bluuebunny/crossref_metadata_2025_split huggingface dataset:
098 Hyperestrogenism is Associated with Sexual Function Impairment in Men – Findings from a Cross-Sectional, Real-Life Study
Authors: Boeri L , Capogrosso P , Cazzaniga W , Candela L , Fallara G , Pozzi E , Belladelli F , Schifano N , Cignoli D , Colandrea G , Abbate C , Montorsi F , Salonia A 
Published: May 2022

ABSTRACT

Introduction
High serum estrogens levels have been associated with higher rates of heart attacks, strokes, and prostate cancer. Moreover, hyperestrogenism is believed to be harmful to male sexuality.

Objectives
We aimed to investigate the prevalence of and the impact of hyperestrogenism on sexual functioning in a cohort of men seeking medical attention for new onset erectile dysfunction (ED) in the real-life setting.

Methods
Data from 481 men seeking first medical help for new-onset ED at a single andrology centre were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All patients completed the International Index of Erectile Function (IIEF) and the IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri's criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estrogen (E2) levels &gt;42.6 pg/mL (Tan RS et al. 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and IIEF scores.

Results
Overall, 88 (18.3%) patients had serum estrogen levels suggestive for hyperestrogenism. Men with hyperestrogenism were older [median (IQR) 46 (34-58) vs. 44 (32-55) years; p&lt;0.001], had more comorbidities [CCI≥2: 18 (20.5%) vs. 28 (7.1%); p&lt;0.001] and higher serum testosterone (TT) levels [5.4 (4.2-7.3) vs. 4.3 (3.1-5.7); p=0.02] than those with normal E2 values. A higher rate of severe ED was found in men with elevated E2 levels (48.9% vs. 30%; p=0.02). Moreover, the IIEF-orgasmic function (IIEF-OF) domain was lower in ED men with hyperestrogenism than those with normal E2 values [6 (3-10) vs. 9 (6-10), p=0.03]. Serum E2 levels were positively correlated with TT levels (rho 0.25, p&lt;0.001), but negatively correlated with IIEF-OF scores (rho -0.17, p=0.005) and IIEF-EF scores (rho -0.32, p&lt;0.001) (Figure 1). At multivariable logistic regression analysis, hyperestrogenism (OR 2.37, p=0.03) was associated with severe ED after accounting for age, BMI, CCI and serum T values.

Conclusions
One out of five men seeking first medical help for ED showed elevated serum E2 values in the real-life setting. Hyperestrogenism was associated with health significant comorbidities, orgasmic function impairment and higher severity of ED.

Disclosure
Work supported by industry: no.
136 Clinical Outcomes of Testosterone Replacement Therapy in Japanese Patients with Late Onset Hypogonadism (LOH) Syndrome
Authors: Kuratsukuri K , Minami A , Naganuma T , Uchida J 
Published: May 2022

ABSTRACT

Objectives
The Japanese late-onset hypogonadism (LOH) guideline is using serum free testosterone (FT) level for diagnosis of LOH syndrome. On the other hand, the European and American guidelines are using total testosterone level (TT) for diagnosis of LOH syndrome. Serum total testosterone levels below 8 nmol/L (231 ng/dL) require substitution of testosterone in the E.A.U. recommendations. In this study, we compared serum free testosterone level and total testosterone level in patients who visited our LOH syndrome out-patient department. We also investigate clinical outcomes of testosterone replacement therapy (TRT) in patients with LOH syndrome.

Material and Methods
Two hundred thirty male patients who visited our LOH syndrome out-patient department from January, 2008 to September, 2017 were targeted at this study. The patient's average age was 55.1 years old. Average of AMS score in patients was 51.7 points.

Results
Only 20 patients (8.7%) were low value (less than 2.31ng/ml) and 86 (37.4%) patients were low and borderline value (less than 3.46ng/ml) in serum total testosterone (TT) level. On the other hand, 99 patients (43.1%) were low values (less than 8.5pg/ml), and also 175 examples (76.1%) were low and borderline value (less than 11.8pg/ml) in serum free testosterone (FT) level. Testosterone replacement therapy (TRT) was carried out for 3 months in 84 patients with patient with LOH syndrome. Sixty nine patients (82.1%) were effective for ART. Only four patients dropped out TRT because of dysuria and plethora. Fifty four patients (83%) with patients who were low value (l less than 8.5pg/ml) in serum free testosterone (FT) were effective for ART in 53 patients. Also 25 patients (80.6༅) who was borderline value (less than 11.8pg/ml) in serum free testosterone (FT) level were effective for TRT in 31 patients.

Conclusions
Including borderline case, high frequency patient is suited at the diagnostic criteria of LOH syndrome using serum FT value compared to TT value. It might be necessary to also consider measurement of the auxiliary total testosterone, and compensation of the isolation testosterone by age. Testosterone replacement therapy (TRT) was also effective in patients with LOH syndrome not only low value but also borderline value in serum free testosterone (FT).

Disclosure
Work supported by industry: no.
143 Selecting Patients for Penile Doppler Ultrasound in Clinical Practice
Authors: Capogrosso P. , Candela L. , Costa A. , Cazzaniga W. , Fallara G. , Cignoli D. , Boeri L. , Colandrea G. , Schifano N. , Cornelius J. , Abbate C. , Dehò F. , Mattei A. , Montorsi F. , Salonia A. 
Published: May 2022

ABSTRACT

Introduction
The routine use of dynamic duplex ultrasound of the penis (DDUP) to detect vasculogenic erectile dysfunction (V-ED) has been questioned because of a related patient’ discomfort and costs issues.

Objective
to investigate clinical factors which could guide the physician in selecting candidates for DDUP in routine practice.

Methods
Data were collected for 119 patients with ED who underwent DDUP regardless of their clinical history, to rule out V-ED at a single centre. Baseline data included: age, comorbidities (as scored with the Charlson Comorbidity Index (CCI)), BMI, recreational habits and the International Index of Erectile Function–6 (IIEF-6). DDUP was performed after intracavernous injection of alprostadil 20 ug and self sexual stimulation. V-ED was defined as a peak systolic velocity (PSV)&lt;30 cm/s ± end diastolic velocity (EDV) of &gt;3 cm/s and a resistance index (RI)&lt;0.8. Logistic regression analysis tested clinical predictors of V-ED. The accuracy of the predictive model was assessed and decision curve analyses (DCA) tested their clinical benefit.

Results
Median (IQR) age was 54(43-60) years and IIEF-6 was 15(8-21). Of 119, 44 (37%) patients had comorbidities (CCI≥1), with cardiovascular disease (CVDs) and diabetes in 13(11%) and 16(14%) patients. Of all, 18(15%) patients were current smokers and 58(49%) had no regular physical activity. At DDUP, median right and left PSV were 36.7(25.7-43.9) and 36.1(25.3-44.9) cm/s. V-ED was detected in 50(42%) patients. Age (OR:1.05;95%CI 1.01–1.08; p=0.004) and smoking history (OR:3.33; 95%CI 1.13–9.8; p=0.02) were associated with a higher risk of V-ED, while physical activity was a protective factor (OR:0.43; 95%CI:0.20-091; p=0.03). Conversely, BMI, IIEF-6, CVDs, diabetes and CCI were not associated with V-ED. The model including age, smoking and physical activity had a fine accuracy to predict V-ED (AUC:0.70;95%CI:0.60- 0.79). At DCA (fig 1), the use of those clinical factors to select candidates for DDUP would result in the best clinical strategy if a threshold risk of V-ED≥35% is considered as a reasonable value to trigger the investigation.

Conclusions
Clinical factors including age and lifestyle habits could be used in the everyday clinical practice to better select patients for DDUP, if the use of this test is considered clinically reasonable for patients with ≥35% risk of V-ED.

Disclosure
Work supported by industry: no.
146 Does the Risk of Obstructive Sleep Apnea (OSA) Affect Erectile Function Recovery (EFR) After Radical Prostatectomy (RP)?
Authors: Martinez J. Flores , Salter C.A. , Ruiz K. , Benfante N. , Schofield E. , Tan M. , Laudone V. , Mulhall J.P. 
Published: May 2022

ABSTRACT

Introduction
Obstructive sleep apnea (OSA) affects as many as 7% of adult men in the general population, higher in men with obesity and large neck sizes. OSA is associated with ED. No data to date has assessed EFR after RP in men with OSA.

Objective
The objective of this study was to define EFR rates 2 years post-RP.

Methods
Records of men who underwent RP with 24-month post-RP follow-up were reviewed. ADT and radiation therapy were exclusions. Men completed the OSA screening questionnaire, STOP-BANG (SB) pre-RP. Men were divided into OSA risk groups: high, intermediate, and low. EFR was recorded using IIEF-EFD score, with a score of at least 24 indicating recovery. Univariable and multivariable logistic regression analyses assessed predictors of EFR.

Results
454 men were analyzed. Mean age 62 ± 7 years. Of the studied population,12% had a history of OSA,10% had diabetes,12% were current smokers, and 37% were former smokers. The median STOP-BANG (SB) score was 2. High, intermediate, and low risk of OSA scores were 8%, 41% and 51% respectively. Mean baseline testosterone (T) was 495 ng/dL, PSA 7.4 ng/mL, and EFD score 22. Most men had a Gleason sum of 7 (87%). 73% of patients had bilateral or unilateral neurovascular bundle preservation. At the 2-year follow up, median EFD score in high, intermediate and low OSA risk groups: were 9, 16, and 18 respectively. The low OSA risk group was significantly more likely to recover (OR = 1.6, 1.1 – 2.4) than the moderate/high group. Younger age (OR = 0.92, 0.89 – 0.95), absence of diabetes (OR = 0.31, 0.14 – 0.72), higher baseline T (OR per 100 units = 1.40, 1.04 – 1.89), higher baseline EFD score (OR = 1.16, 1.11 – 1.22), and lower Gleason score (OR = 0.53, 0.34 – 0.82) were also associated with recovery at 2 years.

Conclusions
In our cohort, at 2 years post-RP, increasing OSA risk is associated with poorer EFR in men post-RP.

Disclosure
Work supported by industry: no.
150 Lipid Abnormality, Current Diabetes and Age Affect Erectile Hardness ∼ An Analysis of Data from Complete Medical Checkups Performed at a Single Hospital in Japan
Authors: Ishikawa K. , Sasaki H. , Ogushi Y. , Niikura A. , Ota T. , Ichimura Y. , Hashimoto Y. , Kurokawa I. , Sugishita H. , Tanifuji S. , Yamagishi M. , Shimoyama H. , Ota M. , Oshinomi K. , Hayashi K. , Morita J. , Shichijo T. , Fukagai T. , Sugawara S. 
Published: May 2022

ABSTRACT

Objectives
The Erection Hardness Score (EHS) can assess erectile hardness with a single question and is readily used in routine clinical practice. We investigated the correlation between EHS and both erectile function and metabolic risk, lifestyle, and other factors.

Methods
This study included 548 men who underwent a complete standard medical checkup at our hospital between July 1, 2016, and August 31, 2018, and answered the question about erectile hardness. The following variables were evaluated: age, erectile hardness on the EHS, erectile function on the Sexual Health Inventory for Men (SHIM), current medical history (diabetes, hypertension, dyslipidemia, heart disease, stroke), metabolic risk factors (abdominal circumference, hyperglycemia, high blood pressure, lipid abnormality), and lifestyle factors. First, to examine the correlation between erectile hardness and erectile function, the mean SHIM score by EHS grade was determined for each age group. Then, an analyses was performed to examine the association between erectile hardness and age, current medical history, metabolic risk factors, and lifestyle factors.

Results
In each age group, a lower EHS grade was associated with a lower mean SHIM score. Lipid abnormality, diabetes, and age were independent risk factors for decreased erectile hardness.

Conclusion
The EHS as a measure of erectile hardness was correlated with erectile functional as assessed using the SHIM, and current diabetes and lipid abnormality were independent risk factors for decreased erectile hardness. However, neither dyslipidemia nor lipid abnormality is listed as a risk factor in the ED guidelines. Traditionally, lipid abnormality was assessed based mainly on the presence or absence of current hyper-lipidemia and serum total cholesterol level. Today, the diagnostic criteria for metabolic syndrome proposed by the World Health Organization, International Diabetes Federation, and Japanese Society of Internal Medicine also recommend the use of serum triglyceride and HDL cholesterol levels, instead of total cholesterol level, for evaluating lipid abnormality. I think the assessment of lipid abnormality should be used triglyceride and HDL cholesterol levels, instead of total cholesterol level.

Disclosure
Work supported by industry: no.
152 Sexual Dysfunction in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis
Authors: Pyrgidis N. , Mykoniatis I. , Sokolakis I. , Tishukov M. , Kalyvianakis D. , Sountoulides P. , Hatzichristodoulou G. , Hatzichristou D. 
Published: May 2022

ABSTRACT

Introduction
Sexual dysfunction (SD) is an under-recognized clinical entity in both men and women with end-stage renal disease (ESRD). Studies on renal transplant recipients and dialysis patients report different prevalence rates and severity of SD among these groups. Moreover, the effect of renal transplantation on sexual function remains unknown.

Objectives
To explore the prevalence, severity, correlates, diagnostic approach and treatment modalities of sexual symptoms in patients with ESRD.

Methods
We performed a systematic review and meta-analysis assessing the prevalence of SD in ESRD individuals and evaluating the effect of renal transplantation on sexual function. Records were identified by searching PubMed, EMBASE, Scopus, and CENTRAL databases, as well as sources of grey literature. We conducted a random-effects meta-analysis of proportions (double arcsine transformation) to estimate the prevalence of SD in patients with ESRD. Multiple subgroup and sensitivity analyses, cumulative meta-analyses and univariate meta-regression analyses of important correlates were also performed.

Results
We included 94 studies with 10,320 ESRD male individuals and 47 studies with 3,490 ESRD female individuals. Overall, 7,253 males experienced erectile dysfunction (71%, 95% CI: 67% to 74%, I2= 92%). The pooled prevalence of erectile dysfunction was 59% (95% CI: 53% to 64%, I2= 92%) among renal transplant recipients, 79% (95% CI: 75% to 82%, I2= 86%) in hemodialysis patients and 71% (95% CI: 58% to 83%, I2= 86%) in peritoneal dialysis patients. On the contrary, 1,797 females experienced SD (74%, 95%CI: 67%-80%, I2=92%). The pooled prevalence of female SD was 63% (95%CI: 43%-81%, I2=92%) in renal transplant recipients, 80% (95%CI: 72%-87%, I2=91%) in hemodialysis patients and 67% (95%CI: 46%-84%, I2=90%) in peritoneal dialysis patients. In studies comparing erectile function before and after renal transplantation, renal transplant recipients reported an improvement in EF (RR: 2.53, 95%CI: 1.44 to 4.44, I2= 90%). The latter was also observed in women.

Conclusions
Sexual symptoms negatively affect the quality of life and warrant appropriate clinical attention, as they are an underdetermined and undertreated clinical entity in patients with ESRD. Renal transplantation seems to improve sexual function both in men and in women. Still, further studies on the field are mandatory.

Disclosure
Work supported by industry: no.
179 Assessment of Erectile and Ejaculatory Functions after Bladder-Sparing Therapy Against Muscle-Invasive Bladder Cancer
Authors: Uchida Y. , Yokoyama M. , Nakamura Y. , Fukuda S. , Uehara S. , Tanaka H. , Yoshida S. , Matsuoka Y. , Fujii Y. 
Published: May 2022

ABSTRACT

Introduction
Radical cystectomy (RC) is still gold standard for muscle invasive bladder cancer (MIBC). Whereas, bladder-sparing therapy with transurethral resection of bladder tumor (TUR) and chemoradiation therapy (CRT) has been recognized as an alternative treatment to RC for selected patients with MIBC. We have developed and implemented tetra-modality bladder-sparing therapy (TeMT) incorporating partial cystectomy (PC) in addition to maximal TUR and induction CRT to overcome local recurrence after bladder-sparing therapy (Kageyama et al. Am J Clin Oncol 2003, Koga et al. BJU Int 2012, Kijima et al. BJU Int 2019). There are few studies on erectile and ejaculatory functions after bladder-sparing therapy.

Objective
To cross-sectionally survey erectile and ejaculatory functions after TeMT in patients with MIBC.

Methods
Of the total 117 male patients with MIBC who completed TeMT between 2006 and 2019, 70 patients were set as the target to distribute the questionnaires after excluding patients lost to follow up as of February 2020, patients with local recurrence of MIBC or additional prostate cancer treatment. Erectile function was assessed using the International Index of Erectile Function short form (IIEF-5), and ejaculatory function using Male Sexual Health Questionnaire Ejaculatory Dysfunction short form (MSHQ-EjD-SF). Attending physicians handed the questionnaires to the patients at the first regular outpatient visit after February 2020 and had the patients complete them outside the office.

Results
Of 44 patients received the questionnaires between February and August 2020, 35 completed the questionnaires. The median age (range) of the eligible patients was 70 (50-87) years old, and the median time from the date of PC to the date of response was 5.2 (0.35-14) years. The results of IIEF-5 showed that 3 (9%) had no erectile dysfunction (ED) (22-25 points), 9 (26%) had mild ED (17-21 points), 4 (11%) had mild to moderate ED (12-16 points), 4 (11%) had moderate ED (8-11 points), and 15 (43%) had severe ED (5-7 points). Based on the results of MSHQ-EjD-SF, 23 patients (66%) responded that they could ejaculate. Of those, 5 patients (14%) scored 4 or higher on all questions 1-3 of MSHQ-EjD-SF, suggesting that they did not have ejaculatory dysfunction.

Conclusions
Preservation of erectile and ejaculatory functions was observed in MIBC patients treated with bladder-sparing therapy. Along with that of lower urinary tract function, preservation of male sexual function in bladder-sparing therapy, especially ejaculatory function which is inevitably lost by RC, is considered to be an advantage over RC.

Disclosure
Work supported by industry: no.
183 Evaluation of Ejaculation Function Using a Simple Questionnaire
Authors: Kimura M. , Yoshimura I. , Yanagida K. , Yoshida T. , Hagiwara K. , Kaneko T. , Yamada Y. , Nakagawa T. 
Published: May 2022

ABSTRACT

Introduction
There is a wide range of problems associated with ejaculation, including decreased semen volume, vaginal ejaculation problems, premature ejaculation, delayed ejaculation, hematospermia, and pain associated with ejaculation. However, there is no simple questionnaire that can comprehensively evaluate these ejaculatory functions.

Objective
In this study, we evaluated the overall ejaculation function of the patients in question using an originally developed ejaculation function score (Kimura and Shoji's Ejaculation Function Score).

Methods
We examined 20 patients who visited our sexual function outpatient clinic with a chief complaint of ejaculation. As a control group, we also examined 20 patients who had undergone vasectomy using the same score. The questionnaire consisted of the following five items (1) Awareness of sufficient momentum, (2) Pleasant sensation during ejaculation, (3) Presence of pain associated with ejaculation, (4) Presence of blood in semen, and (5) Perception of decreased semen volume. The total score was also evaluated. In addition, satisfaction with the current ejaculation was assessed.

Results
The mean age of the ejaculation disorder group was 43.5±15.1 years. The main complaints were decreased semen volume in 7 cases (35%), vaginal ejaculation disorder in 6 cases (30%), delayed ejaculation in 2 cases (10%), premature ejaculation in 2 cases (10%), lack of orgasm in 1 case (5%), and pain associated with ejaculation in 1 case (5%). The mean scores for each item were 1.5 for item 1, 1.8 for item 2, 3.0 for item 3, 3.0 for item 4, and 2.0 for item 5, resulting in a mean total score of 11.2. On the other hand, the mean age of the vasectomy group was 42.0±9.4 years, item 1 was 2.8, item 2 was 2.9, item 3 was 3.0, item 4 was 3.0, item 5 was 2.9, and the mean total score was 14.6. When the two groups were compared, significant differences were found except for items 3 and 4. There was also a significant difference in satisfaction of present ejaculation with mean scores of 1.3 and 2.9. As a result of examining the clinical severity and the total score, the total score of 5-6 was considered severe, 7-9 moderate, 10-13 mild ejaculation disorder, and 14-15 within the normal range.

Conclusion
Although our ejaculation function score is still in the developmental stage, we believe that it can be a screening tool for ejaculation function in practical medical care and self-assessment.

Disclosure
Work supported by industry: no.
192 Association Between Vascular Lesion and Penile Erection Hardness in Japanese Patients With Erectile Dysfunction
Authors: Hayashi K. , Sasaki H. , Mugita T. , Tomiyama T. , Koizumi S. , Kurokawa I. , Saito K. , Fuji K. , Ishikawa K. , Fukagai T. 
Published: May 2022

ABSTRACT

Introduction
It is generally recognized that erectile dysfunction (ED) is largely attributable to vascular endothelial dysfunction which develops secondary to atherosclerotic changes and blood flow disorder. It is suggested that many patients with ED usually have advanced atherosclerosis because both ED and atherosclerosis share common risk factors.

Objective
Many erectile dysfunction(ED) cases are attributed to vascular endothelial dysfunction and impaired blood flow due to arteriosclerotic changes. In this study, we examined the association among the erection hardness score (EHS), Pulse Wave Velocity(PWV), and the presence of carotid artery plaques.

Materials and Methods
The study was enrolled 67 patients who visited our hospital with the chief complaint of ED. Based on the history at the first visit, 28 of the 67 patients were categorized into the EHS 3-4 group and the remaining 39 into the EHS 0-2 group. The two groups were retrospectively analyzed.

Results
The PWV points were significantly higher in the EHS 0-2 group than in the EHS 3-4 group (P = 0.047). In consideration for error in age, the modified points (PWV at the first visit - reference PWV by age) were significantly higher in the EHS 0-2 group than in the EHS 3-4 group (P = 0.026). This group also showed a higher detection rate of plaques by carotid ultrasound (66.7%).

Conclusions
This study showed that patients with lower points of EHS had higher PWV and were more likely to have carotid artery plaques. While ED has occasionally been considered as an early risk marker for the onset of cardiovascular events, this study suggests that the hardness of the penis can be an easier-to-measure and more sensitive index.

Disclosure
Work supported by industry: no.