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PubMed2005

Endothelial dysfunction links erectile dysfunction to heart disease.

Erectile dysfunction (ED) and coronary artery disease (CAD) overlap in risk factors, aetiology and clinical outcomes. It has become clear that ED is an important marker of vascular disease throughout the arterial tree--including CAD, stroke and diabetes. Epidemiological studies have demonstrated a close association between ED and vascular disease. The shared aetiological factor is endothelial dysfunction. The fact that ED tends to precede the onset of symptoms of other vascular diseases--because blood vessels in the penis are narrower in diameter than elsewhere in the body so blood flow is restricted sooner by atherosclerosis--means that it can be used as a 'window' on vascular health. There is growing evidence that patients presenting with ED should be investigated for cardiovascular disease (CVD), including diabetes, even if they have no symptoms. Early detection could facilitate prompt intervention and a reduction in long-term complications. Treatments that reduce endothelial dysfunction offer the potential of improving the functioning of the entire vascular system, improving outcomes in CVD and diabetes, as well as providing effective treatment for ED.

Biomarkers↗
PubMed2005

Metabolic syndrome, endothelial dysfunction, and erectile dysfunction: association and management.

The metabolic syndrome, the criteria for which include glucose intolerance, obesity, hypertension, and dyslipidemia, has rapidly become understood to have a major association with erectile dysfunction (ED). On a mechanistic level, their common grounds may involve endothelial dysfunction, although the conditions of oxidative stress understood to be a pathologic element of the syndrome also may affect various components of the vascular biology of the penis. The foremost importance of recognizing the association between ED and the metabolic syndrome is that addressing ED presentations may afford opportunities to identify and improve a major adverse health profile and thereby promote health maintenance objectives for patients.

Endothelium, Vascular↗
PubMed2006

Endothelial dysfunction in diabetic erectile dysfunction.

Erectile dysfunction (ED) is highly prevalent in diabetes mellitus. Pathophysiological mechanisms underlying diabetes-associated ED are in large part due to endothelial dysfunction, which functionally refers to the inability of the endothelium to produce vasorelaxing messengers and to maintain vasodilation and vascular homeostasis. The precise mechanisms leading to endothelial dysfunction in the diabetic vasculature, including the penis, are not yet fully understood. Hyperglycemia affects endothelial nitric oxide synthase activity and nitric oxide production/bioavailability, nitric oxide-independent relaxing factors, oxidative stress, production and/or action of hormones, growth factors and/or cytokines, and generation and activity of opposing vasoconstrictors. Considering recent advances in the field of vascular biology and diabetes, the emphasis in this review is placed on the mechanisms of hyperglycemia-induced endothelial dysfunction in the pathophysiology of diabetes-associated ED.

Diabetes Complications↗
PubMed2000

Prevalence of erectile dysfunction in Thailand. Thai Erectile Dysfunction Epidemiological Study Group.

A study of the prevalence rate of erectile dysfunction (ED) in the Thai population has never been done previously, except for a small study in the hospital. The project was carried out across the whole country, including in the north, south, eastern and central plains, and there were representatives from one small and one large province and the Bangkok metropolitan area. There were 250 males in each area, giving as total of 1250 males. The interviews were carried out in urban areas, so that the questions and answers could produce good data. The interviewer was trained by one of our EDACTT members, before going to the interview locations, and the supervisor were also onsite to clarify any the questions that might occur. The questions and pretest were carried out stringently, to help in term of statistics. All the health questions were asked taking care to accommodate the interviewee's feelings, so as not to cause embarrassment. The interviews were held individually and strictly privately, so that the interviewees could speak freely The interviewees were between 40 and 70-years old, to match with MMAS. The rate of ED in this age group is increasing gradually, and the relationship between ED and hypertension, diabetics or heart disease, and lifestyle factors, including smoking habits, alcohol consumption, caffeine and risk factors is of interest.

Adult↗
PubMed2004

[Establishment of the animal model of induced high-cholesterol-atherosclerotic erectile dysfunction and the mechanisms of atherosclerotic erectile dysfunction].

OBJECTIVE: To establish the animal model of atherosclerotic erectile dysfunction induced by high-cholesterol diet and explore the mechanisms of atherosclerotic erectile dysfunction. METHODS: Thirty male rabbits were divided into two groups randomly: normal diet (ND) group (n = 10) and high-cholesterol (HCH) group fed with 1.5% cholesterol diet (n = 20). Serum total cholesterol, plaque areas of the ascending aorta, the ratio of intima/media thickness and level of vascular cell adhesion molecule 1 (VCAM-1) mRNA expression of internal pudendal artery were determined after twelve weeks. RESULTS: After twelve weeks, all rabbits of the HCH group got hyperlipemia, 9 of which presented typical atherosclerosis (ATH). The rate of atherosclerosis induced by high-cholesterol diet was 52.9%. Serum total cholesterol levels of the ATH and HCH groups were higher than that of the ND group (P<0.01). The penile erection times and rate in the ATH and HCH groups decreased significantly, compared with the ND group (P<0.01). Both the ratio of intima/media thickness and the level of VCAM-1 mRNA expression of internal pudendal artery in the ATH group were higher than those in the HCH and ND groups (P<0.01). CONCLUSION: It is easy, prectuable and reliable to establish the animal model of atherosclerotic erectile dysfunction induced by high-cholesterol diet. And one of the main causes of atherosclerotic erectile dysfunction is hypercholesterolemia, which through VCAM-1 may induce the structural and functional modifications of the endothelium of the internal pudendal artery and make the corpus cavernosum ischemia.

Animals↗
PubMed2003

Longitudinal differences in disease specific quality of life in men with erectile dysfunction: results from the Exploratory Comprehensive Evaluation of Erectile Dysfunction study.

PURPOSE: We assessed the impact of erectile dysfunction therapy on 1-year health related quality of life using a validated erectile dysfunction specific instrument. MATERIALS AND METHODS: Using an observational erectile dysfunction registry clinical, sociodemographic and health related quality of life information was collected at baseline, and 3, 6 and 12 months later. Only men who reported undergoing erectile dysfunction treatment were included in this analysis sub-sample. Patients were classified as treatment responders based on improvements in International Index of Erectile Function scores. Changes in health related quality of life scores from baseline were compared between responders and nonresponders. RESULTS: The cohort consisted of 89 patients, of whom 40 (45%) responded to therapy by International Index of Erectile Function criteria. Responders and nonresponders had comparable baseline disease severity and health related quality of life. At 1 year responders reported significantly better health related quality of life and greater improvement from baseline in sexual experience (mean change -1.64 versus 3.19) and emotional life (mean -3.01 for responders versus 1.75) domains of the Psychological Impact of Erectile Dysfunction scales (p <0.01). This 4.5 to 5 point difference in mean change score (1/2 SD) was considered moderately clinically significant. CONCLUSIONS: Men who respond to erectile dysfunction treatment report significantly better health related quality of life 1 year after initial presentation for erectile dysfunction than nonresponders. This finding should motivate providers to be more proactive in diagnosing and treating men with erectile dysfunction since successful therapy appears to improve health related quality of life. These data suggest that men in whom primary therapy for erectile dysfunction fails should be offered secondary treatment because many men in this study in whom previous therapies failed reported improved health related quality of life when they began effective secondary treatment.

Adult↗
PubMed2000

The relationship between depression and erectile dysfunction.

Normal sexual function is a biopsychosocial process; sexual dysfunction almost always has organic and psychologic components, and it requires multidisciplinary, goal-directed evaluation and treatment. Factors such as aging, declining testosterone levels, medical illness, certain medications, and comorbid depressive illness can contribute to sexual dysfunction. Erectile dysfunction (ED) is the most common male sexual dysfunction encountered in the clinical setting. Comorbidity between ED and depressive illness is high, but the causal relationship is unclear, and likely bidirectional. In this article, we review the existing literature on the relationship between depression and ED.

Comorbidity↗
PubMed2003

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

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

Aged↗
PubMed1994

Total cholesterol and high density lipoprotein cholesterol as important predictors of erectile dysfunction.

Although erectile dysfunction is frequently seen in patients with manifestations of arteriosclerotic disease, the independent contribution of serum cholesterol in predicting erectile dysfunction is unclear. The aim of this study was to examine the relation between serum cholesterol and erectile dysfunction. Medical histories, physical examinations, and blood tests were obtained at Cooper Clinic, Dallas, Texas, from 3,250 men aged 26-83 years (mean, 51 years) without erectile dysfunction at their first visit, who had one more clinic visit, all between 1987 and 1991. These men were followed 6-48 months after the first clinic visit (mean, 22 months). Erectile dysfunction was reported in 71 men (2.2%) during follow-up. Every mmol/liter of increase in total cholesterol was associated with 1.32 times the risk of erectile dysfunction (95% confidence interval 1.04-1.68), while every mmol/liter of increase in high density lipoprotein cholesterol was associated with 0.38 times the risk (95% confidence interval 0.18-0.80). Men with a high density lipoprotein cholesterol measurement over 1.55 mmol/liter (60 mg/dl) had 0.30 times the risk (95% confidence interval 0.09-1.03) as did men with less than 0.78 mmol/liter (30 mg/dl). Men with total cholesterol over 6.21 mmol/liter (240 mg/dl) had 1.83 times the risk (95% confidence interval 1.00-3.37) as did men with less than 4.65 mmol/liter (180 mg/dl). Those differences remained essentially unchanged after adjustment for other potential confounders. The authors conclude that a high level of total cholesterol and a low level of high density lipoprotein cholesterol are important risk factors for erectile dysfunction.

Adult↗
PubMed1995

[Diagnosis and treatment of erectile dysfunctions].

OBJECTIVES: Erectile dysfunction (ED) is the most frequent form of male sexual dysfunctions. The incidence is not known. Approximately 10% of men suffer from ED. Aging is concomitted by an exponential increase in the occurrence of erectile dysfunctions. Some groups of men (suffering from diabetes, alcoholism, ICHS, renal diseases) yield several times higher values of their occurrence. In general, ED (formerly impotentio coeundi) can be defined as an inability to achieve erection and maintain it for an appropriately long period enabling sexual intercourse. ETIOPATHOGENESIS: The etiology includes psychological, neurological, arterial, sinusoidal, venous and hormonal factors which participate in erectile function. ED arises predominantly in consequence of impaired haemodynamics of the penis. It develops either due to insufficient blood inflow into the erectile bodies or due to their excessive drainage. The traumatic lesions of penile vessels are less frequent. Drugs and medicaments play a significant role among etiologic factors causing erectile dysfunctions. DIAGNOSIS: No regulations and principles are generally valid in coincidence with examination of patients with erectile dysfunction. The signs of neurologic, hormonal and vascular defects are detected. An objective method of examination of erectile capacity of the penis resides in the monitoring of penile nocturnal tumescensions. The examination of arterial system of the penis provides information on the perfusion pressure and blood flow in the cavernous arteries. The vascular structures of the penis and their functions can be evaluated by means of duplex ultrasonography and flowmetry. The quality to arterial supply to erectile bodies is evaluated by dynamic examination of arteries prior to and after intracavernous application of vasoactive substances. The functional state and size of venous leak from the cavernous bodies are evaluated by dynamic cavernosometry. THERAPY: The application of vasoactive substances meant a significant contribution to the diagnosis establishment and therapy of erectile dysfunctions. They have a common feature which resides in their myorelaxation effect and thus in their ability to induce erection by means of relaxation of the smooth muscles of cavernous bodies. Intracavernous application of vasoactive substances is the mostly spread means of therapy of erectile dysfunction as a whole, frequently with no regard to the etiology. Surgical therapy of vasculogenous impotence is based on knowledge concerning the impact of vascular lesions on the haemodynamics of erectile function of the penis. the revascularisation operations are aimed at the regeneration of normal haemodynamic conditions in the penis. CONCLUSION: Sexual life is currently considered as a proportion of life of individuals. The physicians therefore have to seek ways of how to help the patients who due to acquired erectile dysfunctions are handicapped in the establishment of family harmony and sexual life. (Ref. 31).

Erectile Dysfunction↗
PubMed2002

Psychological impact of erectile dysfunction: validation of a new health related quality of life measure for patients with erectile dysfunction.

PURPOSE: Male erectile dysfunction has a substantial impact on health related quality of life. We examined the psychometric properties of 2 new scales created to measure the psychological impact of erectile dysfunction. MATERIALS AND METHODS: Patients enrolled in a long-term study of men with erectile dysfunction completed clinical and health related quality of life information at baseline and at 3 followup points. The questionnaire incorporated a number of standard scales of psychosocial characteristics as well as questions developed from comments made during focus groups of men with erectile dysfunction and of their female partners. Principal components analysis was used to identify underlying constructs in response to the new questions. RESULTS: A total of 168 men completed the baseline quality of life questionnaire. The principal components analysis of the psychological impact of erectile dysfunction questions resulted in 2 new scales. Reliability was good with an internal consistency reliability of 0.91 for scale 1 and 0.72 for scale 2. Test-retest reliability was 0.76 and 0.66, respectively. Men reporting a greater psychological impact of erectile dysfunction also reported greater impairment in functional status, lower sexual self-efficacy, greater depression and anxiety at the last intercourse. Each new scale significantly differentiated men with mild/moderate versus severe erectile dysfunction. CONCLUSIONS: We developed 2 new scales to measure the psychological impact of erectile dysfunction and they showed good reliability and validity. These new scales, named the Psychological Impact of Erectile Dysfunction instrument, comprehensively capture the psychological effect of erectile dysfunction on health related quality of life, which is not adequately assessed by existing patient centered measures of erectile function.

Adult↗
PubMed2006

Treatment-seeking behavior of erectile dysfunction patients in Europe: Results of the Erectile Dysfunction Observational Study.

INTRODUCTION: The Erectile Dysfunction Observational Study (EDOS) is a 6-month, pan-European prospective, observational study of health outcomes designed to assess patients' profiles and characteristics and the effectiveness of erectile dysfunction (ED) treatment in routine clinical practice. AIM: To present baseline characteristics and treatment-seeking behavior of a large sample of ED patients recruited in real-life clinical settings. METHODS: Men aged 18 years and older who visited a physician to initiate or change any ED treatment were enrolled in EDOS. They were assessed at baseline, 3 months, and 6 months as part of their normal course of care in nine European countries. MAIN OUTCOME MEASURES: Sexual health outcomes using the short form of the Psychological and Interpersonal Relationship Scales. Treatment effectiveness and satisfaction were assessed using the International Index of Erectile Function questionnaire, Global Assessment Questions, and further single-item questions. RESULTS: Of the 8,186 patients enrolled by 904 investigators (69% general practitioners [GPs]) across nine European countries, 8,055 patients were eligible for analysis at baseline; 63.9% were ED treatment-naive. Of the total patient population, mean age was 56.5 years, mean body mass index (BMI) was 27.2 kg/m2, 18.3% were obese (BMI > 30 kg/m2), 42.5% had severe ED, and there was a high frequency of comorbidities and concomitant medication use. A similar proportion of the treatment-naive patients were seen by GPs (62.9%) and specialists (65.8%). In the treatment-naive group, there was a higher frequency of severe ED among ex-smokers, obese patients, and in those who drank no alcohol or excessive amounts of alcohol. CONCLUSIONS: Unmet need of treatment in ED is high; 66% of patients had experienced ED symptoms for 1 year or longer when they were looking for treatment. Severity seems to be related to treatment seeking.

Adult↗
PubMed1996

Clinical guidelines panel on erectile dysfunction: summary report on the treatment of organic erectile dysfunction. The American Urological Association.

PURPOSE: The American Urological Association convened the Clinical Guidelines Panel on Erectile Dysfunction to analyze the literature regarding available methods for treating organic erectile dysfunction and to make practice recommendations based on the treatment outcomes data. MATERIALS AND METHODS: The panel searched the MEDLINE data base for all articles from 1979 through 1994 on treatment of organic erectile dysfunction and meta-analyzed outcomes data for oral drug therapy (yohimbine), vacuum constriction devices, vasoactive drug injection therapy, penile prosthesis implantation and venous and arterial surgery. RESULTS: Estimated probabilities of desirable outcomes are relatively high for vacuum constriction devices, vasoactive drug injection therapy and penile prosthesis therapy. However, patients must be aware of potential complications. The outcomes data for yohimbine clearly indicate a therapy with marginal efficacy. For venous and arterial surgery, based on reported outcomes, chances of success do not appear high enough to justify routine use of such surgery. CONCLUSIONS: For the standard patient, defined as a man with acquired organic erectile dysfunction and no evidence of hypogonadism or hyperprolactinemia, the panel recommends 3 treatment alternatives: vacuum constriction devices, vasoactive drug injection therapy and penile prosthesis implantation. Based on the data to date, yohimbine does not appear to be effective for organic erectile dysfunction and, thus, it should not be recommended as treatment for the standard patient. Venous surgery and arterial surgery in men with arteriolosclerotic disease are considered investigational and should be performed only in a research setting with long-term followup available.

Erectile Dysfunction↗
PubMed2000

An epidemiological study of erectile dysfunction in Thailand (Part 1: Prevalence). Thai Erectile Dysfunction Epidemiologic Study Group (TEDES).

The Epidemiological Study of Erectile dysfunction in Thailand empirically investigates erectile dysfunction (ED) in Thailand. This article is part of this study with the major aim of estimating prevalence in the country. A nationwide representative sample of 1,250 urban Thai men aged between 40 and 70 years were studied. The estimation of overall prevalence of ED among the respondents living in urban areas was 37.5 per cent. This proportion consisted of 19.1 per cent of males with mild dysfunction, while about 13.7 per cent and 4.7 per cent of the samples had moderate and severe dysfunction. Of all four regions together with Bangkok Metropolis, the latter had the lowest prevalence while the North had the highest level. In addition, the prevalence estimation for smaller provinces was 36.4 per cent and 46.4 per cent for larger provinces. Moreover, results of this study indicated that when men become older, they have a greater likelihood of suffering from ED and the prevalence rate of ED rapidly increased from age group 40-49 years to 60-70 years.

Adult↗
PubMed2000

The anocavernosal erectile dysfunction syndrome. II Anal fissure and erectile dysfunction.

A previous study has demonstrated that the bulbocavernosus muscle (BCM) is a part of the external anal sphincter (EAS) [Shafik, Arch Androl, 1999]. It aids erection by compressing the penile bulb and the dorsal penile vein, and acts as a 'suction-ejection' pump in the ejaculatory process. Being a part of the EAS, the BCM is assumed to be involved in the different EAS pathologies. A recent study showed that erectile (ED) and ejaculatory dysfunction in 16 men with fecal incontinence (FI) after an anal fistula operation was cured after sphincteroplasty [Shafik, in press]. This article investigates the erectile and ejaculatory status in patients with anal fissure. The study comprised 32 men with acute anal fissure (mean age 36.7 +/- 8.2 s.d. years), 21 with chronic anal fissure (mean age 38.8 +/- 10.3 s.d. years), and 10 healthy volunteers (mean age 35.2 +/- 7.3 s.d. years). Erectile dysfunction occurred in all men with an acute fissure and in 16 of the chronic fissure patients; erection had been normal before fissure occurrence. The volunteers had normal erection. The anal pain radiated to the penis and was exaggerated on erection and penile thrusting. Erectile dysfunction investigations showed normal results. The electromyographic (EMG) activity of the external and internal (IAS) anal sphincters and the BCM as well as anal, penile bulb and cavernosal pressures were recorded. The acute fissures were treated conservatively and chronic ones by internal anal sphincterotomy. The patients were followed for mean periods of 17.3 +/- 3.6 s.d. months. The bulbocavernosus reflex as well as EMG activity of EAS and BCM were normal, while the resting EMG activity of the IAS was increased. The anal pressure in the acute and chronic anal fissure was increased (P < 0.01, P < 0.05, respectively), while the bulbar and cavernosal pressures showed no significant changes. Fissure treatment effected cure of the fissure and the ED in 30/32 of the acute and in 19/21 of the chronic cases. Erectile dysfunction persisted in the four patients in whom the fissures did not heal. In conclusion, a relationship is suggested to exist between anal fissure and ED. The ED occurred in the presence of anal fissure and was normalized with fissure cure. The BCM and anal pain seem to play a role in the etiology of ED associated with anal fissure.

Adult↗
PubMed1989

[Hormonal aspects of erectile dysfunction].

Organic erectile dysfunction may be due to vascular, local, neurogenic, or hormonal disturbances. Various ascertainments of basal levels of testosterone, prolactin, and other hormones produced inconsistent results, although hyperprolactinemia and hypogonadism have been shown to be associated with erectile dysfunction. Recent studies by means of the dexamethasone suppression test (DST) revealed not only clinical but also endocrinological connections between erectile dysfunction and depression. These results suggest possible multiendocrinological alterations in some of the patients suffering from erectile dysfunction, similar to those obtained in depressive disorders.

Depressive Disorder↗
PubMedDate not supplied

Sexual intercourse frequency in men presenting for treatment of erectile dysfunction: results from the pan-European erectile dysfunction observational study.

Factors that influence the number of sexual intercourse attempts among men with erectile dysfunction (ED) before initiation of ED treatment were investigated in a population of 4998 men enrolled in the (Erectile Dysfunctions) Observation Study (EDOS). Our results showed that increasing age, increasing severity and duration of ED, and decreasing satisfaction with one's sex life and partner were all associated with a reduced number of sexual intercourse attempts in the 4 weeks prior to enrollment in EDOS.

Adult↗