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There are currently no studies exploring omicron infection and male sexual function and semen quality. Our aim was to estimate changes in sexual function and semen quality in men recovering from infection since the COVID-19 Omicron pandemic started in China in late 2022. We collected 1540 questionnaires and assessed male function before infection and acute phase after infection by using International Index of Erectile Function-5, Premature Ejaculation Diagnostic Tool, and Arizona Sexual Experience Scale. We also collected the before and after semen analysis results of 247 male patients. During the acute phase after infection, the proportion of erectile dysfunction was significantly higher than before infection, but ejaculatory function was not significantly altered; In addition, semen analysis showed significant difference in semen concentration, semen activity and PR a+b sperm forward movement after infection compared to pre-infection.: COVID-19 Omicron can affect erectile function as well as sexual experience in male patients in the acute phase. Decreased sexual function due to COVID-19 Omicron may be related to body temperature and anxiety during infection. [ABSTRACT FROM AUTHOR]

Background Although nutraceutical-based treatments are often offered for erectile dysfunction (ED), their efficacy remains doubtful, and the choice of one substance over the other is challenged by the dearth of head-to-head comparative studies. Aim We aimed to compare the efficacy of available nutraceutical interventions, alone or in combination with phosphodiesterase type 5 inhibitors (PDE5i), in improving erectile function in men with ED through a network meta-analysis (NMA), which incorporates direct and indirect evidence into one model thus generating a hierarchy of effectiveness. Methods PubMed, Scopus, Web of Sciences, and Cochrane Library databases were searched for randomized placebo-controlled trials (RCTs) assessing the effect of any nutraceutical regimen in improving erectile function when compared to each other, placebo, and/or PDE5i in men with ED. Data were included in a random-effects NMA, where efficacy of treatments was ranked by surface under the cumulative ranking curve (SUCRA). Two NMAs were also conducted separately for organic and non-organic ED. Reciprocal comparisons between all treatments were analyzed by league tables. Outcomes The main outcome was the standardized mean difference in the score of the International Index of Erectile Function (IIEF)-5 or IIEF-6. Results Fifteen RCTs provided information on 1000 men with ED. In the overall NMA, compared to placebo, the combination propionyl L-carnitine (PLC) + acetyl L-carnitine (ALC) + Sildenafil was associated with the highest SUCRA (97%) in improving erectile function score, followed by L-Arginine + Tadalafil (84%), Sildenafil (79%), Tadalafil (72%), and L-Arginine (52%). No other treatment regimen showed efficacy with statistical significance. In patients with organic ED, the efficacy of Sildenafil and Tadalafil was significantly improved by PLC + ALC and L-Arginine, respectively. On the contrary, in non-organic ED, nutraceuticals did not improve the therapeutic performance of daily Tadalafil. Clinical Implications This NMA contributes valuable insights into the potential of nutraceutical interventions for ED. Strengths and Limitations We employed strict inclusion criteria related to study design and diagnostic tool, ensuring the assumption of transitivity and the consistency of the analysis. Conclusion Against a background of general ineffectiveness of most nutraceutical interventions, L-Arginine and the mix PLC + ALC appeared to be of some usefulness in improving erectile function, especially in combination with PDE5i in organic ED. [ABSTRACT FROM AUTHOR]

Background The 3-piece inflatable penile prosthesis (IPP) is the most widely used device for erectile dysfunction refractory to medications, containing a reservoir inserted into the retropubic space (RPS) or an alternative/ectopic space (AES). Indications for removal of the reservoir include malfunction, malposition, or infection. In revision cases without infection, reservoir removal is sometimes optional. Aim We reviewed outcomes and complications related to reservoir removal from a large multi-institutional series. Methods We retrospectively reviewed databases at 6 institutions over 7 years. Patients with artificial urethral sphincter, urethral sling, or mini-jupette were excluded. Outcomes Outcomes and complications related to IPP reservoir removal were analyzed. Data were collected, but only reservoir-related complications at surgery were included. Data were compared between the RPS and AES cohorts to evaluate differences with a χ2 test, with significance at P <.05. Results Of 215 cases, there were 172 RPS and 43 AES reservoirs. The mean patient age was 65.3 years. An overall 131 procedures were due to malfunction and 49 to malposition of an IPP component; 35 were secondary to infection. Among those retained (n = 44), reasons included reuse, avoiding surrounding structure damage, and difficult dissection. Among those removed (n = 171), 15 required a counterincision. To determine the statistical difference between those removed from the RPS and an AES, the χ2 test result was P =.00059, indicating a significant difference in the need for a counterincision between the groups. Complications included bladder perforation (n = 1) in the RPS group and an avulsion of the epigastric vessels requiring abdominal exploration (n = 1) in the AES group. To determine the statistical difference between RPS and AES complications, the χ2 test result was P =.365, indicating no significant difference between the groups. Strengths and Limitations Strengths include being a multi-institutional study with high-volume skilled implanters. Limitations include being a retrospective review, with implanters exclusively performing penoscrotal incisions and not utilizing an infrapubic approach. Last, there was a lack of long-term follow-up with these patients. Conclusions Removal of an IPP reservoir remains safe, with few intraoperative complications. Surgeons should be aware of the inferior epigastric vessels during removal in an AES or be willing to perform a counterincision to avoid injury to surrounding structures. Surgeons should also obtain preoperative imaging to identify the specific location of the reservoir and adjacent anatomy. This is the first multi-institutional study reviewing outcomes related to reservoir removal during IPP revision or removal surgery. [ABSTRACT FROM AUTHOR]

Background: Erectile dysfunction (ED) is a condition that affects many males. Physical therapy (PT) is the one potential treatment for ED that may improve blood flow, muscle strength, and other factors that may contribute to the issue. Data on the prevalence and trends of research on PT for ED are lacking. Objective: This study aimed to evaluate the literature trends in PT for ED via bibliometric and visualized analysis. Methods: Data on publications were collected from Scopus covering the period between 1989 and 2022. To refine the data, bibliometric analyses were conducted using Microsoft Access, Microsoft Excel, an online visualization platform, and BiblioAnalytics. Power BI and Bibliomaster were used to generate figures and tables, while Biblioshiny and VOSviewer were used for visualization. Results: A total of 494 documents were identified. The year 2019 generated the largest number of publications, with a total of 54. These studies have received 12,917 citations related to PT for ED. The most common document type was the original article with 283 publications. The University of California, USA, was the most productive institution on this topic, with 21 publications and 2,035 citations. The USA led all countries with 114 publications on the topic. The Journal of Sexual Medicine secured the top ranking with an h‐index of 18. The main topics studied were erectile dysfunction, shockwave therapy, and physiotherapy. Conclusion: The number of publications on PT for ED has demonstrated an upward trend over the last three decades. [ABSTRACT FROM AUTHOR]

In this work, we employed a new ambient ionization mass spectrometry technique, sandpaper spray mass spectrometry (SPS‐MS), as an efficient tool to analyze pills and tablets of pharmaceutical formulations. The following samples were analyzed: regulators of blood pressure, cholesterol, and diabetes, and drugs for the treatment of erectile dysfunction (ED). Additionally, a hard candy of Cannabis sativa containing Δ9‐tetrahydrocannabinol (Δ9‐THC) and its related isomer cannabidiol (CBD) was also evaluated. The surfaces of the samples, without any prior treatment, were sanded onto triangular‐cut sandpaper, and full MS scans (and MS/MS) were acquired in both positive and negative ionization modes. SPS‐MS (and MS/MS) allowed for prompt detection of the active pharmaceutical ingredients (APIs) in each formulation. Other components of the formulations, added as excipients, were also tentatively identified. The results described herein indicate that the SPS‐MS technique can be applied to fast screening of pills and tablets being potentially used as an efficient tool to detect counterfeit pharmaceutical and illicit products, a current issue of increasing concern. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the relationship between multiple indicators of inflammation and erectile dysfunction through an analysis of data from the National Health and Nutrition Examination Survey (NHANES). This represents the first large-scale, cross-sectional investigation that explores this association by jointly analyzing various inflammatory markers. Methods: We performed a cross-sectional analysis with NHANES data from 2001 to 2004. Erectile dysfunction (ED) was evaluated through a self-reported questionnaire and testosterone levels, while inflammatory markers were derived from standard blood test parameters. Our approach included multivariate logistic regression, subgroup analyses, generalized additive modeling (GAM), and smoothed curve fitting to evaluate the link between inflammatory markers (NLR, MLR, SII, SIRI, AISI) and ED. Additionally, we utilized receiver operating characteristic (ROC) curves to determine the diagnostic utility of these markers, comparing their area under the curve (AUC) values. Results: A total of 3610 participants were included in this study, and the population-weighted ED patients were 18.91%. In the adjusted model, multiple logistic regression analysis showed a positive association between five inflammatory indicators (Ln-NLR, Ln-MLR, Ln-SII, Ln-SIRI, and Ln-AISI) and ED. Smoothed curve fitting showed a nonlinear positive correlation between the five inflammatory indicators and ED. Furthermore, subgroup analyses showed that this correlation was stronger in people older than 50 year. ROC curve analysis showed the highest diagnostic performance for the study outcome with MLR (AUC = 0.616, 95% CI: 0.5952–0.637), which was significantly better than SIRI, NLR, AISI, and SII. Conclusion: MLR is potentially more effective than other biomarkers (NLR, SIRI, AISI, SII) in predicting ED. Men with elevated MLR levels should be particularly aware of their increased risk of developing ED. [ABSTRACT FROM AUTHOR]

Background Objectives Materials and methods Results Discussion Conclusions Intracavernosal injection therapy is often used as second‐line therapy for erectile dysfunction associated with radical prostatectomy when therapy with phosphodiesterase‐5 inhibitors has failed, but prostaglandin E1‐containing vasoactive agents are associated with penile pain in some men.To define the incidence of pain with prostaglandin E1‐containing intracavernosal injection mixtures for erectile dysfunction associated with radical prostatectomy when therapy with phosphodiesterase‐5 inhibitors has failed, and whether pain was a predictor of erectile function recovery.Men who underwent radical prostatectomy and were commenced on intracavernosal injection within 12 months of radical prostatectomy were included. A pain visual analog scale (0–10) was used to assess the degree of pain. Erectile function recovery was defined as the International Index of Erectile Function domain score ≥24 using phosphodiesterase‐5 inhibitors at 24 months.The study included 566 patients, mean age was 58 ± 14 (42–74) years. Duration post‐radical prostatectomy at intracavernosal injection training was 3.5 ± 3.5 m. Nerve sparing status: bilateral 76%, unilateral 13%, and non‐nerve sparing 11%. Incidence of pain with intracavernosal injection per nerve sparing status: bilateral 10% of patients, unilateral 32%, non‐nerve sparing 92% (p < 0.001). Median visual analog scale in those experiencing pain: bilateral 4 (interquartile range 3, 5), unilateral 5.5 (interquartile range 3, 6), non‐nerve sparing 7 (interquartile range 3, 9) (p < 0.001). Phosphodiesterase‐5 inhibitors success at 24 months (no pain vs. pain): bilateral 70% vs. 40% (p < 0.001), unilateral 50% vs. 28% (p < 0.001), non‐nerve sparing 10% vs. 0% (p < 0.001). On multivariate analysis, predictors of failure to respond to phosphodiesterase‐5 inhibitors at 24 months post‐radical prostatectomy included baseline erectile function, increasing age, incomplete nerve‐sparing surgery, and presence of pain.The presence of penile pain with intracavernosal injection is associated with poorer erectile function recovery post‐radical prostatectomy.Incidence of pain is high in men with non‐nerve sparing radical prostatectomy; older patient age, poorer nerve sparing, poor baseline erectile function, and the presence of penile pain with prostaglandin E1‐containing intracavernosal injection medication, were predictive of poor erectile function recovery using phosphodiesterase‐5 inhibitors at 24 months. [ABSTRACT FROM AUTHOR]

This article examines Nietzsche’s evaluations of silence and laughter as Pyrrho’s two responses to the dilemma caused by doubts about truth in aphorism 213 of ‘The Wanderer and His Shadow’ (WS 213). Contrary to the common belief that speechlessness leads Pyrrho to tranquillity (ataraxia), in WS 213, it is a symptom of his intellectual impotence caused by logical impasse. Silence proves to be subject to the same traps as speeches. In his later period, Nietzsche deems Pyrrho’s impotent will to truth and pursuit of tranquility nihilism. He contends that Pyrrho’s impotence triggers his ressentiment of dogmatists and labels Pyrrho as a Greek Buddhist in unpublished sections writtenin 1888. For Nietzsche, the only antidote to dogmatism and even nihilism is laughter, a way of overcoming Pyrrho’s obstinate will to truth embodied in the form of logical argumentation. Nietzsche seems to attribute the Democritean cheerfulness (euthumia) to Pyrrho, a manifestation of healthy skepticism and a dynamicconstellation of drives that embrace and overcome suffering. In Thus Spoke Zarathustra, Nietzsche claims that laughter is a sign of recovery from a spirit of excessive seriousness, which is embodied by the free-spirited Zarathustra, an antipode to Pyrrho ‘the fanatic of mistrust.’ [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusion Clomipramine (CLOMI) has shown effectiveness in treating premature ejaculation but is linked to erectile dysfunction and reduced libido. Yohimbine (YOH), by contrast, is effective in treating erectile dysfunction and may improve libido. Combining CLOMI and YOH could potentially leverage the benefits of both drugs. This study aimed to investigate the interactions between these drugs and to evaluate their safety profile.A prospective, open‐labelled, single‐centre, pharmacokinetic (PK) drug–drug interaction study was performed in 15 healthy male subjects. Single‐dose and steady‐state PK were investigated using noncompartmental analysis after mono‐ and combination therapy of the 2 orally applied drugs. Plasma sampling was performed at baseline, 0.5 (YOH), 1, 1.5 (YOH), 2, 3, 4, 5, 6, 8, 12 and 24 h (CLOMI). Differences in the area under the curve after multiple dosing (MD) were determined using an equivalence boundary of 80–125%.The geometric mean ratio of the area under the curve up to 12 h for MD CLOMI (combination vs. monotherapy) was 112% (90% confidence interval: 104–120%), whereas for MD YOH this ratio was 137% (90% confidence interval: 112–168%). The study drugs were safe and well tolerated as mono‐ and combination therapy, with no major adverse events reported.A PK assessment of clomipramine and yohimbine indicated a clinically significant drug–drug interaction for MD YOH in combination with CLOMI. This might be explained by competitive, CLOMI‐related inhibition of YOH metabolism, probably mediated by cytochrome P450 2D6. However, according to European Medicines Agency guidelines, the effect can be classified as interaction absent (<1,25 fold) or minor (>1.25–<2‐fold). Given the complimentary mechanisms of action and the favourable safety profiles, the findings pave the way for future efficacy studies. [ABSTRACT FROM AUTHOR]

The rising occurrence of erectile dysfunction related to diabetes mellitus (DMED) has led to the creation of new medications. Proanthocyanidins (PROs) is a potential agent for DMED. In this study, the DMED rat model was established using streptozotocin (STZ) and erectile function was assessed using apomorphine (APO) in rats. Following this, the rats were subjected to oral treatment with PRO. Then, we evaluated the influence of PROs on DMED rats. The findings suggest that PROs significantly enhance erectile function in DMED rats. PROs modulated glucose and lipid metabolism in DMED rats by decreasing blood glucose and lipid levels while increasing liver glycogen and serum insulin levels. Furthermore, PROs enhanced vascular endothelial function in DMED rats by augmenting nitric oxide (NO) levels and reducing the levels of endothelin-1 (ET-1) and lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1). Additionally, PROs have been shown to elevate testosterone (T) levels, mitigate pathological testicular damage, and enhance sperm concentration and survival rates. Finally, the core targets were screened using network pharmacology, followed by validation through molecular docking, enzyme-linked immunoassay (ELISA), and real-time PCR methodologies. Our findings imply that PROs may treat DMED by elevating AKT1 levels while concurrently diminishing CASP3 levels, thereby effectively regulating the PI3K-Akt signaling pathway. Overall, these results support using PROs as a potential candidate for the treatment of DMED. [ABSTRACT FROM AUTHOR]

Introduction: Sexual dysfunction is characterized by difficulties that interfere with achieving satisfying sexual activity, affecting desire, arousal, orgasm, and overall satisfaction. A recent study in Ethiopia identified heart failure as one of the most common cardiovascular diseases in the country. Sexual dysfunction significantly affects the quality of life in individuals with heart failure, yet it often goes underdiagnosed and underreported. Understanding the prevalence of sexual dysfunction and the factors influencing sexuality in these patients is essential. Therefore, the primary objective of this study was to determine the prevalence of sexual dysfunction among patients with heart failure in Gondar City and the northern and western zones of Gondar public hospitals. Method: This study included 423 participants diagnosed with heart failure, selected through simple random sampling from January 3 to February 30, 2024. Data were collected using an interviewer-administered questionnaire covering socio-demographic, behavioral, and clinical information. Sexual dysfunction in males was assessed using the International Index of Erectile Function-5, while the Female Sexual Function Index-6 was used for females. Data were entered into Epidata version 3.6 and later exported to SPSS version 25 for analysis. Binary logistic regression was employed to identify factors associated with sexual dysfunction, with a significance level set at p ≤ 0.05. Result: A total of 423 heart failure patients participated in the study, achieving a 100% response rate. The results indicated a significant prevalence of sexual dysfunction, affecting 57.92% of participants (95% CI 54.76%–63.76%). Female participants reported a higher prevalence of sexual dysfunction, with 63% of the 138 female heart failure patients affected. Among the 285 male participants, 55.4% (158 patients) were identified as having erectile dysfunction. Multivariable logistic regression analysis revealed that factors such as body mass index, age, insufficient physical activity, and smoking were significantly associated with sexual dysfunction in females. In males, erectile dysfunction was significantly linked to diabetes mellitus, heart failure classification, age, and insufficient physical activity. Conclusion and recommendation: This study identified a high prevalence of sexual dysfunction, with females being more affected than males. Additionally, the research identified several factors influencing sexual dysfunction among patients with heart failure, including BMI, age, cigarette smoking, diabetes mellitus, and the classification of heart failure. The study recommends that healthcare providers and other stakeholders take proactive measures to alleviate the burden of sexual dysfunction in patients with heart failure. Strategies should focus on controlling the severity of heart failure symptoms, effectively managing comorbidities, and addressing factors such as body weight, psychological well-being, and behavioral patterns. By targeting these areas, healthcare providers can work toward minimizing the risk of sexual dysfunction and improving the overall quality of life for patients with heart failure. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of low‑intensity pulsed ultrasound (LIPUS) for the treatment of Peyronie's disease (PD). Methods: To analyze the treatment effect of 106 PD patients, 56 patients treated with LIPUS as therapy group and 50 patients with oral L‐carnitine and vitamin E as control group. 56 patients were treated with LIPUS three times per week for four consecutive weeks (12 times totally). Penile erectile pain, erectile function, the size of penile plaques, and penile curvature were assessed for all of these 106 PD patients before treatment and at 4‐ and 24‐week follow‐ups to evaluate the treatment effect. Erectile pain was assessed by visual analog scale (VAS), while erectile function using the International Index of Erectile Function scale (IIEF‐5), and penile plaque size was measured by ultrasound. After alprostadil was injected into the penile body to induce a full erection, the penis was measured with a protractor at the maximum bending degree. Results: After 4‐weeks follow‐up, the VAS scores of the LIPUS group were significantly lower than the baseline (P < 0.01), while no significant differences were found in the control group (P > 0.05). After 24‐weeks follow‐up, the VAS scores of the control group reduced significantly but also were significantly higher than the LIPUS group (P < 0.01). The IIEF‐5 scores of the LIPUS group were significantly higher than the baseline (P < 0.01). While the IIEF‐5 scores of the control group showed no significant differences both after 4‐ and 24‐weeks follow‐up (P > 0.05). The penile plaque size showed no significant differences after 4‐ and 24‐weeks follow‐up both in the LIPUS group and the control group (P > 0.05). The penile curvature degrees showed a significant reduction after 4‐weeks follow‐up in LIPUS group (P < 0.01). While the penile curvature degrees of the control group showed no significant differences both after 4‐ and 24‐weeks follow‐up (P > 0.05). No complications, such as penile pain, hematoma, or skin ecchymosis, were observed during the entire process of LIPUS treatment, nor did they appear during follow‐up. Conclusions: In patients with acute PD, LIPUS could relieve erectile pain and improve erectile dysfunction. Moreover, it appears not to reduce plaque size and not to have a clinically significant effect on penile curvature. Furthermore, LIPUS also shows a good safety profile during the management of PD and should be recommended for the clinical management of PD. [ABSTRACT FROM AUTHOR]

Objectives: To develop a risk prediction model for the identification of features involved in the prediction of erectile dysfunction (ED) at 12 months following COVID-19 recovery. Methods: We performed an observational prospective multicentre study. Participants were classified according to their history of COVID-19: (I) patients with a past history of COVID-19 and (II) patients without a previous microbiological diagnosis of COVID-19. A total of 361 patients (past history of COVID-19, n = 166; no past history of COVID-19, n = 195) were assessed from January 2022 to March 2023. Patients with a past history of COVID-19 were assessed at 12 months following COVID-19 recovery. The primary outcome measure was ED, assessed through the 5-item International Index of Erectile Function (IIEF-5). Data concerning epidemiologic variables, comorbidities and active treatment were also collected. We performed a binary logistic regression to develop a risk predictive model. Among the models developed, we selected the one with the higher Area Under the Curve (AUC). Results: The median age was 55 years in both groups. The ED prevalence was 55.9% in patients with past history of COVID-19 and 44.1% in those with no past history of COVID-19. The best predictive model developed for ED comprised 40 variables and had an AUC of 0.8. Conclusions: We developed a regression model for the prediction of ED 12 months after COVID-19 recovery. The application of our predictive tool in a community setting could eventually prevent the adverse effects of ED on cardiovascular health and the associated unfavourable economic impact. [ABSTRACT FROM AUTHOR]

\nHIGHLIGHTSInfertility affects 8–12% of couples globally, with male factors contributing to around 40% of cases. Common male infertility issues include erectile dysfunction (ED) and low sperm count or quality, which account for over 90% of cases. These problems often result from anatomical, hormonal, or genetic abnormalities. This review focuses on natural aphrodisiac herbs commonly used to address ED, providing detailed information on their botanical characteristics, metabolic pathways, recommended dosages, phytochemical properties, side effects, origins, and traditional uses. It also reviews recent studies on medicinal herbs that boost sexual desire and treat urological conditions. By compiling reliable findings from the past decade, the study aims to serve as a comprehensive resource for individuals dealing with sexual health issues. Through careful evaluation of each herb, it offers insights into their effectiveness and limitations, emphasizing the potential of natural treatments as complementary alternatives to conventional therapies for male infertility and related conditions.Anatomy, hormone abnormalities and genetic flaws may contribute to male infertility.The most popular natural aphrodisiac herbs used in the treatment of infertility were revised.Unique and reliable references to sexual desire and urological problems were provided.Safe aphrodisiac herbs including phytochemical products were emphasized.Plants were investigated for their potential as aphrodisiacs and fertility enhancersAnatomy, hormone abnormalities and genetic flaws may contribute to male infertility.The most popular natural aphrodisiac herbs used in the treatment of infertility were revised.Unique and reliable references to sexual desire and urological problems were provided.Safe aphrodisiac herbs including phytochemical products were emphasized.Plants were investigated for their potential as aphrodisiacs and fertility enhancers [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: To compare 1‐year functional and 5‐year oncological outcomes of men undergoing robot‐assisted laparoscopic prostatectomy (RALP) with neurovascular structure‐adjacent frozen‐section examination (NeuroSAFE) with those in men undergoing RALP without NeuroSAFE (standard of care [SOC]). Subjects and Methods: Men undergoing RALP in our centre between 1 January 2009 and 30 June 2018 were enrolled from a prospectively maintained database. Patients were excluded if they had undergone preoperative therapy or postoperative adjuvant therapy or were enrolled in clinical trials. Patients were grouped based on use of NeuroSAFE. Follow‐up was censored at 5 years. The primary outcome was difference in time to biochemical recurrence (BCR) on multivariable analysis, defined as prostate‐specific antigen (PSA) >0.2 ng/L on two consecutive measurements. Secondary outcomes were difference in 1‐year erectile dysfunction and incontinence. Results: In the enrolment period, 1199 consecutive men underwent RALP, of whom 1140 were eligible, including 317 with NeuroSAFE and 823 with SOC. The median PSA follow‐up was 60 months in both groups. Rates of 5‐year BCR were similar on Kaplan–Meier survival curve analysis (11% vs 11%; P = 0.9), as was time to BCR on multivariable Cox proportional hazards modelling (hazard ratio 1.2; P = 0.6). Compared with the SOC group at 1 year, the NeuroSAFE group had similar unadjusted rates of incontinence (5.1% vs 7.7%) and lower unadjusted impotence (57% vs 80%). On multivariable analysis, NeuroSAFE patients had equivalent risk of incontinence (odds ratio [OR] 0.59, 95% CI 0.17–1.6; P = 0.4) but significantly reduced risk of erectile dysfunction (OR 0.37, 95% CI 0.22–0.60; P < 0.001). Conclusions: For men undergoing RALP, compared with SOC, NeuroSAFE patients had equivalent time to BCR and risk of 1‐year incontinence, and significantly lower risk of 1‐year erectile dysfunction. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of a new strategy of transperineal anastomotic urethroplasty (TAU) with proximal transection in treating pelvic fracture urethral injury (PFUI) associated with urethrorectal fistula (URF). Patients and Methods: A retrospective review of all patients treated by TAU with proximal transection and fistula repair for PFUI associated with URF was performed between August 2013 and July 2022. Information on demographics, peri‐operative variables, and postoperative follow‐up outcomes was collected. Successful surgery was defined as restoration of a uniform urethral calibre using flexible cystoscopy (third postoperative month) without strictures or leakage, with no further interventions required. Functional outcomes, including erectile function (assessed using the five‐item International Index of Erectile Function) and urinary continence, were assessed. Results: Forty patients diagnosed with PFUI associated with URF and treated by TAU with proximal transection and rectal fistula repair were enrolled. Six patients (15.0%) had a history of failed urethral reconstruction. The mean stenosis length and fistula diameter were 2.9 cm and 1.2 cm, respectively. All patients underwent faecal diversion before urethroplasty. After a median (range) follow‐up of 45 (3–115) months, the final success rate was 90.0% (36/40). Postoperative complications included haematoma in three patients, epididymo‐orchitis in three, wound infection in one, wound bleeding in one, delayed wound healing in three, and wound numbness in three. The overall incidence of postoperative erectile dysfunction reached 75.0%, with a median (range) score of 9 (0–19). Normal continence was achieved in 31 patients (77.5%). Occasional incontinence without the need for urinal pads occurred in eight patients, whereas one patient required urinal pads. Conclusions: Transperineal anastomotic urethroplasty with proximal transection is a precise and effective surgical strategy for treating PFUI associated with URF. This strategy ensures a high success rate and improves surgical efficiency. [ABSTRACT FROM AUTHOR]

Purpose: Explore the causal relationship between the gut microbiota and erectile dysfunction (ED) at phylum, class, order, family, and genus levels, and identify specific pathogenic bacteria that may be associated with the onset and progression of ED. Materials and Methods: The genetic variation data of 196 human gut microbiota incorporated in our study came from the human gut microbiome Genome Wide Association Studies (GWAS) dataset released by the MiBioGen Consortium. The GWAS statistics for ED were extracted from one study by Bovijn et al., which included 223,805 participants of European ancestry, of whom 6,175 were diagnosed with ED. Subsequently, Mendelian randomization (MR) analysis was carried out to explore whether a causal relationship exists between the gut microbiota and ED. Additionally, bidirectional MR analysis was performed to examine the directionality of the causal relationship. Results: Through MR analysis, we found that family Lachnospiraceae (odds ratio [OR]: 1.27, 95% confidence interval [CI]: 1.05–1.52, p=0.01) and its subclass genus LachnospiraceaeNC2004 group (OR: 1.17, 95% CI: 1.01–1.37, p=0.04) are associated with a higher risk of ED. In addition, genus Oscillibacter (OR: 1.17, 95% CI: 1.02–1.35, p=0.03), genus Senegalimassilia (OR: 1.32, 95% CI: 1.06–1.64, p=0.01) and genus Tyzzerella3 (OR: 1.14, 95% CI: 1.02–1.27, p=0.02) also increase the risk of ED. In contrast, the inverse variance weighted estimate of genus RuminococcaceaeUCG013 (OR: 0.77, 95% CI: 0.61–0.96, p=0.02) suggests that it has a protective effect against the occurrence of ED. Conclusions: This study preliminarily identified 6 bacterial taxa that may have a causal relationship with ED, including family Lachnospiraceae, genus Lachnospiraceae NC2004 group, Oscillibacter, Senegalimassilia, Tyzzerella 3 and Ruminococcaceae UCG013. These identified important bacterial taxa may serve as candidates for microbiome intervention in future ED clinical trials. [ABSTRACT FROM AUTHOR]

Purpose: Erectile dysfunction (ED) is associated with several vascular disorders, but the associations between ED and vascular parameters are still unclear. Materials and Methods: We analyzed and synthesized a comprehensive range of studies from PubMed, Web of Science, and Scopus regarding the associations between ED and the following measures: ankle-brachial index (ABI), pulse wave velocity (PWV), intima-media thickness (IMT), nitrate-mediated dilation (NMD), flow-mediated dilation (FMD), augmentation index (AI), endothelial progenitor cells (EPCs) and other vascular parameters. Subgroup analysis was conducted according to specific types of parameters. Study quality was assessed by using the Newcastle–Ottawa Scale. Sensitivity analysis was conducted to confirm the robustness of the pooled results. Results: Fifty-seven studies with 7,312 individuals were included. Twenty-eight studies were considered to be high-quality. ED patients had a 0.11 mm higher IMT (95% confidence interval [CI]: 0.07, 0.15), a 2.86% lower FMD (95% CI: -3.56, -2.17), a 2.34% lower NMD (95% CI: -3.37, -1.31), a 2.83% higher AI (95% CI: 0.02, 5.63), a 1.11 m/s higher PWV (95% CI: 0.01, 2.21), and a 0.72% lower percentage of EPCs (95% CI: -1.19, -0.24) compared to those without ED. However, ABI was similar between ED patients and non-ED individuals. According to sensitivity analysis, the pooled results were robust. Conclusions: Our study confirmed the associations between ED and several vascular parameters and highlighted the importance of prevention and management of vascular and endothelial dysfunction in ED patients. [ABSTRACT FROM AUTHOR]

For many males, sexual function holds significant value in determining their quality of life. Despite the importance of male erectile function, no quantitative method to measure it accurately is currently available. Standardized assessment methods such as RigiScan™, International Index of Erectile Function (IIEF-5), and the stamp test are used to evaluate sexual function, but those methods cannot repetitively and quantitatively measure erectile function. Only direct measurement can quantitatively assess the shape of an erect penis. This paper presents the essential requirements for developing an ideal measurement method for penile erection. It also introduces current approaches for diagnosing male sexual function and reviews ongoing research to quantitatively measure erectile function. The paper further summarizes and analyzes the advantages and disadvantages of each method with respect to the essential requirements. Finally, the paper discusses the future direction toward the development of Penile Erection Morphometry [ABSTRACT FROM AUTHOR]

Sexual health is an important part of a healthy life. The aim of this study is to define Behçet's sexual dysfunction and the factors affecting it. Sixty-nine patients with Behçet's disease (BD) and 74 healthy controls were included in the study. International Index of Erectile Function (IIEF), the Female Sexual Function Index (FSFI), the Beck Depression Inventory (BDI), and the Short Form Health Survey (SF-36) were filled out by patients and healthy control group (HCG). Follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin and estradiol or testosterone levels according to gender were measured in Behçet's patients. The rate of sexual dysfunction and its relationship with gonadal hormones, Beck depression and SF 36 subgroups were evaluated in Behçet's patients. Sixty-nine patients with BD (mean age 39.55 ± 11.7) and 74 HCG (mean age 36.9 ± 6.84) were included in the study. Sexual dysfunction was observed in 74% (49) of BD and 59.5% (44) of HCG (p = 0.047). Prolactin level is within normal limits in all patients. Although there are abnormal levels of gonadal hormones, no relationship was found with sexual dysfunction. Depression especially is more prevalent compared to the healthy population (p = 0.016). The presence of depression negatively affects sexual life. Depression, SF 36 physical role limitations, energy vitality, vitality and mental health were associated with sexual dysfunction in patients with Behçet's disease. Sexual dysfunction was associated with the presence of depression and SF-36 subscales in Behçet's patients. [ABSTRACT FROM AUTHOR]

Background: Erectile dysfunction (ED) is a common condition with various contributing factors, including lifestyle and dietary habits. Caffeine, a widely consumed stimulant, has been linked to multiple physiological effects on vascular function and hormonal balance that might influence sexual function. This meta-analysis aims to evaluate the association between caffeine intake and the risk of ED by analyzing data from cohort studies. Methods: A systematic search was conducted across PubMed, Web of Science, Scopus, and Embase databases, and a manual search was conducted on Google Scholar for studies on the relationship between caffeine intake and ED in adult men. The search included observational studies published up to April 1, 2024. Four cohort studies were included, and their data were extracted and analyzed by STATA version 18. Results: Four included cohort studies comprised 51,665 cohort members. The study population included adult males, on average, aged 18 to 80. The results indicate that there was no significant relationship between coffee consumption and the risk of ED (relative risk [RR] = 0.94, 95% CI: 0.86–1.03; p = 0.999). Conclusions: The current evidence suggests no significant relationship between caffeine intake and ED, but limited studies limit conclusions. Future research should focus on larger sample sizes, standardized outcome assessments, and different dosages and forms of caffeine consumption. [ABSTRACT FROM AUTHOR]

Background: Irisin is an exercise-induced myokine that alleviates endothelial dysfunction and reduces insulin resistance in type 2 diabetes mellitus (T2DM). The current study aimed to assess the serum level of irisin in T2DM men with erectile dysfunction (ED) compared to T2DM patients with normal erectile function and healthy controls, as well as investigate the association between serum irisin level and the severity of ED in T2DM patients. Patients and methods: A cross-sectional study was conducted on 90 males, divided into three groups: 32 T2DM patients with ED, 24 T2DM patients without ED, and 34 healthy controls. Socio-demographic characteristics and scores of the validated Arabic version of the international Index of Erectile Function-5 (ArIIEF-5), Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were obtained. Furthermore, routine laboratory tests employed for diabetes monitoring and serum levels of total testosterone and irisin were assessed within these groups. Results: T2DM men with ED had significantly lower serum levels of irisin and testosterone, as well as a lower ArIIEF-5 score, but their GAD-7 and PHQ-9 scores were significantly higher than those without ED or controls (p < 0.001). Among T2DM men, serum irisin levels positively associated with ArIIEF-5 scores and serum testosterone (r = 0.413, p = 0.002; r = 0.936, p < 0.001, respectively) but negatively associated with glycosylated hemoglobin levels (r = -0.377, p = 0.004). Multivariate regression analysis to predict ED in T2DM patients found that GAD-7 score was the only most significant predictor for ED (ꞵ = − 1.176, standard error = 0.062, p < 0.001). Conclusion: The current study had demonstrated that irisin positively correlated with the ArIIEF-5 and serum testosterone but negatively correlated with HbA1c in T2DM men. Nevertheless, further validation of these findings is necessary through cohort studies. [ABSTRACT FROM AUTHOR]

Background Aim Methods Outcomes Results Clinical implications Strengths and limitations Conclusion Chronic periodontitis may induce erectile dysfunction (ED), however, the specific mechanism involved is unclear. The endothelial glycocalyx (eGlx) is a structure that can regulate endothelial nitric oxide synthase (eNOS) phosphorylation on the cavity surface of vessels.To investigate whether chronic periodontitis leads to ED by affecting the eGlx.Twenty‐four 4‐week‐old male Sprague‒Dawley rats were randomly divided into four groups (n = 6): the control group, chronic periodontitis group, chronic periodontitis + heparin group (subcutaneous heparin 200 U/kg/day, 7 days), and control + heparin group. Four weeks after the induction of periodontitis in the rats, the maximum intra‐cavernous pressure/mean arterial pressure (ICPmax/MAP), serum C‐reactive protein (CRP), tumor necrosis factor alpha (TNF‐α), interleukin‐6 (IL‐6), nitric oxide (NO), heparin sulfate (HS), syndecan‐1 (SDC‐1), heparanase (HPSE), eNOS, and phosphor‐eNOS (p‐eNOS) concentration were measured, and the eGlx of the penile corpus cavernosum was observed by transmission electron microscopy (TEM).Chronic periodontitis can degrade eGlx on the rat penile corpus cavernosum by increasing serum CRP, TNF‐α, and IL‐6 levels, reducing the p‐eNOS/eNOS ratio and the NO concentration in the penile corpus cavernosum, and resulting in the inhibition of the erectile function.Serum CRP, TNF‐α, and IL‐6 levels and HPSE expression in penile cavernous tissue were significantly greater in the chronic periodontitis group than in the control group and the chronic periodontitis + heparin group (P < 0.05). The average thickness of the eGlx muscle in the penile corpus cavernosum in the chronic periodontitis group was significantly lower than those in the control group and chronic periodontitis + heparin group (P < 0.05). The HS concentration, SDC‐1 expression, p‐eNOS/eNOS, NO concentration, and ICPmax/MAP in the chronic periodontitis group were significantly lower than those in the control group and chronic periodontitis+ heparin group (P < 0.01).The eGlx on penile cavernosum vessels may be a new therapeutic target for the treatment of ED.This study revealed that chronic periodontitis promotes the decomposition of vascular eGlx in the rat penile corpus cavernosum, however, it is not clear whether chronic periodontitis inhibits the synthesis of eGlx.Chronic periodontitis can degrade eGlx on the rat penile corpus cavernosum by increasing serum CRP, TNF‐α, and IL‐6 levels, reducing the p‐eNOS/eNOS ratio and the NO concentration in penile cavernous tissue, and resulting in the inhibition of the erectile function. Heparin inhibited eGlx decomposition and improved erectile function in rats with chronic periodontitis. [ABSTRACT FROM AUTHOR]

Erectile dysfunction (ED) is closely related to oxidative stress, and antioxidant is a treatment and prevention method for erectile dysfunction. The Compound Dietary Antioxidant Index (CDAI) represents the overall dietary antioxidant intake of the human body. However, the link between CDAI and ED is unclear. The objective of this research was to examine the linkage between CDAI and ED. The research utilized information collected from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2001 to 2004. To assess the association between CDAI and ED, the analysis employed weighted multivariate logistic regression along with weighted restricted cubic splines (RCS). Additionally, subgroup interaction analysis was conducted to confirm the findings. In this investigation, 3184 adults from the U.S., all above the age of 20, were part of the study cohort, with 863 of them identified as having ED. Adjustments for potential confounding variables revealed that the odds ratio (95% confidence interval) of CDAI associating with ED was 0.95 (0.92–0.99; P = 0.01). Besides, compared to the lowest tertile, the highest tertile of CDAI was associated with a lower risk of ED (0.63 [0.46–0.88]; P = 0.01). The application of weighted restricted cubic splines (RCS) analysis delineated a nonlinear inverse relationship between CDAI levels and the probability of ED. Subgroup analysis further demonstrated that the association between CDAI and ED remained consistent across subgroups. This cross-sectional analysis revealed a significant correlation, indicating that elevated levels of CDAI are closely linked with a lower likelihood of ED. [ABSTRACT FROM AUTHOR]

Background : Neurogenic erectile dysfunction, characterized by neurological repair disorders and progressive corpus cavernosum fibrosis (CCF), is an unbearable disease with limited treatment success. IL-17A exhibits a complex role in tissue remodelling. Nevertheless, the precise role and underlying mechanisms of IL-17A in CCF under denervation remain unclear. Methods: PCR array was employed to identified differentially expressed genes between neurogenic ED and normal rats. IL-17A expression and its main target cells were analyzed using Western blotting, immunofluorescence and immunohistochemistry. The phenotypic regulation of IL-17A on corpus cavernosum smooth muscle cells (CSMCs) was evaluated by cell cycle experiments and SA-β-Gal staining. The mechanism of IL-17A was elucidated using non-target metabolomics and siRNA technique. Finally, IL-17A antagonist and ABT-263 (an inhibitor of B-cell lymphoma 2/w/xL) were utilized to enhance the therapeutic effect in a rat model of neurogenic ED. Results: IL-17A emerged as the most significantly upregulated gene in the corpus cavernosum of model rats. It augmented the senescence transformation and fibrotic response of CSMCs, and exhibited a strong correlation with CCF. Mechanistically, IL-17A facilitated CCF by activating the mTORC2-ACACA signalling pathway, upregulating of CSMCs lipid synthesis and senescence transition, and increasing the secretion of fibro-matrix proteins. In vivo, the blockade of IL-17A-senescence signalling improved erectile function and alleviated CCF in neurogenic ED. Conclusions: IL-17A assumes a pivotal role in denervated CCF by activating the mTORC2-ACACA signalling pathway, presenting itself as a potential therapeutic target for effectively overcoming CCF and erection rehabilitation in neurogenic ED. IL-17A is significantly upregulated in the corpus cavernosum under denervated conditions, promoting the senescence transformation and fibrotic response of corpus cavernosum smooth muscle cells, primarily through the activation of the mTORC2-ACACA signalling pathway. Blocking the IL-17A-senescence signalling axis can improve erectile function and alleviate corpus cavernosum fibrosis, suggesting that this pathway represents a potential therapeutic target for neurogenic erectile dysfunction. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions The vacuum erection device (VED) is a second‐line treatment tool recommended in erectile dysfunction (ED) guidelines but has long been unavailable in Japan. A new VED, Vigor 2020® (A & HB Company Limited, Tokyo, Japan), has now been manufactured and received medical approval from the Pharmaceuticals and Medical Devices Agency in Japan. We conducted a retrospective observational study of ED patients who used Vigor 2020 in clinical practice.We analyzed male ED patients aged ≥20 years treated with Vigor 2020 in our outpatient clinics. The primary endpoint was improvement of erection as evaluated by an Erection Hardness Score (EHS) of ≥1 point. Secondary endpoints were improvement of sexual function and adverse events as evaluated by the International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire for assessing ejaculatory dysfunction (MSHQ‐EjD).Thirty‐three patients (mean age, 57.21 [27–86] years) could be evaluated before and after using Vigor 2020. Among the 16 patients with baseline EHS ≤2, 14 (93.33%) improved by ≥1 point, and 10 of these 16 patients (62.50%) improved to EHS ≥3 and could insert vaginally. Significant improvement was observed for IIEF total score and for the MSHQ‐EjD in patients with an EHS of ≥3 after use of Vigor 2020. No patient experienced significant adverse events.The Vigor 2020 may be an efficacious treatment tool for ED. Patients with significant ED experienced not only significant improvement of erection but also improvement of ejaculation with its use. [ABSTRACT FROM AUTHOR]

Introduction: Platelet-rich plasma (PRP) has shown positive effects on enhancing erectile function in animal studies. Human clinical trials are limited and provide contradictory results. This review aims to conduct a meta-analysis of the available Randomized controlled trials (RCT) to assess the efficacy of PRP in males with ED. Methods: A systematic review was carried out following the Cochrane Handbook of Intervention and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered in PROSPERO (CRD42023441655). Results: A total of three RCTs were included in the analysis for a total of 221 patients with mild to moderate ED. The patients receiving PRP reported significantly better improvement of IIEF-EF score during 1,3- and 6-months follow-up compared to the placebo group (mean difference [MD] 2.66, 95% confidence interval [CI] 1.48 to 3.83, p < 0.01; MD 2.11, 95%CI 0.13 to 4.09, p = 0.04; MD 2.99, 95%CI 1.79 to 4.19, p < 0.01). The pooled analysis indicated that attainment of minimally clinical important difference (MCID) was significantly higher in patients receiving PRP compared to the placebo group during one and 6-month follow-up (odds ratio [OR] 5.51, 95%CI 1.2 to 254, p = 0.03; OR 5.64, 95%CI 2.05 to 15.55, p < 0.01; respectively). Encouragingly, no major AEs were reported in all three trials in the PRP and placebo groups (p = 0.99). Conclusions: This review highlights the potential role of PRP in providing short-term improvement of erectile function parameters for up to 6 months in mild to moderate ED patients. Future RCTs with longer-duration follow-ups and more standardized treatment protocols are necessary to gain sufficient details on PRP's long-term effectiveness and safety. [ABSTRACT FROM AUTHOR]

Objective: Childhood traumas (CT), particularly sexual abuse, are linked with sexual dysfunction and reduced sexual satisfaction. This study explores the association between CT, anxiety, and sexual satisfaction in individuals with erectile dysfunction (ED). Method: The study cohort consisted of 93 patients with ED and 95 control group volunteers. Participants completed self-report forms on demographic data and sexual histories, along with the Childhood Trauma Questionnaire (CTQ), the State and Trait Anxiety Inventory (STAI), and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Results: Forty participants from the ED groups also had a co-diagnosis of premature ejaculation (PE). Those with co-morbid PE were categorized as a separate group (ED + PE). Physical abuse, sexual abuse, and minimization as measured by the CTQ, along with impotence, infrequency, and dissatisfaction as measured by the GRISS, were significantly lower in the control group compared to the ED and ED + PE groups (p<0.001). Anxiety scores were significantly different between the ED + PE group and both the ED and control groups (p<0.001). A history of childhood sexual abuse was linked to avoidance behavior (p<0.05). Significant correlations were observed between emotional maltreatment and PE (p<0.05), impotence and minimization (p<0.001), impotence and psychical neglect (p<0.05), and tactile avoidance and emotional neglect (p<0.01). Conclusion: This study highlights the importance of CT, including types other than sexual abuse, in contributing to sexual dysfunction and diminished satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this randomized controlled trial was to investigate the impact of manual therapy (friction massage) and pelvic floor muscle (PFM) training on erectile dysfunction (ED), pelvic floor muscle thickness, and blood flow in the penile arteries and veins in men who have undergone prostatic adenectomy (PA). Materials and Methods: This study employed a randomized, double-blinded, controlled trial design. Forty patients participated and were divided into two groups: intervention and control (n=20 per group). The intervention group received 10 sessions of pelvic floor muscle training and manual therapy, while the control group solely underwent pelvic floor muscle training. The recovery rate was measured using the International Index of Erectile Function 15 (IIEF-15) questionnaire and Erection Hardness Score (EHS). Sonographic factors were assessed using simple and Doppler ultrasound. Results: The intervention group exhibited significantly higher erectile function scores (F(1,37)=158.04, P < 0.001, η2 P = 0.810) and a higher average total (IIEF-15) score (20.52) (F(1,37)=136.76, P < 0.001, η2 P = 0.787) com- pared to the control group in the post-test assessment. Comparison between the two groups revealed an increase in ultrasonic parameters such as the thickness of the ischiocavernosus and bulbospongiosus muscles, maximum systolic velocity, and minimum diastolic velocity of the cavernosal artery in the intervention group. However, the maximum blood flow velocity in the posterior vein decreased. Conclusion: PFM training and friction massage play a significant role in managing ED following PA, positioning them as the primary treatment approach for men experiencing ED post-prostatectomy. [ABSTRACT FROM AUTHOR]

Introduction: Erectile dysfunction (ED) is common in men who are in their sixth decade of life and older, particularly those with diabetes. This study aimed to determine whether long-term glycaemic control affects the severity of ED in diabetic male patients attending the diabetic clinic at Kalafong Provincial Tertiary Hospital (KPTH). Methods: This cross-sectional study used data collected at the KPTH Diabetic Clinic, Gauteng, South Africa. Eighty-one male patients aged over 55 years who attended the diabetic clinic in 2017 were selected to participate in this study. The Sexual Health Inventory for Men (SHIM) questionnaire was used to determine the severity of ED, and the mean glycated haemoglobin A1c (HbA1c) over the preceding two years was used to assess glycaemic control. Results: The SHIM distinguished between ED categories among the participants (Cronbach's alpha: 0.964). The HbA1c did not differ significantly between SHIM ED categories (p = 0.867). No significant difference was detected between the mean HbA1c in those with ED (8.26%, IQR: 7.2 to 9.4) and those without ED (7.6%, IQR: 6.7 to 8.9) (p = 0.494). Multivariate analyses revealed that a longer duration of diabetes, moderate albuminuria, the presence of any peripheral neuropathy, the number of antihypertensive agents used, and smoking history were associated with ED. However, the mean HbA1c of the preceding two years did not significantly contribute to ED (p = 0.133). Conclusion: The SHIM reliably distinguished between ED categories in this population, with high internal consistency; however, glycaemic control, as measured by HbA1c over the preceding two years, did not play a significant role in predicting the presence or severity of ED. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to compare gout patients and healthy subjects in terms of erectile dysfunction, carotid intima-media thickness (CIMT), and other variables and to investigate the relationship between CIMT and erectile dysfunction. Patients and methods: This cross-sectional study was conducted with 134 male gout patients (median age: 56 years; range, 48 to 62 years) and 104 healthy males (median age: 47 years; range, 40.5 to 54.5 years) between September 2022 and June 2023. Age, comorbidities, height, weight, laboratory results, gout treatment data, insulin resistance evaluated by the homeostatic model assessment for insulin resistance, presence and severity of erectile dysfunction evaluated by the six-item International Index of Erectile Function erectile function domain (IIEF-EF), and CIMT measured by ultrasound were assessed. Results: Hypertension, hyperlipidemia, greater insulin resistance, erectile dysfunction, and bilaterally increased CIMT were significantly more common in the gout group. The mean IIEF-EF score of gout patients was significantly lower than that of controls. Multivariable logistic regression revealed increased CIMT as the sole parameter independently associated with erectile dysfunction (p=0.010). When both groups were categorized into CIMT-based subsets, erectile dysfunction was present in 97.9% of patients with coexistence of gout and increased CIMT (≥0.9 mm), a significantly higher proportion compared to the other three subsets (p<0.001). Conclusion: Increased CIMT was the only factor independently associated with a greater likelihood of erectile dysfunction in patients with and without gout; however, coexistence of gout and increased CIMT appears to result in a significantly elevated risk for erectile dysfunction. [ABSTRACT FROM AUTHOR]

Simple Summary: Placental allograft tissue has been extensively used in wound healing. It can also be placed along the neurovascular bundles during radical prostatectomy to improve post-operative continence and erectile function recovery. The existing literature shows how placental allografts lead to improved functional recovery after radical prostatectomy. It is unknown whether these allografts have an impact on biochemical recurrence (BCR). Our study was a single surgeon retrospective review of 362 radical prostatectomy cases. The subgroups were the negative control group and two brands of cryopreserved amniotic membrane (CAM). Our data show improved continence recovery using CAM allografts. At a median follow-up of 41 months, there was no observed impact of BCR. Interestingly, in vitro analysis also revealed decreased cell viability of prostate cancer cell lines when incubated with the CAM allograft. Although further investigation is required, our data do not support a need for oncologic concern while using CAM allografts during radical prostatectomy. Background: Human placental allografts are widely used to promote wound healing. Placental (or amniotic membrane/umbilical cord) allografts are placed along the neurovascular bundles during radical prostatectomy to improve continence and erectile function recovery. It is unknown whether placental allografts impact biochemical recurrence (BCR). Methods: This was a single-surgeon retrospective study of 566 robotic radical prostatectomies performed from April 2015 to March 2021. The patients were divided into three groups: the negative control, Brand A, and Brand B. Brand A and Brand B were both cryopreserved amniotic membrane (CAM) allografts. A total of 324 cases were included for BCR Kaplan–Meier and risk-adjusted multivariate analyses (362 for continence analysis). In vitro analyses were performed to determine the effect of CAM allografts on prostate cancer (PCa) cell line growth. Results: For propensity score-matched analysis (adjusting for pre-operative PSA, tumor stage, Gleason Grade, and margin status), (1) the allograft groups did not show differences in time to BCR vs. the negative control group (p = 0.7), and (2) combined allograft treatment groups showed better continence recovery vs. the negative controls (p = 0.01). In vitro, placental allografts reduced PCa cell line growth in co-culture assays. Conclusions: cryopreserved AM allografts (combined or individual brands) did not show a significant effect on BCR but improved continence recovery for PCa patients. [ABSTRACT FROM AUTHOR]

Objective: Many complications after prostate biopsy (PB) have been reported. One of the possible complication after PB is erectile dysfunction (ED). In this study, we showed the early (1 month after PB) effect of PB on erectile function. Materials and Methods: A total of 207 men who underwent PB between April 2021 and October 2021 were evaluated. Before and 1 month after PB, all patients were evaluated with the IIEF-5 (5-item version of the International Index of Erectile Function) prospectively. Patient data such as age, body mass index, prostate-specific antigen levels, prostate volume, periprostatic local anesthesia, pathological results, and post-biopsy complications were noted. Results: The mean IIEF-5 score was 13.3 (5-25) before PB. One month after the biopsy it was 13.5 (5-25). There were no differences between the before and after PB IIEF scores. The only significant change was observed in the prostate cancer (PCa) group. Conclusion: In past studies, it has been shown that ED after prostate biopsy is mostly seen at the first month and improves after that. In our study, PB did not affect erectile function. Only the PCa-diagnosed group showed a significant decrease in erectile function, and this effect was not attributed to prostate biopsy. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The relationship between erectile dysfunction (ED) and type 1 diabetes mellitus (T1DM) is currently a hot topic of medical research. It has been reported that autophagy plays a crucial role in causing erectile dysfunction in T1DM. Recent research has shown that mitochondrial 3‐hydroxy‐3‐methylglutaryl‐CoA synthase 2 (HMGCS2) is strongly linked to the development of T1DM. However, the specific mechanism by which it regulates the erectile function is not yet fully understood. Objectives: To investigate whether HMGCS2 affects erectile function in type 1 diabetic rats by regulating autophagy in corpus cavernosum endothelial cells (CCECs). Materials and methods: First, the rat model of T1DM was established. Then, the ratio of maximum penile intracavernous pressure (ICPmax) and mean arterial pressure (MAP) was detected to assess the erectile function in various groups, and the protein expression of HMGCS2, mTOR and p‐mTOR was evaluated by western blot (WB) and immunohistochemistry (IHC). To explore the relationship between HMGCS2 and the mTOR signaling pathway in T1DM ED rats, we silenced the expression of HMGCS2 and activated the mTOR signaling pathway with MHY1485 in CCECs and then assessed the expression of beclin1, P62, LC3, autophagosome, endothelial nitric oxide synthase (eNOS), phosphorylation of eNOS (p‐eNOS), and nitric oxide (NO) to evaluate autophagy and the erectile function by reverse transcription quantitative polymerase chain reaction and western blot. Results: The study conducted on T1DM ED rats showed that the expression of HMGCS2 was significantly increased, while the autophagy was suppressed. Additionally, the mTOR signaling pathway was highly activated. In contrast, when HMGCS2 was silenced in vitro, p‐mTOR/mTOR was reduced, and autophagy was improved. These effects were accompanied by the enhanced activity of eNOS. Furthermore, when HMGCS2 was silenced and the mTOR signaling pathway was simultaneously activated, the results revealed a decrease in autophagy as well as a reduction in activity of eNOS in comparison to just silencing HMGCS2 alone. Discussion and conclusion: HMGCS2 upregulation in T1DM rats inhibited autophagy and eNOS activity by activating the mTOR pathway and led to a decrease in the erectile function. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the causal relationship between erectile dysfunction (ED) and psychological states including worry, tension, insomnia, sensitivity to environmental stress and adversity (SESA). Method: This study the used two‐sample bi‐directional Mendelian randomization (MR) method. The study data was obtained from a pooled dataset of genome‐wide association studies (GWAS). The bi‐directional MR analysis was performed using inverse variance weighting, weighted median method, and MR‐Egger regression analysis to assess the causality between ED and psychological states including worry, tension, insomnia, SESA in terms of odd ratios (OR). The study tested for heterogeneity using the Cochran Q method and for multiple validity using the MR‐Egger and MR‐PRESSO methods. Results: In forward MR analysis correlating worry, tension, insomnia, and SESA as exposures, no causal relationship was found between worry or tension and ED (p < 0.05). However, insomnia (p = 0.001, OR = 3.441, 95%CI = 1.593–7.435) and SESA (p = 0.004, OR = 1.804, 95%CI = 1.203–2.701) were found to have a significant causal effect on ED risk. The reverse MR analysis with ED as the exposure did not show any significant correlation (all p > 0.05). Conclusion: Individuals with insomnia and SESA are at higher risk for developing ED. Clinical evaluation should be more thorough for these individuals. Insomnia can be treated simultaneously with psychological counseling to reduce the risk of ED. In addition, there is no evidence to suggest that worry and tension increase the risk of ED. [ABSTRACT FROM AUTHOR]

Context Although the nutritional composition of organic food has been thoroughly researched, there is a dearth of published data relating to its impact on human health. Objective This systematic review aimed to examine the association between organic food intake and health effects, including changes in in vivo biomarkers, disease prevalence, and functional changes. Data Sources PubMed, EMBASE, Web of Science, the Cochrane Library, and ClinicalTrials.gov were searched from inception through Nov 13, 2022. Data Extraction Both observational and interventional studies conducted in human populations were included, and association between level of organic food intake and each outcome was quantified as "no association," "inconsistent," "beneficial correlation/harmful correlation," or "insufficient". For outcomes with sufficient data reported by at least 3 studies, meta-analyses were conducted, using random-effects models to calculate standardized mean differences. Data Analysis Based on the included 23 observational and 27 interventional studies, the association between levels of organic food intake and (i) pesticide exposure biomarker was assessed as "beneficial correlation," (ii) toxic metals and carotenoids in the plasma was assessed as "no association," (iii) fatty acids in human milk was assessed as "insufficient," (iv) phenolics was assessed as "beneficial", and serum parameters and antioxidant status was assessed as "inconsistent". For diseases and functional changes, there was an overall "beneficial" association with organic food intake, and there were similar findings for obesity and body mass index. However, evidence for association of organic food intake with other single diseases was assessed as "insufficient" due to the limited number and extent of studies. Conclusion Organic food intake was found to have a beneficial impact in terms of reducing pesticide exposure, and the general effect on disease and functional changes (body mass index, male sperm quality) was appreciable. More long-term studies are required, especially for single diseases. Systematic Review Registration PROSPERO registration no. CRD42022350175. [ABSTRACT FROM AUTHOR]

Erectile dysfunction (ED) is a prevalent condition affecting over 150 million men worldwide. While there is a wealth of publications and research in the field of ED, there is a noticeable scarcity of bibliometric analyses of the literature on this topic. This study aims to analyze the scientific activity and research trends related to ED. We conducted a comprehensive search of the Scopus database to identify potentially relevant studies on ED published from 1841 to November 12, 2022. We used the primary keywords "erectile dysfunction" or "impotence" for the search. Several software tools were employed for data calculation and visualization. Analysis of variance (ANOVA) and linear correlation statistical test were used. The main outcomes of interest included the number of publications, year of publication, document type, country of origin, affiliated organizations, and journals of publication. Our search revealed a total of 30,634 publications with a cumulative 657,894 citations in the field of ED literature over the past 18 decades. "Original Article" emerged as the most common document type, accounting for 22,292 records. The United States stood out as the most prolific country, contributing 8809 publications (25% of the total). The University of California in the United States led in research output with 581 publications. Notably, the 'Journal of Sexual Medicine' was the leading publication source, with 1715 publications associated with it. Clinicians and experts in sexual medicine should take authorship trends into account when they review ED articles to improve patient care. A primary strength of our study is that it presents a comprehensive bibliometric review of ED reports spanning 18 decades. Results are limited to ED literature published in the sexual medicine journals and the urology analyzed. The publication volume on ED literature witnessed a substantial increase from 1975 to 2022. The findings from this bibliometric analysis provide valuable insights into research hotspots and emerging trends in the field of ED, which can aid researchers in gaining a better understanding of this topic. [ABSTRACT FROM AUTHOR]

AbstractObjectives: To evaluate whether the presence of sexual problems in men (i.e., erectile dysfunction, premature ejaculation, or delayed ejaculation) is associated with differential sexual behavior during masturbation and partnered sex. Methods: Cisgender participants (n = 2,807) completed an internet-based, cross-sectional questionnaire about sexual interest, behavior, and functioning. Results: Men with premature ejaculation were less likely to engage in foreplay-type behaviors, whereas men with erectile dysfunction or delayed ejaculation were more likely to include self-stimulation and/or other stimulation strategies during partnered sex. Conclusions: Different behavioral patterns among dysfunctional men represent potential strategies for modulating sexual arousal levels. [ABSTRACT FROM AUTHOR]

Introduction Objectives Materials and methods Results Discussion and conclusion Several robust epidemiological studies suggest that men are often engaged in sexual relationships with younger women with a variable, age‐dependent age difference. However, the ageing process determines a significant worsening of the andrological status, which favors the onset of erectile dysfunction and hypogonadism.To analyze the effects of differences in age between the partners [delta (Δ) age (M − F)] on patients referring to the Andrology Unit of Careggi University Hospital for male sexual dysfunction.A monocentre cohort of 4055 male subjects was evaluated by SIEDY structured interview. The cross‐sectional analysis assessed the psychobiological and relational correlates. The rate of forthcoming major cardiovascular events (MACE) was investigated in the longitudinal analysis. All the models have been adjusted for age, education, lifestyle, and chronic disease score.∆ age (M–F) shows a stepwise increase, according to the increasing age bands of the male partner. ∆ age (M–F) was associated with a greater number of children, at the cost of more conflictual relationships within the family. The phenotype of these relationships is characterized by the report of a partner with a higher sexual desire and a higher ability to reach climax. Men seeking a younger partner show more often a histrionic personality (p = 0.023) and higher testosterone levels (p = 0.032). However, having a younger partner doesn't improve the ability to obtain a full erection. Kaplan–Maier analysis of a longitudinal subgroup of patients followed longitudinally (N = 1402) for 4.3 ± 2,59 years, showed that patients in the fourth quartile had a higher rate of forthcoming MACE versus those in the first quartile (p = 0.005).In subjects with sexual dysfunctions (as in the general population) age‐different relationships increase as a function of male ageing. A greater Δ age (M–F) is associated with specific men and relationship features and a higher risk of MACE. [ABSTRACT FROM AUTHOR]

The mechanisms of adenosine and specific adenosine receptor subtypes in promoting penile rehabilitation remain unclear. Single‐cell RNA sequencing of human corpus cavernosum, adenosine deaminase (ADA) and adenosine receptors knock‐out mice (ADA−/−, A1−/−, A2a−/−, A2b−/−, and A3−/−), and primary corpus cavernosum smooth muscle cells are used to determine receptor subtypes responsible for adenosine‐induced erection. Three rat models are established to characterize refractory erectile dysfunction (ED): age‐related ED, bilateral cavernous nerve crush related ED (BCNC), and diabetes mellitus‐induced ED. In single‐cell RNA sequencing data, the corpus cavernosum of ED patients show a decrease in adenosine A1, A2a and A2b receptors. In vivo, A2b receptor knock‐out abolishes adenosine‐induced erection but not that of A1, A2a, or A3 receptor. Under hypoxic conditions in vitro, activating the A2b receptor increases HIF‐1α and decreases PDE5 expression. In refractory ED models, activating the A2b receptor with Bay 60–6583 improves erectile function and down‐regulates HIF‐1α and TGF‐β. Administering Dipyridamole (40 mg Kg−1) to BCNC rats improve penile adenosine levels and erectile function. Our study reveals that the A2b receptor mediates adenosine‐induced penile erection. Activating the A2b receptor promotes penile rehabilitation of refractory ED by alleviating hypoxia and fibrosis. [ABSTRACT FROM AUTHOR]

Background Objectives Materials and methods Results Conclusion Priapism is a urological condition characterized by a persistent erection. The management varies based on its subclassifications. Despite established clinical guidelines for ischemic priapism, there is a lack of large‐scale research focused on patient characteristics and management strategies.To analyze the contemporary management of ischemic priapism in the US, exploring patient demographics and clinical characteristics, as well as predictors of erectile dysfunction (ED) and penile prosthesis implantation (PPI).We performed a retrospective analysis of the PearlDiver Mariner database, reviewing records from 2010–2021. Adult males diagnosed with ischemic priapism were included. Data analysis covered demographic, clinical variables, and management strategies. Predictors of de novo ED and PPI were evaluated using multivariable logistic regression analysis.Of 36,120 patients, most (93%) received only medical management, and a minority underwent surgical interventions (penile shunt surgery [PSS], PPI or both). Medical management was typically effective, as 67.08% of the patients in this group experienced only one episode of priapism. However, de novo ED occurred in 16.57% of these patients. The majority of patients undergoing PPI had an inflatable prosthesis (81%). Older age (odds ratio, OR 1.02), the presence of metabolic diseases (OR 1.39), neurogenic disorders (OR 1.72), solid pelvic malignancies (OR 1.09), and multiple episodes of priapism were identified as significant predictors of de novo ED (all p < 0.05). Similarly, age (OR 1.03), the presence of metabolic diseases (OR 1.23), solid pelvic malignancies (OR 1.99), and multiple episodes of priapism were associated with higher likelihood of PPI (all p < 0.05).Most cases of ischemic priapism are managed with the medical therapy. Less than 3% of patients with ischemic priapism receive PPI, and when this occurs an inflatable prosthesis is favored. Age, specific comorbidities, and multiple episodes of priapism appear to be significant predictors of ED and PPI. [ABSTRACT FROM AUTHOR]

Objectives: Several systematic reviews and meta‐analyses have reported positive relationships between erectile dysfunction (ED) and periodontal disease. However, no study has evaluated the relationships of occlusal support status and the number of remaining teeth with ED. The aim of the present study was to investigate the relationships between ED and the remaining teeth number, periodontal disease, and occlusal support status. Methods: This study included 400 community‐dwelling men. Periodontal health status and occlusal support condition were evaluated using the Community Periodontal Index (CPI) and Eichner classification. Multivariable analyses were performed to evaluate the relationships between ED and the remaining teeth number, periodontal disease, and occlusal support status. Results: The median age was 53 years. Of the 400 men, 333 (83%) were classified into ED group. In univariable analyses, remaining teeth number, CPI score, and Eichner classification were significantly associated with ED. In multivariable analyses, the remaining teeth number (odds ratio [OR]: 0.907, p = 0.114) and CPI score (OR: 0.978, p = 0.864) were not significantly associated with ED, whereas the Eichner classification was independently and significantly associated with ED (OR: 3.490, p = 0.042). Conclusions: Poor occlusal support status was significantly associated with ED in community‐dwelling men, as opposed to remaining teeth number and periodontal health status. [ABSTRACT FROM AUTHOR]

Relationship obsessive compulsive disorder (ROCD) is a disabling presentation of obsessive compulsive disorder (OCD) that has recently received increased research attention. ROCD refers to obsessive preoccupation, doubts, and compulsive behaviors focusing on one's relationship and relationship partner's qualities and attributes). In this paper, we present ROCD through a case study, describe its phenomenology and evaluate the impact of ROCD symptoms on sexual functioning. We then describe processes that may underlie dysfunctional sexual behavior in ROCD drawing on cognitive-behavioral models of ROCD and contemporary theories of sexual response. Conceptual links between ROCD and related constructs to various propensities of sexual behavior are discussed and treatment suggestions are outlined. This paper describes the phenomenon of relationship obsessive compulsive disorder (ROCD), via a case description that presents the reader with the possible effect of ROCD on sexual functioning. We them suggest possible cognitive-behavioral mechanisms that might explain the association between ROCD and sexual dysfunction, and finally, outline several treatment implications. [ABSTRACT FROM AUTHOR]

Background: It is reported that treatment with anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) induces hypogonadism both in male patients with ALK‐positive cancer and in murine models. Methods: In this study, three groups, including an experimental group of male patients with ALK‐positive, advanced non–small cell lung cancer (ANSCLC) who were receiving alectinib (cohort A), a control group of female patients with ALK‐positive ANSCLC who were receiving alectinib (cohort B), and a control group of male patients with ALK‐negative ANSCLC (cohort C), prospectively underwent a full hormone assessment for androgen deficiency at 8 weeks after the start of treatment and in case of reported suspected symptoms. Patients with major sexual dysfunctions were referred to an endocrinologist. Results: Ninety‐five patients were consecutively enrolled onto the study. Among sixty‐eight male patients, both median total testosterone levels (2.93 vs. 4.92 ng/ml; p =.0001) and free testosterone levels (0.11 vs. 0.17 pg/ml; p =.0002) were significantly lower in ALK‐positive ANSCLC patients in cohort A compared with ALK‐negative patients in cohort C; conversely, median FSH (10.32 vs. 17.52 mUI/ml; p =.0059) and LH levels (4.72 vs. 7.49 mUI/ml; p =.0131) were significantly higher in cohort C compared to cohort A. Median inhibin B levels were higher in ALK‐positive male patients (74.3 vs. 44.24 pg/ml; p =.0038), but all patients had inhibin B values within the normal range. The percentage of male patients who had positive scores on the Androgen Deficiency in Aging Males (ADAM) questionnaire was 62% in cohort A and 26.8% in cohort C, including eight patients who reported at least one major symptom and were referred to Andrology Unit. No significant differences in the endocrine assessment were reported between cohorts A and B. Conclusions: Symptoms of androgen deficiency should be tracked in male patients with ALK‐positive ANSCLC who are receiving alectinib, and testosterone replacement should be considered, as appropriate. Male patients with ALK‐positive advanced non–small cell lung cancer treated with first‐line alectinib had lower median total testosterone (p =.0001) and free testosterone (p =.0002) levels compared with male patients who had ALK‐negative disease and were receiving other anticancer treatments. Symptoms of hypogonadism were more frequent in ALK‐positive patients compared with ALK‐negative patients (62% vs 26.8% rates of positive score at ADAM questionnaire, respectively), suggesting the need for hormone assessment and referral to an andrologist, as appropriate. [ABSTRACT FROM AUTHOR]

To assess surgical success and patient-reported outcomes of perineal urethrostomy via midline approach. Charts of patients undergoing primary perineal urethrostomy between May 2008 and June 2022 were reviewed. Background characteristics were assessed; success was defined as freedom from re-intervention. Patient-reported outcome measures were assessed using a cross-sectional phone survey. Several validated questionnaires were used to assess lower urinary tract symptoms, quality of life, and erectile dysfunction. Among 1768 urethroplasties performed over the study period, 103 patients (5.8%) underwent midline perineal urethrostomy. Surgery was successful in 95.1% of cases (98/103); 5 patients (4.9%) required re-intervention at a median of 8.7 months. Post-operative complications occurred in 5.8% of cases (6/103) and were both mild and self-limited. Forty-nine patients (47.6%) were reached via phone survey at a median of 61 months post-operatively. Some questions were not answered by all patients. Most patients (42/49, 86%) were satisfied or very satisfied with surgical results, and 82% (40/49) reported an improvement in their overall health. Most patients (31/41, 76%) were unbothered by sitting to urinate. Although 20% of patients (10/49) reported post-operative urinary symptoms that interfered "a lot" with their daily life, only 3 (6%) of these patients reported dissatisfaction with the outcome. Regarding sexual function, 64% (27/42) reported indifference to or increased satisfaction with sexual encounters vs before surgery. The rate of de novo erectile dysfunction was 24% (12/49). The midline approach to perineal urethrostomy provides excellent, durable success rates with high levels of patient satisfaction. [ABSTRACT FROM AUTHOR]

Male infertility arises from a complex interplay of factors affecting reproductive organs and various physiological pathways. Among these, erectile dysfunction (ED), a widespread global issue, plays a key role. While existing ED treatments address some aspects, achieving complete reversibility and avoiding side effects remains a challenge. In this context, stem cell therapy emerges as a promising, potentially transformative approach. Preliminary evidence from preclinical animal models and clinical trials highlights stem cell therapy's remarkable efficacy and effectiveness for ED. This novel strategy offers several advantages, including enhanced effectiveness and a reported absence of adverse side effects. This review delves into the causes of male infertility, with a particular focus on ED and its pathophysiology. We explore the current treatment landscape, highlighting therapy's existing strategies' limitations and stem cell therapy's unique potential. By examining relevant preclinical and clinical studies, we provide a comprehensive picture of this innovative approach and its promising future in restoring men's fertility and quality of life. [ABSTRACT FROM AUTHOR]

Background: The mechanism by which a state of low testosterone leads to erectile dysfunction (ED) has not been determined. Endocan is a novel marker of endothelial function. However, whether endocan is involved in the regulation of erectile function under low testosterone levels remains unclear. Aim: In this study we sought to determine whether a low-testosterone state inhibits erectile function by regulating endocan expression in the endothelial cells of the rat penile corpus cavernosum. Methods: Thirty-six male Sprague–Dawley rats aged 8 weeks were randomly assigned to 6 groups (n = 6 per group) as follows: (1) control, (2) castration, (3) castration + testosterone treatment (treated with 3 mg/kg testosterone propionate per 2 days), (4) control + transfection (4 weeks after castration, injected with lentiviral vector (1 × 108 transduction units/mL, 10 μL), (5) castration + transfection, or (6) castration + empty transfection. One week after the injection, we measured the maximal intracavernous pressure/mean arterial pressure (ICPmax/MAP), serum testosterone and nitric oxide (NO) levels, and the expression of endocan, phospho–endothelial NO synthase (p-eNOS), eNOS, phospho–protein kinase B (p-AKT), and AKT in the rat penile corpus cavernosum. Outcomes: Under a low-androgen state, the expression of endocan in the rat penile corpus cavernosum was significantly increased, which inhibited the AKT/eNOS/NO signaling pathway and resulted in ED. Results: In the castration group, the expression of endocan in the rat penile corpus cavernosum was significantly higher than that in the control group (P < .05). Additionally, the levels of p-AKT/AKT, p-eNOS/eNOS, and NO in the rat penile corpus cavernosum and ICPmax/MAP were significantly lower in the castration group than in the control group (P < .05). In the castration + transfection group compared with the castration group there was a significant decrease in the expression of endocan (P < .05) and an increase in the ratios of p-AKT/AKT, p-eNOS/eNOS, and ICPmax/MAP (P < .05) in the rat penile corpus cavernosum. Clinical implications: Downregulating the expression of endocan in the penile corpus cavernosum may be a feasible approach for treating ED caused by hypoandrogenism. Strengths and limitations: The results of this study indicte that endocan may affect NO levels and erectile function through multiple signaling pathways, but further experiments are needed to clarify the relationship between endocan and androgens. Conclusion: A low-testosterone state inhibits the AKT/eNOS/NO signaling pathway by increasing the expression of endocan in the rat penile corpus cavernosum and impairing erectile function in rats. Decreasing the expression of endocan in the penile corpus cavernosum can improve erectile function in rats with low testosterone levels. [ABSTRACT FROM AUTHOR]

Vardenafil hydrochloride tablet is an inhibitor of phosphodiesterase type 5, primarily for the treatment of erectile dysfunction. This postprandial study evaluated the pharmacokinetics and bioequivalence of the test and reference formulations of vardenafil hydrochloride tablets in healthy Chinese volunteers. An open, randomized, single‐center, single‐dose, 2‐period, 2‐sequence bioequivalence test was conducted on 66 healthy subjects under fed conditions. Subjects were randomly assigned to a 20‐mg test or reference formulation with a 7‐day washout period. Venous blood samples (4 mL) were collected from each subject 25 times spanning predose (0 hour) to 24 hours after dosing. The plasma concentration of vardenafil was determined by high‐performance liquid chromatography‐tandem mass spectrometry. Sixty‐two volunteers completed the study. Under fed conditions, the maximum plasma concentration was 29.1 ng/mL, the area under the concentration–time curve (AUC) from time 0 to the time of the last measurable concentration was 85.3 ng•h/mL, and AUC from time 0 to infinity was 87.1 ng•h/mL. The 90% confidence intervals of the geometric mean ratio of AUC time 0 to the time of the last measurable concentration and AUC from time 0 to infinity were within the bioequivalence acceptance range of 0.80‐1.25. The test formulation was a bioequivalent alternative to the reference formulation when taken under fed conditions in healthy Chinese subjects. [ABSTRACT FROM AUTHOR]