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Context: Erectile dysfunction (ED) is associated with an increased risk of cardiovascular morbidity and mortality., Objective: To systematically review and analyze the cardiac structure and function in men with ED assessed with echocardiography., Evidence Acquisition: We performed a systematic review and meta-analysis according to the guideline of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. We searched PubMed and the Cochrane Library on June 2, 2022, and included studies evaluating cardiac structure and function using echocardiography in men with ED compared with controls without ED. The Newcastle-Ottawa Quality Assessment Scale was used for assessing the quality of studies. We analyzed the mean differences in left ventricular ejection fraction (LVEF), the ratio of early transmitral filling velocity to early diastolic mitral annular velocity (E/e'), ratio of the early to late diastolic transmitral flow velocity (E/A), isovolumic relaxation time (IVRT), and left ventricular mass index (LVMi) in a random-effect model computed using means and standard deviations. The review was preregistered with PROSPERO (CRD42022337183). We received no funding., Evidence Synthesis: We included ten studies with 763 men diagnosed with ED (mean age: 55.6 yr) and 358 control men (mean age: 54.4 yr). E/e' was significantly worse in men with ED than in controls (mean absolute difference = 1.17, 95% confidence interval or CI [0.68, 1.65], p < 0.005). No significant differences were observed in LVEF, E/A, IVRT, or LVMi (-0.06, 95% CI [-1.06, 0.95], p = 0.91; -0.06, 95% CI [-0.24, 0.13], p = 0.55; 11.76, 95% CI [-0.88, 24.39], p = 0.07; and 4.37, 95% CI [-2.91, 11.65], respectively). The studies exhibited heterogeneity regarding study populations, reported echocardiography data, and variations in adjustments for confounding factors., Conclusions: Left ventricle diastolic dysfunction, as assessed by E/e', was more frequent in men with ED than in matched controls without ED. The results imply that echocardiography may be useful in the cardiovascular evaluation of men with ED to help identify myocardial impairment., Patient Summary: This study reviewed for the first time previous research on cardiac structure and function in men with erectile dysfunction (ED), as assessed by echocardiography. We found that men with ED, compared with men without ED, had a higher ratio of early transmitral filling velocity to early diastolic mitral annular velocity , indicating a potentially higher rate of impaired diastolic function-a potential early indicator of heart disease. Identification of early signs of heart problems in men with ED may help initiate necessary lifestyle modifications or preventative therapies before the development of heart disease. However, more research is required to determine the clinical utility of using echocardiography as a risk assessment method., (Copyright © 2023. Published by Elsevier B.V.)

Men with spinal cord injuries often suffer from erectile dysfunction, ejaculatory dysfunction, infertility and hypogonadism. However, efficient and safe treatments exist as summarised in this review. Erectile dysfunction can be treated step by step with phosphodiesterase 5 inhibitors, intracavernous injections and penile implant surgery. Ejaculatory dysfunction can in almost all cases be treated by using penile vibratory stimulation and electroejaculation. Surgical sperm retrieval can be used as a last resort. These patients have a high prevalence of hypogonadism, and testosterone replacement therapy can be used to alleviate symptoms of low testosterone levels.

Objective: Erectile dysfunction (ED) is common following radical prostatectomies, and phosphodiesterase type 5 inhibitors (PDE5 inhibitors) are generally considered the first choice of treatment. The purpose of this study was to analyze the long-term efficacy of PDE5 inhibitors in a group of men who did not achieve sufficient erectile function from the medication in the short term following surgery., Materials and Methods: Prospectively collected data from patients with postprostatectomy ED, initial failure of PDE5-inhibitor treatment at 3 and/or 6 months and at least 12 months' follow-up were included. All patients had completed the International Index of Erectile Function short-form questionnaires (IIEF-5) before surgery and at follow-up visits. Response to PDE5 inhibitors was defined as an IIEF-5 score of at least 17., Results: The inclusion criteria were fulfilled by 349 patients. At 12 months, 228 patients were still using PDE5 inhibitors. Of these patients, 92 had undergone bilateral and 120 had undergone unilateral nerve-sparing radical prostatectomies. Overall, 42 PDE5-inhibitor users (18%) were responders at 12 months. Bilateral nerve sparing was the only independent predictor of a late response (odds ratio = 2.9). Thus, 28% of bilaterally nerve-spared patients were responders, while corresponding numbers for unilaterally nerve-spared patients and non-nerve-spared patients were 13% and 6%, respectively., Conclusions: Patients who have undergone bilateral nerve-sparing radical prostatectomy should be rechallenged periodically with PDE5 inhibitors even if the treatment is unsuccessful initially. Unilaterally nerve-spared patients and especially non-nerve-spared patients are likely to need more aggressive treatment.

Introduction: Changes in sexual function other than erectile dysfunction are sparsely investigated after radiation therapy for prostate cancer., Aim: To investigate orgasmic dysfunction, urinary incontinence during sexual activity, changes in penile morphology, and sensory disturbances in the penis in patients with prostate cancer treated with external-beam radiation therapy (EBRT)., Methods: In February 2015, men treated with EBRT at our center 3 months to 5 years previously (N = 519) received a study-specific questionnaire. This was developed from purpose-built questions and validated tools including the Erection Hardness Scale. All patients had received a radiation dose of 78 Gy. Androgen deprivation therapy was administered according to disease characteristics., Main Outcome Measures: Outcome measurements were prevalence rates and predictors of these side effects as identified by multivariate logistic regression analyses., Results: One hundred nine patients were eligible (sexually active and had completed androgen deprivation therapy) for inclusion. Twenty-four percent reported anorgasmia, 44% reported a decreased intensity of their orgasms, and 40% reported that the time it took to reach orgasm had increased. Eleven percent reported anejaculation. Fifteen percent reported orgasm-associated pain. Only 4% reported urinary incontinence during sexual activity. Subjective penile length loss in excess of 1 cm was reported by 42%. Twelve percent reported an altered curvature of their penis after EBRT. Six percent reported painful erections. Twenty-seven percent reported decreased sensitivity in the penis after EBRT, 2% reported a cold sensation, and 2% reported paresthesia. Increasing time since final treatment increased the risk of penile sensory disturbances (odds ratio = 1.05; P = .028)., Conclusion: Orgasmic dysfunction, changes in penile morphology, and sensory disturbances in the penis are common side effects of ERBT. Patients should be properly informed of the occurrence of these side effects before deciding which treatment to pursue. Frey A, Pedersen C, Lindberg H, et al. Prevalence and Predicting Factors for Commonly Neglected Sexual Side Effects to External-Beam Radiation Therapy for Prostate Cancer. J Sex Med 2017;14:558-565., (Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to assess postprostatectomy erectile function compared to preoperative status by subjective patient perception and the abbreviated International Index of Erectile Function (IIEF-5) questionnaire., Materials and Methods: The study used data from a prospectively collected database and a cross-sectional, questionnaire-based study in patients following radical prostatectomy. Erectile function was assessed with the IIEF-5 and the question "Is your erectile function as good as before the surgery (yes/no)". Patients were included if they were sexually active before surgery and had at least 1 year of follow-up. The main outcome measure was the proportion of patients returning to self-perceived baseline erectile function. Secondary outcome measures included the proportion of patients returning to baseline erectile function according to the IIEF-5 and predictors of return to baseline function., Results: Questionnaires from 210 patients were available. Overall, 14 patients (6.7%) reported that their erections were as good as before surgery. Bilateral nerve-sparing was the only significant predictor of a return to baseline erectile function (p = 0.004). Forty-three patients (20.5%), who did not report use of erectile aids, showed no decline in IIEF-5 score. When including patients who used erectogenic aids, 69 (32.9%) maintained their preoperative IIEF-5 score. On multivariate analysis a low preoperative IIEF-5 score was a significant predictor of return to baseline IIEF-5 score (p < 0.0001)., Conclusions: Return to subjective baseline erectile function following radical prostatectomy is rare. The IIEF-5 questionnaire may not adequately reflect patients' experience. This should be considered in preoperative patient counselling.

Objective: The objective was to investigate the effect and feasibility of low-intensity extracorporeal shockwave therapy (LI-ESWT) as a treatment for erectile dysfunction (ED) after bilateral nerve-sparing radical prostatectomy (RP)., Materials and Methods: Patients who had undergone robot-assisted bilateral nerve-sparing RP more than a year before entering this pilot study, had no preoperative ED and were suffering from mild to severe postoperative ED were invited to participate. Six treatments were given over a 6 week period, using the Duolith® SD1 T-Top machine. The effect of the treatment was evaluated 1 month (t1) and 1 year (t2) after the final treatment. The main outcome measure was changes in the five-item International Index of Erectile Function (IIEF-5) scores., Results: Eighteen patients were included in the study. However, two patients breached the protocol and consequently 16 patients were included in the analysis at t1 and 15 patients were included in the analysis at t2. At baseline the median age was 62 years (range 51 to 70 years) and the median time since surgery was 24 months (range 12 to 54 months). The median preoperative IIEF-5 score was 25 (range 22 to 25) and the median baseline IIEF-5 score was 9.5 (range 5 to 20). The median change in IIEF-5 scores was +3.5 (range -1 to 8; p = 0.0049) and +1 (range -3 to 14; p = 0.046) at t1 and t2, respectively. No severe side-effects were reported., Conclusions: LI-ESWT may improve erectile function after bilateral nerve-sparing RP. Based on these results, further studies in patients with ED after nerve-sparing RP are justified.

When other treatments fail, penile implants represent the last treatment option in erectile dysfunction. The most commonly used implant is the inflatable three-piece device, which allows the penis to be rigid for sexual intercourse and flaccid during the remaining time. Earlier penile implants were associated with high rates of infection and mechanical malfunction. However, technical improvements have greatly reduced these problems. This has resulted in a patient satisfaction rate of 80-90% in most studies. Thus, penile implants are a valid option in motivated patients with erectile dysfunction.

Introduction: Altered perception of orgasm, orgasm-associated pain, penile sensory changes, urinary incontinence (UI) during sexual activity, penile shortening (PS), and penile deformity following radical prostatectomy (RP) have received increasing attention from researchers., Aim: The aim of this study is to describe the prevalence and predictors of the above-mentioned side effects., Methods: This was a cross-sectional questionnaire-based study among men who had undergone RP between 3 and 36 months prior to study inclusion. Predicting factors were identified through logistic regression analyses., Main Outcome Measures: The primary outcome measures were prevalence rates of the above-mentioned side effects., Results: Overall, 316 questionnaires were available for analyses. Of the sexually active patients (n = 256), 12 (5%) reported anorgasmia, whereas 153 (60%) reported decreased orgasm intensity. Delayed orgasms were reported by 146 (57%). Twenty-three patients (10%) had experienced pain during orgasm. UI during sexual activity were reported by 99 patients (38%). Out of the whole population, 77 patients (25%) reported sensory changes in the penis. A total of 143 patients (47%) reported a subjective loss of penile length of >1 cm. An altered curvature of the penis was reported by 30 patients (10%). Patients had increasing risk of UI during sexual activity (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.10-1.25) and orgasmic dysfunction (OR 1.09; 95% CI 1.01-1.16) with increasing International Consultation on Incontinence Questionnaire scores. Erectile dysfunction (OR 1.81; 95% CI 1.07-3.10) and a high body mass index (OR 1.10; 95% CI 1.02-1.19) increased the risk of PS after RP. Nerve-sparing (OR 0.32; 95% CI 0.16-0.95) reduced the risk of PS., Conclusions: Orgasm-associated problems, UI during sexual activity, penile sensory changes, PS, and penile deformity are common side effects to RP. Daytime UI, erectile dysfunction, and nerve-sparing status can help identify patients at risk., (© 2014 International Society for Sexual Medicine.)

Objective: To examine the effect of penile vibratory stimulation (PVS) in the preservation and restoration of erectile function and urinary continence in conjunction with nerve-sparing radical prostatectomy (RP)., Patients and Methods: The present study was conducted between July 2010 and March 2013 as a randomized prospective trial at two university hospitals. Eligible participants were continent men with an International Index of Erectile Function-5 (IIEF-5) score of at least 18, scheduled to undergo nerve-sparing RP. Patients were randomized to a PVS group or a control group. Patients in the PVS group were instructed in using a PVS device (FERTI CARE(®) vibrator). Stimulation was performed at the frenulum once daily by the patients in their own homes for at least 1 week before surgery. After catheter removal, daily PVS was re-initiated for a period of 6 weeks. Participants were evaluated at 3, 6 and 12 months after surgery with the IIEF-5 questionnaire and questions regarding urinary bother. Patients using up to one pad daily for security reasons only were considered continent. The study was registered at http://clinicaltrials.gov/ (NCT01067261)., Results: Data from 68 patients were available for analyses (30 patients randomized to PVS and 38 patients randomized to the control group). The IIEF-5 score was highest in the PVS group at all time points after surgery with a median score of 18 vs 7.5 in the control group at 12 months (P = 0.09), but the difference only reached borderline significance. At 12 months, 16/30 (53%) patients in the PVS group had reached an IIEF-5 score of at least 18, while this was the case for 12/38 (32%) patients in the control group (P = 0.07). There were no significant differences in the proportions of continent patients between groups at 3, 6 or 12 months. At 12 months 90% of the PVS patients were continent, while 94.7% of the control patients were continent (P = 0.46)., Conclusion: The present study did not document a significant effect of PVS. However, the method proved to be acceptable for most patients and there was a trend towards better erectile function with PVS. More studies are needed to explore this possible effect further., (© 2013 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.)

Several population-based studies have described a link between erectile dysfunction (ED) and cardiovascular disease. In addition, ED has been found to precede serious cardiovascular disease with 3-5 years. The most likely pathofysiological mechanisms include atherosclerosis and endothelial dysfunction, which result in ED before they cause disease in the remaining cardiovascular system. The link between ED and subsequent cardiovascular disease permits physicians to perform opportunistic screening and initiate secondary prophylaxis with regard to cardiovascular risk factors in men with ED.

Penile rehabilitation programmes aim to improve long-term sexual function after nerve-sparing radical prostatectomy. Programmes aim to improve cavernous oxygenation to avoid structural damage in penile tissue. Especially, daily use of phosphodiesterase type 5 (PDE5) inhibitors has been studied. The method is effective in animal models, but the results cannot be confirmed in humans. At this time, treatment regimens which actually create erections and allow for sexual intercourse following surgery should be prescribed. These include PDE5 inhibitors, vacuum erection devices, injection therapy, urethral suppositories and penile implants.

Objective: The aim of this study was to assess complication rates and patient satisfaction with Coloplast Titan® one-touch release (OTR) inflatable penile implants inserted at one university hospital centre between November 2008 and April 2011., Material and Methods: Overall, 33 patients with organic erectile dysfunction underwent penile implant surgery during the study period. The Titan OTR inflatable penile implants were inserted using a penoscrotal approach. Patient and partner satisfaction was assessed with the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire., Results: One implant was removed because of infection, and three patients underwent revision surgery due to problems with autoinflation, deflation, and a displaced reservoir, respectively. In all cases the problems were solved and the implants were salvaged. Further complications included one patient with haematoma and sustained scrotal pain, one patient with meatal stenosis, and four patients with infections not related to the implant. In total, 30 EDITS questionnaires were administered and 26 (87%) were completed. Twenty-two patients (85%) reported being satisfied with the implant and two (8%) were dissatisfied. Twenty-four patients (92%) would recommend a penile implant to someone with a similar medical condition. Eighteen patients (72%) believed that their partner was satisfied with the implant. Nineteen patients (76%) felt that the process of achieving an erection with the implant was natural., Conclusion: Although it is important to inform patients about potential problems such as infection, pain and mechanical failure, the results show that inflatable penile implants are a good treatment choice for erectile dysfunction when conservative measures have failed.

The pathophysiology of erectile dysfunction after radical prostatectomy (RP) is believed to include neuropraxia, which leads to temporarily reduced oxygenation and subsequent structural changes in penile tissue. This results in veno-occlusive dysfunction, therefore, penile rehabilitation programmes focus on tissue oxygenation. Animal studies support the use of phosphodiesterase type 5 inhibitors (PDE5Is) after cavernous nerve damage but results from human studies are contradictory. The largest study to date found no long-term effect of either daily or on-demand PDE5I administration after RP compared with placebo. The effects of prostaglandin and vacuum erection devices are questionable and high-quality studies are lacking. Better documentation for current penile rehabilitation and/or better rehabilitation protocols are needed. One must be careful not to repeat the statement that penile rehabilitation improves erectile function after RP so many times that it becomes a truth even without the proper scientific backing., (© 2013 The Authors. BJU International © 2013 BJU International.)

A spinal cord lesion (SCL) changes most functions below the level of lesion, including sexual function. Most women had sexual intercourse after the lesion, but describe practical problems. Many of them are capable of achieving organism, and are normally fertile. During pregnancy there is an increased risk of urinary tract infection. Delivery can take place vaginally. In the case of lack of progression or severe autonomic dysreflexia, cesarean section may be necessary. For erectile dysfunction in men with SCL, oral sildenafil may be used, alternatively intracavernous injection with prostaglandin E1. To obtain ejaculation penile vibratory stimulation (PVS) is used, and if this fails then electroejaculation. Impaired sperm quality with low motility is observed. Vaginal insemination at home with sperm obtained by PVS is possible. The fertility potential may be enhanced with assisted reproduction techniques, like intrauterine insemination and in vitro fertilisation.

Objective. The aim of this study was to compare oncological and functional outcomes between robot-assisted laparoscopic radical prostatectomy (RALP) and retropubic radical prostatectomy (RRP) during the initial phase with RALP at a large university hospital. Material and methods. Patient and tumour characteristics, surgeon, nerve sparing, surgical margins and blood loss were recorded prospectively in patients who underwent RRP or RALP between April 2008 and May 2012. Patients filled out the Danish Prostate Symptom Score (DAN-PSS) and International Index of Erectile Function 5 (IIEF-5) questionnaires before surgery and at follow-up and they were asked to report their use of pads/diapers. Potency was defined as an IIEF-5 score of at least 17 with or without phosphodiesterase-5 inhibitors. Patients using up to one pad daily for security reasons only were considered continent. Positive surgical margins, blood loss and functional outcomes were compared between groups. Results. Overall, 453 patients were treated with RRP and 585 with RALP. On multivariate logistic regression analyses, the type of surgery did not affect surgical margins ( p = 0.96) or potency at 12 months ( p = 0.7). Patients who had undergone RRP had an increased chance of reporting subjective continence at 12 months (odds ratio 2.6, p = 0.014). There was no difference in the proportion of RRP and RALP patients who underwent surgical treatment for incontinence ( p = 0.57). On multivariate linear regression analysis, RALP was an independent predictor of a low perioperative blood loss (RRP:RALP ratio = 2.89, p < 0.0001). Conclusions. RALP is a safe procedure with regard to perioperative and oncological results. However, it is important to be aware that functional outcomes may be compromised in the initial phase when introducing RALP. [ABSTRACT FROM AUTHOR]