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Abstract: The aim of this study was to explore the incidence of new-onset erectile dysfunction (ED) in diabetes mellitus (DM) patients with sodium-glucose cotransporter 2 inhibitors (SGLT2I) use compared with a control group of non-SGLT2I use by propensity score matching approach. Cox proportional hazards regression models were used to examine the effect of SGLT2I and risk factors on the risk of developing ED, presented as a hazard ratio with a 95% confidence interval. One lakhs fifty nine thousand seven hundred seventy three patients with DM using SGLT2I and 159,773 propensity score matching patients with DM who had never used SGLT2I were included. SGLT2I users had a higher risk of ED than the non-SGLT2I users (adjusted hazard ratio = 1.55, 95% confidence interval = 1.40-1.72). The likelihood of developing ED was higher in patients with SGLT2I use was found., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: New indices of dyslipidemia, such as the Atherogenic Index of Plasma (AIP) or Castelli Risk Index I and II (CR-I/II), have been tested to predict erectile dysfunction (ED). The aim of this study was to assess the role of these lipidic scores in predicting severe ED and erectile function (EF) worsening in patients who underwent robot-assisted radical prostatectomy (RARP)., Methods: Data from 1249 prostate cancer patients who underwent RARP at our single tertiary academic referral center from September 2021 to April 2023 were reviewed. RARP patients with a complete lipid panel were included in the final analysis. Two independent multivariable logistic regression models (LRMs) were fitted to identify predictors of ED severity and worsening in RARP patients., Results: Among the 357 RARP patients, the median age was 70 (interquartile range [IQR]: 65-74), and the median BMI was 28.4 (IQR: 26-30.4). According to the preoperative IIEF5, 115 (32.2%), 86 (24.5%), 26 (7.3%), and 40 (11.2%) were mild, mild-moderate, moderate, and severe ED patients, respectively. After multivariable LRMs predicting severe ED, only the nerve-sparing (NS) approach (odds ratio [OR]: 0.09) as well as the preoperative IIEF5 score (OR: 0.32) were independent predictors (p < 0.001). After LRMs predicting EF worsening, only preoperative IIEF5 was an independent predictor (OR: 1.42, p < 0.001)., Conclusion: The power of novel lipidic scores in predicting severe ED and EF worsening in RARP patients was low, and they should not be routinely applied as a screening method in this patient subgroup. Only preoperative IIEF5 and nerve-sparing approaches are relevant in EF prediction after RARP., (© 2024 The Japanese Urological Association.)

Introduction: Platelet-rich plasma (PRP) is rich in factors that play a role in stem cell recruitment, inflammation modulation, and angiogenesis. With numerous preclinical and clinical studies exploring PRP as a potential treatment for erectile dysfunction (ED), this study focused on assessing the effectiveness of intracorporeal PRP injection for ED patients based on randomized controlled trials (RCTs)., Objectives: The study sought to evaluate the efficacy and safety of intracorporeal injection of PRP in treating ED through a systematic review and meta-analysis of RCTs., Methods: This study adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search was conducted on online databases (PubMed, Scopus, and ScienceDirect) to identify RCTs comparing PRP with a placebo for ED treatment. The primary outcomes assessed were the proportion of patients achieving the minimal clinically important difference in the International Index of Erectile Function (IIEF) domain and the change in the IIEF domain from baseline. The results were combined as a standardized mean difference between the PRP and placebo groups., Results: Three RCTs comprising 230 patients were included. The overall effect favored PRP over placebo: total patients attaining minimal clinically important difference in the IIEF domain (odds ratio [OR], 5.64; 95% confidence interval [CI], 2.05 to 15.55; P = .0008), IIEF change from baseline (mean difference [MD], 2.99; 95% CI, 1.74 to 4.24; P = .00001), PSV (MD, 9.34; 95% CI, 0.84 to 17.84; P = .03), end-diastolic volume (standardized MD, 0.50; 95% CI, 0.17 to 0.83; P = .003), Sexual Encounter Profile question 3 (standardized MD, 0.78; 95% CI, 0.45 to 1.12; P = .00001), and visual analog scale score (MD, -0.30; 95% CI, -0.53 to -0.08; P = .008)., Conclusion: PRP appears to be a safe and effective treatment for mild-to-moderate ED. However, further support from high-quality RCTs is needed to strengthen these findings., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society of Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The current study aimed to evaluate the serum levels of nitric oxide (NO) and adropin in males with non-alcoholic fatty liver disease (NAFLD) induced erectile dysfunction (ED) and NAFLD patients without ED and controls. The current study selected 165 participants from the hepatology department from November 2021 to November 2022. The patients were either suffering from NAFLD with normal liver functions or non-alcoholic steatohepatitis with abnormal liver functions. They were diagnosed by abdominal ultrasonography. Participants were evaluated using the validated Arabic version of the International Index of Erectile Function (ArIIEF-5), the Arabic form of the Generalized Anxiety Disorder-7 (GAD-7) questionnaire and the Patient Health Questionnaire-9 (PHQ-9). Noteworthy, there were significant positive correlations between ArIIEF-5 score, NO, adropin and total testosterone (r = 0.380, p = 0.001; r = 0.507, p =  < 0.001; r = 0.246, p = 0.038, respectively). Meanwhile, there were significant negative correlations between ArIIEF-5 score, creatinine, duration of the disease and scores of GAD-7 and PHQ-9 (r = -0.656, p =  < 0.001; r = -0.368, p = 0.002; r = -0.663, p =  < 0.001; r = -0.248, p = 0.037, respectively). Finally, a linear regression analysis revealed that GAD-7, creatinine, and adropin were the only strong independent predictors of ArIIEF-5, as the 95% confidence interval in the form of upper and lower bounds was -0.349, -0.843, p < 0.001, -6.507, -18.402, p < 0.001, 0.476, 0.117, and p 0.002, respectively. Impaired NO and adropin levels play a potential role in the development of ED in patients with NAFLD., (© 2024. The Author(s).)

Objective: To assess the association among preoperative total testosterone levels, postoperative sexual function, and prognosis after robot-assisted radical prostatectomy., Methods: Patients who underwent robot-assisted radical prostatectomy in our institution were included in the study. Based on preoperative total testosterone levels, they were divided into low (<3.0 ng/mL) and high (≥3.0 ng/mL) total testosterone groups. Sexual function was evaluated using the International Index of Erectile Function scores, Expanded Prostate Cancer Index Composite scores, and the potency rate from preoperatively to 12 months after surgery. Oncological outcomes were evaluated based on biochemical recurrence., Results: Out of 233 patients included, no significant difference in sexual function was found between the high (n = 183) and the low (n = 50) total testosterone groups at any point before or after surgery. However, in nerve-sparing cases, preservation in postoperative sexual function was observed only in the high total testosterone group (International Index of Erectile Function scores and Expanded Prostate Cancer Index Composite sexual function scores, at any point after surgery, p < 0.05; potency rate, at 3, 6, and 12 months after surgery; p < 0.05). Additionally, the high total testosterone group showed better biochemical recurrence-free survival than the low total testosterone group (p = 0.008)., Conclusions: In the high total testosterone group, preservation in sexual function was observed after the nerve-sparing procedure, while the biochemical recurrence rate was low. Therefore, patients with high levels of total testosterone may be advised to consider nerve-sparing interventions., (© 2024 The Author(s). International Journal of Urology published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Urological Association.)

The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative symposium dedicated to optimizing sexual function and preserving cardiovascular health. The Fourth Princeton Consensus Conference was convened on March 10-11, 2023, at the Huntington Medical Research Institutes in Pasadena, California. Princeton panels I to III addressed the clinical management of men with erectile dysfunction (ED) who also had cardiovascular disease. Thirteen years since Princeton III, Princeton IV builds on previous foundations in several key areas. Mounting evidence supports the need for providers to treat men with ED as being at risk for cardiac events until proven otherwise. Algorithms for the diagnosis and treatment of ED are updated with new recommendations for coronary artery calcium scoring for advanced cardiovascular risk stratification. Optimization of oral phosphodiesterase type 5 inhibitors in the treatment of men with ED and cardiovascular disease is thoroughly explored, including recent evidence of potential cardioprotective effects of these drugs., (Copyright © 2024 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the efficacy of a novel approach to achieve the optimal penile erection during the penile doppler ultrasound (PDU) examination, which was oral sildenafil combined alprostadil injection., Materials and Methods: A total of 60 ED patients were enrolled in our prospective study, and they were randomly assigned to two group with different PDU order. The approaches assisted the PDU included two models, mode A meaning injection of 15 μg alprostadil and model B meaning oral sildenafil 100 mg plus injection of 15 μg alprostadil. The PDU parameters were measured continuously before induced erection, and 5, 10, 15, 20, 25 min., Results: Each group included 30 ED patients with similar clinical characteristics. After pooling the results together, the PSV, EDV, and RI were all improved significantly, when adding the oral sildenafil administration to assist PDU. Also, the clinical response of oral sildenafil administration plus alprostadil injection was better than that in alprostadil injection alone ( p  = 0.016). The arterial ED were decreased from 31.67% to 15.00% with the P value 0.031, and the mixed ED was also decreased statistically (23.33% vs 8.33%, p  = 0.024)., Conclusion: Oral sildenafil administration plus alprostadil injection could improve the diagnostic accuracy of PDU.

Objective: The aim of this study is to evaluate the impact of methotrexate (MTX) on erectile function in male patients through the International Index of Erectile Function (IIEF5) questionnaire and hormonal dosage., Methods: Male patients affected by inflammatory arthritis (rheumatoid arthritis [RA] or psoriatic arthritis [PsA]) with good disease control and treated with chronic MTX were enrolled. Age-matched patients affected by chronic arthritis not treated with MTX were enrolled as controls. Each patient had a complete sexual hormone evaluation. IIEF5 questionnaire was administered to each patient., Results: One hundred and nine patients were included, 77 in the MTX group and 32 as controls. The median weekly MTX dose was 10mg (IQR 7.5) with a median MTX duration therapy of 8 years (IQR 17). The total IIEF5 score was lower in patients MTX exposed compared to the control group without a significant result. The total IIEF5 score of patients treated with MTX≥5 years was statistically significantly lower when compared to those non-MTX exposed patients (17 [IQR 15] versus 20 [IQR 7.7]; P=0.04) and compared to those treated for<5 years (17 [IQR 15] versus 20 [IQR 7]; P=0.01). A negative correlation was identified between the total IIEF5 score and MTX time exposure (r=-0.20 CI [-0.38 to -0.04]; P=0.039). MTX exposure was still associated with a lower IIEF5 score when adjusted for age (β Estimate=-2.63; CI [-5.13 to -0.13]; P=0.039). Hormonal dosage was similar in both groups for all hormones evaluated., Conclusion: MTX exposure was associated with a lower IIEF5 score in male patients adjusted for age. The preliminary results need to be confirmed in larger prospective studies., (Copyright © 2024 Société française de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.)

Purpose: To validate and culturally adapt the Sexual Health Inventory for Men (IIEF-5) and the Premature Ejaculation Diagnostic Tool (PEDT), to compare the frequency and severity of erectile dysfunction (ED) and premature ejaculation (PE) in male individuals with MS (mwMS) in comparison with healthy controls (HC) and to investigate predictors of the severity of ED and PE in mwMS., Methods: 216 consecutive mwMS and 37 HC completed IIEF-5 and PEDT. Additionally, 114 mwMS completed the Modified Fatigue Impact Scale (MFIS), Beck Depression Inventory (BDI-2), Composite Autonomic System Score-31 (COMPASS-31), and the 5-level EQ-5D questionnaire., Results: The test-retest reliability was satisfactory for both questionnaires, with acceptable reliability for both questionnaires. mwMS scored less on IIEF-5 compared to HC (23, IQR 18.25-25 vs 24, IQR 20.25-25, p = 0.028). ED was present in 39.4 % of mwMS and 27.8 % of HC (p = 0.198). Definite PE was present in 12.1 %, and possible PE in 7.8 % of mwMS; and 5.6 % and 11.1 % of HC respectively (p = 0.496). An increase in EDSS was a positive predictor (Exp(B) 1.455, 95 %CI 1.135-1.886, p = 0.003) and the presence of cremasteric reflex was a negative predictor (Exp(B) 0.381, 95 %CI 0.183-0.790, p = 0.010) for the presence of ED. For the PE, disease duration was the only positive predictor in a univariable logistic regression (Exp(B) 1.084, 95 %CI 1.019-1.153, p = 0.070)., Conclusion: SD is frequent in mwMS with EDSS being a positive and the presence of cremasteric reflex a negative predictor of ED and disease duration a positive predictor of PE symptoms., Competing Interests: Declaration of competing interest TS, MS, AK, AJ, LC: Nothing to disclose. IA, BB, TG, MH: Participated as a clinical investigator and/or received consultation and/or speaker fees from: Biogen, Sanofi Genzyme, Merck, Bayer, Novartis, Pliva/Teva, Roche, Alvogen, Actelion, Alexion Pharmaceuticals, TG Pharmaceuticals. MKS: received consultation and/or speaker fees from: Sanofi Genzyme, Roche., (Copyright © 2024. Published by Elsevier B.V.)

Psychometric scales, commonly used to gauge sexual function, can sometimes be influenced by response biases. In our research from June 2020 to April 2021, we examined the accuracy of self-reported sexual function scales. We invited patients from the Department of Infertility and Sexual Medicine at the Third Affiliated Hospital of Sun Yat-sen University (Guangzhou, China), who have male sexual dysfunction, to participate by filling out a self-reported version of a specific questionnaire. In addition, they went through a clinician-assisted version of this questionnaire, encompassing tools such as the Premature Ejaculation Diagnostic Tool (PEDT), the 6-item International Index of Erectile Function (IIEF-6), the Erection Hardness Scale (EHS), and the Masturbation Erection Index (MEI). Using the clinician-assisted version as a reference, we categorized patients and applied various statistical methods, such as the Chi-square test, intraclass correlation coefficient (ICC), logistic regression, and the Bland-Altman plot, to gauge reliability. In our study with 322 participants, we found that while there were no notable discrepancies in error rates based on our categorization, certain scales showed significant differences in terms of overestimation and underestimation, with the exception of the PEDT. The positive diagnosis rate consistency between the self-reported and clinician-assisted versions was observed. High ICC values between the two versions across the scales were indicative of remarkable reliability. Our findings show that the self-reported versions of tools such as EHS, IIEF-6, MEI, and PEDT are credible and hold clinical reliability. However, employing a dual-diagnosis approach might be more prudent to circumvent potential misdiagnoses., (Copyright © 2023 Copyright: © The Author(s)(2023).)

Our objective was to analyze the rates of erectile dysfunction and Peyronie's disease following a penile fracture using a large, multi-institutional claims database. Inclusion criteria included men ages 15 or older with a diagnosis of penile fracture and any office visit within 5 years of the penile fracture. Exclusion criteria included prior erectile dysfunction, prescription of erectile aids, or penile prosthesis placement. Our primary outcome was the diagnosis of erectile dysfunction or prescription of phosphodiesterase-5 inhibitors within 5 years. A secondary analysis assessed rates of Peyronie's disease following penile fracture. 1242 men were identified with penile fracture and subsequently matched to men without penile fracture, resulting in equal cohorts of 1227 men. Men with a history of penile fracture were more likely to receive a diagnosis of erectile dysfunction or require phosphodiesterase-5 inhibitors (RR 3.18, 95% CI: 2.30-4.40). Men who did not undergo immediate repair had higher rates of erectile dysfunction or treatment (RR: 1.84, 95% CI: 1.22-2.78). Men over the age of 45 years who had a penile fracture were more likely to develop erectile dysfunction or treatment compared to men under 45 years (RR: 1.65, 95% CI: 1.14-2.39). Rates of Peyronie's disease were higher in men with a history of penile fracture (5.8% vs 0%, p < 0.0001). Rates of Peyronie's disease were lower if immediate repair of the fracture was performed (RR: 0.20, 95% CI: 0.10-0.41). Men over the age of 45 years with penile fracture were more likely to develop Peyronie's Disease within 5 years compared to men under the age of 45 years penile fracture (RR: 3.72, 95% CI: 1.94-7.16). Penile fracture increases the risk of both erectile dysfunction and Peyronie's disease, especially those treated with conservative measures or over the age of 45 years compared to patients under 45 years with a penile fracture., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: There has been a great deal of public speculation regarding a surge in erectile dysfunction (ED) in younger men despite data consistently indicating that the ED prevalence rates increase with age., Aim: In this study we sought to assess the prevalence and risk of experiencing ED in a nationally representative sample of men in the United States across various social groups, describe comorbidities, and examine barriers to treatment., Methods: Data from the 2021 National Survey of Sexual Wellbeing were analyzed by utilizing the Ipsos KnowledgePanel®, a probability-based online panel, for the purpose of obtaining US nationally representative data of adults aged 18 years and older. The analytic sample consisted of 1822 cisgender men ranging in age from 18 to 87 years, with a mean age of 47.5 years., Outcomes: Study outcomes were ED as measured by the 5-item version of the International Index of Erectile Function (IIEF-5), as well as self-reported diagnosis by a medical professional, comorbidities with other health issues, medications taken for ED, and barriers to treatment., Results: The ED prevalence rate based on IIEF-5 scores was 24.2%. Prevalence increased with age: 52.2% of the 75+ age group, and 48.0% of the 65-74 age group meeting diagnostic criteria for ED. Diagnostic criteria were met for more participants in the 18-24 age group (17.9%) than the 25-34 (13.3%) or 35-44 (12.7%) age groups, but less than the 45-54 (25.3%) or 55-64 (33.9%) age groups. Only 7.7% (n = 141) of the sample reported having been diagnosed by a provider (n = 4 in 25-34, n = 6 in 35-44, n = 13 in 45-54, n = 39 in 55-64, n = 44 in 65-74, and n = 34 in ≥75-year olds), indicating a gap in access to treatment. The most common reason selected for not accessing care for ED concerns was a lack of need to see a provider in the past year., Clinical Implications: The discrepancy between ED self-report and medical diagnosis is critical, given that ED can be an indication of underlying health risks., Strengths and Limitations: This study is the first nationally representative update to information regarding the prevalence of ED in almost 2 decades. Standard administration of the IIEF-5 is limited to participants who have had sex in the last 6 months, so these rates do not include those men with ED who have been avoiding penetrative sex for a significant time., Conclusion: The results indicate that ED prevalence and severity remain highest in older age groups and that most individuals who meet criteria for ED have not sought medical care related to this concern., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society of Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Male erectile dysfunction is an important complication of rectal surgery. In this research, the effect of prostate dimensions on the development of postoperative erectile dysfunction in patients diagnosed with mid-rectum adenocarcinoma who underwent low anterior resection (LAR) is examined., Patients and Methods: Thirty-one male patients diagnosed as mid-rectal adenocancer were included. The International Index of Erectile Function (IIEF) questionnaire was used to determine the patients' pre and postoperative erectile dysfunction levels, and the level of relationship between the change in these IIEF scores and prostate measurements determined by computed tomography were evaluated., Results: There were statistically significant differences between IIEF index score and anterior posterior (AP) and transverse (TR) measurements (p≤0.001; p≤0.001), but no statistically significant difference was found between craniocaudal (CC) measurement values (p=0.169)., Conclusions: The risk of nerve injury will be higher in those with a small prostate transverse diameter. Intraoperative nerve monitoring should be recommended primarily in younger patient groups.

The diagnostic value of audiovisual sexual stimulation (AVSS) for psychogenic erectile dysfunction (ED) is still unclear. We investigated the independent diagnostic value and optimal cut-off parameter of AVSS for psychogenic ED. All participants had received the AVSS test and nocturnal penile tumescence and rigidity (NPTR) monitoring at least twice. ED patients were divided into psychogenic ED and organic ED according to NPTR examination. The diagnostic accuracy of AVSS parameters was evaluated with the receiver operating characteristic (ROC) curve, and the Youden index was employed to determine the optimal diagnostic cut-off values. A total of 346 patients with ED and 60 healthy men were included in this study, among which 162 and 184 cases of psychogenic and organic ED were identified based on NPTR, respectively. When comparing the two ED groups, the area under the curve (AUC) of AVSS parameters was 0.85-0.89. Six-selected AVSS parameters could precisely diagnose psychogenic ED, exhibiting increased diagnostic specificity compared with corresponding sensitivity. When comparing psychogenic ED with the control group, the AUC of the tumescence of the tip was superior to the AUC other parameters (0.81 vs. 0.58, 0.66, 0.59, 0.53, 0.68), and the best determined diagnostic cut-off value was the tumescence of the tip < 29.87%. Independent AVSS could diagnose psychogenic ED objectively and effectively, and its diagnostic value was highest when 1.50% ≤ tumescence of the tip < 29.87%., (© 2023. The Author(s).)

Background and Objectives: Repurposing phosphodiesterase type 5 inhibitors (PDE5Is) as drugs for Alzheimer disease (AD) risk reduction has shown promise based on animal studies. However, evidence in humans remains inconclusive. Therefore, we conducted a cohort study to evaluate the association between PDE5I initiation compared with nonuse and the risk of developing AD in men with erectile dysfunction (ED)., Methods: Using electronic health records from IQVIA Medical Research Data UK (formerly known as the THIN database), we identified men aged ≥40 years with a new diagnosis of ED between 2000 and 2017. Individuals with a previous diagnosis of dementia, cognitive impairment, confusion, or prescription for dementia symptoms were excluded. The occurrence of incident AD was identified using diagnostic read codes. To minimize immortal-time bias, PDE5I initiation was treated as a time-varying exposure variable. Potential confounders were adjusted using inverse probability of treatment weighting based on propensity scores. Cox proportional hazard models were used to estimate the adjusted hazard ratio (HR) with 95% CIs. A secondary analysis explored the association between AD and the cumulative number of PDE5I prescriptions. Sensitivity analyses included lag (delay) periods of 1 and 3 years after cohort entry to address the prodromal stage of AD., Results: The study included 269,725 men, with 1,119 newly diagnosed with AD during a median follow-up of 5.1 (interquartile range 2.9-8.9) years. The adjusted HR in PDE5I initiators compared with nonuse was 0.82 (95% CI 0.72-0.93). The associated risk of AD decreased in individuals issued >20 prescriptions: HR 0.56 (95% CI 0.43-0.73) for 21-50 prescriptions and HR 0.65 (95% CI 0.49-0.87) for >50 prescriptions. Sensitivity analysis with a 1-year lag period supported the primary findings (HR 0.82, 95% CI 0.72-0.94), but the results differed with the inclusion of a 3-year lag period (HR 0.93, 95% CI 0.80-1.08)., Discussion: PDE5I initiation in men with ED was associated with a lower risk of AD, particularly in those most frequently issued prescriptions. The differences between primary and sensitivity analyses highlight the need to explore the optimal lag period. To enhance the generalizability of our findings, a randomized controlled trial including both sexes and exploring various PDE5I doses would be beneficial to confirm the association between PDE5I and AD.

Background: Erectile dysfunction (ED) is closely associated with dyslipidemia; however, it is yet unknown how ED and remnant cholesterol (RC) are related. As such, this research sought to explore the correlation between RC and ED among individuals with diagnosed with diabetes., Methods: This cross-sectional study used information from 215 males from National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004. RC was calculated as follows: the values of high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) were subtracted from the total cholesterol (TC) value, while ED diagnoses were based on self-reports. Weighted logistic regression analyses using both univariate and multivariate approaches were conducted to assess the correlation between RC and ED., Results: After comprehensive adjustment, multivariable logistic regression models revealed a strong correlation between RC and ED in subjects with diabetes (with an odds ratio (OR) of 7.49 and a 95% confidence interval (CI) of 1.98-28.37; P = 0.004). On categorizing RC into 3 grades (T1-T3), the OR corresponding to higher RC grade increased. Despite the results not reaching statistical significance upon categorization, a consistent and statistically significant trend (P for trend < 0.05) was observed., Conclusion: This study indicated a correlation between increased RC levels and a higher prevalence of ED in diabetic males. RC may serve as a promising predictor of ED in individuals with diabetes. However, additional studies are required to confirm these findings., (© 2024. The Author(s).)

Objective: To investigate the effects of visualized precision electrophysiological diagnosis and transcutaneous low-frequency electrical stimulation (TES) on hypoxia-induced ED in high-altitude areas., Methods: This study included 152 ED patients from high-altitude hypoxic areas treated by TES based on the parameters obtained from visualized precision electrophysiological diagnosis. We followed up the patients for 1 to 3 months and compared their IIEF-5 scores, nocturnal penile tumescence and rigidity (NPTR) and infrared thermal metabolic technology (TMT)-based temperature of the whole body and diseased parts before and after treatment., Results: All the patients successfully completed 1 to 3 courses of TES. There were no statistically significant differences in the IIEF-5 scores (P<0.05) and penile tip optimal erection rigidity and duration (P<0.01) of the patients before and after treatment. TMT images indicated a temperature change of >1.5 ℃ in the penis and bilateral inguinal regions after treatment, suggesting the effectiveness of electrical stimulation. No recurrence was observed during the follow-up., Conclusion: TES based on the parameters obtained from visualized precision electrophysiological diagnosis has a definite effect on hypoxia-induced ED by enhancing oxygen supply to the penile corpus cavernosum and improving its function and structure.

Objective: Recently, a close association between ulcerative colitis (UC) and erectile dysfunction (ED) was reported. An inverse relationship between serum albumin and ED is found in patients with chronic disease. However, the association between serum albumin levels and ED in patients with UC is unclear. This study aims to investigate this issue in Japanese patients with UC., Methods: One hundred and thirty-six Japanese male UC patients were enrolled in this study. Information on serum albumin levels and medications for UC from medical records, Sexual Health Inventory for Men (SHIM) score information from self-administered questionnaires and information on the severity of UC from physician reports were obtained from medical records, self-administered questionnaires, and reports from physicians. The participants were divided into tertiles based on the total protein, serum globulin, serum albumin, aspartate aminotransferase, and C-reactive protein levels. The definition of ED and severe ED was SHIM score < 22 and SHIM score < 8, respectively. The association between these serum markers and ED was assessed by multivariate logistic regression., Results: The prevalence of severe ED in the low, moderate, and high albumin groups was 66.0%, 51.0%, and 28.3%, respectively. After adjusting for confounding factors, the low albumin group was independently and positively associated with severe ED (adjusted odds ratio: 2.74, 95% confidence interval: 1.03-7.48, p for trend =0.044). No association between other marker and ED was found., Conclusion: Serum albumin was independently inversely associated with severe ED in Japanese patients with UC. Hypoalbuminemia might be a useful complementary marker for assessing the prevalence and severity of ED in UC patients., (© 2023 The Japanese Urological Association.)

Penile prosthesis implantation is a surgical option for erectile dysfunction when other treatments fail or the patient prefers implantation. Although penile prosthesis is generally considered safe and effective, various complications have been reported in the literature. High-flow priapism, resulting from an arteriovenous fistula between the cavernosal artery and the corpora cavernosa, is a rare complication after penile prosthesis implantation. Managing the condition as autoinflation may lead to unfortunate complications. A 54-year-old male patient underwent a penile prosthesis implantation due to erectile dysfunction lasting for 5 years. Doppler ultrasound revealed arterial insufficiency that was refractory to oral and intracavernosal treatments. A 3-piece inflatable penile prosthesis (Coloplast - Titan) was implanted through a midline penoscrotal incision without any complications. The patient reported uncontrolled tumescence after activating the device, which led us to suspect autoinflation. The final diagnosis was high-flow priapism due to an arteriovenous fistula in the cavernosal artery. The patient was given an antiandrogenic medication and the prosthesis was deflated for 3 months. The fistula closed without any additional intervention. High-flow priapism is a rare but potential complication of penile prosthesis implantation. Careful evaluation and management of patients' symptoms are necessary for diagnosing and treating this condition. This case highlights the importance of considering high-flow priapism as a potential cause of uncontrolled tumescence after penile prosthesis implantation and the possibility of successful non-surgical management., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Sleep, particularly rapid eye movement sleep, has been found to be associated with sleep-related erections. While RigiScan is currently a more accurate method for monitoring nocturnal erectile events, the Fitbit, a smart wearable device, shows great potential for sleep monitoring., Objectives: To analyze the relationship between sleep-related erections and sleep by recruiting sexually active, healthy men for simultaneous monitoring of sleep and nocturnal penile tumescence and rigidity., Patients and Methods: Using Fitbit Charge2 and RigiScan, we simultaneously monitored nocturnal sleep and erections in 43 healthy male volunteers, and analyzed the relationship between sleep periods and erectile events with the Statistical Package for Social Sciences., Results: Among all erectile events, 89.8% were related to rapid eye movement, and 79.2% of all rapid eye movement periods were associated with erectile events. Moreover, a statistical correlation was shown between the duration of rapid eye movement and the time of total erectile events (first night: 𝜌 = 0.316, p = 0.039; second night: 𝜌 = 0.370, p = 0.015)., Discussion and Conclusion: Our study shows a potential link between sleep-related erections and rapid eye movement sleep, which has implications for the current examination of sleep-related erections and further research into the mechanisms of erectile function. Meanwhile, the wearable device Fitbit has shown a potential promise for sleep monitoring in patients with erectile dysfunction. The results provide an alternative approach for further research on the relationship between erectile function and sleep with large sample sizes in the future., (© 2023 American Society of Andrology and European Academy of Andrology.)

Background: Current evidence indicates that erectile dysfunction (ED) is an independent risk factor for future cardiovascular events. This study aimed to estimate the cost-effectiveness of screening and subsequent preventive treatment for cardiovascular risk factors among men newly diagnosed with ED from the Swiss healthcare system perspective. Methods: Based on known data on ED and cardiovascular disease (CVD) prevalence and incidence costs and effects of a screening intervention for cardiovascular risk including corresponding cardiovascular prevention in men with ED were calculated for the Swiss population over a period of 10 years. Results: Screening and cardiovascular prevention over a period of 10 years in Swiss men with ED of all seriousness degrees, moderate and severe ED only, or severe ED only can probably avoid 41,564, 35,627, or 21,206 acute CVD events, respectively. Number needed to screen (NNS) to prevent one acute CVD event is 30, 23, and 10, respectively. Costs for the screening intervention are expected to be covered at the seventh, the fifth, and the first year, respectively. Conclusion: Screening and intervention for cardiovascular risk factors in men suffering from ED is a cost-effective tool not only to strengthen prevention and early detection of cardiovascular diseases but also to avoid future cardiovascular events.

Conditions referred to as 'male sexual dysfunctions' usually include erectile dysfunction, ejaculatory disorders and male hypogonadism. However, some less common male sexual disorders exist, which are under-recognized and under-treated, leading to considerable morbidity, with adverse effects on individuals' sexual health and relationships. Such conditions include post-finasteride syndrome, restless genital syndrome, post-orgasmic illness syndrome, post-selective serotonin reuptake inhibitor (SSRI) sexual dysfunction, hard-flaccid syndrome, sleep-related painful erections and post-retinoid sexual dysfunction. Information about these disorders usually originates from case-control trials or small case series; thus, the published literature is scarce. As the aetiology of these diseases has not been fully elucidated, the optimal investigational work-up and therapy are not well defined, and the available options cannot, therefore, adequately address patients' sexual problems and implement appropriate treatment. Thus, larger-scale studies - including prospective trials and comprehensive case registries - are crucial to better understand the aetiology, prevalence and clinical characteristics of these conditions. Furthermore, collaborative efforts among researchers, health-care professionals and patient advocacy groups will be essential in order to develop evidence-based guidelines and novel therapeutic approaches that can effectively address these disorders. By advancing our understanding and refining treatment strategies, we can strive towards improving the quality of life and fostering healthier sexual relationships for individuals suffering from these rare sexual disorders., (© 2023. Springer Nature Limited.)

Objective: The number of studies in the field of andrology is increasing day by day, but a bibliometric study covering the entire literature on andrology has not yet been conducted. This bibliometric study aims to shed light on the question of where we came from and where we are going in andrology from past to present. It also aimed to summarize the intellectual structure of andrology to reveal global productivity and identify and map the latest trends of scientific articles published in the field of andrology., Materials and Methods: 16,659 articles published between 1980 and 2022 were extracted from the Web of Science and analyzed using various statistical methods. Bibliometric network visualization maps revealed trending topics, global productivity, the most influential studies, and international collaborations. Spearman's correlation analysis was used for determining correlations., Results: The top three productive countries were United States of America (3,452; 20.7%), China (2,300; 13.8%), and Germany (1,069; 6.4%). The top two most productive authors were Agarwal A. (n=130) and Nieschlag E. (n=130). The most productive institution was the Egyptian Knowledge Bank (n=422). From past to present, the most studied subjects were testis, male infertility, spermatozoa, testosterone, infertility, erectile dysfunction, spermatogenesis, sperm, prostate cancer (PCA)/neoplasms, oxidative stress, fertility/fertilization, semen, rat(s), apoptosis, azoospermia, sperm motility, human and varicocele., Conclusions: The trend topics that have been researched more in recent years include erectile dysfunction, oxidative stress, prostate cancer, sperm quality, sperm parameters, infertility, premature ejaculation, diabetes mellitus, obesity, prognosis, sperm DNA fragmentation/damage, antioxidant, asthenozoospermia, varicocelectomy, COVID-19, inflammation, prostatectomy, metabolic syndrome, hypogonadism, benign prostatic hyperplasia, lower urinary tract symptoms, meta-analysis, sexual dysfunction, peyronie's disease, and proliferation. We identified the research leadership of China, Japan, Turkey and India, in addition to Western countries, such as the USA and European countries.

Objectives: To explore and analyze [1] the differences in the total number of patients visiting urology practices in Germany, [2] explore and analyze any differences in the number of newly diagnosed erectile dysfunction (ED) patients as well as [3] the number of new drug prescription, before and during the COVID-19 pandemic in Germany (April 2019-March 2020 and April 2020-March 2021)., Methods: This retrospective cross-sectional study used data from the Disease Analyzer database (IQVIA) and included all patients aged ≥18 years with at least one visit to one of 85 urology practices across Germany. Outcomes were the mean number of patients with [1] new diagnosis of ED and [2] new prescription of drugs for erectile dysfunction per practice, in pandemic (April 2020-March 2021) versus non-pandemic (April 2019-March 2020) time periods. Differences between the periods were assessed using Wilcoxon tests., Results: In the non-pandemic period, there were 195,895 men, and in the pandemic period, 192,659 men visiting urology practices in Germany. A total of 10,977 men were initially diagnosed with ED in non-pandemic and 12,213 (+11.26%) men in pandemic time periods. Although the differences of new ED diagnoses were not statistically significant, a non-significant increase of new ED diagnoses was observed across all age groups. Also, a non-significant increase in new ED prescription drugs was detected across all age groups., Conclusions: Even though less urology practice-visits of men with ED were recorded during the COVID-19 pandemic, an increase of new ED diagnosis was observed across all age groups between April 2020 and March 2021., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objective: In order to exploring Erectile Dysfunction(ED) syndrome and syndrome differentiation based on latent structure to provide objective evidence to support Traditional Chinese Medicine(TCM) dialectic., Methods: Cases and clinical experience in the treatment of erectile dysfunction in Chinese medicine in CNKI, Wanfang Database, cqVIP Database, were searched. Time from the database construction to January, 2023. Extraction and specification of symptom data with reference to national standards. Lantern 5.0 software was used to make the latent structure of the data based on LTM-EAST method. Latent probability, conditional probability, information coverage, mutual information and other data were combined to manually interpret the model and perform clustering analysis on the latent classes to analyze the symptomatic features and clinical evidence of erectile dysfunction and establish the rules of identification., Result: A total of 361 cases of erectile dysfunction were included, 21 latent variables were constructed, 9 comprehensive clustering models and 13 discriminative rules were established. The pathological factors of the obtained erectile dysfunction are dampness, heat, yin deficiency, blood stasis, spleen deficiency, kidney deficiency, liver depression, and qi stagnation. The certificate types are stasis of blood, liver qi stagnation, damp-heat entrapment (dampness is heavy, heat is heavy, damp-heat is heavy), yin deficiency (yin deficiency with heat, kidney yin deficiency), vital fire failure, qi deficiency (qi deficiency with heat, kidney qi deficiency), heart and spleen deficiency, panic injury to kidney, spleen and kidney deficiency., Conclusion: The common types of erectile dysfunction obtained are generally consistent with existing guidelines, but more subcategories exist in the certificate type. The presence of symptoms that cannot be well matched in some of the certificate types is presumed to be due to the complex pathogenesis of erectile dysfunction common compound evidence, many evidence models are seen in the main symptoms of liver qi stagnation evidence pulse strings, suggesting that clinical treatment should pay attention to the regulation of emotional and moral, to ease the patient's emotions. The corresponding dialectical rules can quantify the dialectical criteria and provide an objective basis for non-TCM professionals to clinically determine the TCM evidence type of patients.

Erectile dysfunction in patients who underwent radical prostatectomy was evaluated with pudendal somatosensory evoked potentials (PSEP) to measure and predict erectile dysfunction objectively. Fifty-seven patients who completed requirements were included in the study. Patients were divided into 2 groups (potency/non-potency). Erectile function recovery was defined as question 2 and 3 on the IIEF-5 questionnaire at 12 months after surgery. The two-channel PSEP test was performed at the day before RP and 3-6 months after RP. Twenty patients were assigned to the potency group and 37 to the non-potency group. Mean age was less in the potency group. Other clinical variables were similar in two groups. The non-potency group had prolonged lumbar and cortical latencies in postoperative PSEP, and the mean differences of latencies between pre- and postoperative PSEP in lumbar and cortical regions were also greater in the non-potency group. Logistic regression analysis showed that age, lumbar post-operative latency, cortical post-operative latency, and difference of latency in lumbar region were associated with non-potency; odds ratios were 1.292 (p = 0.018), 0.425 (p = 0.047), 1.637 (p < 0.001), and 3.272 (p = 0.010), respectively. This study suggests that PSEP is an effective means of evaluating erectile dysfunction in prostate cancer patients after surgery., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kwon, Park. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Sexual dysfunction pertains to any issue that hinders an individual from attaining sexual contentment. This health issue can have a significant impact on the quality of life and psychological health of affected individuals. Sexual dysfunction can generate stress, anxiety, depression, and low self-esteem, which can lead to a reduction in overall life satisfaction and the quality of interpersonal relationships. Sexual dysfunction can manifest as erectile dysfunction in men or lack of sexual desire in women. Although both sexes can experience sexual problems, there are some significant differences in the manifestation of sexual dysfunction between men and women. In men, sexual dysfunction is usually physical and associated with problems such as erectile dysfunction, while in women, sexual dysfunction is usually related to psychological factors. Additionally, there was an association between hypertension and sexual dysfunction in both the sexes. In men, hypertension can cause erection problems, whereas in women, it can cause vaginal dryness and a decrease in sexual desire. Furthermore, antihypertensive drugs can negatively impact sexual function, which can decrease adherence to drug treatment. However, nebivolol, an antihypertensive drug, has beneficial effects on erectile dysfunction in men. This is believed to be because nebivolol improves blood flow to the penis by producing nitric oxide, which can help improve erections., Competing Interests: The authors declare no conflict of interest., (© 2023 Lou et al.)

It is the responsibility of the clinician to assess for the presence of erectile dysfunction, ejaculatory dysfunction, or diminished libido in men presenting for evaluation of infertility. Referral to a reproductive urologist or other appropriate specialist with the requisite expertise in the evaluation and treatment of such conditions, including appropriate treatment of testosterone deficiency, is often warranted. This article replaces the article of the same name, last published in 2018., (Copyright © 2023 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The majority of people living with HIV in our country are younger men. However, limited data exist for the sexual health of these patients. Knowledge of the epidemiology in this population may improve health outcomes across the continuum of HIV care. The aim of this study was to determine the prevalence of erectile dysfunction (ED) and its association with some clinical and laboratory factors., Methods: A cross-sectional study was conducted using random sampling in men living with HIV (MLWH) at a tertiary hospital in Turkey. Patients were asked to fill out the five-item International Index of Erectile Function (IIEF-5), and blood was collected for HIV viral load, CD4 + T lymphocyte count, lipids and hormone levels to assess biological aspects at the same clinical visit., Results: A total of 107 MLWH were recruited. Mean age was 40.4 ± 12.4 years. ED was found in 73.8% ( n = 79) of the participants. Severe ED was found in 6.3%, moderate in 5.1%, mild-moderate 35.4%, mild 53.2% of the participants, respectively. The mean age of men with erectile dysfunction was 42.5 ± 12.5 years, while those without erectile dysfunction were 34.5 ± 10 years (p:0.00). ED was detected more frequently in cases with high Low Density Lipoprotein (LDL) levels (p:0.003). There was no statistically significant difference between ED presence and having hormone abnormality. There was a moderate, negative correlation between age and ED score (r: -0.440, p < 0.001). A negative and low correlation was found between triglyceride level and ED score (r: -0.233, p:0.02). The only predictive variable was age in the multivariate analysis [B: -0.155 (95% CI -0.232 to -0.078), p : <0.001]., Conclusions: Our study revealed a high prevalence of ED in the MLWH cohort. Age was found to be the only factor associated with ED. HIV clinicians should consider routine ED screening with validated measures as a part of the follow-up scheme to improve integrated wellbeing in MLWH., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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/m 2 , 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., (© 2023 American Society of Andrology and European Academy of Andrology.)

Erectile dysfunction (ED) is a common comorbidity in type 2 diabetes (T2D). ED has been studied as an outcome in diabetes, but it is not known if ED is a risk factor for T2D. We determined if patients with ED have an increased risk for prediabetes and/or T2D and measured the duration between ED and prediabetes/T2D diagnosis. Retrospective cohort study using de-identified medical record data from a large mid-western health care system to measure ED, T2D and potential confounding factors. Patients were 18 to 40 years of age because we were interested in early onset pre-diabetes/T2D. Eligible patients had ED and were free of prediabetes, hyperglycemia and T2D at index. Entropy balancing controlled for confounding. Modified Poisson regression models with robust error variances calculated relative risk (RR) and 95% confidence intervals for the association of ED and pre-diabetes/T2D. Patients' mean age was 28.3 (±7.0) years, 81.7% were White and 14.0% were Black. After controlling for confounding, ED was associated with increased risk for prediabetes/T2D (RR = 1.34; 95%CI:1.16-1.55). This association was similar to that between ED and T2D alone (RR = 1.38; 95% CI: 1.10-1.74). About 30% had ED and prediabetes/T2D diagnosed on the same day and nearly 75% were diagnosed within a year of ED. ED is a marker for undiagnosed prediabetes/T2D and a risk factor for near term onset of prediabetes/T2D. ED may offer the opportunity for earlier detection and diagnoses of T2D, particularly in younger men. Younger patients presenting with ED should be screened for hyperglycemia., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: We evaluate the applicability of the International Index of Erectile Function in young men with spina bifida and identify spina bifida-specific sexual experiences not captured by this measure., Materials and Methods: Semistructured interviews were conducted between February 2021 and May 2021 with men ≥18 years of age with spina bifida. The International Index of Erectile Function was completed by participants, and perspectives on its applicability were discussed. Participant experiences and perspectives around sexual health were discussed to identify aspects of the sexual experience not well captured by the International Index of Erectile Function. Demographic and clinical characteristics were obtained from a patient survey and chart review. Conventional content analysis framework was used for transcript coding., Results: Of 30 eligible patients approached, 20 participated. Median age was 22.5 years (range 18-29), and 80% had myelomeningocele. Most identified as heterosexual (17/20, 85%), were not in a relationship (14/20, 70%), and were not currently sexually active (13/20, 65%). Some perceived the International Index of Erectile Function as applicable, while others reported it was not, as they do not define themselves as sexually active. Aspects of the sexual experience not captured by the International Index of Erectile Function included (1) lack of control over sexual function, (2) poor lower body sensation, (3) urinary incontinence, (4) spina bifida-specific physical limitations, and (5) psychosocial barriers. Participant suggestions for improving the International Index of Erectile Function to increase its applicability were identified., Conclusions: While many perceived the International Index of Erectile Function as applicable, the measure inadequately captures the diverse sexual experiences of young men with spina bifida. Disease-specific instruments to evaluate sexual health are needed in this population.

The incidence of erectile dysfunction (ED) has been reported to increase after COVID-19 infection, and it is common in COVID-19 patients during recovery. This paper presents a summary of the latest research progress on COVID-19-induced ED and explores the traditional Chinese medicine (TCM) diagnosis and treatment approach based on TCM theory and clinical experience. COVID-19 infection may lead to ED through endothelial dysfunction, testicular injury, hormonal imbalance, and psychological factors. The pathogenesis of COVID-19-related ED is mainly characterized by deficiency of the body's essence and excess of pathogenic factors. In the early stage, it is dominated by deficiency of qi and yin, while in the middle stage, it is mainly due to deficiency of qi and blood stasis. In the long-term, ED is based on the imbalance of yin and yang, with liver stagnation and qi stagnation often co-existing. Clinical manifestations of ED vary, and treatment should focus on tonifying qi and nourishing yin, promoting blood circulation, regulating yin and yang, and soothing liver depression according to TCM diagnosis and treatment principles.

Although male hypogonadism (MH) is a prevalent comorbidity in patients presenting for erectile dysfunction (ED), its screening relies solely on total testosterone (TT). Ageing and other conditions can increase sex hormone-binding globulin (SHBG) and lower free testosterone (FT) causing symptomatic MH despite normal TT. The primary objective was to measure the prevalence of normal TT/low FT among patients presenting for ED. From January 2019 to December 2020, 408 patients referred for sexual dysfunction were screened; 180 men with a confirmed diagnosis of ED were included. MH was screened using TT, SHBG, albumin and LH. FT was calculated (cFT). Low TT, high SHBG and low cFT were defined as <345 ng/dL, >50 nmol/L and <6.5 ng/dL, respectively. Patients were divided into groups according to TT/cFT status and to age group. The frequency of normal TT/low cFT was 17.2%. From all 31 patients with normal TT/low cFT, only four (12.9%) had either hyperthyroidism, hepatic disease or HIV infection, while 23 (74.2%) were older than 60 years. Patients with normal TT/low cFT were older (65.57 ± 10.43 vs. 56.79 ± 10.63 yo, p = 0.001) and had higher SHBG (78.48 ± 40.14 vs. 52.35 ± 20.39 nmol/L, p = 0.014) than patients with normal TT/cFT. Patients over 60 years represented 48.9% of the sample, 52.5% had elevated SHBG and their frequency of normal TT/low cFT was 26.3%. Normal TT/low cFT is frequent and can be missed by current screening recommendations for MH in patients presenting for ED. Ageing seems to be the main culprit as elevated SHBG prevalence increases steeply after the sixth decade. TT cannot solely be relied on to exclude biochemical MH in patients presenting for ED, especially in patients over 60 years old. Current guidelines for MH screening in ED should be amended., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: The present study is the first to explore the correlation between serum folic acid (FA) level and penile arterial peak systolic velocity (PSV) as measured via penile color Doppler ultrasonography (PDU), which directly reflects endothelial function in the penile artery., Materials and Methods: A total of 244 consecutive erectile dysfunction (ED) patients and 72 healthy controls, recruited from the Andrology department and the Healthy Physical Examination Center of our hospital, respectively, from June 2020 to April 2022, were included in the study. Serum FA was measured in ED patients and healthy controls, and PDU examinations were conducted for all eligible ED patients. The Pearson method was used to evaluate the correlation between FA levels and PDU parameters in ED patients. A receiver operating characteristic (ROC) curve analysis was also performed to calculate the sensitivity and specificity of these parameters for prediction of arteriogenic ED., Results: After the PDU test, the average serum FA level among patients diagnosed with arteriogenic ED was 8.08 ± 2.64 ng/ml, lower than the average of 10.78 ± 2.87 ng/ml among healthy controls. There were no statistically significant inter-group differences on any basic parameters, including age, body mass index, fasting blood glucose, total cholesterol, and triglyceride. For further analysis, we divided the arteriogenic ED group into three subgroups by PSV range to compare serum FA levels among these subgroups. The mean FA levels in each of these groups were 5.97 ± 1.51ng/ml, and 8.21 ± 2.37ng/ml, and 10.55 ± 2.56ng/ml, while the corresponding PSV values were 15.75 ± 2.39cm/s, 23.53 ± 2.19cm/s, and 32.72 ± 1.64cm/s. Overall, a positive correlation between PSV and FA level was found among patients with arteriogenic ED (r=0.605, P<0.001). Furthermore, when FA level was used, with a cut-off value of 10.045 ng/ml, as a criterion to distinguish patients with arteriogenic ED from healthy controls, the area under the curve (AUC) was 0.772 (95% confidential interval: [0.696, 0.848]), for a sensitivity of 0.611 and specificity of 0.824., Conclusion: Serum FA level is positively correlated with PSV in ED patients, and has the ability to distinguish patients with arteriogenic ED from healthy controls. Taking these findings together, FA deficiency should be regarded as an independent risk factor for arteriogenic ED., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Feng, Mei, Xie, Xing, Wang, Cui and Xu.)

Background Diabetes mellitus (DM) is a chronic disorder with hyperglycemia that affects multiple systems with hypogonadism and erectile dysfunction some common issues affecting their quality sexual life. Quantitative androgen deficiency in aging males (qADAM) questionnaire is a trusted tool to assess hypogonadism and erectile dysfunction among diabetic patients and has been commonly used in Nepal too. However, the accuracy, sensitivity, and specificity of its Nepali version are yet to be tested. Objective To assess the accuracy, sensitivity, and specificity of the Nepali version of the quantitative androgen deficiency in aging males questionnaire among diabetic patients. Method A cross-sectional study was conducted among diabetic patients attending Dhulikhel Hospital, Kathmandu University Hospital. The Patients were asked to complete the valid Nepali translated version of quantitative Androgen Deficiency in Aging Males questionnaire. Participants' serum total and free testosterone, lipid profile, fasting blood glucose, HbA1c and Sex Hormone Binding Globulin (SHBG) were measured in clinical biochemistry laboratory and the accuracy, sensitivity and specificity of Nepali version of quantitative androgen deficiency in aging males were analyzed. Result The translated Nepali version of quantitative androgen deficiency in aging males questionnaire showed 61.9% sensitivity, 45.5% specificity, and 56.7% accuracy in diagnosing hypogonadism in reference to serum testosterone level. Conclusion This Nepali translated version of quantitative androgen deficiency in aging males questionnaire can be a noninvasive tool to assess hypogonadism and erectile dysfunction.

Introduction: ED and PE are the most common male sexual dysfunctions, although they remain underdiagnosed and undertreated., Aim: To ascertain how a group of Spanish urologists currently address ED and PE., Methods: Descriptive study based on a self-designed questionnaire about the clinical practice in ED and PE upon diagnosis, treatment and monitoring, patient-physician relationship and the role of the patient's partner., Results: The survey was completed by 188 experienced urologists. Most patients went to the urologist's office without a previous diagnosis (92% of the urologists found <10 PE-diagnosed patients in public settings). The diagnosis of ED and/or PE was mainly carried out by the current urologist and not by another professional, particularly in private centres as opposed to public centres (78.8% vs 57.0% for ED; 82.0% vs 62.6% for PE). Most urologists believed that these disorders are underdiagnosed and deemed them as general health issues. 38% of urologists acknowledged using validated questionnaires to diagnose ED. PE was considered a subjective problem rather than a true disease and the use of PRO-based diagnosis of PE was not generally accepted (14%). Treatment options of both disorders were chosen as expected. Referral to the andrologist is usually scheduled in moderate-to-severe PE or severe ED. The cohort seemed to be mostly neutral (50%-75% for ED and 40%-55% for PE) regarding patient reluctancy to talk about their sexual problem. Patients' partners play an important role in helping men seeking treatment., Conclusion: Urologists should show more proactivity during anamnesis and routine visits to improve management of ED and PD., (Copyright © 2023 Asociación Española de Andrología, Medicina Sexual y Reproductiva. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: To evaluate the association among andrological diseases at the first outpatient visit and the medications taken by patients for other comorbidities, as well as the differential impact between specific medication and relative comorbidities., Methods: This is a single-center retrospective study based on subjects who referred to the Andrology Unit with a well-defined andrological diagnosis., Results: A total of 3752 subjects were studied (mean age ± DS 46.2 ± 16.5 years). A total of 19 categories of andrological diseases and 110 type of medications for other comorbidities were identified. ED was the most frequent andrological pathology at the first andrological examination (28.7%), followed by infertility (12.4%). The couple of variables that were statistically significant in the univariate association analysis (p < 0.001) were: ED and (a) antihypertensives; (b) antihyperglycemics; (c) lipids-lowering; (d) psychotropics. The univariate and multivariate regression analyses confirmed the association. All the related comorbidities were also significantly associated with the univariate analysis, and all remained significantly associated with multivariate analysis. A multivariate analysis was also conducted to analyze the association between ED and the following pairs of variables "DM-antihyperglycemics", "dyslipidemia-lipids-lowering", and "hypertension-antihypertensives". In all cases, the pathology, but not the specific treatment, was significantly associated with ED., Conclusion: ED is significantly associated with antihypertensive, antihyperglycemic, lipid-lowering, psychotropic drugs' intake. Anyway, ED appears to be more related to the diseases than to the specific therapies. The definitive cause/effect relationship should be established based on future prospective studies., (© 2023. The Author(s).)

Background: Atherosclerotic disease of erection-related arteries is a major reason for erectile dysfunction (ED). Lp(a) has been implied in the pathophysiology of atherosclerosis in the coronary and lower limb arteries. Here, we investigated if Lp(a) plays a specific role in ED due with symptomatic pelvic artery atherosclerosis. Patients and methods: Out of 276 consecutive patients treated for ED with angioplasties on proximal (69%) and distal (31%, distal to Alcock channel) erection-related arteries, 236 patients (age: 62±10 years) of which Lp(a) values were available were retrospectively analyzed. Results: The baseline International Index of Erectile Function-15 (IIEF-15) score was 29±15 and significantly increased to 43±20 (increase: 14±21) after treatment at average follow up of 286±201 days. In 25%, Lp(a) values were elevated to more than 30 mg/dL. Hypercholesterolemia, coronary, lower extremity peripheral, and polyvascular disease were more common in patients with Lp(a) ≥60 mg/dl. Anatomic arterial lesion distribution (proximal/distal), improvement in IIEF-15 and clinically driven re-intervention rate (overall 7%) did not differ between patients with <30, 30-59, and ≥60 mg/dL Lp(a). Conclusions: While angioplasty is an effective therapy for ED of arterial origin in patients with obstruction of erection-related arteries, Lp(a) does not seem to play a major role for clinical outcomes in these patients.

Background and Objectives: Erectile dysfunction is a significant problem, which diminishes the quality of life. The aim of this study was to investigate the relationship of childhood trauma and attachment styles in the aetiology of psychogenic erectile dysfunction. Materials and Methods: The study included 80 participants (40 patients who presented with the complaint of erectile dysfunction, were not determined with an organic pathology, and were diagnosed with erectile dysfunction according to the DSM-5 criteria; and a control group of 40 healthy subjects.) The structured clinical interview form for DSM-5 (SCID-5) was applied to all the participants, together with the International Erectile Function Index (IIEF), the Childhood Trauma Questionnaire (CTQ), the Relationship Scale Questionnaire (RSQ), and the Beck Depression Inventory (BDI). Results: The emotional abuse ( p = 0.002), physical abuse ( p = 0.049), emotional neglect ( p = 0.004), physical neglect ( p = 0.002), and total scale points of the CTQ were determined to be significantly higher in the patient group than in the control group. Secure ( p = 0.022) and dismissive ( p = 0.009) attachment styles were found to be higher in the control group. As the time together with the current sexual partner increased, so the severity of erectile dysfunction increased, and sexual function, orgasmic function, sexual satisfaction, and general satisfaction decreased. As emotional abuse, sexual abuse, and physical neglect increased, the severity of erectile dysfunction increased. Childhood trauma ( β = -0.275, t (73) = -2.704, p = 0.009) and the duration together with the partner ( β = -0.249, t (73) = -2.512, p = 0.014) were found to be predictive of erectile dysfunction. Conclusions: The results of this study demonstrated that childhood trauma and the time elapsed without treatment are predictors of psychogenic erectile dysfunction severity, and secure attachment style and self-esteem play an important role in the aetiology of psychogenic erectile dysfunction.

Purpose: Erectile dysfunction (ED) is one of the most prevalent male sexual dysfunctions. ED has been in the past mistakenly considered a purely psycho-sexological symptom by patients and doctors. However, an ever-growing body of evidence supporting the role of several organic factors in the pathophysiological mechanisms underlying ED has been recognized., Methods: The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving several other National Societies to provide an updated guideline on the diagnosis and management of ED. Derived recommendations were based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system., Results: Several evidence-based statements were released providing the necessary up-to-date guidance in the context of ED with organic and psychosexual comorbidities. Many of them were related to incorrect lifestyle habits suggesting how to associate pharmacotherapies and counseling, in a couple-centered approach. Having the oral therapy with phosphodiesterase type 5 inhibitors as the gold standard along with several other medical and surgical therapies, new therapeutic or controversial options were also discussed., Conclusions: These are the first guidelines based on a multidisciplinary approach that involves the most important Societies related to the field of sexual medicine. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving couple sexual satisfaction and overall general health., (© 2023. The Author(s), under exclusive licence to Italian Society of Endocrinology (SIE).)

Objective: The purpose of this study is to examine the association between a novel adiposity parameter, the weight-adjusted-waist index (WWI), and erectile dysfunction (ED)., Methods: According to National Health and Nutrition Examination Survey (NHANES) 2001-2004, a total of 3884 participants were categorized as ED and non-ED individuals. WWI was calculated as waist circumference (WC, cm) divided by the square root of weight (kg). Weighted univariable and multivariable logistic regression models were conducted to assess the correlation between WWI and ED. Smooth curve fitting was utilized to examine the linear association. The receiver operating characteristic (ROC) curve and DeLong et al.'s test were applied to compare the area under curve (AUC) value and predictive power among WWI, body mass index (BMI), and WC for ED., Results: WWI was positively related to ED with the full adjustment [odds ratio (OR)=1.75, 95% confidence interval (95% CI): 1.32-2.32, p=0.002]. After converting WWI to a categorical variable by quartiles (Q1-Q4), compared to Q1 the highest WWI quartile was linked to an obviously increased likelihood of ED (OR=2.78, 95% CI: 1.39-5.59. p=0.010). Subgroup analysis revealed the stability of the independent positive relationship between WWI and ED. It was shown that WWI had a stronger prediction for ED (AUC=0.745) than BMI (AUC=0.528) and WC (AUC=0.609). Sensitivity analysis was performed to verify the significantly positive connection between WWI and stricter ED (OR=2.00, 95% CI: 1.36-2.94, p=0.003)., Conclusion: An elevated WWI was related to higher risks of ED in the United State adults, and a stronger predictive power of WWI for ED was observed than BMI and WC., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Cao, Hu, Shao, Wang, Tang, Ren and Li.)

Background: This study aimed to determine the incidence of erectile dysfunction (ED) reported by patients, and to define the prognostic relationship between ED and conservatively treated sacral fracture without urethral injury., Methods: Patients aged between 20 - 50 years who were sexually active and had no known sexual dysfunction prior to the trauma were included in the study. Seventy-seven patients (47 married, 30 single) treated conservatively for sacral fracture between April 2012 and February 2017 were retrospectively screened. Patients were compared in terms of age, marital status, body mass index (BMI), trauma mechanism, additional system injury, functional outcomes, and complications. Functional outcomes were assessed using the International Index of Erectile Function (IIEF-5) and the Majeed pelvic fracture functional assessment scale (MPS)., Results: No statistically significant difference was observed between fracture types with respect to age, BMI, follow-up, marital status, trauma mechanism, and accompanying injury. The incidence of ED was 27.3% for those that received conservative treatment after sacrum fracture. The mean score of IIEF-5 was 18.6 ± 6.6 and MPS was 77.2 ± 13.2. There was no significant relationship between the injury type of the patients and the IIEF-5 and MPS scores (p = 0.593 and p = 0.907, respectively). The lowest IIEF-5 score was found in Denis type 2 fractures (p = 0.020)., Conclusion: The frequency of ED was higher in Denis type 2 sacrum fractures. Sexual function should be questioned in the follow-up, especially in those fracture types., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Introduction: Erectile dysfunction (ED) represents an independent and/or predictive risk factor for coronary heart disease according to many studies. The aim of our study is to determine the prevalence and risk factors associated with erectile dysfunction in coronary patients confirmed by coronary angiography., Material and Method: We conducted a descriptive and analytical cross-sectional study. A total of 60 patients were included with proven atheromatous coronary lesions after coronary angiography. The study period was from June 1, 2020 to February 29, 2021. After assessment of erectile status based on the short version of the International Index of Erectile Function (IIEF-5). Measures of association were adjusted odds ratios and odd ratios with their confidence intervals. Multivariate analysis was conducted using logistic regression. Only patients with erectile insufficiency underwent penile pharmocodoppler., Results: The mean age was 56 ± 8.4 years with extremes of 28 and 65 years. Erectile status was classified according to the IIEF-5 score as follows: severe ED (32%), moderate (13%), mild (15%) and normal erectile function (40%). The time to onset of ED was> 2 years in 69.4% of cases before the onset of coronary artery disease with a mean time of 2.37 years ± 1.29. In 20% of the cases, the patients were already on treatment before the erectile disorder, 65% undergoing treatment after the erectile disorder and 15% had no undergoing treatment. The main factors associated with ED were: high blood pressure (OR = 7; p = 0.0007), dyslipidemia (OR = 4.86; p = 0.004), diabetes (OR = 3.8; p = 0.02), obesity (OR = 4, 45; p = 0.02) as well as beta blockers (OR = 5.3; p = 0.004), calcium channel blockers (OR = 4.5; p = 0.004) and angiotensin-converting enzyme inhibitors (OR = 4.3; p = 0.008). The vascular cause clearly dominates (95%) of which 61% arterial mechanism, 17% mixed and 17% venous mechanism. The factor associated with a decrease PSVpi was the diabetes (OR = 28; p = 0.01). In multivariate analysis, no factor was statistically associated with ED or decrease in PSVpi., Conclusion: Isolated ED appears as an early marker of generalized endothelial dysfunction. Hence the advantage of systematic screening, especially in subjects at risk of cardiovascular disease., Competing Interests: Déclaration de liens d'intérêts Les auteurs déclarent n'avoir aucun lien d'intérêt., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Objective: We investigated the association between anxiety and depression and erectile dysfunction (ED) in patients who developed ED after coronavirus disease 2019 (COVID-19)., Patients and Methods: This study included 228 men who were hospitalized in pandemic wards between July 2021 and January 2022 with positive reverse transcription-polymerase chain reaction test results for the severe acute respiratory syndrome coronavirus 2 RNA. All patients responded to a Turkish version of the International Index of Erectile Function (IIEF) questionnaire to determine erectile status. Patients were administered the Turkish version of the Beck Depression Inventory (BDI) and Generalized Anxiety Disorder 7-item scale (GAD-7) questionnaires the day after hospitalization and also during the 1st month after diagnosis of COVID-19 to compare the COVID-19 situation with the previous situation., Results: Patients' mean age was 49.66 ± 13.3 years. The mean pre-COVID-19 erectile function score of 28.65 ± 1.33 decreased to a mean post-COVID-19 score of 26.58 ± 4.23, which indicates a statistically significant difference (p=0.03). Post-COVID-19 ED occurred in 46 (20.1%) patients; 10 (4.3%) patients had mild, 23 (10.0%) had mild-to-moderate, 5 (2.1%) had moderate, and 8 (3.5%) patients had severe ED. The mean pre-COVID-19 BDI score (which indicates depression) of 1.79 ± 2.45 increased to a mean post-COVID-19 score of 2.42 ± 2.89 (p<0.01). Additionally, the mean pre-COVID-19 GAD-7 score of 4.79 ± 1.83 increased to a mean post-COVID-19 score of 6.79 ± 2.52, which indicates a statistically significant difference (p<0.01). We observed a negative correlation between the increase in BDI and GAD-7 scores and the decrease in IIEF scores (r=0.426, p<.001, r=0.568, p<.001, respectively)., Conclusions: Our study highlights that COVID-19 can cause ED and that disease-induced anxiety and depression serve as primary contributors to ED.

Despite the high prevalence of erectile dysfunction, patients are reluctant to seek medical advice, which leads to low diagnostic rates in clinical practice. Artificial intelligence has been widely applied in the diagnosis of many diseases and may alleviate the situation. However, the applications of artificial intelligence in erectile dysfunction have not been reviewed to date. Therefore, the assistance from artificial intelligence needs to be summarized. In this review, 418 publications before January 10, 2021, regarding artificial intelligence applications in diagnosing and predicting erectile dysfunction, were retrieved from five databases, including PubMed, EMBASE, the Cochrane Library, and two Chinese databases (WANFANG and CNKI). In addition, the reference lists of the included studies or relevant reviews were checked to avoid bias. Finally, 30 articles were reviewed to summarize the current status, merits, and limitations of applying artificial intelligence in diagnosing and predicting erectile dysfunction. The results showed that artificial intelligence contributed to developing novel diagnostic questionnaires, equipment, expert systems, classifiers by images and predictive models. However, most of the included studies were not subjected to external validations, resulting in doubt on the generalizability. In the future, more rigorously designed studies with high-quality datasets for erectile dysfunction are required., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Erectile dysfunction is a common problem in males of couples experiencing pregnancy loss. Erectile dysfunction in males with couple infertile has been extensively investigated and found to be closely linked with semen quality impairment and psychological distress, but it is less clear if this relation exists in males of couples experiencing pregnancy loss., Method: A cross-sectional analysis of 437 men who attended our outpatient clinic between June 2021 and October 2021 for couple pregnancy loss. All subjects underwent a complete physical examination, palpation, inspection of the male genitalia, and semen analysis. Validated assessment tools for erectile dysfunction (the International Index of Sexual Function5 -IIEF-5) and anxiety (the seven-item Generalized Anxiety Disorder Scale- GAD-7) were used., Results: Among 437 men of couples with pregnancy loss, we found several relevant sperm parameters confirmed a significant correlation between IIEF-5 scores and sperm parameters, including: sperm progressive motility (r = 0.1627, p = 0.001), sperm normal morphology (r = 0.1373, p = 0.004) and sperm DNA fragmentation (r =-0.1248, p = 0.009). Males with an IIEF-5 scores range between 5-11 presented the worst results in terms of sperm progressive motility (p = 0.002), normal morphology (p = 0.001), and SDF levels (p = 0.003). GAD-7 score, as well as anxiety level, was significantly higher in those males with an IIEF-5 score between 5 and 11 (p = 0.000)., Conclusion: Although current evidence does not demonstrate the importance of spermatozoa in the etiology of pregnancy loss, significant correlations have been observed between impaired sperm quality and low IIEF-5 scores. Also, anxiety is more likely to occur in males with sexual dysfunction., (© 2023. The Author(s).)