OBJECTIVE: To compare the clinical efficacy of herbal cake-separated moxibustion at Baliao acupoints combined with western medication versus western medication alone in treating erectile dysfunction (ED) with kidney deficiency and blood stasis. METHODS: A total of 108 ED patients were randomly divided into a combination group (54 cases, 2 cases dropped out) and a western medication group (54 cases, 1 case was eliminated, 2 cases dropped out). The western medication group received oral tadalafil tablets 5 mg a time, once daily. The combination group received additional herbal cake-separated moxibustion at Baliao acupoints (Shangliao [BL31], Ciliao [BL32], Zhongliao [BL33], Xialiao [BL34]) twice weekly (administered on Tuesdays and Fridays). Both groups were treated for 4 weeks. The 5-question international index of erectile function (IIEF-5) score, erectile hardness assessment (EHS) score, TCM syndrome score, serum sex hormone levels (follicle-stimulating hormone [FSH], luteinizing hormone [LH], prolactin [PRL], testosterone [T]), penile hemodynamic parameters [peak systolic velocity (PSV) of penile cavernosal artery, end-diastolic velocity (EDV), resistance index (RI)] were compared before and after treatment between the two groups, and the safety and clinical efficacy were evaluated. RESULTS: After treatment, the IIEF-5 scores, EHS scores, serum T levels, PSV and RI of penile cavernosal artery were increased compared with those before treatment in the two groups (P<0.05). Except for RI, the combination group exhibited significantly higher improvements in the above indexes than those in the western medication group (P<0.05). After treatment, the TCM syndrome scores, the serum FSH, LH levels, and EDV in the two groups and the serum PRL level in the combination group were decreased compared with those before treatment (P<0.05), while the above indexes in the combination group were lower than those in the western medication group (P<0.05). The total effective rate of the combination group was 88.5% (46/52), which was superior to 72.5% (37/51) in the western medication group (P<0.05). No significant adverse reactions occurred in either group. CONCLUSION Herbal cake-separated moxibustion at Baliao acupoints combined with western medicine can regulate sex hormone levels, improve penile blood supply, enhance erectile function and hardness, and is superior to western medication alone, with no observed adverse reactions.
Humans ; Male ; Moxibustion ; Erectile Dysfunction/drug therapy* ; Middle Aged ; Adult ; Acupuncture Points ; Drugs, Chinese Herbal/administration & dosage* ; Kidney/physiopathology* ; Aged ; Follicle Stimulating Hormone/blood* ; Luteinizing Hormone/blood* ; Treatment Outcome

Recent studies have revealed a significant relationship between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS), both of which commonly affect middle-aged and older men. These conditions share underlying causes, particularly endothelial dysfunction, atherosclerosis, and chronic pelvic ischemia (CPI). This study investigated the therapeutic potential of LDD175, a large-conductance Ca 2+ -activated K + channel (BKCa channel) opener, in simultaneously treating both conditions using a CPI animal model of male Sprague Dawley rats. Our study investigated the induction of CPI through surgical endothelial damage combined with a high-cholesterol diet. We assessed erectile and voiding functions by measuring intracavernosal pressure (ICP) and intraurethral pressure (IUP), respectively, after nerve stimulation. We performed histological examinations of vascular changes and western blot analyses of cavernous and prostate tissues to understand the underlying mechanisms. This study evaluated the effectiveness of LDD175 compared to standard treatments, such as sildenafil for ED and tamsulosin for LUTS. Therefore, the CPI model successfully demonstrated ED and LUTS symptoms with decreased ICP and increased IUP. Analysis revealed elevated levels of hypoxia-inducible factor-1α, transforming growth factor-β1 and β2 in cavernous tissue, and increased α1A-adrenoceptor expression in prostate tissue. LDD175 administration showed promising results, with dose-dependent improvements in ICP and IUP, and therapeutic effects comparable to those of established treatments. Our findings suggest a novel therapeutic approach that can simultaneously address ED and LUTS, opening new possibilities for clinical application in the treatment of these interconnected conditions.
Male ; Animals ; Erectile Dysfunction/etiology* ; Rats, Sprague-Dawley ; Lower Urinary Tract Symptoms/etiology* ; Ischemia/drug therapy* ; Rats ; Tamsulosin ; Hypoxia-Inducible Factor 1, alpha Subunit/drug effects* ; Sildenafil Citrate/therapeutic use* ; Penis/blood supply* ; Disease Models, Animal ; Transforming Growth Factor beta1/metabolism* ; Pelvis/blood supply* ; Prostate/metabolism* ; Sulfonamides/therapeutic use* ; Large-Conductance Calcium-Activated Potassium Channels/agonists*

UNLABELLEDOCTOBER: To explore the effects of the glucagon-like peptide 1 (GLP-1) liraglutide on the penile erectile function of rats with diabetic erectile dysfunction (DED) by observing the impact of liraglutide on the expression of eNOS in the corpus cavernosum of diabetic rats.

METHODSWe randomly divided 30 six-week-old male SD rats into a normal control (n = 10) and an experimental group (n = 20) , established models of diabetes mellitus (DM) in the experimental rats, and subdivided them into a DM (n = 8) and a GLP-1 group (n = 8) to receive intramuscular injection of normal saline and liraglutide at 5 mg per kg of the body weight per day, respectively. After 12 weeks of intervention, we obtained the levels of FPG, FINS, TG, TC, HDL-C, LDL-C, testosterone, and IL-6 and the indexes of Homa-IR and Homa-β, detected the expressions of Akt/p-Akt and eNOS/p-eNOS in the corpus cavernosum by Western blot, and compared the erectile function between different groups.

RESULTSThe frequency and rate of penile erection were significantly lower in the DM group than in the GLP-1 and normal control groups (P < 0.05) and also lower in the GLP-1 group than in the normal controls (P < 0.05). Immunofluorescence staining showed the expression of eNOS mainly in the cytoplasm of the cavernosal vessels and sinusoidal endothelial cells, markedly lower in the DM and GLP-1 groups than in the normal rats (P < 0.05), but higher in the GLP-1 than in the DM group (P < 0.05). The level of eNOS/p-eNOS in the penile tissue was significantly decreased in the DM and GLP-1 groups in comparison with the normal controls (P < 0.01 or P < 0.05), while that of p-eNOS was markedly increased in the GLP-1 group as compared with the DM group (P < 0.05). No statistically significant differences were observed in the Akt level among the three groups of animals (P > 0.05). The expression of p-Akt was remarkably reduced in the DM and GLP-1 groups in comparison with the control rats (P < 0.01 or P < 0.05), but higher in the GLP-1 than in the DM group (P < 0.05).

CONCLUSIONGLP-1 can protect the function of endothelial cells in the corpus cavernosum and improve the erectile function of DED rats by regulating the Akt/ eNOS signaling pathway, which indicates that GLP-1 could be an important option for the treatment and prevention of DED.

Animals ; Blotting, Western ; Diabetes Mellitus, Experimental ; Erectile Dysfunction ; drug therapy ; enzymology ; Hypoglycemic Agents ; pharmacology ; Liraglutide ; pharmacology ; Male ; Nitric Oxide Synthase Type III ; metabolism ; Penile Erection ; drug effects ; Penis ; drug effects ; enzymology ; physiopathology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Testosterone ; blood

The vacuum erectile device (VED) uses negative pressure to increase blood inflow into the corpora cavernosum, with a ring at the base of the penis to maintain erection for intercourse or without a ring for penile rehabilitation. Owing to the limitation of phosphodiesterase 5 inhibitors (PDE5I) shown in the treatment of refractory erectile dysfunction (ED), the use of VED has resurged and is becoming the first line therapy in the treatment of ED following radical prostatectomy (RP). Currently, the combination therapy of VED with PDE5I and that of VED with intracavernous injection are advocated for post-RP ED. Hereby, we review the role of VED in penile rehabilitation, its underlying mechanisms, and the combination therapies for it.
Coitus ; Combined Modality Therapy ; methods ; Erectile Dysfunction ; drug therapy ; etiology ; rehabilitation ; Humans ; Male ; Penile Prosthesis ; Penis ; blood supply ; Phosphodiesterase 5 Inhibitors ; therapeutic use ; Prostatectomy ; adverse effects ; Regional Blood Flow ; Vacuum

AIMTo investigate the influence of an extract obtained from five Chinese medicinal plants on sexual behavior of adult male rats.

METHODSThe extract was administered at doses of 30, 60 and 120 mg/kg by oral gavage, acutely (one time, 45 min before mating test) or subchronically (daily for 10 days) in sexually potent and sexually sluggish/impotent rats. Sexual behavior, serum levels of luteinizing hormone (LH) and testosterone (T) were evaluated in treated rats and compared with controls receiving vehicle. The effect of the extract on central dopaminergic neurotransmission was assessed in the nucleus accumbens using a microdialysis technique.

RESULTSIn sexually potent rats, both acute and subchronic treatment with the extract dosed at 30 and 60 mg/kg reduced mount latency and intromission latency. In sluggish/impotent rats, the acutely administered extract at the dose of 60 mg/kg shortened ejaculation latency, whereas subchronically administered at the doses of 30 and 60 mg/kg, reduced mount, intromission and ejaculation latencies, increasing also the percentage of mounting and ejaculating rats. The extract dosed at 60 mg/kg significantly increased LH and T following acute and subchronic administration and increased 3,4-dihydroxyphenylacetic acid levels in the nucleus accumbens, 30 min after the acute administration.

CONCLUSIONThe improvement in both appetitive and consummatory components of sexual behavior observed in male rats treated with the extract could be ascribed to increased serum T level in parallel with the activation of the central dopaminergic system.

Animals ; Brain Chemistry ; drug effects ; Central Nervous System ; drug effects ; Copulation ; drug effects ; Dopamine ; physiology ; Drugs, Chinese Herbal ; pharmacology ; Ejaculation ; drug effects ; Erectile Dysfunction ; drug therapy ; psychology ; Female ; Gonadal Steroid Hormones ; blood ; Luteinizing Hormone ; blood ; Male ; Microdialysis ; Motivation ; Plant Extracts ; pharmacology ; Plants, Medicinal ; chemistry ; Rats ; Rats, Sprague-Dawley ; Sexual Behavior, Animal ; drug effects ; Stimulation, Chemical ; Synaptic Transmission ; drug effects ; Testosterone ; blood

AIMTo evaluate whether the response to sildenafil administration in patients with arterial erectile dysfunction (ED) was related to their peak systolic velocity (PSV), peripheral atherosclerosis, cardiovascular risk factors (RF) and/or comorbidities at low cardiovascular risk.

METHODSWe enrolled 97 patients with 1-2 RF and comorbidities, combined with arterial ED alone (group A, n = 27), ED plus atherosclerotic carotid artery (group B, n = 23), ED plus lower limb artery abnormalities (group C, n = 25), and ED plus carotid and lower limb artery abnormalities (group D, n = 22). Sildenafil efficacy (100 mg twice a week for 12 weeks) was also examined in patients with =or>3 RF, peripheral atherosclerosis and no cardiovascular comorbidities (group E, n = 20).

RESULTSMedian PSV was 24.1, 21.0, 19.3, 14.5 and 17.5 cm/s in groups A, B, C, D and E, respectively. Sildenafil response was higher in group A patients (77.8%), intermediate in groups B and C (65.2% and 56%) and lowest in groups D (45.4%) and E (50%), and the response in latter two groups was significantly lower than in the other three groups. In addition, sildenafil response was negatively influenced by: =or>3 RF, peripheral atherosclerosis and no systemic comorbidity, or presence of 1-2 RF associated with extended atherosclerosis and comorbidities. The number of comorbidities was positively related to atherosclerosis localization or extension (25, 35, 38 and 47 in groups A, B, C and D, respectively).

CONCLUSIONLow sildenafil efficacy in patients with arterial ED was associated with extended atherosclerosis. These patients should undergo extensive ultrasonography and a full cardiovascular examination.

Aged ; Arterial Occlusive Diseases ; complications ; drug therapy ; physiopathology ; Atherosclerosis ; complications ; Cardiovascular Diseases ; complications ; drug therapy ; Erectile Dysfunction ; drug therapy ; etiology ; physiopathology ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Physical Examination ; Piperazines ; therapeutic use ; Purines ; therapeutic use ; Regional Blood Flow ; physiology ; Retrospective Studies ; Risk Factors ; Sildenafil Citrate ; Sulfones ; therapeutic use ; Treatment Outcome ; Vasodilator Agents ; therapeutic use

Testosterone (T) as a compound for treatment of T deficiency has been available for almost 70 years, but the pharmaceutical formulations have been less than ideal. Traditionally, injectable T esters have been used for treatment, but they generate supranormal T levels shortly after the 2-3 weekly injection interval. T levels then decline very rapidly, becoming subnormal during the days preceding the next injection. The rapid fluctuations in plasma T are subjectively experienced as disagreeable. T undecanoate (TU) is a new injectable T preparation with a considerably better pharmacokinetic profile. After two initial injections separated by a 6-week interval, the following intervals between two injections are generally 12 weeks, eventually amounting to a total of four injections per year. Plasma T levels with this preparation are nearly always in the range of normal men, as are its metabolic products estradiol and dihydrotestosterone (DHT). It reverses the effects of hypogonadism on bone and muscle and metabolic parameters, and on sex functions. It is suitable for male contraception. Its safety profile is excellent because of the continuous normalcy of plasma T levels. No polycythemia has been observed and no adverse effects on lipid profiles. Prostate safety parameters are well within reference limits. TU is a valuable treatment option of androgen deficiency.
Contraceptive Agents, Male ; pharmacokinetics ; therapeutic use ; Erectile Dysfunction ; drug therapy ; Humans ; Hypogonadism ; drug therapy ; Injections, Intramuscular ; Male ; Testosterone ; analogs & derivatives ; blood ; pharmacokinetics ; therapeutic use ; Testosterone Congeners ; pharmacokinetics ; therapeutic use

The diagnosis and treatment of erectile dysfunction has changed dramatically since the availability of safe and effective oral therapies. Unfortunately, not all men can be adequately treated in this way, and might require more invasive testing to diagnose and treat the specific cause of their dysfunction. This review looks at the tests and strategies available for men who cannot be treated by oral therapy alone.
3',5'-Cyclic-GMP Phosphodiesterases ; antagonists & inhibitors ; Administration, Oral ; Angiography ; Blood Flow Velocity ; Cyclic Nucleotide Phosphodiesterases, Type 5 ; Enzyme Inhibitors ; administration & dosage ; therapeutic use ; Erectile Dysfunction ; diagnosis ; drug therapy ; Humans ; Injections ; Male ; Penis ; blood supply ; diagnostic imaging ; Phosphodiesterase Inhibitors ; therapeutic use ; Vasodilator Agents ; therapeutic use

AIMTo examine the treatment efficacy of Korean Red Ginseng (KRG) in impotent men with erectile dysfunction (ED).

METHODSA total of 60 patients presenting mild or mild to moderate ED were enrolled in a double-blind, placebo-controlled study in which the efficacies of KRG and a placebo were compared. The patients received either 1,000 mg (3 times daily) of KRG or a placebo.

RESULTSThe five-item version of the International Index of Erectile Function (IIEF-5) score after the treatment was significantly higher in the KRG group compared with that before the treatment (from 16.4 +/- 2.9 to 21.0 +/- 6.3, P < 0.0001). In contrast, there was no difference before and after the treatment in the placebo group (from 17.0 +/- 3.1 to 17.7 +/- 5.6, P > 0.05). In the KRG group, 20 patients (66.6%), reported improved erection, significant in the global efficacy question (P < 0.01); in the placebo group there was no significance. Scores on questions 2 (rigidity), 3 (penetration), 4 and 5 (maintenance), were significantly higher for KRG than those for the placebo when those questions were answered after 12 weeks of each treatment (P < 0.01). When the score in the KRG group was compared to the placebo group after the treatment, there was a significant improvement in total score (IIEF-5 score) in questions 3 and 5 for the KRG-treated group (P < 0.001 and P < 0.0001, respectively). The levels of serum testosterone, prolactine and cholesterol after the treatment were not statistically significant different between the KRG and the placebo group (P > 0.05).

CONCLUSIONOur data show that KRG can be an effective alternative to the invasive approaches for treating male ED.

Adult ; Aged ; Cholesterol ; blood ; Double-Blind Method ; Erectile Dysfunction ; drug therapy ; Humans ; Lipoproteins, HDL ; blood ; Lipoproteins, LDL ; Male ; Middle Aged ; Panax ; Patient Satisfaction ; Phytotherapy ; Plant Extracts ; therapeutic use ; Prolactin ; blood ; Testosterone ; blood

OBJECTIVETo observe the efficacy and safety of Jingui Shengqi Pill in treating partial androgen deficiency in aging males (PADAM), and to explore the new approach in improving the quality of life in PADAM patients.

METHODSForty patients with PADAM were treated with JSP, the efficacy was evaluated with international index of erectile function (IIEF) scoring, PADAM questionnaire scoring, hormone, prostatic specific antigen (PSA), etc., and the data before treatment were compared with those after treatment in the same group.

RESULTSAfter 3 months of treatment, PADAM scoring and IIEF scoring were all significantly improved. Symptoms regarding physical ability, vasomotion, and psychical and mental condition all got improved more markedly than symptoms regarding sexual hypofunction. The serum level of testosterone was 3.85 +/- 0.36 before treatment and 5.02 +/- 0.83 after treatment (P < 0.05); luteinizing hormone of 7.33 +/- 2.14 and 4.84 +/- 1.43 (P < 0.01), follicle-stimulating hormone of 10.22 +/- 4.48 and 6.47 +/- 3.28 (P < 0.01), respectively. The level of PSA failed to change significantly (1.94 +/- 0.55 and 2.06 +/- 0.47, P > 0.05).

CONCLUSIONJSP is effective and safe in treating PADAM, the mechanism of it is different from supplementing extrinsic androgen. It may have produced the effect by means of favorably regulating the condition of sex hormone to improve the balance of pituitary-sex gland axis, so it has more extensive clinical application.

Aged ; Androgens ; deficiency ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Erectile Dysfunction ; drug therapy ; Follicle Stimulating Hormone ; blood ; Humans ; Luteinizing Hormone ; blood ; Male ; Middle Aged ; Prostate-Specific Antigen ; blood ; Testosterone ; blood