Effect of kidney transplantation on sexual dysfunction in patients with end stage renal disease:A systematic review

BACKGROUND End-stage renal disease(ESRD)is associated with a multitude of physical,psychological,and social health challenges,including a profound impact on sexual and reproductive health.Among males with ESRD,erectile dysfunction(ED)is highly prevalent due to factors such as underlying comorbidities,including diabetes and hypertension,and the physiological effects of long-term dialysis.Kidney transplantation(KTx)has been proposed as a potential intervention to mitigate the effects of ED by restoring renal function and improving hormonal balance.However,the evidence surrounding the effectiveness of KTx in improving sexual function,specifically erectile function(EF),remains inconclusive.This systematic review and meta-analysis aim to evaluate the effects of KTx on sexual dysfunction(SexDys),particularly ED,in male ESRD patients.AIM To evaluate the benefits and potential harms of KTx compared to other forms of renal replacement therapy in improving EF in adult males with ESRD,assessed using the international index of EF(IIEF),to survey the prevalence of SexDys in this population,and to assess the correlation between various factors and SexDys through regression analysis.METHODS A systematic search of PubMed,EMBASE,Cochrane Library,Scopus,Clinical-Trials.gov,and Google Scholar was conducted,following the PRISMA 2020 guidelines.Prospective and retrospective cohort studies,as well as cross-sectional studies assessing EF pre-and post-transplantation,were included.These studies used validated tools such as the IIEF to measure EF.Meta-analyses were performed using a random-effects model to estimate standardized mean differences(SMD)and hazard ratios(HR)with 95%confidence intervals(CI).Heterogeneity was assessed using the I²statistic,and publication bias was evaluated with a funnel plot and the Egger’s test.RESULTS A total of 2419 studies were identified,with 362 abstracts screened and 193 full-text articles reviewed.Ultimately,11 studies were included for qualitative analysis and 7 for quantitative synthesis.The random effects model for SMD yielded a combined estimate of 0.43(95%CI:-0.20-1.07),indicating a small but non-significant improvement in EF post-transplantation.The heterogeneity across studies was substantial(I²=90%),reflecting significant variability in outcomes.Subgroup analysis showed greater improvements in EF among living-donor transplant recipients compared to those receiving organs from deceased donors.Despite this trend,the overall result for changes in EF was not statistically significant(P=0.15).Additionally,the combined HR from the meta-analysis was 2.87(95%CI:1.76-4.69),suggesting that KTx significantly increases the likelihood of improved EF,though variability between studies persisted(I²=63%).CONCLUSION While KTx offers some promise for improving EF in male ESRD patients,the overall evidence remains inconclusive due to high heterogeneity between studies and a lack of statistical significance in the combined results.Despite this,individual studies suggest that KTx may lead to significant improvements in EF for certain subgroups,particularly living-donor recipients.Future research should focus on larger,well-designed cohort studies with standardized outcome measures to provide more definitive conclusions.Addressing SexDys as part of routine care for ESRD patients undergoing KTx is crucial to improving their overall quality of life.However,adjunct therapies such as phosphodiesterase type 5 inhibitors may be necessary for those who do not experience adequate improvements post-transplantation.

Study on Female Sexual Dysfunction in Type 2 Diabetic Chinese Women

Objective To investigate the female sexual dysfunction(FSD)in type 2 diabetes patients,by comparing the sexual function between type 2 diabetic women and non-diabetic women with Female Sexual Function Index(FSFI).Methods 215 type 2 diabetic women and 107 age-matched non-diabetes women were enrolled with similar backgrounds.Their sexual functions were evaluated with FSFI.Metabolic parameters such as body mass index,blood lipid profile,hemoglobin AlC,plasma glucose were also collected.Results Total score of FSFI of the type 2 diabetic women were significantly lower than that of the non-diabetic controls(18.27±8.96 vs.23.02±5.78,P=0.000).Scores of the FSFI domains(desire,arousal,lubrication,orgasm,satisfaction,pain)of the type 2 diabetic group were also lower than those of the control group.According to the FSD criterion(FSFI〈25)available in China,the percentage of FSD in the type 2 diabetic group was significantly higher than that of the control group(79.2%vs.55.0%,P〈0.001).These trends seemed more prominent in pre-menopause subgroups.The logistic regression analysis indicated that age and diabetes were independent risk factors of FSD.Body Mass Index(BMI)also had influence in the diabetes group.Conclusion Findings from this study showed that there are more FDS in Chinese type 2 diabetic women than in their non-diabetic counterparts,especially in pre-menopause participants.

How to recognize late-onset hypogonadism in men wit sexual dysfunction

Late-onset hypogonadism （LOH） has been considered the most common form of male hypogonadism with a prevalence of approximately 1 in 100 men. Diagnosis of LOH should be made in symptomatic men with unequivocally low serum testosterone （T） levels. However, its clinical presentation is often insidious and difficult to recognize because it is characterized by nonspecific symptoms that make differential diagnosis with physiological ageing problematic. Sexual dysfunction is the most important determinant for medical consultation and the most specific symptom associated with low T. We therefore analysed a consecutive series of 1734 subjects who attended our unit for sexual dysfunction to investigate the associations between low T （different thresholds）, sexual parameters, medical history data （delayed puberty, pituitary disease or cryptorchidism） and their physical exam results. Metabolic parameters, in particular waist circumference, display the greatest accuracy in detecting low T. We found that only the association of several symptoms and signs could significantly raise the clinical suspicion of low T. Structured inventories, which cluster together symptoms and signs of hypogonadism, can help clinicians suspect androgen deficiency. In particular, structured interviews, such as ANDROTEST, have been demonstrated to have a greater accuracy when compared to self reported questionnaires in detecting low T levels.

Sexual Dysfunction among Chinese Nurses:Prevalence and Predictors

This study aimed to estimate the prevalence of and identify the factors influencing female sexual dysfunction （FSD） among Chinese nurses. A cross-sectional survey was conducted from March 2013 to May 2014 among 6 hospitals in Suzhou, China. In total, 2,030 married female nurses were included in the analysis.

Multiple sclerosis and sexual dysfunction

Multiple sclerosis （MS） is a chronic inflammatory demyelinating disorder of the central nervous system characterized by episodic and progressive neurologic dysfunction resulting from inflammatory and autoimmune reactions. The underlying pathogenesis of MS remains largely unclear. However, it is currently accepted as a T cell-mediated autoimmune disease. Among other clinical manifestations, sexual dysfunction （SD） is a painful but still underreported and underdiagnosed symptom of the disorder. SD in MS patients may result from a complex set of conditions and may be associated with multiple anatomic, physiologic, biologic, medical and psychological factors. SD arises primarily from lesions affecting the neural pathways involved in physiologic function. In addition, psychological factors, the side effects of medications and physical symptoms such as fatigue, muscular weakness, menstrual changes, pain and concerns about bladder and bowel incontinence may also be involved. Since MS primarily affects young people, SD secondary to MS may have a great impact on quality of life. Thus, maintaining a healthy sexual life with MS is an important priority. The treatment of SD requires multidisciDlinarv teamwork and coooeration amone specialists,individual patients, partners and the society.

Sexual dysfunctions and their treatment in liver diseases

Sexual dysfunction(SD)is a prevalent but very commonly ignored aspect in the treatment of liver diseases and cirrhosis.The etiology of SD is multifactorial and therefore treatment strategies are complex,especially in females.Phosphodiesterase inhibitors are useful and effective in erectile dysfunction in males but in females,no single drug is available for SD,therefore multimodal treatment is required depending upon the cause.The foremost and fundamental requirement in both genders is to be stress-free and have adequate control of liver diseases.Improved quality of life is helpful in improving SD and vice versa is also true.Therefore,patients suffering from liver diseases should come forward and ask for treatment for SD,and physicians should actively enquire about SD while history taking and evaluating these patients.SD results in deterioration of quality of life,and both are modifiable and treatable aspects of liver diseases,which are never addressed actively,due to social taboos and fears of SD treatment in the presence of liver diseases.The diagnosis of SD does not require costly investigations,as the diagnosis can be established based on validated questionnaires available for both genders,therefore detailed targeted history taking using questionnaires is essential.Data are emerging in this area but is still at an early stage.More studies should be dedicated to SD in liver diseases.

Assessment of Female Sexual Dysfunction in Patients with Premenopausal Female Pattern Hair Loss

Introduction: Female sexual dysfunction (FSD) is a serious problem that affects negatively the quality of life, interpersonal relationships and female self- confidence and might be a direct cause of psychopathological disturbances. Female pattern hair loss (FPHL) is a common cosmetically disturbing condition affecting many women with social and psychological consequences. Aim of the Work: Assessment of the relationship between female sexual dysfunction and Female pattern hair loss in premenopausal females. Methods: A case-control study was carried on 47 female patients with FPHL and 43 age- matched control women without FPHL among premenopausal women attending dermatology and Andrology outpatient’s clinics, Suez Canal University hospital during the period from May 2018 to January 2019. History taking, clinical examination and hormonal investigation (Free Testosterone, Total Testosterone, and SHBG) were performed to all participants in the study. Main Outcome Measures: The Female Sexual Function Index (FSFI) was used to assess the key aspects of female sexual function in patients and controls. FPHL was diagnosed and graded by Ludwig’s classification. Results: Mean age of patients group was 30.12 ± 5.49 years, Regarding FPHL grading, 55.3%, 42.6% & 2.1% of patients were grades 1, 2 and 3 Ludwig’s classification respectively. FSD was found in 44.7% of patients while it was 44.2% in control group (P > 0.05). FSFI score in patients group was 26.40 ± 4.61 and in control group was 27.05 ± 3.12 (P > 0.05). Correlation between FSD prevalence and grade of FPHL by Ludwig’s classification was statistically insignificant. FSD was significantly compromised by increasing age and parity in patients and control groups (P < 0.05). Conclusions: The present study suggests that FSD was not significantly related to FPHL. Increased age and parity may have strong impact on sexual function in premenopausal women, while androgen hormones levels were not determinant factor.

Epidemiology of Male Sexual Dysfunction (MSD) in Patients Consulting in Some Health Services in the City of Douala, Cameroon

Sexual dysfunction is a group of diseases, disorders or difficulties experienced by men or women during any stage of normal sexual activity. In Africa in general and Cameroon in particular, statistical data concerning the prevelance and the main causes of male sexual dysfunction are rare due to socio-cultural and religious burdens and sometimes self-medication. The objective of this work was to determine the prevalences, comorbidities and the risk factors of the main sexual dysfunction in some hospitals in city of Douala. Through a descriptive retrospective study carried out from Novembre 2019 to June 2021, sociodemographic parameter, reasons of consultation, risk factors and type of male sexual dysfunction (erectile dysfunction or erectile dysfunction (ED), ejaculation disorders (EjD), libido disorders (LD) and disorders of sexual activity with pain or painful sexual intercourse (PSI)) were collected in the medical files of patients who have made urological consultation between 2016 and 2020 at the Deido District hospital, Laquintinie Douala Hospital and Douala General hospital respectively. At the end of our data collection, out of a total of 24995 consultations, 2743 (10.98%) patients were suffering from at least one male sexual dysfunction. Moreover, sexual disorders were the 2nd reason of urological consultation (13.69%) after urinary disorders (33.85%). Among sexual disorders, erectile (76%) and ejaculatory (20%) disorders were the predominant pathologies recorded with the prevalences of 9.79 et 2.62% respectively, and were mostly represented in patients from [41 - 50] for erectile dysfunction, and [18 - 30] years old for ejaculative dysfunction. In addition, the number of patients with ejaculatory and erectile dysfunctions was more important in patients from [18 - 30] and [31 - 40] years old respectively. Among patients presenting sexual disorders, several risk factors or pathologies were associated with the dysfunction: benign prostatic hyperplasia and metabolic syndrome (in patients over 50 years old);psychosocial problems, infections, and alcohol (in patients under 50 years old). These findings could be useful in the elaboration of therapeutic strategies for the management of the Cameroonian population suffering from sexual dysfunctions.

Effect of Varicocelectomy on Gonadal Function among Patients Reporting with Sexual Dysfunction in Ghana

Background: Long-standing varicocele is often associated with testicular hypoxia and that might worsen Leydig cell function, a significant risk factor for hypogonadism. This may affect both the secretory and endocrine functions of the testis. This study aims to determine the effect of microsurgical sub-inguinal varicocelectomy on gonadal function among men reporting sexual dysfunction in Ghana. Methods: This was an intervention study conducted at the Tamale Teaching Hospital from September 2017 to August 2021. A total of 103 participants were randomized into two groups;the surgery group (n = 52) and the observed group (n = 51). Venous blood samples were collected at baseline, varicocelectomy was performed for the surgery group, and no intervention was given to the other. Blood samples were subsequently collected at 12-, 24-, 36-, and 48-month intervals for assay of serum total testosterone, FSH, and LH. The data were analyzed in GraphPad Prism (v8.0) at an alpha value of 0.05. Results: All the participants had varicocele and were aged between 55.0 to 69.0 years old. At the baseline of the study, all participants presented with sexual dysfunction but a significant improvement (p Conclusions: Microsurgical sub-inguinal varicocelectomy improved gonadal function among varicocele patients reporting sexual dysfunction. It is recommended to use this choice for similar patients;however, these findings should be verified by a multi-institutional study to provide more evidence for this choice.

A summary of the pharmacologically tested aphrodisiac plants for sexual dysfunction

Sexual dysfunction is a disruption of normal sexual intercourse and may be a consequence of various organic and psychological disorders. It is the most frequent at patients with cardiovascular and neurological diseases, sedentary lifestyle, arterial hypertension, diabetes, obesity and metabolic syndrome, and may disrupt their emotional life. But, sexual dysfunction may occur simply because of the physical aging of the body. Physiologic changes that occur with aging will aff ect sexual function and could be exacerbated by the above-mentioned diseases. Except for the sexual counseling and standard medications (phosphodiesterase type 5 (PDE5)– inhibitors, local estrogen therapy), some of the herbal medicines (aphrodisiacs) may be helpful in the treatment of these patients making them emotionally younger and happier. In this review, we bring a list of the pharmacologically tested aphrodisiac plants. But, we have a lack of information about their mechanisms of action, drug interaction and safety profi le. Until the relevant information is collected, uses of these products may be risky to the human being and should be prescribed only in consultation with a specialist.

Therapeutic Approach in Female Sexual Dysfunctions in an Outpatient Clinic of Sexology in the Public Health System: A Longitudinal and Prospective Study

INTRODUCTION: Sexuality is one of the parameters of quality of life, and it is essential to include care for sexual dysfunctions in primary health care. OBJECTIVE: To evaluate the therapeutic approach in female sexual dysfunction in a public health outpatient clinic. DESIGN: A prospective cohort of women with sexual dysfunctions in an outpatient clinic of sexology in the Public Health System. The Female Sexual Function Index (FSFI) and scored 0 - 10 their sexual satisfaction were applied at the beginning and end of the follow-up. RESULTS: Eighty-nine women were included with a median age of 45 years, 69 (77.5%) had less than 11 years of schooling and 95.5% lived with a partner. The main reasons for referral for follow-up at the outpatient clinic of sexuality were dysfunction of hypoactive sexual desire disorder in 67.4% and pain related to sexual function in 46%. The average number of consultations was five and the main therapeutic interventions were guidance and clarification on sexuality (86.5%), use of topical estrogen (56.2%), and relaxation techniques (37.1%). All FSFI-19 domains had better post-intervention rates (p ≤ 0.005). Considering the domains of the FSFI-19, the medians of desire, arousal, lubrication, orgasm, pleasure and pain were higher in the post-intervention period in relation to the pre-intervention period (p ≤ 0.0001 for all analysis). In addition, the score given by the participant on their sexual satisfaction was higher at the post-intervention time compared to the pre-intervention period (p ≤ 0.0001). CONCLUSION: In public health, even with the care being performed by different professionals in each consultation, we conclude that through simple interventions, it is possible to improve the sexualities of the women attended. Still, offering care in sexuality is fundamental as part of primary health care and the training of medical professionals.

Research progress of male sexual dysfunction following stroke

Stroke is a major disabling and fatal disease worldwide.There are many studies on neurological deficits and cognitive impairment after stroke,but there are few studies on sexual dysfunction,which is an important part of patients'quality of life.Studies have shown that male sexual dysfunction following stroke is very common,such as loss of libido,erectile dysfunction and ejaculatory weakness.Among them,young male stroke patients have particularly high requirements for quality of life and are ashamed to speak when they have secondary dysfunction.Related knowledge and degree of attention of medical staff are also relatively less.The location and area of stroke and the occurrence and development process of the disease may affect the sexual function of patients.Its etiology roughly includes both organic and functional aspects.Further study of post-stroke sexual dysfunction and strengthening the diagnosis and treatment of sexual dysfunction in stroke patients should be included in the category of stroke rehabilitation.

Construction and Initial Structure of Sexual Dysfunctions Tendencies Measure

Disclosure of sexual dysfunctions is difficult due to shame and social stigma.The instruments to measure sexual dysfunctions so far were quite backdated and lengthy.Moreover,there was no specific instrument available that could evaluate all the sexual dysfunctions on the Diagnostic and Statistical Manual of Mental Disorders’criteria in a single scale;separate for men and women.The objective to develop the scale was to provide the non-clinical population with a short and straight-forward measure in English which could help them in deciding about seeking professional help.The constructed scale comprised of 7 items for males and 7 for females and employed 6-points Likert scale for responses.The study involved 79 men and 105 women(N=184;Kaiser-Meyer-Olkin Measure of Sample Adequacy=0.682 for males and 0.618 for females).The inclusion criteria were the practical involvement of the participants in sexual practices and ability to respond to a questionnaire in English.Exploratory Factor Analysis was conducted to measure the reliability and validity of the scale.While employing Principal Component Analysis for extraction and Oblimin with Kaiser Normalization as Rotation,Exploratory Factor Analysis was conducted on 7 items for males and 7 items for females separately.Sampling adequacy was found good and the adequacy of correlations between items and was found highly significant.The Cronbach’s Alpha reliability was satisfactory.4 factors were extracted for males with 78.65%variance explained.3 factors were extracted for females with 66.57%variance explained.The communalities for all the 14 items ranged between 0.554 to 0.937.The study established that Sexual Dysfunctions Tendencies Measure is a valid and reliable tool to measure sexual dysfunctions with the criteria of the Diagnostic and Statistical Manual of Mental Disorders.

Incidence and risk factors of female sexual dysfunction in urban and rural China:a 4-year prospective cohort study

This study aimed to investigate the incidence and risk factors for female sexual dysfunction(FSD)in urban and rural China.A prospective cohort study was conducted from February 2014 to January 2016,with follow-up from June to December 2018.Women aged≥20 years were recruited from urban and rural areas in six provinces of China using a multistage,stratified,cluster sampling method.Sexual function was assessed using the Female Sexual Function Index questionnaire.A total of 16827 women without sexual dysfunction at baseline participated in this study,9489 of them(urban,5321;rural,4168)who had complete information from baseline to follow-up were included in the final analysis.The rate of follow-up was 68.81%,and the median follow-up time was 4.13 years.The 4-year incidence of FSD was 43.07%,with an incidence density of 12.02 per 100 person-years.In particular,the 4-year incidence and incidence density of FSD were 41.03%and 11.88 per 100 person-years in the urban group and 45.68%and 12.17 per 100 person-years in the rural group.Among women with sexual dysfunction,difficulties in sexual desire,satisfaction,and arousal were the main symptoms.In urban women,the risk factors for FSD included age≥45 years(adjusted relative risk 1.69,95%confidence interval 1.57-1.81),hypertension(1.31,1.14-1.49),previous delivery(1.26,1.13-1.41),post-menopausal status(1.20,1.10-1.32),pelvic inflammatory disease(1.13,1.05-1.21),and multiparity(1.11,1.03-1.19).In the rural group,the risk factors significantly associated with FSD were age≥45 years(1.50,1.40-1.61),previous delivery(1.39,1.17-1.65),hypertension(1.18,1.06-1.30),multiparity(1.16,1.07-1.27),and post-menopausal status(1.15,1.07-1.23).FSD is a hidden epidemic condition in China,and the development of prevention strategies should consider the distinct risk factors present in rural and urban areas.

Electroacupuncture for postpartum sexual dysfunction with urinary incontinence:A prospective case series study

Objective:To observe the clinical therapeutic effect of electroacupuncture on postpartum sexual dysfunction associated with urinary incontinence.Methods:The prospective case-series study was adopted.A total of 36 patients with postpartum sexual dysfunction associated with urinary incontinence were included consecutively.Electroacupuncture was applied to Shènshū(肾俞BL23),Huìyáng(会阳BL35),Pángguāngshū(膀胱俞BL28),Shíqīzhuī(十七椎EX-B8),Cìliáo(次髎BL32),Zhōngliáo(中髎BL33),Qìhǎi(气海CV6),Guānyuán(关元CV4),Zhōngjí(中极CV3),Qūgǔ(曲骨CV2),Shuǐdào(水道ST28),Zǐgōng(子宫EX-CA1),ZXsānlǐ(足三里ST36) and Sānyīnjiāo(三阴交SP6),once daily,6 times a week.The treatment for 2 weeks was as one phase and it should be completed in one menstrual cycle.For the cases without menstrual cycle recovery,the treatment should be given for any two weeks in one menstrual cycle and for those with menstrual cycle recovery,the treatment should avoid the menstrual period.Totally,the treatment lasted for 3 menstrual cycles.Before and after treatment,the scores of postpartum female sexual dysfunction diagnostic scale(PFSDDS),sexual intercourse pain assessment scale(SIPAS) and pelvic floor muscle strength test(PFMST),as well as the results of urodynamic examination(UE) were observed before and after treatment in the patients.Results:After treatment,the scores of PFSDDS,SIPAS and PFMST were all increased as compared with those before treatment separately,presenting the statistical significance(all P <0.05).Regarding UE,after treatment,the maximum bladder capacity,detrusor pressure at maximum flow,maximum flow rate and maximal urethral closure pressure were increased and postvoiding residual urine volume was reduced obviously as compared with the values before treatment,respectively,indicating the statistical differences(all P <0.05).Conclusion:Electroacupuncture has the significant effect on postpartum sexual dysfunction associated with urinary incontinence.

Effect of Chlorophytum Borivilianum Santapau and Fernandes on Sexual Dysfunction in Hyperglycemic Male Rats

Objective:To investigate the effects of Chlorophytum borivilianum(CB) on sexual dysfunction, loss of body weight,and lack of libido in hyperglycemic rats induced with streptozotocin or alloxan.Methods: Wistar strain male albino rats were divided into five groups of six animals each:the control group(2% polyvinylpyrollidone solution),the streptozotocin control group(50 mg/kg),the alloxan control group(100 mg/kg), the streptozotocin + CB treated group(200 mg/kg),and the alloxan + CB treated group(200 mg/kg).O...

Risk factors and the prognosis of sexual dysfunction in male patients with pituitary adenomas： a multivariate analysis

The impact of sexual dysfunction （SD） is distressing to many male patients with pituitary adenomas which affect both physical and psychological health. The research explored to identify risk factors affecting sexual function and the prognosis of male patients with pituitary adenomas. Two hundred and fifty-four male patients, who aged between 18 and 60 （mean ± s.d. ： 44.16 ± 10.14） years and diagnosed with pituitary adenomas, were retrospectively analyzed. One hundred and fifty-nine patients （62.6%） complained of SD prior to surgery. The mean International Index of Erectile Function （IIEF-5） in patients with giant adenomas was 16.13 ± 2.51, much smaller than those with microadenomas or macroadenomas （P 〈 0.05）. All the patients showed significant improvement in terms of erectile dysfunction （ED） following surgery （P 〈 0.05）. In addition, complete resection achieved a higher degree of SD relief than partial resection. The incidence of SD in functioning pituitary adenomas （FPAs） was much higher than that in nonfunctioning pituitary adenomas （NFPAs） （P 〈 0.05）. In addition, compared with NFPAs, males with prolactinomas （82.8%） had the higher prevalence of SD and significantly improvement following surgical intervention （P 〈 0.05）. An inverse relationship was identified between decreasing testosterone levels and increasing incidence of SD before surgery （P 〈 0.05）. There was no significant difference between 6 months and 12 months after surgery in serum testosterone level （P〉 0.05）. Our results indicated that surgical therapy could be optimized for improvements in SD and that testosterone levels can be used as a sensitive indicator to predict the recovery rate of sexual function in patients with pituitary adenomas following surgery and the serum testosterone level will stay stable in 6 months after surgery.

Use of a Natural Compound Made of Ecklonia bicyclis Seaweed, Tribulus terrestris and Water-Soluble Chitosan Oligosaccharide, in Male Sexual Asthenia with Mild or Mild-Moderate Erectile Dysfunction and Serum Testosterone Levels at the Lower Limit of Normal

Objectives: to evaluate the effectiveness of a natural compound made of Ecklonia bicyclis Seaweed, Tribulus terrestris and water-soluble chitosan oligosaccharide, in the male sexual asthenia with mild or mild-moderate erectile dysfunction and serum testosterone levels between 280 and 350 ng/dl. Materials and Methods: 84 male patients affected by reduced libido and serum testosterone levels at the lower limit of normal, were recruited. We have separated patients in three different age groups: group A (18 - 45 years), group B (45 - 59 years), group C (>60 years). All subjects answered the International index of erectile function questionnaire (IIEF-5) and underwent determination of serum total testosterone before and after 30 days of treatment. Results: Before treatment, the group A showed mean (± standard deviation) total testosterone 321.9 ± 19.2 ng/dl and mean IIEF-5 18.6 ± 1.97, in the group B it was 318.5 ± 18.1 ng/dl and 16.3 ± 2.66, and finally in the group C it was 305.4 ± 13.1 ng/dl and 14.2 ± 1.95 respectively. After treatment mean total testosterone and mean IIEF-5 were respectively: group A (448 ± 111.46 ng/dl and 21.84 ± 3.41);group B (453.8 ± 105.23 ng/dl and 20.4 ± 3.81);group C (385.8 ± 87.29 ng/dl and 16.7 ± 3.84). Conclusions: The treatment with Ecklonia bicyclis, Tribulus terrestris and water-soluble chitosan oligosaccharide might represent a safe and effective option on the improvement of libido and erectile function in man with testosterone level at the lower limit of normal.

Efficacy and safety of platelet-rich plasma intracavernous injection for patients with erectile dysfunction:A systematic review,meta-analysis,and meta-regression

Objective:Intracavernous injection might be offered to patients with erectile dysfunction (ED) who did not respond to the first-line oral treatment. Platelet-rich plasma (PRP) might offer improvement in erectile function since it contains numerous growth factors. This study aimed to evaluate the efficacy and safety of PRP intracavernous injection for patients with ED.Methods:We conducted relevant literature searches on Cochrane Library, Medline, Scopus, and ClinicalTrials.gov databases using specific keywords. The results of continuous variables were pooled into the mean difference (MD) and dichotomous variables into the odds ratio along with 95% confidence interval (95% CI).Results:A total of six studies were included. Our pooled analysis revealed that PRP intracavernous injection was associated with a significant increase in the erectile function domain of the International Index of Erectile Function at 1 month (MD 3.47 [95% CI 2.62–4.32], p<0.00001, I^(2)=7%), 3 months (MD 3.19 [95% CI 2.25–4.12], p<0.00001, I^(2)=0%), and 6 months (MD 3.21 [95% CI 2.30–4.13], p<0.00001, I^(2)=0%) after the intervention when compared with baseline values. PRP was also superior to a placebo in terms of improvement in erectile function domain of the International Index of Erectile Function score at 1 month (MD 2.83, p<0.00001), 3 months (MD 2.87, p<0.00001), and 6 months (MD 3.20, p<0.00001) post-intervention. The adverse events from PRP injection were only mild without any serious adverse events.Conclusion:PRP intracavernous injection may offer benefits in improving erectile function in patients with ED with a relatively good safety profile.

Prospective randomized study to evaluate and compare the post-procedural sexual function in patients undergoing semi-rigid ureterorenoscopy for distal ureteric stones in three different operating room settings

Objective:To evaluate and compare the effect of semi-rigid ureterorenoscopy on post-procedural sexual function with three different operating room settings.Methods:In this prospective randomized study,consecutive sexually active patients with normal pre-operative sexual function undergoing uncomplicated semi-rigid ureterorenoscopy for distal ureteric stones were randomized into three groups,with three different operating room settings.Procedure-related anxiety and sexual function were assessed pre-operatively using Amsterdam Preoperative Anxiety and Information Scale and Brief Sexual Function Inventory(in males)and Female Sexual Function Index-6(in females),respectively.All the participants were stented following the procedure,and the stent was removed after 3 weeks.Post-procedural sexual function and general discomfort were assessed and compared between three groups at 1 week,3 weeks,and 12 weeks.The effect of surgery-related anxiety,preoperative sexual function,age,and general discomfort(including stent-related discomfort)on post-procedural sexual function were analyzed using multiple regression analysis.A p-value of less than 0.05 was considered statistically significant.Results:Totally,327 eligible patients were randomized into three groups.The group of patients who underwent the procedural with a screen separating the operating area from the patient vision,while the patient could watch the endoscopy through a separate monitor,had better post-procedural sexual function compared to those who had total vision of the operating area as well as to those whose eyes were blocked.This difference was statistically significant.This post-procedural reduction in sexual function could not be attributed to in situ stent alone.Conclusions:Our study showed that semi-rigid ureterorenoscopy can have significant negative effect on sexual function,which can be reduced with proper preoperative counseling and an ideal operating room settings.