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International Urology and Nephrology Sep 2022To apply a new review methodology, called reverse systematic review (RSR), to assess how different classification criteria can influence erectile dysfunction rates in... (Review)
Review
OBJECTIVE
To apply a new review methodology, called reverse systematic review (RSR), to assess how different classification criteria can influence erectile dysfunction rates in patients undergoing laparoscopic radical prostatectomy (LRP).
METHODS
We used RSR from January 1, 2000, until December 31, 2020. The post-prostatectomy erectile dysfunction (PPED) rates were evaluated at 1, 3, 6, 12, and 18 months after surgery in different criteria selected as the most commonly used and divided into four groups: "Erection Sufficient for Intercourse (ESI)", "IIEF-5 > 17", "IIEF-5 > 22" and "Not Available". Temporal distribution of different criteria was analyzed to identify patterns throughout the "natural history" of LRP.
RESULTS
40 systematic reviews on LRP evaluated 81 cohorts and 21,618 patients on PPED. ESI was the predominant form of PPED evaluation (75.3%) followed by IIEF-5 > 22 (11.1%). Despite being a simpler criterion, ESI showed worse PPED rates at 1, 3, 6 and 12 months (8%, 27%, 43% and 51%) than IIEF-5 > 22 (14%, 26%, 45% and 58%). The studies were published between 2005 and 2015, but it was in 2010 that the ESI criterion was established as predominant in the literature, reducing the application of others.
CONCLUSION
The RSR has proven effective in demonstrating how the PPED evaluation criteria behaved in the "natural history" of the LRP. It showed how a simple and easy-to-apply criterion, such as the ESI, was preferred by the authors, even showing worse PPED rates than other more complex.
Topics: Erectile Dysfunction; Humans; Laparoscopy; Male; Penile Erection; Prostate; Prostatectomy
PubMed: 35764756
DOI: 10.1007/s11255-022-03262-w -
International Journal of Impotence... Mar 2022COVID-19 pandemic is associated with devastating effects on social, psychological, and economical aspects of survivors. We assume that erectile function (EF) is affected... (Review)
Review
COVID-19 pandemic is associated with devastating effects on social, psychological, and economical aspects of survivors. We assume that erectile function (EF) is affected as well. We performed a systematic review of the published articles about the change in EF among patients and health care providers during the COVID-19 pandemic. We searched PubMed and Cochrane databases for English literature using a combination of medical subject headings (MeSH) terms and keywords. We extracted data of erectile dysfunction (ED) rate, international index of erectile function (IIEF), changes related to exposure to the pandemic (Primary objectives), and factors affecting these differences (Secondary objectives). Twenty articles were included in the screening phase. Only 3 articles were eligible for primary objectives, and 2 articles were included for the secondary objective. Three articles revealed an increase in ED cases and a reduction in IIEF-5 scores during the pandemic. Rates of ED have ranged from 32% to 87% of the study populations. Anxiety, depression, and post-traumatic stress disorder (PTSD) were associated with increased ED rates. We conclude that the COVID-19 pandemic is associated with increased rates of ED. Anxiety and depression augment this increase. Health care providers are at higher risk for PTSD, which increases the risk of ED.
Topics: COVID-19; Erectile Dysfunction; Health Personnel; Humans; Male; Pandemics; Penile Erection
PubMed: 34992226
DOI: 10.1038/s41443-021-00504-w -
International Journal of Molecular... Jan 2023Current literature has indicated that Peyronie's disease (PD) could be initiated by microtrauma and the subsequent inflammation episodes that follow. PD could be sorted... (Review)
Review
Current literature has indicated that Peyronie's disease (PD) could be initiated by microtrauma and the subsequent inflammation episodes that follow. PD could be sorted into acute or chronic status, and it can differ when selecting the clinical therapeutics. PD would cause pain and penile deformity to diseased men and impair their erectile function. Occasionally, surgical revision of the penis might be needed to correct the penile curvature. We find that there are limited effective options of intra-lesion injections for the PD plaques. By searching the databases and screening the literature with the PRISMA 2020 guideline, we observed that several preclinical studies that applied stem cell therapy in treating PD were fruitful in the acute phase. Although in the chronic phase of PD, erectile parameters were not significantly improved, and therefore, future studies might be better elevated in certain aspects, such as the sites selected for harvesting stem cells or changing the centrifugation forces. In this review, we concluded the contemporary understanding of inflammatory microenvironments in PD, the stem cell therapy in PD, and our perspectives on future studies. We concluded that there may be great potential in stem cell therapy for treating both acute and chronic phases PD.
Topics: Male; Humans; Penile Induration; Penis; Penile Erection; Injections; Stem Cells
PubMed: 36614220
DOI: 10.3390/ijms24010777 -
Urologiia (Moscow, Russia : 1999) Dec 2021a systematic review of the available literature sources about criteria for nocturnal penile tumescences (NPT) registration, as well as the development our own criteria...
OBJECTIVE
a systematic review of the available literature sources about criteria for nocturnal penile tumescences (NPT) registration, as well as the development our own criteria for evaluating erectograms obtained from Androscan "MIT" software complex.
MATERIALS AND METHODS
a systematic search about NPT criteria was conducted in the Medline database. A PRISMA flowchart was used to visually represent the design of the study. The necessary calculations were carried out using the STATISTICA 12 software.
RESULTS
Normal erectile function is characterized by a relative increase in penis diameter (RIn) of 30% or more with the duration of such NPTs of more than 60 minutes. For a mild ED in the case of a good RIn (30% or more) with a duration of NPT with such RIn less than 10 minutes (the time of 1 effective erection), it is advisable to determine the duration of the NPT with a RIn of 20% or more. If RIn is less than 30% it is advisable to use the duration of sufficient erections (with a relative increase in diameter of 20% or more) and the border value in this case is 60 minutes or more. Severe ED is characterized by RIn less than 20% or duration of NPT of less than 10 minutes with any RIn.
CONCLUSION
at the moment there are no uniform criteria for the diagnosis of ED using the Androscan "MIT" software complex. As part of the unification of ED diagnostics we first introduced the terms of "effective erection", "sufficient erection", "relative increase" and also developed regulatory criteria and an algorithm for evaluating erectograms which will ensure continuity as well as the possibility of comparison of the results from different research groups.
Topics: Algorithms; Erectile Dysfunction; Humans; Male; Penile Erection; Penis; Software
PubMed: 34967171
DOI: No ID Found -
The Cochrane Database of Systematic... Nov 2012Psychotropic drugs are associated with sexual dysfunction. Symptoms may concern penile erection, lubrication, orgasm, libido, retrograde ejaculation, sexual arousal, or... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Psychotropic drugs are associated with sexual dysfunction. Symptoms may concern penile erection, lubrication, orgasm, libido, retrograde ejaculation, sexual arousal, or overall sexual satisfaction. These are major aspects of tolerability and can highly affect patients' compliance.
OBJECTIVES
To determine the effects of different strategies (e.g. dose reduction, drug holidays, adjunctive medication, switching to another drug) for treatment of sexual dysfunction due to antipsychotic therapy.
SEARCH METHODS
An updated search was performed in the Cochrane Schizophrenia Group's Trials Register (3 May 2012) and the references of all identified studies for further trials.
SELECTION CRITERIA
We included all relevant randomised controlled trials involving people with schizophrenia and sexual dysfunction.
DATA COLLECTION AND ANALYSIS
We extracted data independently. For dichotomous data we calculated random effects risk ratios (RR) with 95% confidence intervals (CI), for crossover trials we calculated Odds Ratios (OR) with 95% CI. For continuous data, we calculated mean differences (MD) on the basis of a random-effects model. We analysed cross-over trials under consideration of correlation of paired measures.
MAIN RESULTS
Currently this review includes four pioneering studies (total n = 138 , duration two weeks to four months), two of which are cross-over trials. One trial reported significantly more erections sufficient for penetration when receiving sildenafil compared with when receiving placebo (n = 32, MD 3.20 95% CI 1.83 to 4.57), a greater mean duration of erections (n = 32, MD 1.18 95% CI 0.52 to 1.84) and frequency of satisfactory intercourse (n = 32, MD 2.84 95% CI 1.61 to 4.07). The second trial found no evidence for selegiline as symptomatic treatment for antipsychotic-induced sexual dysfunction compared with placebo (n = 10, MD change on Aizenberg's sexual functioning scale -0.40 95% CI -3.95 to 3.15). No evidence was found for switching to quetiapine from risperidone to improve sexual functioning (n = 36, MD -2.02 95% CI -5.79 to 1.75). One trial reported significant improvement in sexual functioning when participants switched from risperidone or an typical antipsychotic to olanzapine (n = 54, MD -0.80 95% CI -1.55 to -0.05).
AUTHORS' CONCLUSIONS
We are not confident that cross-over studies are appropriate for this participant group as they are best for conditions that are stable and for interventions with no physiological and psychological carry-over. Sildenafil may be a useful option in the treatment of antipsychotic-induced sexual dysfunction in men with schizophrenia, but this conclusion is based only on one small short trial. Switching to olanzapine may improve sexual functioning in men and women, but the trial assessing this was a small, open label trial. Further well designed randomised control trials that are blinded and well conducted and reported, which investigate the effects of dose reduction, drug holidays, symptomatic therapy and switching antipsychotic on sexual function in people with antipsychotic-induced sexual dysfunction are urgently needed.
Topics: Antipsychotic Agents; Benzodiazepines; Cross-Over Studies; Drug Substitution; Erectile Dysfunction; Female; Humans; Male; Olanzapine; Piperazines; Purines; Randomized Controlled Trials as Topic; Selegiline; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vasodilator Agents
PubMed: 23152218
DOI: 10.1002/14651858.CD003546.pub3 -
European Urology May 2013Phosphodiesterase type 5 inhibitors (PDE5-Is) are currently the first-line therapy for erectile dysfunction (ED), but available studies investigating the comparative... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Phosphodiesterase type 5 inhibitors (PDE5-Is) are currently the first-line therapy for erectile dysfunction (ED), but available studies investigating the comparative effects of different PDE5-Is are limited.
OBJECTIVE
To compare the efficacy and safety of different classes of oral PDE5-Is for ED.
EVIDENCE ACQUISITION
A systematic search was performed in PubMed, Cochrane Library, and Embase to identify randomized controlled trials that compared different PDE5-Is or PDE5-Is with a placebo for ED. The methodological quality of included studies was appraised with the Cochrane Collaboration bias appraisal tool, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation system.
EVIDENCE SYNTHESIS
A total of 118 trials (31 195 individuals) were included. There was no major difference in the results between the traditional meta-analysis and the network meta-analysis. Network meta-analysis demonstrated that PDE5-Is were superior to placebo to improve erectile function. Compared with tadalafil (relative risk [RR]: 0.61; 95% confidence interval [CI], 0.33-0.90) and vardenafil (RR: 0.63; 95% CI, 0.35-0.92), avanafil was less effective on Global Assessment Questionnaire question 1. Tadalafil was more effective than vardenafil (mean difference [MD]: 1.49; 95% CI, 0.50-2.50) and udenafil (MD: -1.84; 95% CI, -3.31 to -0.33) as measured by the erectile function domain of the International Index of Erectile Function. For all efficacy outcomes, the absolute effects and the rank tests indicated that tadalafil and vardenafil were the most effective agents. After adjusting for dosage, the conclusion remained the same. Safety analysis showed there was no major difference among different agents.
CONCLUSIONS
In recommended doses, oral PDE5-Is are more effective than placebo for ED, and tadalafil seems to be the most effective agent, followed by vardenafil. PDE5-Is are generally safe and well tolerated, and there is no major difference on the safety profile.
Topics: Administration, Oral; Carbolines; Erectile Dysfunction; Humans; Imidazoles; Male; Odds Ratio; Penile Erection; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Risk Assessment; Risk Factors; Sildenafil Citrate; Sulfones; Tadalafil; Treatment Outcome; Triazines; Vardenafil Dihydrochloride
PubMed: 23395275
DOI: 10.1016/j.eururo.2013.01.012 -
Sexual Medicine Reviews Dec 2023Erectile dysfunction (ED) is a common condition that negatively affects men's quality of life. It can have various causes, including psychological, vascular, and...
INTRODUCTION
Erectile dysfunction (ED) is a common condition that negatively affects men's quality of life. It can have various causes, including psychological, vascular, and neurologic factors. Existing treatments for ED mainly focus on symptom relief rather than addressing the underlying cause. Stem cells (SCs) have shown potential as a therapeutic approach for ED due to their anti-inflammatory properties.
OBJECTIVES
This systematic review aims to assess the current status of trials and determine the potential impact of SCs on male sexual health.
METHODS
A comprehensive search strategy was employed to gather relevant articles from 6 electronic databases. The search included articles published until March 2023. The reference lists of articles were manually reviewed to identify additional studies of relevance. The eligibility criteria for inclusion in the analysis focused on clinical trials involving humans that evaluated the safety and efficacy of SC therapy for ED. Exclusion criteria encompassed case reports, case series, abstracts, reviews, and editorials, as well as studies involving animals or SC derivatives. Data extraction was performed via a standardized form with a focus on erectile outcomes.
RESULTS
A total of 2847 articles were initially identified; 18 were included in the final analysis. These studies involved 373 patients with ED and various underlying medical conditions. Multiple types of SC were utilized in the treatment of ED: mesenchymal SCs, placental matrix-derived mesenchymal SCs, mesenchymal SC-derived exosomes, adipose-derived SCs, bone marrow-derived mononuclear SCs, and umbilical cord blood SCs.
CONCLUSION
SC therapy shows promise as an innovative and safe treatment for organic ED. However, the lack of standardized techniques and controlled groups in many studies hampers the ability to evaluate and compare trials.
Topics: Female; Pregnancy; Animals; Male; Humans; Erectile Dysfunction; Quality of Life; Placenta; Stem Cell Transplantation; Penile Erection
PubMed: 37758225
DOI: 10.1093/sxmrev/qead040 -
Andrologia May 2021The meta-analysis was performed to assess the efficacy and safety of daily oral L-arginine and phosphodiesterase type 5 inhibitors (PDE5Is) alone or combination in... (Meta-Analysis)
Meta-Analysis
Comparison of efficacy and safety of daily oral L-arginine and PDE5Is alone or combination in treating erectile dysfunction: A systematic review and meta-analysis of randomised controlled trials.
The meta-analysis was performed to assess the efficacy and safety of daily oral L-arginine and phosphodiesterase type 5 inhibitors (PDE5Is) alone or combination in treating patients with erectile dysfunction (ED). We performed a search of randomised controlled trials in the following databases: PubMed, EMBASE and Cochrane Library databases. Four articles including 373 patients were studied. Erectile functions were significantly improved in three therapy groups compared with baseline. Patients who received the combination of L-arginine and PDE5Is showed significant improvement compared to those treated with L-arginine and PDE5Is alone, as assessed by sexual function index (p <0.00001 and p =0.005, respectively) and total testosterone (p <0.00001 and p =0.0007, respectively). Furthermore, patients who treated with PDE5Is alone exhibited the better efficacy than those treated with L-arginine alone in respects of sexual function index (p <0.00001) and total testosterone (p =0.0001). However, the combination of L-arginine and PDE5Is had no obvious difference relative to PDE5Is alone in terms of various adverse events (AEs). Conclusively, compared with monotherapy, the combination of L-arginine and PDE5Is showed a greater improvement of sexual function and total testosterone, and did not significantly increase the AEs. Besides, PDE5Is alone revealed a better effect than those treated with L-arginine alone for patients with ED.
Topics: Arginine; Erectile Dysfunction; Humans; Male; Penile Erection; Phosphodiesterase 5 Inhibitors; Randomized Controlled Trials as Topic
PubMed: 33587304
DOI: 10.1111/and.14007 -
The Journal of Sexual Medicine Jun 2020Erectile dysfunction (ED) is the most common side effect of prostate radiotherapy (RT), but reported rates over time and across modalities have varied widely.
BACKGROUND
Erectile dysfunction (ED) is the most common side effect of prostate radiotherapy (RT), but reported rates over time and across modalities have varied widely.
AIM
To evaluate the published literature between 2002 and 2018 for high quality data utilizing prospectively gathered patient-reported ED, and to summarize the challenges in reporting of RT-induced ED (RIED).
METHODS
A PubMed search and literature review was performed to identify articles describing rates of ED before and after definitive external beam RT or brachytherapy without androgen deprivation.
OUTCOMES
Patient-reported ED, patient and treatment variables, and study follow-up constituted the main outcomes of this study.
RESULTS
24 articles were identified, reporting RIED rates between 17% and 90%. Variables contributing to this range included patient, treatment, and study characteristics known to impact ED reporting.
CLINICAL IMPLICATIONS
For future studies, we recommend the use of validated patient-reported questionnaires and reporting of baseline function and comorbidities, RT type and dose, and use of androgen deprivation therapy and erectile aids at the time of ED measurement. With sufficient follow-up to understand the late nature of RIED, these recommendations will improve comparison of results between studies and the applicability of results to patients undergoing pretreatment counseling regarding the risks of RIED.
STRENGTHS & LIMITATIONS
The literature search and formulation of results were based on a broad understanding of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the literature, but because of the focus on data reporting, a comprehensive systematic review of all RIED literature was not performed.
CONCLUSION
Reported rates of ED after RT vary widely due to differences in patients' baseline reported erectile function, age, comorbidities, and characteristics of the treatment delivered. The methodology of ED measurement has significant impact on the applicability and comparability of results to other studies and clinical practice. Nukala V, Incrocci L, Hunt AA, et al. Challenges in Reporting the Effect of Radiotherapy on Erectile Function. J Sex Med 2020;17:1053-1059.
Topics: Androgen Antagonists; Brachytherapy; Erectile Dysfunction; Humans; Male; Penile Erection; Prostatic Neoplasms
PubMed: 32312661
DOI: 10.1016/j.jsxm.2020.03.008 -
Progres En Urologie : Journal de... Sep 2020The efficiency of extracorporeal shock waves (SW) for Peyronie's disease (PD) is controversial.
INTRODUCTION
The efficiency of extracorporeal shock waves (SW) for Peyronie's disease (PD) is controversial.
METHODS
A systematic review of the literature published between 2000 and 2019 was conducted using the PRISMA methodology. We used Medline data with the following.
KEYWORDS
"extracorporeal shock wave therapy" ; "Peyronie's disease"; "Sexuality"; Penile erection.
RESULTS
Thirteen articles were selected. Our review showed that SW were beneficial in terms of pain. Regarding plaques size and penile curvature, the results remain divergent.
CONCLUSION
SW may be useful in the management of pain in selected patients with PD. Its effectiveness on plaques size and penile curvature needs to be demonstrated through controlled and randomized trials. The population has to be targeted, and the treatment protocol must also be standardized.
Topics: Extracorporeal Shockwave Therapy; Humans; Male; Penile Induration
PubMed: 32370921
DOI: 10.1016/j.purol.2020.04.003