Male Erectile Dysfunction and Health-Related Quality of Life

doi:10.1016/S0302-2838(03)00215-X

European Urology

Volume 44, Issue 2, August 2003, Pages 245-253

https://doi.org/10.1016/S0302-2838(03)00215-X Get rights and content

Abstract

Objective: The purpose of this work was to assess the health-related quality of life factors associated with erectile dysfunction (ED).

Methods: 2476 non-institutionalised Spanish males, age ranging from 25 to 70 years, were interviewed. ED was defined using two instruments: a simple self-assessment question (ED-sq) and the International Index of Erectile Function (IIEF). Health-related quality of life (HRQoL) was measured through the SF-36 questionnaire.

Results: The severity of ED (measured both through the ED-sq and with the IIEF) increased as the scores of the scales of the SF-36 decreased (Mantel–Hänszel χ²-test statistic range: [26–305]; p<0.001). The two summary components (physical and mental) showed a downward trend, more for the physical than for the mental component.

Conclusion: We found a clear pattern of negative association between self-perceived erectile dysfunction and HRQoL. This association was clearer when ED-sq (rather than IIEF) was used, and stronger for the physical summary component than for the mental one.

Introduction

Erectile dysfunction (ED) is a serious public health problem affecting millions of citizens and their quality of life [1], [2]. The directly proportional correlation between the age of the subjects and both the probability of suffering erectile dysfunction and its degree of severity is widely documented [3], [4]. As the populations of the Organization for Economic Cooperation Development (OECD) countries are aging but maintaining their interest in sex [5], [6], erectile dysfunction has acquired greater significance as a public health problem, to which the health systems and policies must devote an increasing amount of attention and resources. In the last decade, measurements of health-related quality of life (HRQoL) have gained great relevance in the study of the health status of patients and populations and in the evaluation of both the quality of clinical and health care in general and the efficacy of public health interventions. This has been the result of an historic evolution in the concept of health, which, under the influence of both biomedical and social sciences and of environmental movements, has become more complex and multidimensional [7]. Currently, we are not only concerned with the traditional clinical aspects of the disease—presumably more objective—but also with other more subjective dimensions, in agreement with the definition of health made by the WHO [8], related to the degree of the individual’s physical, social or emotional function, and which considers the satisfaction and well-being of patients in relation to their health as perceived by the individuals themselves. This is known as the health-related quality of life (HRQoL) [9].

This study was made in the context of the EDEM project (Epidemiologı́a de la Disfunción Eréctil Masculina [4], which investigates the prevalence and independent risk factors for Erectile Dysfunction in Spain) and its objective was to establish the HRQoL factors associated with erectile dysfunction.

Section snippets

Design

This is a population-based, prevalence study in which the target population consists of Spanish men aged from 25 to 70 years inclusively, taken from the community at large, who are not institutionalised and who are resident in the Spanish peninsula. A probabilistic, multistage sampling design was used, with stratification of the primary sampling units. The primary sampling units were census section, then secondary sampling units were dwellings and the final sampling units were subjects. The

Results

Participation rate was 75% (n=2476 subjects), and 12.1% (95% CI: 10.8%–13.3%), of men showed some degree of ED: 5.2% mild, 5% moderate and 1.9% severe/complete when simple question is used and 18.9% (95% CI: 17.2%–20.7%) when IIEF instrument is applied to assess ED prevalence. Sociodemographic characteristics were similar between subjects with and without erectile dysfunction. Table 2 shows the age-adjusted odd ratios (ORs) of the different physical and sociodemographic characteristics

Discussion

We found a clear pattern of negative association between self-perceived erectile dysfunction and health-related quality of life, this association being more apparent when ED-sq was used for measuring the degree of EF than when erectile condition was ascertained through the erectile domain of the IIEF. This pattern of negative association is more apparent for the physical summary component of the SF-36 than for the mental one. Although the data strongly suggest that this effect may be different

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Neurovascular-Sparing MR-Guided Adaptive Radiotherapy in Prostate Cancer; Defining the Potential Population for Erectile Function-Sparing Treatment
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Magnetic resonance-guided adaptive radiotherapy (MRgRT) enables neurovascular-sparing treatment for localized prostate cancer (PCa). The aim of this treatment is preservation of erectile function by sparing the neurovascular bundles, the internal pudendal arteries, the corpora cavernosa, and the penile bulb. Internal pudendal arteries, corpora cavernosa, and penile bulb sparing can generally be achieved in all patients, but NVB sparing can be challenging due to its proximity to the prostate and is therefore dependent on tumor location. PCa patients that have sufficient erectile function at baseline and favorable tumor characteristics might benefit from this treatment. Currently, it is unclear what proportion of patients are eligible for neurovascular-sparing treatment and to what extent this is technically feasible.
To define the eligibility and technical feasibility for neurovascular-sparing MRgRT in intermediate-risk localized PCa patients.
A consecutive series of men that received 5 × 7.25 gray (Gy) MRgRT for localized PCa were included. Baseline erectile function was assessed using the International Index of Erectile Function (IIEF)-5 questionnaire. Additionally, the ability of sparing the neurovascular bundles was assessed in all patients. Per neurovascular-sparing protocol, the dominant intraprostatic lesion with a 4 mm isotropic margin should receive 34.44 Gy in ≥ 99% of the volume (i.e., high-dose area). When the high-dose area directly borders or overlaps the NVB because of a dorsolateral position of the dominant intraprostatic lesion, sparing of the NVB was considered not feasible on that side.
Patient-reported IIEF-5 baseline questionnaires and the technical feasibility of NVB sparing were assessed.
Of the 102 men that completed the IIEF-5 questionnaire at baseline, 49.0% of patients reported to have an IIEF-5 score of ≥ 17. In those patients, the NVB could technically have been spared bilaterally in 20.0% and unilaterally in 68.0%.
Our findings define the potential population for neurovascular-sparing MRgRT for localized PCa and indicate the proportion in which the NVB can technically be spared.
The major strength of this study is the prospective collection of data. The limitations include that the neurovascular-sparing feasibility definition is based on pre-clinical planning data.
A substantial group of 49.0% of patients in our study had mild or no erectile dysfunction at baseline. Of these patients, the NVB could technically have been spared bilaterally in 20.0% and unilaterally in 68.0% during MRgRT. Trials need to assess the effect of neurovascular-sparing MRgRT on erectile function.
Teunissen FR, van der Voort van Zyp JRN, Verkooijen HM, et al., Neurovascular-Sparing MR-Guided Adaptive Radiotherapy in Prostate Cancer; Defining the Potential Population for Erectile Function-Sparing Treatment. J Sex Med 2022;19:1196–1200.
Photoacoustic image-guided corpus cavernosum intratunical injection of adipose stem cell-derived exosomes loaded polydopamine thermosensitive hydrogel for erectile dysfunction treatment
2022, Bioactive Materials
Stem cell-derived exosomes (SC-EXO) was an emerging therapeutic agent in regenerative medicine. Intratunical injection of SC-EXO is considered as a prospective approach for erectile dysfunction (ED) treatment. However, high vascularization of cavernous body makes effective retention a major challenge for SC-EXO intratunical injection. In this study, a Polydopamine nanoparticles (PDNPs) incorporated poly (ethylene glycol)-poly(ε-caprolactone-co-lactide) (PDNPs-PELA) thermosensitive hydrogels were fabricated by a facile in situ polymerization for intratunical administration of adipose stem cell-derived exosomes (EXO). The hydrogels exhibited sol-gel transition at body temperature. Moreover, the in-situ polymerization of PDNPs using poly (ethylene glycol)-poly(ε-caprolactone-co-lactide) (PELA) block copolymer as a template was found to be more stable dispersion in the gel system. After being encapsulated into the hydrogel, EXO shows sustained release behavior within two weeks. In vivo animal experiments revealed that exosomes released from hydrogel lead to the healing of endothelial cells and neurons, increase of the cavity's pressure, thereby restoring the erectile function. In particular, since the PDNPs in thermosensitive gels have excellent photoacoustic performance, the hydrogel can be accurately delivered into the tunica albuginea by the guidance of real-time photoacoustic imaging. These results suggest that the as-prepared PDNPs-PELA has a promising future as an injectable exosome carrier for ED treatment.
Erectile Dysfunction in Cirrhosis: Its Prevalence and Risk Factors
2022, Journal of Clinical and Experimental Hepatology
Erectile dysfunction (ED) is common in men with cirrhosis. The aim of this study was to assess the prevalence of ED and the factors associated with ED in men with cirrhosis.
400 men with cirrhosis [Child–Turcotte–Pugh (CTP) class A, 44.0%; CTP class B, 41.0%; and CTP class C, 15.0%] having high Karnofsky performance score, and living in a stable monogamous relationship with a female partner were included in the study. International Index of Erectile Function (IIEF) questionnaire, and Short-Form (36) Health Survey (SF-36) were used to assess erectile function and the health-related quality of life (HRQOL), respectively.
ED was found in 289 (72.3%) patients. Patients with ED reported significantly lower SF-36 scores across all the eight domains of SF-36 (i.e., physical functioning score, role physical score, bodily pain score, general health perception score, vitality score, social functioning score, role emotional score, and mental health score); physical component summary score, and mental physical component summary score, compared with those without ED. On multivariate analysis, factors associated with ED were older age, longer duration of cirrhosis, CTP-C (vs. CTP-A), higher hepatic venous pressure gradient (HVPG), presence of generalized anxiety disorder (GAD), presence of major depression, and lower appendicular skeletal muscle index measured by dual-energy X-ray absorptiometry (DEXA ASMI).
ED is common in men with cirrhosis, and men with ED have poor HRQOL compared with those without ED. Older age, longer duration of cirrhosis, CTP-C (vs. CTP-A), higher HVPG, presence of GAD, presence of major depression, and lower DEXA ASMI are associated with ED.
Early Clinical Results of the Tolerability, Safety, and Efficacy of Autologous Platelet-Rich Plasma Administration in Erectile Dysfunction
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Platelet-rich plasma (PRP) is useful in the treatment of different conditions and diseases as it contains concentrated levels of many growth factors.
The aim of this study was to investigate the effectiveness of autologous PRP application in the treatment of erectile dysfunction (ED) in patients with metabolic syndrome.
In this prospective study conducted in June 2019, 31 patients with ED were included. The International Index of Erectile Function–Erectile Function domain (IIEF-EF) questionnaires were used to evaluate erectile function (EF). After administering the intracavernous autologous PRP 3 times with an interval of 15 days, IIEF-EFs were evaluated 1, 3, and 6 months later.
IIEF in the 1st, 3rd, and 6th months and adverse events.
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T Taş, Çakıroğlu, E Arda, et al. Early Clinical Results of the Tolerability, Safety, and Efficacy of Autologous Platelet-Rich Plasma Administration in Erectile Dysfunction. Sex Med 2021;9:100313.
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The management of arterial hypertension is very challenging in everyday clinical practice. Blood pressure control rates remain disappointingly low, despite intense efforts. Poor adherence to antihypertensive treatment is among the main causes of inadequate blood pressure control. Among the various parameters leading to poor adherence, medication adverse events seem to be the prevailing cause of treatment discontinuation. Β-blockers are a class of drugs commonly used in the management of hypertension. However, β-blockers use has been associated with various adverse events, among which, erectile dysfunction is a prevalent one. Accumulating evidence supports the detrimental role of β-blockers on erectile function. Older studies have shown contradictory findings, which however may be attributed to methodological errors related with the assessment of erectile function. More recent studies, however, unveiled the negative impact of this drug category on erectile function. Nevertheless, β-blockers represent a class of drugs with substantial within class heterogeneity. Nebivolol presents a unique mode of action through enhanced nitric oxide bioavailability that may be associated with benefits on erectile function. Indeed, studies of nebivolol have shown improvement in erectile function, suggesting that nebivolol represents the only exception in this class of drugs in terms of erectile function.
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^☆: The results shown here are part of the EDEM study (J Urol 2001, 166: 569–575), which was supported by an unrestricted grant from Pfizer S.A.

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Male Erectile Dysfunction and Health-Related Quality of Life☆

Abstract

Introduction

Section snippets

Design

Results

Discussion

J. Urol.

J. Urol.

Urology

Urology

Urology

J. Urol.

J. Urol.

Sexuality and aging in male veterans: a cross-sectional study of interest, ability and activity

J. Arch. Sex. Behav.

Sexual function in 1202 aging males: differentiating aspects

Journal of Gerontology: Medical Sciences

The conceptualisation of health

Medical Care Research and Review