Erectile Dysfunction

Discussion in 'Men's Health Forum' started by Michael Scally MD, Nov 10, 2017.

  1. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile Dysfunction in Young Men - A Review of the Prevalence and Risk Factors. Sexual Medicine Reviews 2017;5(4):508-20. http://www.sciencedirect.com/science/article/pii/S2050052117300501

    Introduction - Erectile dysfunction (ED) is an important health concern that can significantly affect a man's psychosocial well-being. ED has traditionally been considered a disease of old age; however, contemporary evidence suggests a growing incidence of ED in men younger than 40 years.

    The process of achieving an erection is multifaceted; there are many potential mechanisms that can be disrupted. It is critical to identify the specific causes of ED before proceeding with potentially costly and invasive therapeutic options. Advances in diagnostic and treatment modalities offer opportunities to identify and manage young men with ED.

    Aim - To provide an update on the prevalence and risk factors of ED in young men and to provide a framework to guide clinicians in identifying and managing the affected young man.

    Methods - Comprehensive review of the literature pertaining to ED in young men.

    Main Outcome Measures - ED in young men was assessed by outlining the prevalence according to recent epidemiologic studies. The pathophysiology, diagnostic considerations, risk factors, and etiologies were reviewed.

    Results - Large multinational studies have estimated the prevalence of ED in young men to be as high as 30%. Several studies have stratified the etiologies of ED into psychogenic and organic causes.

    Psychogenic etiologies of ED include depression, anxiety, and partner-related difficulties. These patients tend to experience sudden onset of symptoms, with decreased libido and good quality of spontaneous or self-stimulated erections.

    Organic etiologies include vasculogenic, endocrinologic, neurogenic, iatrogenic, and structural components. These patients usually experience gradual onset of symptoms and a low to normal libido. Conservative treatments such as phosphodiesterase type 5 inhibitors continue to be the mainstay treatment.

    Conclusions - ED in young men is an increasingly common condition. A careful diagnostic evaluation should focus on the identification of any underlying etiology to ensure appropriate management of patients.
     

    Attached Files:

  2. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Erectile Dysfunction: AUA Guideline

    Purpose - The purpose of this guideline is to provide a clinical strategy for the diagnosis and treatment of erectile dysfunction.

    Materials & Methods - A systematic review of the literature using the Pubmed, Embase, and Cochrane databases (search dates 1/1/1965 to 7/29/17) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of erectile dysfunction.

    Evidence-based statements were based on body of evidence strength Grade A, B, or C and were designated as Strong, Moderate, and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions.

    Results - The American Urological Association has developed an evidence-based guideline on the management of erectile dysfunction. This document is designed to be used in conjunction with the associated treatment algorithm.

    Conclusions - Using the shared decision-making process as a cornerstone for care, all patients should be informed of all treatment modalities that are not contraindicated, regardless of invasiveness or irreversibility, as potential first-line treatments. For each treatment, the clinician should ensure that the man and his partner have a full understanding of the benefits and risk/burdens associated with that choice.

    Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline. The Journal of urology. Erectile Dysfunction: AUA Guideline
     

    Attached Files:

  3. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Dehydroepiandrosterone and Erectile Function

    To review the contemporary knowledge regarding the dehydroepiandrosterone and erectile function. Medline was reviewed for English-language journal articles spanning the time between January 1990 and December 2017, using the terms 'erectile function', 'dehydroepiandrosterone'.

    We used Journal Articles and review articles that found to be relevant to the purpose of this review. Criteria included all pertinent review articles, randomized controlled trials with tight methodological design, cohort studies and retrospective analyses. We also manually revised references from selected articles.

    Several interesting studies have addressed the age-related decline in dehydroepiandrosterone levels with many age-related phenomena or deterioration in various physiological functions. Particularly, aging; neurological functions including decreased well-being, cognition, and memory; increased depression, decreased bone mineral density, obesity, diabetes, increased cardiovascular morbidity, erectile dysfunction (ED), and decreased libido.

    Supporting this result, some trials of dehydroepiandrosterone supplementation in healthy, middle-aged, and elderly subjects have reported improvements in different aspects of well-being. Several studies had demonstrated that dehydroepiandrosterone level is declined as a part of aging.

    Large-scale well-designed prospective studies are warranted to better define indications and therapeutic implications of dehydroepiandrosterone in men with ED.

    El-Sakka AI. Dehydroepiandrosterone and Erectile Function: A Review. World J Mens Health 2018. https://wjmh.org/DOIx.php?id=10.5534/wjmh.180005
     
  4. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    An Update on Emerging Drugs for The Treatment of Erectile Dysfunction

    INTRODUCTION: Erectile dysfunction is an extremely frequent and extensively studied condition, currently affecting the lives of tens of millions of men around the globe. The extensive knowledge of its pathophysiology has led to the development of phosphodiesterase 5-inhibitors, which can facilitate sexual intercourse in a large number of patients. However, an ever-increasing number of patients is unresponsive to these drugs due to underlying comorbidities or previous surgery. Different molecular pathways need to be addressed to provide treatment for a larger patient population.

    AREAS COVERED: In this paper we will review the underlying molecular pathways, discuss already available treatment options and their limitations and provide an overview of the newest therapeutics in development. Centrally and peripherally acting agents will be discussed separately. Additionally, newest advances in regenerative medicine options will be discussed.

    EXPERT OPINION: Even though novel drugs have not been tested in a phase III setting, several phase II clinical trial results are eagerly awaited. These newest therapeutics could be applied as monotherapy or combination therapy in the subset of patients unresponsive to traditional treatment options.

    Milenkovic U, Campbell J, Roussel E, Albersen M. An update on emerging drugs for the treatment of erectile dysfunction. Expert opinion on emerging drugs 2018. https://www.tandfonline.com/doi/abs/10.1080/14728214.2018.1552938?journalCode=iemd20
     
  5. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Sanches BC, Laranja WW, Alonso JC, Rejowski RF, Simoes FA, Reis LO. Does underestimated penile size impact erectile function in healthy men? International journal of impotence research 2018;30:158-62. Does underestimated penile size impact erectile function in healthy men?

    The aim of this study is to assess the impact of objective (stretched) and subjective penile size in the erectile function in a urological check-up program on a cross-sectional study including 689 men aged 35-70 years. IIEF-5 questionnaire, physical examination (penile length, prostate volume, blood pressure, body mass index-BMI), metabolic syndrome (MS), comorbidities, habits (sexual intercourse frequency, physical activity, alcohol, and tobacco use), level of education, serum glucose, total testosterone, estradiol, PSA, lipid profile, and self-perceptions (ejaculation time and subjective penile size) were examined in multivariate models using logistic and linear regressions.

    Penile objective mean length was 13.08 cm +/- 2.32 and 67 (9.72%) patients referred small penis self-perception. Seventy-six (11.03%) participants had severe erectile dysfunction (ED), 75 (10.88%) had mild to moderate and moderate ED, 112 (16.25%) had mild ED and 426 (61.83%) had no ED.

    Risk factors for ED that held statistical significance were
    · self-perceived small penis (OR = 2.23, 95% CI 1.35-3.69, p = .0017),
    · sexual intercourse frequency (per week) (OR = 0.45, 95% CI 0.38-0.52, p < .0001),
    · satisfactory ejaculation time (no vs. yes, OR = 2.06, 95% CI 1.46-2.92, p < .0001),
    · comorbidity (yes vs. no, OR = 2.01, 95% CI 1.46-2.76, p < .0001),
    · age >65 years (OR = 2.93, 95% CI 1.53-5.61, p < .0001),
    · tobacco use (yes vs. no, OR = 1.41, 95% CI 1.02-1.96, p < .0375),
    · regular physical activity (no vs. yes, OR = 1.59, 95% CI 1.13-2.23, p < .0083),
    · serum total testosterone < 200 ng/dl (OR = 3.48, 95% CI 1.69-7.16, p = 0.0009),
    · serum glucose > 100 mg/dl (OR = 1.69, 95% CI 1.18-2.43, p = 0.0044) and
    · systolic blood pressure > 130 mmHg (OR = 1.60, 95% CI 1.16-2.19, p = 0.0037).

    Results suggest that in addition to previously reported risk factors, patient's subjective impressions of penile size negatively impacts sexual life in about 10% of men considered healthy, while objective penile length does not play significant role in erectile function.
     
  6. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Erectile Dysfunction: An Umbrella Review of Meta-Analyses of Risk-Factors, Treatment, and Prevalence Outcomes

    INTRODUCTION: Erectile dysfunction (ED) is a major health care problem that has implications for quality of life. AIM: This umbrella review sought to synthesize all meta-analytic research on risk factors, treatment, and prevalence of ED.

    METHODS: 8 electronic databases were searched for relevant meta-analyses in June 2018. The evidence was graded with 2 measures that use quantitative criteria to establish the quality of report writing and confidence in the effect size reported.

    MAIN OUTCOME MEASURES: Lifestyle factors, genetic markers, medical conditions, treatments.

    RESULTS: In total, 98 meta-analyses were identified that included 421 meta-analytic effects, 4,188 primary-effects, and 3,971,122 participants. Pooled estimates showed that an unhealthy lifestyle, genetic markers, and medical conditions were associated with an increased risk of ED. testosterone therapy and phosphodiesterase type 5 inhibitors showed the greatest treatment efficacy, with mild adverse events observed across treatments.

    Psychological and behavior change interventions produced effect sizes that were comparable to medication but had greater imprecision in effect sizes. There was little evidence that combined treatments were more efficacious than single treatments. Meta-analyses of prevalence estimates showed consistent age trends but were limited to particular regions or clinical samples, meaning that global estimates of ED are difficult to determine.

    CLINICAL IMPLICATIONS: The umbrella review synthesized findings for many treatment options that might aid evidence-based clinical decision-making. Based on prevalence estimates, we recommend that primary care physicians take a proactive approach and enquire about erectile problems in all men over age 40 displaying any health-related issue (eg, overweight, cigarette smoking).

    STRENGTHS & LIMITATIONS: Strengths include the calculation and comparison of summary estimates across multiple meta-analyses. Limitations include heterogeneity in research quality across research themes limiting effect size comparisons.

    CONCLUSION: The review provides summary estimates for 37 risk factors and 28 treatments. Meta-analyses of risk factors often did not control for important confounders, and meta-analyses of randomized trials were not exclusive to double-blinded trials, active placebo controls, or tests of long-term effects. We recommend further meta-analyses that eliminate lower quality studies and further primary research on behavioral and combined treatments.

    Allen MS, Walter EE. Erectile Dysfunction: An Umbrella Review of Meta-Analyses of Risk-Factors, Treatment, and Prevalence Outcomes. J Sex Med 2019. https://www.jsm.jsexmed.org/article/S1743-6095(19)30354-6/abstract