Niepłodność męska (impotencja) – Rokowania, prognozy i postęp choroby

Niepłodność męska (impotencja)
Rokowania, prognozy i postęp choroby

Zaburzenia erekcji (ED) są istotnym markerem chorób układu sercowo-naczyniowego (CVD), często poprzedzającym pierwszy incydent sercowo-naczyniowy średnio o 3 lata. ED koreluje niezależnie ze zwiększonym ryzykiem choroby wieńcowej, udaru oraz śmiertelności z każdej przyczyny. Diagnostyka powinna obejmować szczegółowy wywiad medyczny, seksualny i psychospołeczny, badanie fizykalne oraz selektywne badania laboratoryjne, w tym pomiar porannego stężenia całkowitego testosteronu. Leczenie inhibitorami fosfodiesterazy typu 5 (PDE5i) po zawale mięśnia sercowego wiąże się ze zmniejszoną śmiertelnością i hospitalizacją z powodu niewydolności serca, a skuteczna korekta czynników ryzyka może poprawić zarówno rokowanie sercowo-naczyniowe, jak i funkcję erekcyjną. Zalecane jest stosowanie zwalidowanych kwestionariuszy do oceny nasilenia ED i monitorowania skuteczności terapii.

Niepłodność męska (impotencja) a choroba sercowo-naczyniowa

Wpływ leczenia ED na rokowanie sercowo-naczyniowe

Opcje terapeutyczne wpływające na rokowanie

Wytyczne dotyczące diagnostyki i leczenia ED
Opcje farmakologiczne i niefarmakologiczne

Modele predykcyjne i nowe kierunki badań

Metody eksperymentalne i badawcze

Znaczenie monitorowania objawów ED

Kolejne rozdziały

Niepłodność męska (impotencja) a choroba sercowo-naczyniowa

Zaburzenia erekcji (ED) są ściśle powiązane z chorobami układu sercowo-naczyniowego (CVD), co ma istotne znaczenie prognostyczne. Badania wskazują, że ED jest wczesnym objawem choroby sercowo-naczyniowej, wyprzedzającym wystąpienie pierwszego incydentu sercowo-naczyniowego średnio o trzy lata.¹ Rozpoznanie ED powinno być traktowane jako sygnał ostrzegawczy, wymagający dokładnej oceny czynników ryzyka sercowo-naczyniowego w celu zapobiegania przyszłym poważnym zdarzeniom sercowo-naczyniowym (MACE).²³

U mężczyzn z ED należy uwzględnić zarówno tradycyjne, jak i nietypowe czynniki ryzyka sercowo-naczyniowego. Uznawanie tych czynników ryzyka może pomóc w identyfikacji pacjentów, którzy wymagają bardziej rygorystycznych interwencji w zakresie stylu życia lub farmakoterapii w celu zminimalizowania ryzyka sercowo-naczyniowego.⁴ Skuteczna korekta czynników ryzyka u mężczyzn z ED uważanych za obciążonych wysokim ryzykiem sercowo-naczyniowym, oprócz zmniejszenia tego ryzyka, może również poprawić funkcję erekcyjną.⁵

Metaanaliza 12 prospektywnych badań kohortowych obejmujących 36 744 osób wykazała silne dowody na to, że ED jest znacząco i niezależnie związane ze zwiększonym ryzykiem nie tylko chorób sercowo-naczyniowych, ale także choroby wieńcowej, udaru i śmiertelności z każdej przyczyny.⁶ W badaniu obejmującym 1788 mężczyzn w wieku 40-79 lat, mężczyźni z ED, zmniejszoną liczbą porannych erekcji i niższym libido mieli wyższe ryzyko śmiertelności w porównaniu z mężczyznami bez tych objawów. ED w szczególności przewidywało śmiertelność z wszystkich przyczyn i potencjalnie służy jako sygnał ostrzegawczy o złym stanie zdrowia u starszych mężczyzn.⁷

Wpływ leczenia ED na rokowanie sercowo-naczyniowe

Leczenie zaburzeń erekcji po pierwszym zawale mięśnia sercowego wiąże się ze zmniejszoną śmiertelnością i hospitalizacją z powodu niewydolności serca. W ogólnokrajowym badaniu obserwacyjnym, które objęło 43 145 mężczyzn po pierwszym zawale mięśnia sercowego, wykazano, że leczenie inhibitorami fosfodiesterazy typu 5 (PDE5i) wiązało się ze znacznie zmniejszonym ryzykiem zgonu i hospitalizacji z powodu niewydolności serca.⁸

Co istotne, tylko mężczyźni leczeni inhibitorami fosfodiesterazy-5 mieli zmniejszone ryzyko, które wydawało się być zależne od dawki. Natomiast osoby leczone alprostadylem miały podobne ryzyko niekorzystnych wyników jak mężczyźni bez leczenia ED.⁹ Te wyniki wskazują na potencjalne korzyści sercowo-naczyniowe związane z leczeniem inhibitorami PDE5, które wykraczają poza poprawę funkcji seksualnej.

Opcje terapeutyczne wpływające na rokowanie

Rokowanie w zaburzeniach erekcji jest uzależnione od przyczyny ich wystąpienia. Przyczyny psychoseksualne generalnie dobrze reagują na poradnictwo, a większość innych przyczyn ED korzystnie odpowiada na doustne inhibitory PDE-5. W przypadku braku skuteczności istnieją liczne inne opcje leczenia, w tym zewnętrzne urządzenia próżniowe, dopochwowe czopki prostaglandynowe, wstrzyknięcia do ciał jamistych i terapia skojarzona.¹⁰

Pacjenci rzadko nie reagują na wszystkie te niechirurgiczne opcje; w takich przypadkach nadal dostępna jest operacja wszczepienia protezy prącia, która pozostaje wysoce skuteczna. Prawie każdy pacjent z ED może być skutecznie leczony obecnie dostępnymi terapiami.¹¹

Wytyczne dotyczące diagnostyki i leczenia ED

American Urological Association (AUA) opracowało wytyczne dotyczące diagnozy i leczenia zaburzeń erekcji. Zgodnie z tymi wytycznymi mężczyźni z objawami ED powinni przejść dokładny wywiad medyczny, seksualny i psychospołeczny, badanie fizykalne oraz selektywne badania laboratoryjne.¹² Zaleca się stosowanie zwalidowanych kwestionariuszy w celu oceny nasilenia ED, pomiaru skuteczności leczenia i ukierunkowania przyszłego postępowania.

Mężczyźni powinni być informowani, że ED jest markerem ryzyka podstawowej choroby sercowo-naczyniowej i innych stanów zdrowotnych, które mogą wymagać oceny i leczenia.¹³ U mężczyzn z ED należy mierzyć poranne stężenie całkowitego testosteronu w surowicy.

W przypadku mężczyzn leczonych z powodu ED należy rozważyć skierowanie do specjalisty w zakresie zdrowia psychicznego w celu promowania przestrzegania leczenia, zmniejszenia lęku przed występem i integracji leczenia w związek seksualny.¹⁴ Klinicyści powinni doradzać mężczyznom z ED, którzy mają choroby współistniejące negatywnie wpływające na funkcję erekcyjną, że modyfikacje stylu życia, w tym zmiany w diecie i zwiększona aktywność fizyczna, poprawiają ogólny stan zdrowia i mogą poprawić funkcję erekcyjną.¹⁵

Opcje farmakologiczne i niefarmakologiczne

Mężczyźni z ED powinni być informowani o opcji leczenia zatwierdzonym przez FDA doustnym inhibitorem fosfodiesterazy typu 5 (PDE5i), w tym o omówieniu korzyści i zagrożeń/obciążeń, o ile nie jest to przeciwwskazane.¹⁶ Gdy mężczyznom przepisywany jest doustny PDE5i do leczenia ED, należy udzielić instrukcji, aby zmaksymalizować korzyści/skuteczność.¹⁷ W przypadku mężczyzn, którym przepisano PDE5i, dawkę należy dostosować, aby zapewnić optymalną skuteczność.¹⁸

Mężczyźni z ED i niedoborem testosteronu (TD), którzy rozważają leczenie ED za pomocą PDE5i, powinni być poinformowani, że PDE5i może być bardziej skuteczny w połączeniu z terapią testosteronem.¹⁹

Inne opcje terapeutyczne, które powinny być omówione z pacjentami, obejmują:²⁰

Urządzenia do próżniowej erekcji (VED)
Dopochwowa alprostadyl
Wstrzyknięcia do ciał jamistych (ICI)
Wszczepienie protezy prącia

Dla młodych mężczyzn z ED i ogniskową okluzją tętnic miednicy/prącia, bez udokumentowanej uogólnionej choroby naczyń lub dysfunkcji żylno-okluzyjnej, można rozważyć rekonstrukcję tętnic prącia.²¹ Natomiast chirurgia żylna prącia nie jest zalecana dla mężczyzn z ED.

Modele predykcyjne i nowe kierunki badań

Opracowano modele predykcyjne dla ED przy użyciu uczenia maszynowego na podstawie danych z NHANES 2001-2004. Model wykazał doskonałą wydajność predykcyjną, z wysoką wartością AUC, czułością i wynikiem F1, wskazując, że stosowanie tego modelu predykcyjnego do wspomagania diagnozy ED mogłoby osiągnąć wysoki wskaźnik dokładności przy niskich wskaźnikach niewykrytych diagnoz.²²

Analiza interpretowalności sugerowała nieliniową ujemną korelację między obwodem ramienia a predykcyjnym prawdopodobieństwem ED, gdzie obwód ramienia mniejszy niż 32 cm mógł znacznie zwiększyć predykcyjne prawdopodobieństwo ED.²³ Co ciekawe, wyniki wykresu zależności SHAP w tym badaniu wskazywały, że duszność na schodach/nachyleniach znacznie zwiększa przewidywane prawdopodobieństwo ED, co może być kolejnym potwierdzeniem związku między chorobami sercowo-naczyniowymi a ED.²⁴

Taki model może poszerzyć zakres metod diagnostycznych dla ED, zwiększyć wskaźnik diagnozy ED i wspierać lekarzy we wdrażaniu wczesnych interwencji dla pacjentów z ED, znacznie poprawiając jakość życia pacjentów.²⁵

Metody eksperymentalne i badawcze

Niektóre metody leczenia ED są nadal uznawane za eksperymentalne, badawcze lub niesprawdzone, ponieważ ich skuteczność nie została ustalona.²⁶ Należą do nich:

Niskointensywna terapia falą uderzeniową (ESWT) – powinna być uznana za badawczą
Terapia komórkami macierzystymi do ciał jamistych – powinna być uznana za badawczą
Terapia osoczem bogatopłytkowym (PRP) – powinna być uznana za eksperymentalną

Panel ekspertów AUA ocenił dowody dotyczące wszystkich terapii ED. Leczenie uznane za skuteczne i generalnie bezpieczne (np. PDE5i, VED, ICI) jest zalecane, natomiast wybrane terapie, które są dostępne, ale które w ocenie panelu są nieskuteczne i wiążą się z istotnymi zagrożeniami/obciążeniami (np. operacja podwiązania żył, PRP, ESWT), w oparciu o aktualne dowody, nie powinny być oferowane.²⁷

Znaczenie monitorowania objawów ED

Zaburzenia erekcji są częstsze niż można sądzić, szczególnie u mężczyzn powyżej 40 roku życia. Szacuje się, że połowa wszystkich mężczyzn w wieku od 40 do 70 lat doświadczy ich w pewnym stopniu.²⁸ Mając na uwadze, że ED jest sugerowane jako marker chorób sercowo-naczyniowych, problemy z prąciem mogą być sygnałem ostrzegawczym, że osoby ich doświadczające mogą być zagrożone zdarzeniem sercowym.²⁹

Choć starzenie się, na które nie mamy wpływu, jest ważnym czynnikiem przyczyniającym się do ED (wraz z wiekiem choroby sercowo-naczyniowe, nadciśnienie i inne choroby współistniejące odgrywają coraz większą rolę w ED), istnieje kilka kroków, które można podjąć, oprócz jak najszybszej wizyty u lekarza rodzinnego, aby zapobiec ED lub zmniejszyć jego nasilenie.³⁰

Monitorowanie zdrowia prącia, a także włączenie odpowiednich zachowań związanych ze stylem życia, może przyczynić się do zapobiegania ED i chorobom sercowo-naczyniowym.³¹ Opieka nad pacjentem z ED jest okazją do wdrożenia ścisłej korekty modyfikowalnych czynników ryzyka. Ponadto może to być nie tylko strategia zmniejszenia ryzyka sercowo-naczyniowego, ale także sposób na poprawę dolegliwości seksualnych.³²

Kolejne rozdziały

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Materiały źródłowe

#1 Erectile Dysfunction Is a Hallmark of Cardiovascular Disease: Unavoidable Matter of Fact or Opportunity to Improve Menâs Health?
https://pmc.ncbi.nlm.nih.gov/articles/PMC8161068/
Erectile dysfunction (ED) is an early manifestation of cardiovascular (CV) disease. For this reason, men with ED should be carefully assessed for CV risk factors in order to prevent future major adverse CV events (MACE). […] In men with ED, it is important to take into account not only traditional risk factors but also unconventional ones. […] Recognizing these risk factors may help in identifying, among subjects with ED, those who merit stricter lifestyle or pharmacological interventions to minimize their CV risk. […] Effective correction of risk factors in ED men considered as high risk, besides reducing CV risk, is also able to improve erectile function. […] The temporal relationship between ED and MACE has earned ED the status of a risk factor for CVD. […] It is estimated that ED precedes the first CV event by three years on average.
#2 Erectile Dysfunction Is a Hallmark of Cardiovascular Disease: Unavoidable Matter of Fact or Opportunity to Improve Menâs Health?
https://www.mdpi.com/2077-0383/10/10/2221
Erectile dysfunction (ED) is an early manifestation of cardiovascular (CV) disease. For this reason, men with ED should be carefully assessed for CV risk factors in order to prevent future major adverse CV events (MACE). […] In men with ED, it is important to take into account not only traditional risk factors but also unconventional ones. Several parameters that derive from good clinical assessment of subjects with ED have proven to be valuable predictors of MACE. […] Recognizing these risk factors may help in identifying, among subjects with ED, those who merit stricter lifestyle or pharmacological interventions to minimize their CV risk. Effective correction of risk factors in ED men considered as high risk, besides reducing CV risk, is also able to improve erectile function. […] The aim of this narrative review is to summarize the available knowledge on the role of conventional and unconventional CV risk factors in ED men, either for sexual or CV outcomes.
#3 Why noting signs of erectile dysfunction is vital | Evergreen Life
https://www.evergreen-life.co.uk/health-wellbeing-library/why-monitoring-signs-of-erectile-dysfunction-is-important/
Erectile dysfunction (ED), otherwise known as impotence, is where a male either struggles to get an erection or has difficulty keeping one long enough to have penetrative sex. It can be more common than you think, especially in men aged over 40. In fact, its thought that half of all men between the ages of 40 and 70 will experience it to some extent. […] There may be some associations between symptoms and mortality. For instance, in a study of 1,788 men aged 40-79, men with ED, reduced morning erections and lower libido (sex drive) had a higher mortality risk compared to men without these symptoms. ED, in particular, predicted all-cause mortality and potentially serves as a warning sign of poor health status in older men. […] With ED being suggested as being a marker of cardiovascular diseases, penis problems could very well be a sign that those experiencing them could be at risk of a cardiac event.
#4 Erectile Dysfunction Is a Hallmark of Cardiovascular Disease: Unavoidable Matter of Fact or Opportunity to Improve Menâs Health?
https://www.mdpi.com/2077-0383/10/10/2221
Erectile dysfunction is an early manifestation of cardiovascular disease. For this reason, ED should be considered an alarm bell. Men with ED should be carefully assessed for CV risk factors in order to prevent future MACE. It is, however, known that traditional risk factors do not completely catch all subjects at high CV risk. In fact, a relevant proportion of MACE occurs in men apparently free from risk factors. In men with ED, who should be considered at high CV risk until proven otherwise, it is important to take into account not only traditional risk factors but also unconventional ones. […] Taking care of a patient with ED is an opportunity to implement a strict correction of modifiable risk factors. Furthermore, this may be not only a strategy to decrease CV risk but also a way to improve sexual complaints.
#5 Erectile Dysfunction Is a Hallmark of Cardiovascular Disease: Unavoidable Matter of Fact or Opportunity to Improve Menâs Health?
https://pmc.ncbi.nlm.nih.gov/articles/PMC8161068/
Erectile dysfunction (ED) is an early manifestation of cardiovascular (CV) disease. For this reason, men with ED should be carefully assessed for CV risk factors in order to prevent future major adverse CV events (MACE). […] In men with ED, it is important to take into account not only traditional risk factors but also unconventional ones. […] Recognizing these risk factors may help in identifying, among subjects with ED, those who merit stricter lifestyle or pharmacological interventions to minimize their CV risk. […] Effective correction of risk factors in ED men considered as high risk, besides reducing CV risk, is also able to improve erectile function. […] The temporal relationship between ED and MACE has earned ED the status of a risk factor for CVD. […] It is estimated that ED precedes the first CV event by three years on average.
#6 Why noting signs of erectile dysfunction is vital | Evergreen Life
https://www.evergreen-life.co.uk/health-wellbeing-library/why-monitoring-signs-of-erectile-dysfunction-is-important/
A meta-analysis of 12 prospective cohort studies involving 36,744 people found strong evidence that ED is significantly and independently associated with an increased risk of not only cardiovascular diseases, but coronary heart disease, stroke and all-cause mortality too. […] These associations are significant because other studies have shown lower testosterone levels are associated with chronic medical conditions, for example, metabolic syndrome, type 2 diabetes, dyslipidemia, hypertension all of which are cardiovascular disease risk factors as well as being linked with cardiovascular (CV) events themselves. […] Although ageing, something we cant help, is an important factor contributing to ED (as people age, cardiovascular diseases, hypertension, and other co-morbidities play an increasingly significant role in ED), there are several steps you can take, alongside seeing your GP as soon as possible, to prevent ED or reduce it. […] Keeping an eye on your own or and/or your partners penis health, as well as incorporating the above lifestyle behaviours, can combine to help prevent you from experiencing ED and cardiovascular diseases.
#7 Why noting signs of erectile dysfunction is vital | Evergreen Life
https://www.evergreen-life.co.uk/health-wellbeing-library/why-monitoring-signs-of-erectile-dysfunction-is-important/
Erectile dysfunction (ED), otherwise known as impotence, is where a male either struggles to get an erection or has difficulty keeping one long enough to have penetrative sex. It can be more common than you think, especially in men aged over 40. In fact, its thought that half of all men between the ages of 40 and 70 will experience it to some extent. […] There may be some associations between symptoms and mortality. For instance, in a study of 1,788 men aged 40-79, men with ED, reduced morning erections and lower libido (sex drive) had a higher mortality risk compared to men without these symptoms. ED, in particular, predicted all-cause mortality and potentially serves as a warning sign of poor health status in older men. […] With ED being suggested as being a marker of cardiovascular diseases, penis problems could very well be a sign that those experiencing them could be at risk of a cardiac event.
#8 Association between treatment for erectile dysfunction and death or cardiovascular outcomes after myocardial infarction | Heart
https://heart.bmj.com/content/103/16/1264
Erectile dysfunction (ED) is associated with an increased risk of cardiovascular disease in healthy men. However, the association between treatment for ED and death or cardiovascular outcomes after a first myocardial infarction (MI) is unknown. […] Treatment for ED after a first MI was associated with a reduced mortality and heart failure hospitalisation. Only men treated with phosphodiesterase-5 inhibitors had a reduced risk, which appeared to be dose-dependent. […] In this observational, nationwide study that included 43 145 men with a first MI we found that treatment with phosphodiesterase-5 inhibitors was associated with a markedly reduced risk of death, and hospitalisation for heart failure. […] We found that men who were treated for ED after a first MI had a reduced risk of death and hospitalisation for heart failure. Men who were treated with PDE5-inhibitors had a markedly reduced risk of death or heart failure, which appeared to be dose dependent, whereas those with alprostadil treatment had a similar risk of adverse outcome as men with no treatment for ED.
#9 Association between treatment for erectile dysfunction and death or cardiovascular outcomes after myocardial infarction | Heart
https://heart.bmj.com/content/103/16/1264
Erectile dysfunction (ED) is associated with an increased risk of cardiovascular disease in healthy men. However, the association between treatment for ED and death or cardiovascular outcomes after a first myocardial infarction (MI) is unknown. […] Treatment for ED after a first MI was associated with a reduced mortality and heart failure hospitalisation. Only men treated with phosphodiesterase-5 inhibitors had a reduced risk, which appeared to be dose-dependent. […] In this observational, nationwide study that included 43 145 men with a first MI we found that treatment with phosphodiesterase-5 inhibitors was associated with a markedly reduced risk of death, and hospitalisation for heart failure. […] We found that men who were treated for ED after a first MI had a reduced risk of death and hospitalisation for heart failure. Men who were treated with PDE5-inhibitors had a markedly reduced risk of death or heart failure, which appeared to be dose dependent, whereas those with alprostadil treatment had a similar risk of adverse outcome as men with no treatment for ED.
#10 Erectile Dysfunction – StatPearls – NCBI BookshelfTwitterFacebookLinkedInGitHubNCBI Insights BlogTwitterFacebookYoutube
https://www.ncbi.nlm.nih.gov/books/NBK562253/
The prognosis of ED is dependent on the cause. Psychosexual causes generally have a good response to counseling, and most other causes of ED respond favorably to oral PDE-5 inhibitors. If not, there are multiple other options for treatment, including external vacuum devices, intraurethral prostaglandin pellets, intracavernosal injections, and combined therapy. Patients rarely fail all of these non-surgical options; there is still penile prosthesis implantation surgery, which remains highly successful. Almost every patient with ED can be treated successfully with the currently available therapies.
#11 Erectile Dysfunction – StatPearls – NCBI BookshelfTwitterFacebookLinkedInGitHubNCBI Insights BlogTwitterFacebookYoutube
https://www.ncbi.nlm.nih.gov/books/NBK562253/
The prognosis of ED is dependent on the cause. Psychosexual causes generally have a good response to counseling, and most other causes of ED respond favorably to oral PDE-5 inhibitors. If not, there are multiple other options for treatment, including external vacuum devices, intraurethral prostaglandin pellets, intracavernosal injections, and combined therapy. Patients rarely fail all of these non-surgical options; there is still penile prosthesis implantation surgery, which remains highly successful. Almost every patient with ED can be treated successfully with the currently available therapies.
#12 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
Erectile Dysfunction: AUA Guideline (2018) […] The purpose of this guideline is to provide a clinical strategy for the diagnosis and treatment of erectile dysfunction (ED). […] Men presenting with symptoms of ED should undergo a thorough medical, sexual, and psychosocial history; a physical examination; and selective laboratory testing. (Clinical Principle) […] For the man with ED, validated questionnaires are recommended to assess the severity of ED, to measure treatment effectiveness, and to guide future management. (Expert Opinion) […] Men should be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment. (Clinical Principle) […] For men with ED, morning serum total testosterone levels should be measured. (Moderate Recommendation; Evidence Level: Grade C)
#13 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
Erectile Dysfunction: AUA Guideline (2018) […] The purpose of this guideline is to provide a clinical strategy for the diagnosis and treatment of erectile dysfunction (ED). […] Men presenting with symptoms of ED should undergo a thorough medical, sexual, and psychosocial history; a physical examination; and selective laboratory testing. (Clinical Principle) […] For the man with ED, validated questionnaires are recommended to assess the severity of ED, to measure treatment effectiveness, and to guide future management. (Expert Opinion) […] Men should be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment. (Clinical Principle) […] For men with ED, morning serum total testosterone levels should be measured. (Moderate Recommendation; Evidence Level: Grade C)
#14 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
For men being treated for ED, referral to a mental health professional should be considered to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship. (Moderate Recommendation; Evidence Level: Grade C) […] Clinicians should counsel men with ED who have comorbidities known to negatively affect erectile function that lifestyle modifications, including changes in diet and increased physical activity, improve overall health and may improve erectile function. (Moderate Recommendation; Evidence Level: Grade C) […] Men with ED should be informed regarding the treatment option of an FDA-approved oral phosphodiesterase type 5 inhibitor (PDE5i), including discussion of benefits and risks/burdens, unless contraindicated. (Strong Recommendation; Evidence Level: Grade B)
#15 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
For men being treated for ED, referral to a mental health professional should be considered to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship. (Moderate Recommendation; Evidence Level: Grade C) […] Clinicians should counsel men with ED who have comorbidities known to negatively affect erectile function that lifestyle modifications, including changes in diet and increased physical activity, improve overall health and may improve erectile function. (Moderate Recommendation; Evidence Level: Grade C) […] Men with ED should be informed regarding the treatment option of an FDA-approved oral phosphodiesterase type 5 inhibitor (PDE5i), including discussion of benefits and risks/burdens, unless contraindicated. (Strong Recommendation; Evidence Level: Grade B)
#16 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
For men being treated for ED, referral to a mental health professional should be considered to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship. (Moderate Recommendation; Evidence Level: Grade C) […] Clinicians should counsel men with ED who have comorbidities known to negatively affect erectile function that lifestyle modifications, including changes in diet and increased physical activity, improve overall health and may improve erectile function. (Moderate Recommendation; Evidence Level: Grade C) […] Men with ED should be informed regarding the treatment option of an FDA-approved oral phosphodiesterase type 5 inhibitor (PDE5i), including discussion of benefits and risks/burdens, unless contraindicated. (Strong Recommendation; Evidence Level: Grade B)
#17 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
When men are prescribed an oral PDE5i for the treatment of ED, instructions should be provided to maximize benefit/efficacy. (Strong Recommendation; Evidence Level: Grade C) […] For men who are prescribed PDE5i, the dose should be titrated to provide optimal efficacy. (Strong Recommendation; Evidence Level: Grade B) […] Men who desire preservation of erectile function after treatment for prostate cancer by radical prostatectomy (RP) or radiotherapy (RT) should be informed that early use of PDE5i post-treatment may not improve spontaneous, unassisted erectile function. (Moderate Recommendation; Evidence Level: Grade C) […] Men with ED and testosterone deficiency (TD) who are considering ED treatment with a PDE5i should be informed that PDE5i may be more effective if combined with testosterone therapy. (Moderate Recommendation; Evidence Level: Grade C)
#18 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
When men are prescribed an oral PDE5i for the treatment of ED, instructions should be provided to maximize benefit/efficacy. (Strong Recommendation; Evidence Level: Grade C) […] For men who are prescribed PDE5i, the dose should be titrated to provide optimal efficacy. (Strong Recommendation; Evidence Level: Grade B) […] Men who desire preservation of erectile function after treatment for prostate cancer by radical prostatectomy (RP) or radiotherapy (RT) should be informed that early use of PDE5i post-treatment may not improve spontaneous, unassisted erectile function. (Moderate Recommendation; Evidence Level: Grade C) […] Men with ED and testosterone deficiency (TD) who are considering ED treatment with a PDE5i should be informed that PDE5i may be more effective if combined with testosterone therapy. (Moderate Recommendation; Evidence Level: Grade C)
#19 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
When men are prescribed an oral PDE5i for the treatment of ED, instructions should be provided to maximize benefit/efficacy. (Strong Recommendation; Evidence Level: Grade C) […] For men who are prescribed PDE5i, the dose should be titrated to provide optimal efficacy. (Strong Recommendation; Evidence Level: Grade B) […] Men who desire preservation of erectile function after treatment for prostate cancer by radical prostatectomy (RP) or radiotherapy (RT) should be informed that early use of PDE5i post-treatment may not improve spontaneous, unassisted erectile function. (Moderate Recommendation; Evidence Level: Grade C) […] Men with ED and testosterone deficiency (TD) who are considering ED treatment with a PDE5i should be informed that PDE5i may be more effective if combined with testosterone therapy. (Moderate Recommendation; Evidence Level: Grade C)
#20 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
Men with ED should be informed regarding the treatment option of a vacuum erection device (VED), including discussion of benefits and risks/burdens. (Moderate Recommendation; Evidence Level: Grade C) […] Men with ED should be informed regarding the treatment option of intraurethral (IU) alprostadil, including discussion of benefits and risks/burdens. (Conditional Recommendation; Evidence Level: Grade C) […] Men with ED should be informed regarding the treatment option of intracavernosal injections (ICI), including discussion of benefits and risks/burdens. (Moderate Recommendation; Evidence Level: Grade C) […] Men with ED should be informed regarding the treatment option of penile prosthesis implantation, including discussion of benefits and risks/burdens. (Strong Recommendation; Evidence Level: Grade C)
#21 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
For young men with ED and focal pelvic/penile arterial occlusion and without documented generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction may be considered. (Conditional Recommendation; Evidence Level: Grade C) […] For men with ED, penile venous surgery is not recommended. (Moderate Recommendation; Evidence Level: Grade C) […] For men with ED, low-intensity extracorporeal shock wave therapy (ESWT) should be considered investigational. (Conditional Recommendation; Evidence Level: Grade C) […] For men with ED, intracavernosal stem cell therapy should be considered investigational. (Conditional Recommendation; Evidence Level: Grade C) […] For men with ED, platelet-rich plasma (PRP) therapy should be considered experimental. (Expert Opinion) […] The Panel reviewed the evidence on all therapies for ED. Treatments judged to be effective and that appear to be generally safe (e.g., PDE5i, VED, ICI) are reviewed above, and guidance is provided in the form of statements. Selected treatments that are available but that in the Panel’s judgement are ineffective and involve substantial risks/burdens (e.g., venous ligation surgery, PRP, ESWT) and, based on current evidence, should not be offered also are addressed.
#22 Development and validation of a prediction model for ED using machine learning: according to NHANES 2001â2004 | Scientific Reports
https://www.nature.com/articles/s41598-024-78797-2
The model demonstrated excellent predictive performance, with high AUC value, sensitivity, and F1-Score, indicating that using this prediction model to assist in ED diagnosis could achieve a high rate of accuracy with low rates of missed diagnoses. […] Our model can broaden the range of diagnostic methods for ED, enhance the diagnosis rate of ED, and support doctors in implementing early interventions for ED patients, thereby significantly improving patients life quality.
#23 Development and validation of a prediction model for ED using machine learning: according to NHANES 2001â2004 | Scientific Reports
https://www.nature.com/articles/s41598-024-78797-2
Erectile Dysfunction (ED) is a form of sexual dysfunction in males that imposes significant health and financial burdens globally. […] The model evaluation results revealed that the AUC values are XGBoost: 0.8870.016; LightGBM: 0.8790.016; CatBoost: 0.8710.019. […] Therefore, we believe the ED prediction model trained in this study has strong predictive performance and high interpretability. This model can help to expand the diagnostic options for ED, improve the diagnosis rate of ED, and assist doctors in early intervention for patients with ED, ultimately improving patient prognosis. […] The results of the SHAP dependence plot in this study indicated that Shortness of breath on stairs/inclines significantly increases the predicted probability of ED. […] The interpretability analysis suggested a non-linear negative correlation between arm circumference and the predictive probability of ED, where an arm circumference smaller than 32 cm could significantly increase the predictive probability of ED.
#24 Development and validation of a prediction model for ED using machine learning: according to NHANES 2001â2004 | Scientific Reports
https://www.nature.com/articles/s41598-024-78797-2
Erectile Dysfunction (ED) is a form of sexual dysfunction in males that imposes significant health and financial burdens globally. […] The model evaluation results revealed that the AUC values are XGBoost: 0.8870.016; LightGBM: 0.8790.016; CatBoost: 0.8710.019. […] Therefore, we believe the ED prediction model trained in this study has strong predictive performance and high interpretability. This model can help to expand the diagnostic options for ED, improve the diagnosis rate of ED, and assist doctors in early intervention for patients with ED, ultimately improving patient prognosis. […] The results of the SHAP dependence plot in this study indicated that Shortness of breath on stairs/inclines significantly increases the predicted probability of ED. […] The interpretability analysis suggested a non-linear negative correlation between arm circumference and the predictive probability of ED, where an arm circumference smaller than 32 cm could significantly increase the predictive probability of ED.
#25 Development and validation of a prediction model for ED using machine learning: according to NHANES 2001â2004 | Scientific Reports
https://www.nature.com/articles/s41598-024-78797-2
The model demonstrated excellent predictive performance, with high AUC value, sensitivity, and F1-Score, indicating that using this prediction model to assist in ED diagnosis could achieve a high rate of accuracy with low rates of missed diagnoses. […] Our model can broaden the range of diagnostic methods for ED, enhance the diagnosis rate of ED, and support doctors in implementing early interventions for ED patients, thereby significantly improving patients life quality.
#26 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
For young men with ED and focal pelvic/penile arterial occlusion and without documented generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction may be considered. (Conditional Recommendation; Evidence Level: Grade C) […] For men with ED, penile venous surgery is not recommended. (Moderate Recommendation; Evidence Level: Grade C) […] For men with ED, low-intensity extracorporeal shock wave therapy (ESWT) should be considered investigational. (Conditional Recommendation; Evidence Level: Grade C) […] For men with ED, intracavernosal stem cell therapy should be considered investigational. (Conditional Recommendation; Evidence Level: Grade C) […] For men with ED, platelet-rich plasma (PRP) therapy should be considered experimental. (Expert Opinion) […] The Panel reviewed the evidence on all therapies for ED. Treatments judged to be effective and that appear to be generally safe (e.g., PDE5i, VED, ICI) are reviewed above, and guidance is provided in the form of statements. Selected treatments that are available but that in the Panel’s judgement are ineffective and involve substantial risks/burdens (e.g., venous ligation surgery, PRP, ESWT) and, based on current evidence, should not be offered also are addressed.
#27 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
For young men with ED and focal pelvic/penile arterial occlusion and without documented generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction may be considered. (Conditional Recommendation; Evidence Level: Grade C) […] For men with ED, penile venous surgery is not recommended. (Moderate Recommendation; Evidence Level: Grade C) […] For men with ED, low-intensity extracorporeal shock wave therapy (ESWT) should be considered investigational. (Conditional Recommendation; Evidence Level: Grade C) […] For men with ED, intracavernosal stem cell therapy should be considered investigational. (Conditional Recommendation; Evidence Level: Grade C) […] For men with ED, platelet-rich plasma (PRP) therapy should be considered experimental. (Expert Opinion) […] The Panel reviewed the evidence on all therapies for ED. Treatments judged to be effective and that appear to be generally safe (e.g., PDE5i, VED, ICI) are reviewed above, and guidance is provided in the form of statements. Selected treatments that are available but that in the Panel’s judgement are ineffective and involve substantial risks/burdens (e.g., venous ligation surgery, PRP, ESWT) and, based on current evidence, should not be offered also are addressed.
#28 Why noting signs of erectile dysfunction is vital | Evergreen Life
https://www.evergreen-life.co.uk/health-wellbeing-library/why-monitoring-signs-of-erectile-dysfunction-is-important/
Erectile dysfunction (ED), otherwise known as impotence, is where a male either struggles to get an erection or has difficulty keeping one long enough to have penetrative sex. It can be more common than you think, especially in men aged over 40. In fact, its thought that half of all men between the ages of 40 and 70 will experience it to some extent. […] There may be some associations between symptoms and mortality. For instance, in a study of 1,788 men aged 40-79, men with ED, reduced morning erections and lower libido (sex drive) had a higher mortality risk compared to men without these symptoms. ED, in particular, predicted all-cause mortality and potentially serves as a warning sign of poor health status in older men. […] With ED being suggested as being a marker of cardiovascular diseases, penis problems could very well be a sign that those experiencing them could be at risk of a cardiac event.
#29 Why noting signs of erectile dysfunction is vital | Evergreen Life
https://www.evergreen-life.co.uk/health-wellbeing-library/why-monitoring-signs-of-erectile-dysfunction-is-important/
Erectile dysfunction (ED), otherwise known as impotence, is where a male either struggles to get an erection or has difficulty keeping one long enough to have penetrative sex. It can be more common than you think, especially in men aged over 40. In fact, its thought that half of all men between the ages of 40 and 70 will experience it to some extent. […] There may be some associations between symptoms and mortality. For instance, in a study of 1,788 men aged 40-79, men with ED, reduced morning erections and lower libido (sex drive) had a higher mortality risk compared to men without these symptoms. ED, in particular, predicted all-cause mortality and potentially serves as a warning sign of poor health status in older men. […] With ED being suggested as being a marker of cardiovascular diseases, penis problems could very well be a sign that those experiencing them could be at risk of a cardiac event.
#30 Why noting signs of erectile dysfunction is vital | Evergreen Life
https://www.evergreen-life.co.uk/health-wellbeing-library/why-monitoring-signs-of-erectile-dysfunction-is-important/
A meta-analysis of 12 prospective cohort studies involving 36,744 people found strong evidence that ED is significantly and independently associated with an increased risk of not only cardiovascular diseases, but coronary heart disease, stroke and all-cause mortality too. […] These associations are significant because other studies have shown lower testosterone levels are associated with chronic medical conditions, for example, metabolic syndrome, type 2 diabetes, dyslipidemia, hypertension all of which are cardiovascular disease risk factors as well as being linked with cardiovascular (CV) events themselves. […] Although ageing, something we cant help, is an important factor contributing to ED (as people age, cardiovascular diseases, hypertension, and other co-morbidities play an increasingly significant role in ED), there are several steps you can take, alongside seeing your GP as soon as possible, to prevent ED or reduce it. […] Keeping an eye on your own or and/or your partners penis health, as well as incorporating the above lifestyle behaviours, can combine to help prevent you from experiencing ED and cardiovascular diseases.
#31 Why noting signs of erectile dysfunction is vital | Evergreen Life
https://www.evergreen-life.co.uk/health-wellbeing-library/why-monitoring-signs-of-erectile-dysfunction-is-important/
A meta-analysis of 12 prospective cohort studies involving 36,744 people found strong evidence that ED is significantly and independently associated with an increased risk of not only cardiovascular diseases, but coronary heart disease, stroke and all-cause mortality too. […] These associations are significant because other studies have shown lower testosterone levels are associated with chronic medical conditions, for example, metabolic syndrome, type 2 diabetes, dyslipidemia, hypertension all of which are cardiovascular disease risk factors as well as being linked with cardiovascular (CV) events themselves. […] Although ageing, something we cant help, is an important factor contributing to ED (as people age, cardiovascular diseases, hypertension, and other co-morbidities play an increasingly significant role in ED), there are several steps you can take, alongside seeing your GP as soon as possible, to prevent ED or reduce it. […] Keeping an eye on your own or and/or your partners penis health, as well as incorporating the above lifestyle behaviours, can combine to help prevent you from experiencing ED and cardiovascular diseases.
#32 Erectile Dysfunction Is a Hallmark of Cardiovascular Disease: Unavoidable Matter of Fact or Opportunity to Improve Menâs Health?
https://www.mdpi.com/2077-0383/10/10/2221
Erectile dysfunction is an early manifestation of cardiovascular disease. For this reason, ED should be considered an alarm bell. Men with ED should be carefully assessed for CV risk factors in order to prevent future MACE. It is, however, known that traditional risk factors do not completely catch all subjects at high CV risk. In fact, a relevant proportion of MACE occurs in men apparently free from risk factors. In men with ED, who should be considered at high CV risk until proven otherwise, it is important to take into account not only traditional risk factors but also unconventional ones. […] Taking care of a patient with ED is an opportunity to implement a strict correction of modifiable risk factors. Furthermore, this may be not only a strategy to decrease CV risk but also a way to improve sexual complaints.