scholarly journals Study of the Efficiency of Using Type 5 Phosphodiesterase Inhibitors in the Therapy of Ereсtile Dysfunction in Patients with Metabolic Syndrome

Health of Man ◽  
2021 ◽  
pp. 58-69
Author(s):  
Yurii Gurzhenko
Keyword(s):  
Metabolic Syndrome ◽  
Blood Flow ◽  
Erectile Dysfunction ◽  
Erectile Function ◽  
Metabolic Disorders ◽  
Phosphodiesterase Inhibitors ◽  
Blood Flow Rate ◽  
Free Testosterone ◽  
Sexual Relations ◽  
Significant Difference

Metabolic syndrome is a symptom complex that combines abdominal obesity, insulin resistance, hyperglycemia, dyslipidemia and arterial hypertension. One of the complications of metabolic syndrome is sexual dysfunction in men. The objective: is to evaluate the efficacy and tolerability of udenafil 200 mg in the treatment of erectile dysfunction in patients with metabolic syndrome. Materials and methods. The clinical efficacy of the IV generation PDE-5 inhibitor medicine udenafil in 76 patients with erectile dysfunction of mixed origin and with metabolic syndrome in dynamics was studied. The average age was 51,6±8,2 years. The observation period was 12 weeks, but the control of metabolic syndrome parameters (anthropometry, review, biochemical blood tests) and the assessment of erectile function were carried out for 6 months. Results. After 12 weeks, patients achieved positive results in weight loss, BMI and waist circumference, although not significantly. It is necessary to note the positive changes in the indicators of the cardiovascular system. The downward trend was demonstrated by such indicators as heart. Diet therapy and taking statins have improved the indicators of fat metabolism. Correction of metabolic disorders in patients was accompanied by an increase in total and free testosterone. However, there was no statistically significant difference in the degree of increase in the concentration of androgens. Correction of metabolic disorders in patients was accompanied by an increase in total and free testosterone. During treatment, almost all integrative indices of IIEF increased. Specifically, the index «erectile function» improved 2,26 times (p<0,01), «satisfaction with intercourse» 2,59 times (p<0,001), «orgasm» 2,0 times (p<0,01), «libido» – 2,9 times (p<0,001), «general satisfaction» 2,3 times (p<0,01). According to various indicators, the sexual function of men with metabolic syndrome and erectile dysfunction improved 2–2,9 times. Changes in cavernous blood flow on Doppler ultrasonography showed an increase in peak systolic blood flow rate by 1,5 times, which is associated with the udenafil half-life. Our data indicate that the use of the medicine udenafil is perspective in men with erectile dysfunction and metabolic syndrome and in those who do not have stable family-sexual relations to ensure spontaneity of sexual relations. Conclusions. Udenafil can be considered as a first-line medecine in the treatment of erectile dysfunction in patients with metabolic syndrome.

scholarly journals Low intensity Extra Corporeal Shock Wave Therapy in Patients with Erectile Dysfunction: Our experience in ACKU

2020 ◽  
Vol 23 (2) ◽  
pp. 176-180
Author(s):  
Md Fazal Naser ◽  
Mahmood Hasan ◽  
Md Waliul Islam ◽  
Tajkera Sultana Chowdhury ◽  
Md Shohrab Hossain
Keyword(s):  
Erectile Dysfunction ◽  
Erectile Function ◽  
Treatment Protocol ◽  
Phosphodiesterase Inhibitors ◽  
Shockwave Therapy ◽  
Low Intensity ◽  
Weekly Session ◽  
Linear Probe ◽  
Study Population ◽  
Energy Flux Density

Introduction: Oral 5-phosphodiesterase inhibitors (PDE5-I) is the main therapeutical options in erectile dysfunction (ED). It shows good results, but non-responders lack other effective options and its effect is also not long lasting. Since last few years, low-intensity extracorporeal shockwave therapy (Li-ESWT) in the corpora cavernosa showing promising results. This article presents our early experiences in Advanced Center of Kidney disease and Urology (ACKU) with the aim to evaluate clinical efficacy of Li-ESWT. Materials and methods: Thirty four patients with ED were prospectively included in the study during the period of January 2018 to Jun 2019.Treatment was performed using the PiezoWave2 (Richard Wolf, Germany) device with a linear probe. Treatment protocol included a weekly session for four weeks. Each session delivered 2000 shocks on the perineum plus 4000 shocks on dorsum penis with an energy flux density (EFD) of 0.160 mJ/mm2. Every patient has been re-evaluated 1.5 and 3 months after the last session. Pre- and post-procedure International Index Erectile Function – Erectile function domain (IIEF-EF) score, Erection Hardness Score (EHS) and Global Assessment Questionnaire-Question 1 (GAQ-Q1) answers were obtained. Results: Mean age of the study population was 39.4 (±12.9) years, 35.29% diabetic, 20.59% with hypertension and 55.85% smokers. Mean baseline IIEF-EF was 14.6, at 6 week post LiSWT was 16.4 (p >0.05) and at 3 months post LiSWT was 19.2 (p < 0.05). EHS was significantly improved at 3 month in comparison to baseline (p<0.05). 20.59% patients answered positively to GAQ-Q1 at 6 week and 61.76% at 3 months. IIEF-EF score change of >5 and increase of EHS >2 were observed in 62.88% and 70.59% study subjects respectively. Conclusions: Li-ESWT is a safe, harmless and repeatable treatment tool for ED with good outcomes reported. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.176-180

Combination Therapy Of Tadalafil And Pentoxifylline In Severe Erectile Dysfunction; A Prospective Randomized Trial

2015 ◽  
Vol 87 (8) ◽  
Author(s):  
Santosh Kumar ◽  
Rajesh Roat ◽  
Swati Agrawal ◽  
Kumar Jayant ◽  
Ravimohan S. Mavuduru ◽  
...  
Keyword(s):  
Erectile Dysfunction ◽  
Combination Therapy ◽  
Erectile Function ◽  
T Test ◽  
P Value ◽  
Chi Square ◽  
Significant Difference ◽  
Chi Square Test ◽  
Group A ◽  
Group B

Abstractwas to assess efficacy of Tadalafil alone versus Tadalafil plus Pentoxifylline in the treatment of erectile dysfunction by using self administered IIEF-5 questionnaire.Two hundred and thirty seven patients presenting with ED at andrology OPD were evaluated for ED by a self administered IIEF (International Index of Erectile Function) questionnaire. Patients were systematically randomized by computer generated random table into two groups groups namely, group A: Tadalafil only group, group B: combination of Tadalafil + Pentoxifyl-line. All the patients were re-assessed by IIEF-5 questionnaire after 8 weeks of medical therapy. Statistical analysis was performed using student’s unpaired t-test, paired t-test, chi square test. p-value < 0.05 was considered statistically significant.Two hundred and thirty seven patients were included in the present study, in group A: 92 patients (78.6%) showed improvement in their IIEF score after 8 weeks of tadalafil treatment. While in group B, overall 104 patients(86.6%) showed improvement after combination of Tadalafil and Pentoxifylline. There was a statistically significant difference of percentage change in IIEF score was seen in group B (group A 90.7±15.2%, group B 95.6±13.4%; p value – 0.014). We found this difference even more statistically significant in patients with severe ED (group A 72.7±47.2%, group B 132.3±54.3%; p value – 0.000). There was no significant difference in between the two groups with regards to occur-rence of side effects.Both tadalafil and combination of Tadalafil + Pentoxifylline improve erectile function in patients of ED. Patients with severe ED showed much significant improvement in erectile function with combination therapy.

Penile fracture and investigation of early surgical repair effects on erectile dysfunction

2019 ◽  
Vol 86 (4) ◽  
pp. 207-210
Author(s):  
Bulent Kati ◽  
Yigit Akin ◽  
Mehmet Demir ◽  
Omer Faruk Boran ◽  
Kemal Gumus ◽  
...  
Keyword(s):  
Erectile Dysfunction ◽  
Erectile Function ◽  
Surgical Repair ◽  
Urethral Injury ◽  
Penile Curvature ◽  
Penile Fracture ◽  
Direct Trauma ◽  
Significant Difference ◽  
The Mean ◽  
Erect Penis

Objectives: Penile fracture is one of the urological emergencies caused by direct trauma to an erect penis during sexual intercourse, which results in a tear in the tunica albuginea within the corpus cavernosum. Serious complications such as penile curvature and erectile dysfunction may develop due to inappropriate and/or late surgical repair. This study aims to evaluate patients with penile fracture and to describe their demographics, surgical repairs, and long-term outcomes. Materials and Methods: A total of 56 patients who were diagnosed with penile fracture between January 2012 and June 2017 were reviewed. Clinical features, pre-operative assessment, time from injury to surgery, tunica defect properties, and presence of urethral injury were assessed. Early surgical management was performed. Outcomes, including International Index of Erectile Function 5 pre-operation and after 6 months, were evaluated. Results: The mean age was 30.2 (18–57) years. In etiological questionnaires, 32 (57.2%) patients reported direct trauma to an erect penis during intercourse. The mean size of tunica defects was 1.61 ± 0.42 (0.3–3.6) cm of the nine (16%) patients, and penile fracture was associated with urethral injury. There was no significant difference in International Index of Erectile Function 5 scores before the surgery and 6 months after surgery. Penile skin necrosis developed in one patient 10 days post-operation. Conclusion: Early surgical repair could be an effective method of achieving post-operative erection success in patients with penile fracture due to direct trauma during intercourse.

scholarly journals Penile Low-Intensity Shock Wave Therapy for Erectile Dysfunction: Personal Experience

2016 ◽  
Vol 9 (1) ◽  
pp. 156-156
Author(s):  
P. Letizia ◽  
◽  
G. Alei ◽  
A. Rossi ◽  
F. De Marco ◽  
...  
Keyword(s):  
Shock Wave ◽  
Blood Flow ◽  
Erectile Dysfunction ◽  
Shock Waves ◽  
Endothelial Function ◽  
Erectile Function ◽  
Power Doppler ◽  
Shock Wave Therapy ◽  
Low Intensity ◽  
Intracavernosal Injections

Objective: Penile extracorporeal low-intensity shock wave therapy (LIST) to the penis has recently emerged as a novel and promising modality in the treatment of erectile dysfunction. LIST can improve penile blood flow and endothelial function by stimulating angiogenesis in the penis. Design and Method: We applied LIST to patients with mild to moderate vasculogenic ED who responded well to the use of PDE5i. The treatment protocol consisted of one treatment sessions per week for 6 weeks, a 6 -week no-treatment interval. Each session comprised the application of 3000 shock waves (energy intensity of 4 mJ/mm3) to each penile shaft and 1000 shock waves for each crura. Results: The results showed that 6 weeks after treatment, erectile function improved in the 85% of the cases, good result was achieved in 10% and no results in 5% of the patients. The average increase in the IIEF-EF domain score was 8.8 points. Furthermore, erectile function and penile blood flow were measured using nocturnal penile tumescence (NPT) and color-power Doppler of the penis. All NPT parameters improved as recorded by significant increases in the duration of the erections and penile rigidity. Conclusions: The treatment options for ED have greatly expanded and include PDE5i, intracavernosal injections, and penile prostheses. Our experience presented here demonstrate that LIST of the corpora cavernosa is a novel therapeutic option for ED. LIST may have a fundamental effect on penile endothelial function, increasing penile blood flow, and improving erectile function and consequently sexual satisfaction.

scholarly journals Obstructive Sleep Apnea Is Associated With Low Testosterone Levels in Severely Obese Men

2021 ◽  
Vol 12 ◽  
Author(s):  
Milina Tančić-Gajić ◽  
Miodrag Vukčević ◽  
Miomira Ivović ◽  
Ljiljana V. Marina ◽  
Zorana Arizanović ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Negative Correlation ◽  
Free Testosterone ◽  
Significant Negative Correlation ◽  
Testosterone Levels ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Severely Obese

BackgroundDisrupted sleep affects cardio-metabolic and reproductive health. Obstructive sleep apnea syndrome represents a major complication of obesity and has been associated with gonadal axis activity changes and lower serum testosterone concentration in men. However, there is no consistent opinion on the effect of obstructive sleep apnea on testosterone levels in men.ObjectiveThe aim of this study was to determine the influence of obstructive sleep apnea on total and free testosterone levels in severely obese men.Materials and methodsThe study included 104 severely obese (Body Mass Index (BMI) ≥ 35 kg/m2) men, aged 20 to 60, who underwent anthropometric, blood pressure, fasting plasma glucose, lipid profile, and sex hormone measurements. All participants were subjected to polysomnography. According to apnea-hypopnea index (AHI) patients were divided into 3 groups: &lt;15 (n = 20), 15 - 29.9 (n = 17) and ≥ 30 (n = 67).ResultsThere was a significant difference between AHI groups in age (29.1 ± 7.2, 43.2 ± 13.2, 45.2 ± 10.2 years; p &lt; 0.001), BMI (42.8 ± 5.9, 43.2 ± 5.9, 47.1 ± 7.8 kg/m2; p = 0.023), the prevalence of metabolic syndrome (MetS) (55%, 82.4%, 83.6%, p = 0.017), continuous metabolic syndrome score (siMS) (4.01 ± 1.21, 3.42 ± 0.80, 3.94 ± 1.81, 4.20 ± 1.07; p = 0.038), total testosterone (TT) (16.6 ± 6.1, 15.2 ± 5.3, 11.3 ± 4.44 nmol/l; p &lt; 0.001) and free testosterone (FT) levels (440.4 ± 160.8, 389.6 ± 162.5, 294.5 ± 107.0 pmol/l; p &lt; 0.001). TT level was in a significant negative correlation with AHI, oxygen desaturation index (ODI), BMI, MetS and siMS. Also, FT was in a significant negative correlation with AHI, ODI, BMI, age, MetS and siMS. The multiple regression analysis revealed that both AHI and ODI were in significant correlation with TT and FT after adjustment for age, BMI, siMS score and MetS components.ConclusionObstructive sleep apnea is associated with low TT and FT levels in severely obese men.

Impairment of erectile function after elective repair of abdominal aortic aneurysm

Vascular ◽  
2015 ◽  
Vol 24 (1) ◽  
pp. 37-43 ◽  
Author(s):  
P Majd ◽  
W Ahmad ◽  
Th Luebke ◽  
M Gawenda ◽  
J Brunkwall
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Erectile Dysfunction ◽  
Aortic Aneurysm ◽  
Erectile Function ◽  
Open Repair ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic ◽  
Elective Repair ◽  
Significant Difference ◽  
Aneurysm Repair

The purpose of the present study was to compare the functional change of erectile dysfunction after endovascular repair (EVAR) and open repair (OR) of abdominal aortic aneurysm. Between April 2009 and December 2011, male patients admitted for elective treatment of an asymptomatic infrarenal abdominal aortic aneurysm were included. The erectile function was evaluated by using a validated KEED questionnaire. All patients filled out the questionnaire preoperatively and postoperatively after one year. The number of patients with an increase of erectile dysfunction was 8 (26.6%) to 16 (53.3%) in open repair group vs. 30 (42.6%) to 40 (58.8%) in endovascular aneurysm repair. There was no statistically significant difference between open repair and endovascular aneurysm repair groups in order of new incidence of erectile dysfunction ( p = 0.412). The study showed an increase in the mean value of Erectile Dysfunction -Score postoperatively in both the groups as well. The present study showed an increase of erectile dysfunction postoperatively, but the difference between the two groups was not statistically significant.

scholarly journals Cardiovascular and metabolic syndrome risk among men with and without erectile dysfunction: case-control study

2010 ◽  
Vol 128 (3) ◽  
pp. 137-140 ◽  
Author(s):  
João Paulo Zambon ◽  
Rafaela Rosalba de Mendonça ◽  
Marcelo Langer Wroclawski ◽  
Amir Karam Junior ◽  
Raul D. Santos ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Erectile Dysfunction ◽  
Cardiovascular Risk ◽  
Erectile Function ◽  
Case Control Study ◽  
Case Control ◽  
Retrospective Case ◽  
Healthcare Program ◽  
Severity Of Erectile Dysfunction ◽  
Control Study

CONTEXT AND OBJECTIVE: Erectile dysfunction has been associated with cardiovascular diseases. The aim here was to evaluate cardiovascular risk through the Framingham Risk Score (FRS) criteria, C-reactive protein (CRP) assays and presence of metabolic syndrome (MS) in men with and without erectile dysfunction diagnosed within a healthcare program. DESIGN AND SETTING: A retrospective case-control study was conducted. The patients were selected from a healthcare program at the Hospital Israelita Albert Einstein, between January and December 2007. METHODS: 222 men were retrospectively selected, and they were divided into two groups: men with erectile dysfunction (n = 111) and men without erectile dysfunction (n = 111). The patients were stratified according to the International Index of Erectile Function-Erectile Function domain (IIEF-EF domain). CRP and FRS were analyzed and the two groups were compared. RESULTS: The CRP levels were significantly higher among men with erectile dysfunction (P = 0.04). Patients with erectile dysfunction also had high FRS (P = 0.0015). CRP and FRS did not correlate with the severity of erectile dysfunction. The presence of metabolic syndrome was greater among men with erectile dysfunction (P < 0.05). The severity of erectile dysfunction was directly associated with metabolic syndrome. CONCLUSION: Men with erectile dysfunction presented higher cardiovascular risk according to the FRS criteria and CRP measurements. Severe erectile dysfunction seemed to have a correlation with metabolic syndrome.

scholarly journals Physical activity counteracts metabolic syndrome-induced hypogonadotropic hypogonadism and erectile dysfunction in the rabbit

2019 ◽  
Vol 316 (3) ◽  
pp. E519-E535 ◽  
Author(s):  
Annamaria Morelli ◽  
Sandra Filippi ◽  
Paolo Comeglio ◽  
Erica Sarchielli ◽  
Ilaria Cellai ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Erectile Dysfunction ◽  
Erectile Function ◽  
Lifestyle Modification ◽  
Hypogonadotropic Hypogonadism ◽  
Mrna Levels ◽  
Primary Role ◽  
Lifestyle Modifications ◽  
Inflammatory Status ◽  
Gnrh Release

Metabolic syndrome (MetS) clusters cardiovascular and metabolic risk factors along with hypogonadism and erectile dysfunction. Lifestyle modifications including physical exercise (PhyEx) are well-known treatments for this condition. In this study, we analyzed the effect of PhyEx on hypothalamic-pituitary-testis axis and erectile function by use of an animal MetS model, previously established in rabbits fed a high-fat diet (HFD). Rabbits fed a regular diet (RD) were used as controls. A subset of both groups was trained on a treadmill. HFD rabbits showed typical MetS features, including HG (reduced T and LH) and impairment of erectile function. PhyEx in HFD rabbits completely restored plasma T and LH and the penile alterations. At testicular and hypothalamic levels, an HFD-induced inflammatory status was accompanied by reduced T synthesis and gonadotropin-releasing hormone (GnRH) immunopositivity, respectively. In the testis, PhyEx normalized HFD-related macrophage infiltration and increased the expression of steroidogenic enzymes and T synthesis. In the hypothalamus, PhyEx normalized HFD-induced gene expression changes related to inflammation and glucose metabolism, restored GnRH expression, particularly doubling mRNA levels, and regulated expression of molecules related to GnRH release (kisspeptin, dynorphin). Concerning MetS components, PhyEx significantly reduced circulating cholesterol and visceral fat. In multivariate analyses, cholesterol levels resulted as the main factor associated with MetS-related alterations in penile, testicular, and hypothalamic districts. In conclusion, our results show that PhyEx may rescue erectile function, exert anti-inflammatory effects on hypothalamus and testis, and increase LH levels and T production, thus supporting a primary role for lifestyle modification to combat MetS-associated hypogonadism and erectile dysfunction.

Ventilatory responses to intravenous and airway CO2 administration in anesthetized dogs

1980 ◽  
Vol 48 (2) ◽  
pp. 337-346 ◽  
Author(s):  
W. E. Fordyce ◽  
F. S. Grodins
Keyword(s):  
Blood Flow ◽  
Steady State ◽  
Loading Rate ◽  
Blood Flow Rate ◽  
Time Dependent ◽  
Base Line ◽  
Ventilatory Responses ◽  
Significant Difference ◽  
Anesthetized Dogs ◽  
Randomized Protocol

The ventilatory responses to steady-state venous CO2 loading (iv CO2) and CO2 inhalation have been observed in chloralose-urethan-anesthetized dogs. Intravenous CO2 was administered by increasing the CO2 fraction of gas ventilating a membrane gas exchanger in an arteriovenous bypass; blood flow rate was fixed at 30 ml/min. During the study, we identified a time-dependent hyperventilation in all 14 experimentally treated dogs and in 4 additional sham-treated dogs. When we tested 8 of these animals with a protocol having small progressive increments in iv CO2 loading rate, we observed a response approaching isocapnia during iv CO2 and a large hypocapnia when we returned to control conditions. The use of a randomized protocol in 6 animals demonstrated the necessity of accounting for this systematic base-line shift, because before doing so the response depended more on the passage of time than on the nature of the CO2 load. After this analytical adjustment was made, there was no significant difference between the respiratory controller gains (delta nu E/delta Paco2) for inhaled and iv CO2.

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