in terms of CDDU parameters. At logistic regression analysis, the ASCVD risk score was identified as a strong predictor for arteriogenic ED at CDDU (OR: 1.07, 95% CI: 1.03-1.13, p = 0.007) after adjusting for BMI. Conversely, the ASCVD score was not identified as a predictor of pure venogenic ED (OR: 1.04, 95% CI: 0.98-1.1, p = 0.22). Figure 1 displays the probability of pathological findings at CDDU (PSV < 35 cm/sec vs. RI < 0.7) at different ASCVD scores. The ASCVD risk score can be used as a valuable tool to identify patients with arteriogenic ED at CDDU in the real-life settings. Since vasculogenic ED may anticipate CVs even by some years, the accurate identification of patients with deficient cavernosal arterial flow would certainly allow earlier and more effective cardiovascular prevention in this sub-set of patients. None [ABSTRACT FROM AUTHOR]

The impact of erectile dysfunction (ED) on patients' sexual satisfaction and mood profile could differ across different ages. To investigate the relationship between erectile function (EF), sexual satisfaction, and mood status among patients seeking medical help for ED. Data from 765 patients presenting at a single center for ED were analyzed. Patients were categorized as young (≤50 years), middle-aged (>50 and ≤65 years), and old (>65 years) individuals and completed the International Index of Erectile Function (IIEF) and the Beck's Inventory for Depression (BDI). The IIEF overall satisfaction and intercourse satisfaction domain scores and the BDI score were used to investigate sexual life satisfaction and depressive symptoms (defined as BDI > 11) across ages and according to ED severity. Linear and logistic regression analyses assessed the relationship between satisfaction scores and the risk of depressive symptoms with age and EF. Median (interquartile range) age at first assessment for ED was 50 (38, 59) years. Compared with older men, young and middle-aged patients showed significantly higher IIEF-OS and IIEF– Intercourse Satisfaction scores for increasing IIEF-EF scores. Older men showed no difference in terms of satisfaction scores for mild ED and normal EF status. At linear regression analysis, both IIEF-EF and age were significantly associated with sexual satisfaction (all P <.0001). The interaction term between age and EF was also significant, suggesting that the older the patients, the higher the feeling of sexual satisfaction for the same EF status (P =.004). Overall, 25% of patients reported depressive symptoms. Logistic regression analysis showed a 40% risk of depressive symptoms for patients <45 years with severe ED compared to a risk <20% for a man >65 years of age with the same EF status. Treating older patients with mild ED may not lead to a further improvement in sexual satisfaction as compared with younger patients with the same ED severity. Younger ED patients suffer more from depressive symptoms compared with older men, regardless of ED severity, thus supporting the need for a comprehensive psychological counseling. The single-center design and the lack of the assessment of the impact of ED treatment are the main limits. The clinical management of ED should be tailored according to different ages: younger patients deserve to be investigated and eventually treated for depressive symptoms. Older patients should be counseled for treatment when a sexual satisfaction improvement is expected. Capogrosso P, Ventimiglia E, Boeri L, et al. Should We Tailor the Clinical Management of Erectile Dysfunction According to Different Ages? J Sex Med 2019;16:999–1004. [ABSTRACT FROM AUTHOR]

Patients with low urinary tract symptoms (LUTS) frequently complain some sexual dysfunction and sometimes even episodes of bothersome urinary incontinence (UI). We aimed to assess the relationship between UI (as measured with the ICIQ-UI-SF), and sexual disfunction (as measured with the IIEF), in men presenting with LUTS at a tertiary-referral centre. In this cross-sectional study, data were retrospectively retrieved from 938 consecutive patients aged >18 years seeking first medical help for self-reported LUTS (i.e., all patients had IPSS≥1). All patients had a complete clinical assessment and completed the IPSS, the ICIQ-UI-SF, the OAB-q and the IIEF questionnaires. Patients were stratified into "no UI" (ICIQ-UI-SF=0), "mild UI" (ICIQ-UI-SF=1-7), "moderate UI" (ICIQ-UI-SF=8-13) or "severe UI" (ICIQ-UI-SF=14-21). ANOVA test assessed differences in baseline characteristics among these groups. Spearman correlation test was applied to evaluate the correlation between ICIQ-UI-SF and IIEF domain scores. A linear regression analyses tested putative risk factors associated with increased ICIQ-UI-SF scores. Of 938, 589 (63%) patients had no UI, 237 (25%) had mild UI, 76 (8%) moderate UI and 36 (4%) severe UI. There were no substantial differences in total PSA levels and uroflowmetry parameters among UI groups, whereas prostate volume, IPSS and OAB-q scores were higher as UI symptoms increased (all p≤ 0.03). A negative correlation was found between IIEF-total, IIEF-Erectile Function, IIEF-Intercourse Satisfaction and IIEF-Overall Satisfaction scores and ICIQ-UI-SF scores (i.e., the worse UI symptoms, the worse the overall sexual function (rho= -0.12; p<0.001), IIEF-EF (rho= -0.15; p<0.001), IIEF-IS (rho = -0.1; p=0.004) and IIEF-OS (rho = -0.12; p<0.001). Sexual desire and orgasmic function domains were not correlated with ICIQ-UI-SF. Finally, higher BMI (Coeff 0.12; 95% CI 0.03-0.32; p=0.011), diabetes (Coeff 1.76; 0.35-3.18; p=0.015) and presence of comorbidities (Coeff: 0.9; 0.06-0.1.74; p=0.035) were associated with higher ICIQ-UI-SF scores. Main limitations of the study were that ICIQ-UI-SF does not discriminate between urge or stress UI. In patients presenting with LUTS, the presence of urinary incontinence was associated with worsening of overall sexual function (i.e., erectile function, intercourse satisfaction and overall satisfaction). None [ABSTRACT FROM AUTHOR]