OBJECTIVETo explore the distribution, combination and evolution of various syndromic etiologies of erectile dysfunction (ED) based on the syndrome etiology theory.

METHODSUsing the ED Syndromic Etiology Scale, we collected the clinical data on the Chinese medicine diagnoses of 297 cases of ED, extracted the core syndromic etiologies by analysis of principal components and factors, and analyzed the patterns of distribution, combination, and evolution of ED syndromic etiologies according to the general information of the patients.

RESULTSThrough analysis of principal components and factors, 9 core syndromic etiologies were extracted, i. e. , liver constraint with qi stagnation, kidney yin deficiency, damp-heat, liver constraint transforming into liver-fire, blood stasis, kidney yang deficiency, heart-spleen paired deficiency, qi-yin paired deficiency, and phlegm-damp. Each of these syndrome etiologies exhibited its own specific distribution patterns. Of the total number of cases studied, 51.52% had 2 or 3 core syndromic etiologies and 36.03% had only one.

CONCLUSIONIn the early stage of ED, its syndromic etiologies are usually liver constraint with qi stagnation, kidney yin deficiency, damp-heat, liver constraint transforming into liver-fire, and blood stasis. With the natural progres- sion of the disease, its syndromic etiologies gradually evolve into kidney yang deficiency, heart-spleen paired deficiency, qi-yin paired deficiency, phlegm-damp, and blood stasis, and finally into yin-yang deficiency of the heart, spleen and kidneys, combined with phlegm-damp and blood stasis.

Adult ; Erectile Dysfunction ; diagnosis ; drug therapy ; etiology ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged

OBJECTIVETo investigate the effect of Compound Xuanju Capsule (CXC) combined with bromocriptine on hyperprolactinemia-induced erectile dysfunction (ED).

METHODSWe randomly assigned 46 patients with hyperprolactinemia-induced ED to receive bromocriptine (trial group, n = 23) and bromocriptine plus CXC (control group, n = 23), respectively, both for 12 weeks. Then we compared the two groups of patients in erectile function and the levels of serum prolactin and testosterone.

RESULTSAfter 12 weeks of treatment, the IIEF-5 scores were significantly improved in both the trial and the control groups as compared with the baseline (19.5 +/- 4.1 vs 13.0 +/- 3.8 and 16.4 +/- 3.7 vs 13.7 +/- 3.5, P<0.05), the level of serum prolactin was remarkably decreased ([156.07 +/- 26.31] vs [478.35 +/- 62.28] mIU/L and [164.73 +/- 28.58] vs [445.26 +/- 57.83] mIU/L, P<0.05), while the level of serum testosterone was markedly increased ([15.34 +/- 5.27] vs [3.80 +/- 1.09] nmol/L and [12.02 +/- 2.36] vs [4.07 +/- 1.25] nmol/L, P<0.05). Post-treatment erectile function was significantly better in the trial than in the control group (P<0.05), and the post-treatment serum testosterone level remarkably higher in the former than in the latter (P<0.05), but there was no significant difference in the serum prolactin level after treatment between the two groups (P>0.05).

CONCLUSIONThe combination of Compound Xuanju Capsule and bromocriptine is highly effective in the treatment of hyperprolactinemia-induced ED, and its effect is even better than that of bromocriptine alone.

Adult ; Bromocriptine ; therapeutic use ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Erectile Dysfunction ; drug therapy ; etiology ; Humans ; Hyperprolactinemia ; complications ; drug therapy ; Male ; Phytotherapy

OBJECTIVEPituitary prolactinoma with severe erectile dysfunction (ED) as the initial symptom is often misdiagnosed. This article explores the diagnosis and treatment of severe ED caused by pituitary prolactinoma.

METHODSWe retrospectively analyzed the diagnosis and treatment of 4 cases of pituitary prolactinoma with severe ED (IIEF-5 score 5 - 7) as the initial clinical symptom confirmed by MRI.

RESULTSThe 4 cases of pituitary prolactinoma-induced severe ED, with serum prolactin 10 times above the maximum normal level, were misdiagnosed for 2 years. All failed to respond to the PDE5 inhibitor therapy, and then 3 of them underwent transnasal hypophysectomy. Twenty-four months of follow-up found the level of prolactin restored to normal in 1 case (IIEF-5 = 19), and reduced to 600 and 768 IU/L respectively (IIEF-5 = 15) in the other 2. Then administration of the PDE5 inhibitor was followed, which produced satisfactory efficacy. One case was treated with oral bromocriptine, which restored the prolactin level to normal at 12 months (IIEF-5 > 21).

CONCLUSIONProlactin detection and brain MRI can help to confirm pituitary prolactinoma with severe ED at the onset. As for its treatment, in case of an extremely high level of prolactin, simple administration of the PDE5 inhibitor is ineffective. When the prolactin level is reduced after surgery or medication, the symptom of ED can be improved and, in case of no obvious relief, administration of the PDE5 inhibitor can be followed, which may achieve satisfactory results.

Adult ; Erectile Dysfunction ; diagnosis ; etiology ; Humans ; Male ; Middle Aged ; Phosphodiesterase 5 Inhibitors ; therapeutic use ; Pituitary Neoplasms ; complications ; diagnosis ; drug therapy ; Prolactinoma ; complications ; diagnosis ; drug therapy ; Retrospective Studies

The treatment of Peyronie's disease has been a challenge to urologists, as most of the current oral medications are considered hardly valid and the rest of the therapies require strict control of indications, some of which remain controversial, while the final surgical option may be associated with complications such as penile shortening or erectile dysfunction. Collagenase clostridium histolyticum has been proved to be effective in dissolving the penile cavernosal plaque and approved by the Food and Drug Administration of the USA as the first drug to be used for the treatment of Peyronie's disease. This article presents an introduction to the characteristics, safety, efficacy, and procedures of this new treatment, which may benefit urologists and the patients with Peyronie's disease.
Erectile Dysfunction ; etiology ; Humans ; Injections, Intralesional ; Male ; Microbial Collagenase ; therapeutic use ; Penile Induration ; drug therapy ; surgery ; Penis ; Postoperative Complications ; etiology ; Treatment Outcome

OBJECTIVETo evaluate the efficacy of daily low-dose tadalafil in the treatment of erectile dysfunction (ED) following pelvic fracture-induced urethral injury (PFUI).

METHODSBased on the length of time between pelvic fracture and the patients' clinic visit, we divided 42 PFUI-caused ED patients into groups A (< 1 month), B (6-24 months) and C (> 24 months). We treated them with tadalafil at 5 mg daily for 12 weeks consecutively, followed by evaluation of the therapeutic effect using IIEF-5 questionnaire and Sexual Encounter Profile (SEP) diaries.

RESULTSThirty-four patients (83.3%) completed the investigation and all responded well to tadalafil medication. Group A showed significant differences from B and C in the increase of IIEF-5 scores and the positive rate of SEP.

CONCLUSIONDaily low-dose tadalafil helps penile rehabilitation in ED patients following PFUI, and the earlier the medication is initiated, the better the effect will be.

Adult ; Carbolines ; administration & dosage ; therapeutic use ; Dose-Response Relationship, Drug ; Erectile Dysfunction ; drug therapy ; etiology ; Fractures, Bone ; complications ; Humans ; Male ; Pelvis ; injuries ; Tadalafil ; Treatment Outcome ; Urethra ; injuries

Objective: To evaluate the safety, efficacy and tolerability of China-made sildenafil citrate (Jinge) in the treatment of ED. METHODS: We conducted a multi-center, randomized, double-blind and placebo-controlled clinical trial among 222 ED patients in five urological or andrological clinics of China. The patients were randomly assigned to receive sildenafil citrate (SC, n = 111) or placebo (n = 111) for 8 weeks. We obtained and analyzed the demographic and clinical characteristics of the patients, the scores of International Index of Erectile Function (IIEF), the success rate of sexual intercourse, and the incidence of adverse events. RESULTS: No statistically significant differences were found between the patients of the SC and those of the placebo group in the mean age (［47.2±11.32］ yr vs ［46.67±13.08］ yr, P>0.05), psychological etiology (27.93% vs 23.42%, P>0.05), organic etiology (21.62% vs 29.73%, P>0.05) or mixed etiology (50.45% vs 46.85%, P>0.05), nor in height, weight, nationality, or history of smoking, drinking or allergy. Compared with the placebo controls, the SC-treated patients showed significant increases in the excellence rate of effectiveness (29.91% vs 78.90%, P<0.01), success rate of sexual intercourse (29.16% vs 63.87%, P<0.01), and total effectiveness rate (34.58% vs 77.98%, P<0.01). The effectiveness rates on organic, psychogenic and mixed types ED were remarkably higher in the SC group (64.52%, 83.33%, and 82.14%) than in the placebo control (46.15%, 21.21%, and 25.00%) (P<0.01). Mild or temporary adverse events were observed in 32 cases in the SC group as compared with 13 in the placebo control. CONCLUSIONS China-made sildenafil citrate is an effective, safe and well-tolerated drug for ED of different etiologies in the Chinese population.
Aged ; China ; Coitus ; Double-Blind Method ; Drug Compounding ; Erectile Dysfunction ; drug therapy ; etiology ; Humans ; Male ; Phosphodiesterase 5 Inhibitors ; therapeutic use ; Sildenafil Citrate ; therapeutic use ; Smoking ; Treatment Outcome

OBJECTIVETo explore the mechanism of erectile dysfunction (ED) with testosterone deficiency and discuss the feasibility of long-term testosterone replacement therapy (TRT) by observing a case of ED with testosterone deficiency treated by TRT for 65 months.

METHODSWe treated an ED patient with testosterone deficiency by TST for 65 months, and evaluated the therapeutic effects by analyzing his IIEF-5 score, dynamic changes in testosterone, PSA, hemoglobin and red blood cell count, and adverse events.

RESULTSThe patient was a 46-year-old man, with an IIEF-5 score of 7, baseline serum total testosterone (TT) of 2.79 ng/ml, and no response to phosphodiesterases-5 inhibitors (PDE5i). He was diagnosed with late-onset hypogonadism (LOH) and treated by TRT: testosterone undecanoate at 80 mg bid po for the first 2 weeks and then at 40 mg bid po. Two months after medication, the TT level was increased to normal (3.45 ng/ml), and physical fitness and anxiety symptoms were markedly improved, with no significant improvement in sexual function. Then we administered PDE5i on demand in addition, which elevated his IIEF-5 score to > 21. The combined medication of TRT and on-demand PDE5i lasted for 45 months followed by TRT alone for another 18 months. The patient was restored to normal penile erection and sexual satisfaction, with the IIEF-5 score remaining at > 21. Regular follow-up revealed no significant abnormalities in the testosterone level, PSA, and routine blood tests.

CONCLUSIONTRT enhances the effect of PDE5i in the treatment of androgen deficiency-induced ED, and long-term TRT is safe and effective for androgen deficiency.

Androgens ; deficiency ; Erectile Dysfunction ; drug therapy ; etiology ; Hormone Replacement Therapy ; Humans ; Male ; Middle Aged ; Testosterone ; analogs & derivatives ; therapeutic use ; Treatment Outcome

OBJECTIVETo evaluate the effect of low-dose phosphodiesterase type 5 inhibitor tadalafil on arterial erectile dysfunction.

METHODSForty-three patients with arterial erectile dysfunction were requested to take 5 mg tadalafil after supper on alternate days for 4 weeks. All the patients were scored on IIEF-5 and received intracavernous injection of 10 microg prostaglandin E1, followed by measurement of the peak systolic velocity (PSV) of the cavernosal artery by color Doppler ultrasonography.

RESULTSStatistic analyses showed an obvious increase in the IIEF-5 score and PSV after the treatment, with significant differences from the baseline (P < 0.01).

CONCLUSIONLow-dose tadalafil can significantly improve the PSV of the cavernosal artery and hence the erectile function of arterial ED patients.

Adult ; Aged ; Arteries ; Carbolines ; administration & dosage ; therapeutic use ; Erectile Dysfunction ; drug therapy ; etiology ; Humans ; Male ; Middle Aged ; Phosphodiesterase Inhibitors ; administration & dosage ; therapeutic use ; Tadalafil

OBJECTIVETo observe the clinical effect of tadalafil combined with testosterone undecanoate on late-onset hypogonadism (LOH) in old and middle-aged males.

METHODSA total of 125 old and middle-aged (40 to 60 years) males with LOH were randomly assigned to a treatment group (n = 65) and a control group (n = 60) to be treated with tadalafil + testosterone undecanoate and testosterone undecanoate alone, respectively. We compared the levels of total testosterone (T), IIEF scores and the patients' sexual encounter profile (SEP) diaries before and 4 weeks after medication.

RESULTSThe T level, IIEF score and SEP score were significantly improved in both groups after medication as compared with the baseline (P < 0.05), and even more so in the treatment than in the control group (P < 0.05).

CONCLUSIONTadalafil combined with testosterone undecanoate, superior to testosterone undecanoate alone, can improve the T level, IIEF score and SEP score in old and middle-aged males with LOH and increase their sexual satisfaction and self-confidence.

Carbolines ; therapeutic use ; Erectile Dysfunction ; etiology ; Humans ; Hypogonadism ; drug therapy ; physiopathology ; psychology ; Male ; Middle Aged ; Sexual Behavior ; Tadalafil ; Testosterone ; analogs & derivatives ; analysis ; therapeutic use ; Treatment Outcome

Androgen not only indirectly affects penile erection by enhancing sexual desire and arousal, but also play an important role in maintaining the normal structure of the erectile tissue. Testosterone deficiency may result in a reduction of trabecular smooth muscle content concomitant with increased accumulation of extracellular matrix and deposition of adipocytes in the subtunical region. All this can lead to corporal veno-occlusive dysfunction. In addition, testosterone can affect the expression and activity of nitric oxide synthases (NOS) and RhoA/Rho kinase and influence penile erection directly. Androgen administration may restore erectile function for hypogonadal patients with erectile dysfunction who fail to respond to PDE5 inhibitors alone.
Androgens ; deficiency ; physiology ; Animals ; Erectile Dysfunction ; drug therapy ; etiology ; Humans ; Male ; Penile Erection ; physiology ; Phosphodiesterase Inhibitors ; therapeutic use ; Rabbits ; Rats ; Testosterone ; therapeutic use