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Antiplatelet (aspirin) therapy as a new option in the treatment of vasculogenic erectile dysfunction: a prospective randomized double-blind placebo-controlled study

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Abstract

Purpose: To investigate the efficiency of antiplatelet (aspirin) therapy in vasculogenic erectile dysfunction (VED) patients with a high mean platelet volume. Methods: A total of 184 patients diagnosed with VED between the ages of 18 and 76 were randomly divided into two groups and treated for 6 weeks [group 1: 120 patients (mean age 48.3), aspirin 100 mg/day; group 2: 64 patients (mean age 47.7), placebo 100 mg/day]. The changes from baseline to end point in erectile function scores on the International Index of Erectile Function (IIEF-EF) and the number of patients who answered "yes" to questions 2 and 3 of the sexual encounter profile (SEP) were compared statistically. Results: The mean baseline IIEF-EF scores in groups 1 and 2 were 14.1 ± 4.9 and 14.3 ± 5.2, respectively (p = 0.7966), the number of patients who answered "yes" to SEP-2 was 62 (51.6%) in group 1 and 32 (50%) in group 2 (p = 0.8366), and the number of patients who answered "yes" to SEP-3 was 38 (31.6%) in group 1 and 20 (31.2%) in group 2 (p = 0.9557). In the aspirin group, the changes from baseline to end point in the IIEF-EF, SEP-2, and SEP-3 scores were 7.2, 36.6, and 46.6%, respectively. In the placebo group, these changes were 2.0, 9.4, and 12.5%, respectively. When compared with the placebo group, aspirin-treated subjects showed a significant improvement in all three efficacy measures (p < 0.0001). Conclusions: 100 mg of aspirin administered once a day significantly improved EF in men with VED.
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International Urology and Nephrology
https://doi.org/10.1007/s11255-018-1786-0
UROLOGY - ORIGINAL PAPER
Antiplatelet (aspirin) therapy asanew option inthetreatment
ofvasculogenic erectile dysfunction: aprospective randomized
double‑blind placebo‑controlled study
ZekiBayraktar1 · SelamiAlbayrak1
Received: 6 November 2017 / Accepted: 4 January 2018
© Springer Science+Business Media B.V., part of Springer Nature 2018
Abstract
Purpose To investigate the efficiency of antiplatelet (aspirin) therapy in vasculogenic erectile dysfunction (VED) patients
with a high mean platelet volume.
Methods A total of 184 patients diagnosed with VED between the ages of 18 and 76 were randomly divided into two groups
and treated for 6weeks [group 1: 120 patients (mean age 48.3), aspirin 100mg/day; group 2: 64 patients (mean age 47.7),
placebo 100mg/day]. The changes from baseline to end point in erectile function scores on the International Index of Erec-
tile Function (IIEF-EF) and the number of patients who answered “yes” to questions 2 and 3 of the sexual encounter profile
(SEP) were compared statistically.
Results The mean baseline IIEF-EF scores in groups 1 and 2 were 14.1±4.9 and 14.3±5.2, respectively (p=0.7966), the
number of patients who answered “yes” to SEP-2 was 62 (51.6%) in group 1 and 32 (50%) in group 2 (p=0.8366), and the
number of patients who answered “yes” to SEP-3 was 38 (31.6%) in group 1 and 20 (31.2%) in group 2 (p=0.9557). In the
aspirin group, the changes from baseline to end point in the IIEF-EF, SEP-2, and SEP-3 scores were 7.2, 36.6, and 46.6%,
respectively. In the placebo group, these changes were 2.0, 9.4, and 12.5%, respectively. When compared with the placebo
group, aspirin-treated subjects showed a significant improvement in all three efficacy measures (p<0.0001).
Conclusions 100mg of aspirin administered once a day significantly improved EF in men with VED.
Keywords Aspirin· Antiplatelet· Antithrombocytic· Erectile dysfunction· Treatment
Abbreviations
ASA Acetylsalicylic acid
CAD Coronary artery disease
cAMP Cyclic adenylate monophosphate
cGMP Cyclic guanylate monophosphate
COX Prostaglandin H synthase
DUS Doppler ultrasonography
IIEF International Index of Erectile Function
MPV Mean platelet volume
NO Nitric oxide
PSV Peak systolic velocity
PAD Peripheric artery disease
PG Prostaglandin
SEP Sexual encounter profile
TxA2 Thromboxane
VED Vasculogenic erectile dysfunction
Introduction
Erectile dysfunction (ED) is the inability to attain and/or
maintain sufficient penile erection for satisfactory sexual
intercourse [21]. ED has been classified as psychogenic,
organic, or mixed because it is a multifactorial disease with a
pathophysiology affected by causes that are vascular (periph-
eral and coronary artery disease, etc.), neurogenic (multiple
sclerosis, Parkinson’s disease, Alzheimer’s disease, etc.),
hormonal (hypothyroidism, hypogonadism, hyperprolactine-
mia, etc.), iatrogenic (cystectomy, prostatectomy, etc.), ana-
tomic (trauma, etc.), and psychogenic [4, 8].
* Zeki Bayraktar
zbayraktar@medipol.edu.tr
Selami Albayrak
salbayrak@medipol.edu.tr
1 Department ofUrology, School ofMedicine, Istanbul
Medipol University, Çamlık Mah. Piri Reis Cad. Papatya
Sitesi No: 48, 34890Pendik, Istanbul, Turkey
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Recent data show that more than 90% of ED cases in over
40years old have an organic cause and that vascular diseases
are the most common etiology. Although ED is a natural
consequence of aging, its severity is directly related to vas-
cular risk factors such as high blood pressure, atheroscle-
rosis, coronary artery disease, smoking, dyslipidemia, and
diabetes mellitus, all of which are associated with endothe-
lial dysfunction [8].
Since the penis can be considered a barometer of the
body’s endothelial function, it is reasonable to identify vas-
cular risk factors as direct causes of and contributors to ED.
Therefore, ED may also be the first clinical presentation of
any of these comorbidities, as vascular endothelium plays
a pivotal role in regulating vascular homeostasis of the cor-
pora cavernosa [8].
Some studies have reported that platelets play a pivotal
role in the pathogenesis of atherosclerosis and peripheric
artery disease (PAD). There is evidence of an association
between mean platelet volume (MPV) and cardiovascu-
lar disease, PAD, and stroke. Platelet aggregation plays
an important role in the pathogenesis of acute myocardial
infarction. MPV, an indicator of platelet activation, has been
reported to be higher in patients with coronary artery disease
(CAD) than in healthy individuals and may be an independ-
ent risk factor for myocardial infarction. Large platelet size
is an independent predictor of increased risk for CAD and
PAD [9, 18].
The antiplatelet effect of acetylsalicylic acid (ASA) has
been known for many years, and it is widely used to treat
cardiovascular diseases [11, 25]. Furuno etal. [14] reported
that all doses of ASA suppressed platelet activity and at
higher doses, endothelial-mediated arterial dilatation wors-
ened. Aspirin decreases vascular smooth muscle cell pro-
liferation and proinflammatory mediators and improves
endothelium-dependent vasorelaxation mediated by nitric
oxide (NO) [11, 14, 28]. Aspirin impairs platelet activation,
implying that a prostanoid (PG) is involved in the activation
process. However, the effect of aspirin on platelet PGs is
an exceptional example of the general aspirin–PG relation-
ship. The antiplatelet effects of aspirin endure for the entire
life of the platelet [18]. Aspirin exhibits its antiaggregant
(antithrombocytic) effect by reducing thromboxane A2
(TxA2) synthesis, which is a strong aggregant and vasocon-
strictor agent. It also reduces TxA2 synthesis by irrevers-
ibly inhibiting prostaglandin (PG) H synthase-1 (COX-1)
and prostaglandin H synthase-2 (COX-2) enzyme activities.
PGH2 is the precursor of thromboxane A2. Ultimately, the
antithrombotic effect results from the synthesis of prosta-
glandin and thromboxane A2 being inhibited by aspirin [11].
Mean platelet volume (MPV) is an indicator of platelet
size. It is easily measured by automated blood counters, it
is routinely available at a relatively low cost, and it indi-
rectly reflects platelet activity [19]. Large platelets are
metabolically and enzymatically more active than small
platelets and produce more thromboxane, known as the
most potent vasoconstrictor agent. Increased platelet activity
plays an important role in atherosclerosis formation through
mechanisms such as thrombocyte gathering, thromboxane
synthesis, and expression of adhesion molecules [1, 9, 12].
Some recent studies have reported a relationship between
high MPV values and VED [2, 5, 10, 15, 19, 22, 27]. How-
ever, to date, no studies have investigated the efficacy of
antiplatelet therapy on VED. We hypothesize that aspirin
improves erectile function (EF) in patients with ED. The aim
of the present study was to assess the efficacy of aspirin in
VED patients with high MPV values.
Methods
The study protocol was approved by the institutional eth-
ics committee of the School of Medicine, Istanbul Medipol
University, Turkey (01/06/2015-66291034-32). The study of
192 men too place from August 2015 to September 2017.
Patients were randomized into two treatment groups at a 2:1
ratio according to the order of application. Group 1, with 126
patients, was given aspirin (100mg/day) (Aspirin® 100mg)
for 6weeks [11]. Group 2, with 66 patients, was given a
placebo (100mg/day). Placebo tablets were produced from
starch and contained same ingredients as the aspirin tablets
except acetylsalicylic acid.
Four patients in group 1 and two patients in group 2 were
excluded because of a lack of follow-up. Two patients in
group 1 were excluded because of protocol violations. A
total of 184 patients who completed the study were subjected
to detailed medical histories, physical examinations, erec-
tile function evaluations, laboratory evaluations, and penile
color Doppler ultrasonographies (pDUS). All patients were
reevaluated for drug side effects after 1week. However, IIEF
questionnaire were not conducted at this time. ED level was
evaluated with the sum of IIEF-EF scores (questions 1–5
and 15). Patients were grouped according to their scores as
mild (17–25), moderate (11–16), and severe ED (1–10) [23].
Patients were questioned twice: during the initial visit and
6weeks after treatment. Patients were asked sexual encoun-
ter profile (SEP) question 2 (Were you able to insert your
penis into partner’s vagina?) and SEP question 3 (Did your
erection last long enough for you to have successful inter-
course?). The study’s co-primary efficacy measures were
changes from baseline to end point in the IIEF-ED domain
score and percentage of “yes” responses to SEP questions
2 and 3. All evaluations and analyses were performed by
urologists and were double blind (both patients and urolo-
gists were blind to the study).
Penile color Doppler evaluation was conducted
following La Vignera et al. [18]. Patients were
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classified according to the peak systolic velocity (PSV).
PSV≥ 35 cm/s values were accepted as normal (no
arterial insufficiency). PSV values of<25, 25–29, and
30–34cm/s were categorized as severe, moderate, and
mild arterial insufficiency, respectively. Patients with
PSV values<35cm/s were diagnosed with VED and
were included in the study. Patients with≥35cm/s PSV
were excluded from the study, even if their IIEF-EF scores
were<26.
Total blood count including hemoglobin (Hgb), white
blood cell (WBC), red blood cell (RBC), platelet (PLT),
and mean platelet volume (MPV) were measured in the
patient and control groups. All parameters were meas-
ured by using commercially available assay kits (Sysmex
Europe GmbH, Norderstedt, Germany) with an autoana-
lyzer (Sysmex XT 200i, Hamburg, Germany). Normal val-
ues for MPV according to these assay kits were 7.8–11fL.
Blood samples were drawn from the antecubital vein and
analyzed immediately (without freezing) after overnight
fasting. Blood samples were collected in tubes contain-
ing dipotassium ethylenediaminetetraacetic acid. All of
the measurements were performed immediately after
venipuncture to prevent invitro platelet activation (within
1h of sampling).
The study’s inclusion and exclusion criteria are in
Table1. Statistical analyses were performed using MedCalc
statistical software (Version 16.4.3, MedCalc Software bvba,
Ostend, Belgium). The descriptive statistics (mean±SD and
percentages), Student’s t tests, and Wilcoxon signed-rank
tests were used to compare parametric and nonparametric
values, respectively; p values<0.05 were considered to be
statistically significant.
The 184 subjects were randomized into two treatment
groups at a 2:1 ratio (aspirin:placebo), which was calculated
to provide at least 95% treatment effect (p<0.0001) [4.1
(95% CI 3.7–6.2) for IIEF-EF, 29% (95% CI 14.9–42.9%) for
SEP-2, and 34.6% (95% CI 19.1–48.8%) for SEP-3].
Results
The mean age in groups 1 and 2 was 48.3± 12.5 and
47.7±11.8years, respectively (p=0.7523). MPV values
were 11.57±0.17 in the aspirin group and 11.54±0.16 in
the placebo group (p=0.4130). In the aspirin group, the
Table 1 The inclusion and exclusion criteria of the study
sBP systolic blood pressure, dBP diastolic blood pressure, IIEF International Index of Erectile Function, MPV mean platelet volume, PSV peak
systolic velocity in penile color Doppler
Inclusion criteria Men with vascular ED:
>18years old
IIEF-EF score<26
PSV<35cm/s
MPV>11
Exclusion criteria Patients with neurogenic or endocrinological ED:
History of pelvic trauma or surgery
History of pelvic radiation
Untreated endocrine disease (such as hypopituitarism, hypothyroidism, or hypogonadism)
Recent history of stroke, spinal cord injury, or other significant central nervous system injuries
Vascular risk factors for ED:
Diabetes, smoking, or hypertension (sBP>170 or dBP>100)
Active infectious disease
Malignancy (current treatment with cancer chemotherapy or antiandrogens)
Renal or hepatic failure
Clinically significant penile deformity
Psychiatric diseases
Unstable angina within prior 6months
Myocardial infarction
Coronary artery disease (coronary artery bypass graft surgery or percutaneous coronary intervention within prior 90days)
Evidence of congestive heart failure within prior 6months
New significant conduction defect within prior 90days
Contraindication for aspirin (i.e., allergic reactions, stomach or intestinal ulcer, bleeding of the stomach or intestines,
hematological diseases such as thrombotic thrombocytopenic purpura, hemophilia and Von Willebrand’s disease, or the
habit of drinking too much alcohol)
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mean baseline IIEF-EF score—the number of the patients
who answered “yes” to SEP-2 and SEP-3—was 14.1±4.9,
62 (51.6%) and 38 (31.6%), respectively. In the placebo
group, the mean baseline IIEF-EF score—the number of
the patients who answered “yes” to SEP-2 and SEP-3—was
34 (60.7%) and 20 (35.7%), respectively. There was no sig-
nificant difference between the two groups in terms of the
age, MPV, baseline IIEF-EF scores, or SEP-2 and SEP-3
ratios (Table2).
After treatment, mean scores for IIEF-EF, SEP-2, and
SEP-3 in the aspirin group were 21.3±4.1, 106 (88.3%),
and 94 (78.3%), respectively. In the placebo group, the
scores were 16.3±4.4, 38 (59.3%), and 28 (43.7%), respec-
tively. The changes in the aspirin group from baseline to end
point in the three measures were 7.2 (difference between
means), 36.6, and 46.6%, respectively. The same changes
in the placebo group were 2.0 (difference between means),
9.4, and 12.5%. The change in IIEF-EF score was signifi-
cantly higher in the aspirin group than in the placebo group
(p<0.0001). The change in “yes” responses to SEP-2 was
significantly greater in the aspirin group (36.6%) than in
the placebo group (9.4%) (p=0.0001). The change in
“yes” responses to SEP-3 was significantly greater in the
aspirin group (46.6%) than in the placebo group (12.5%)
(p<0.0001). At the end of the study, 52 patients (43.3%)
in the aspirin group and 18 patients (28.1%) in the placebo
group had an IIEF-EF domain score>25. The difference is
statistically significant (p=0.0436). While the increases in
IIEF, SEP-2, and SEP-3 measures were statistically signifi-
cant in the aspirin group, there was no significant difference
in the placebo group. The aspirin group showed a significant
improvement in all three efficacy measures (p<0.0001).
For mild, moderate, and severe ED subgroups who took
aspirin, the mean increases in IIEF-EF scores were 7.9,
10.1, and 3.6, respectively, but were lower in the placebo
group: 3.3, 2.0, and 0.6 (p<0.0001). IIEF-EF increases
in the aspirin group for the mild and moderate ED sub-
groups were greater than minimal clinically important dif-
ferences (MCID) as reported by Rosen etal. [24]. In the
aspirin group, the changes in SEP-2 and SEP-3 were statis-
tically significant in the mild and moderate ED subgroups
(p<0.0001), but not significant in the severe ED subgroup
(Table3).
None of the patients in the study reported worse sexual
results after treatment. There were minimal gastric com-
plaints such as dyspepsia and abdominal burning in five
patients (4.1%) in the aspirin group (p=0.1015). No drug-
related severe adverse effects were observed.
Discussion
These findings suggest that aspirin may be a new treatment
option in patients with VED, especially those with high
MPV values. Rosen etal. [24] reported that minimal clini-
cally important differences (MCID) on the IIEF-EF scale
were 2, 5, and 7 for mild, moderate, and severe ED, respec-
tively. This study’s mean was higher, 7.2. This difference
means there was a clinically significant increase in IIEF-EF
for ED patients who took aspirin.
Penile erection is controlled by complex neural and
vascular interactions that cause cavernosal smooth muscle
relaxation [16, 29]. ASA is a cardioprotective agent that
inhibits platelet activity, a decrease in vascular smooth
Table 2 Baseline characteristics
of the patients in both groups
ED erectile dysfunction, EF erectile function, IIEF International Index of Erectile Function, n number of
subjects per category, N number of subjects in each treatment group, MPV mean platelet volume, SD stand-
ard deviation
Aspirin (N=120) Placebo (N=64) p values
Age±SD (years) 48.3±12.5 47.7±11.8 0.7523
<40 22 (18.3%) 12 (18.7%) 0.9470
40–49 42 (35%) 20 (31.2%) 0.6044
50–59 40 (33.3%) 22 (34.3%) 0.8915
≥60 16 (13.3%) 10 (15.6%) 0.6703
ED duration [n (%)]
≥3months and<6months 14 (11.6%) 8 (12.5%) 0.8579
≥6months to<12months 60 (50%) 34 (53.1%) 0.6895
≥12months 46 (38.3%) 22 (34.3%) 0.5933
MPV 11.57±0.17 11.54±0.16 0.2462
ED severity [n (%)]
Mild (17–25) 56 (46.6%) 30 (46.8%) 0.9794
Moderate (11–16) 40 (33.3%) 22 (34.3%) 0.8915
Severe (1–10) 24 (20%) 12 (18.7%) 0.8327
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Table 3 Changes in IIEF-ED scores and SEP-2 and SEP-3 ratios with treatment in all groups
All ED patients (N=184) Aspirin (N=120) Placebo (N=64) p values
Age (years±SD) 48.3±12.5 47.7±11.8 0.7523
IIEF-EF score; baseline 14.1±4.9 14.3±5.2 0.7966
Post-treatment 21.3±4.1 16.3±4,4 <0.0001
Change in IIEF-EF +7.2±4.4 +2.0±4.6 <0.0001
p<0.0001 p=0.0204
“Yes” responses, SEP-2, n (%); baseline 62 (51.6%) 32 (50%) 0.8366
Post-treatment 106 (88.3%) 38 (59.3%) <0.0001
Change in SEP-2 44 (36.6%) 6 (9.4%) 0.0001
p<0.0001 p=0.2925
“Yes” responses, SEP-3, n (%); baseline 38 (31.6%) 20 (31.2%) 0.9557
Post-treatment 94 (78.3%) 28 (43.7%) <0.0001
Change in SEP-3 56 (46.6%) 8 (12.5%) <0.0001
p<0.0001 p=0.1456
Mild ED patients (n=86) n=56 n=30 p values
Age, years±SD 41.6±9.3 40.9±8.7 0.7346
IIEF-EF score; baseline 19.2±4.3 19.6±4.7 0.6916
Post-treatment 27.1±4.4 22.9±4.8 0.0001
Change in IIEF-EF 7.9±4.3 3.3±4.6 <0.0001
p<0.0001 p=0.0093
“Yes” responses, SEP-2, n (%); baseline 34 (60.7%) 15 (50%) 0.3423
Post-treatment 54 (96.4%) 17 (56.6%) <0.0001
Change in SEP-2 20 (35.7%) 2 (6.6%) 0.0034
p<0.0001 p=0.6114
“Yes” responses, SEP-3, n (%); baseline 20 (35.7%) 12 (40%) 0.6959
Post-treatment 50 (89.2%) 16 (53.3%) 0.0002
Change in SEP-3 30 (53.5%) 4 (13.3%) 0.0003
p<0.0001 p=0.3059
Moderate ED patients (n=62) n=40 n=22 p values
Age, years±SD 46.2±10.4 45.7±11.3 0.8612
IIEF-EF score; baseline score 14.6±4.4 14.6±4.5 1.000
Post-treatment 24.7±4.5 16.6±4.6 <0.0001
Change in IIEF score 10.1±4.2 2.0±4.5 <0.0001
p<0.0001 p=0.1523
“Yes” responses, SEP-2, n (%); baseline 19 (47.5%) 12 (54.5%) 0.6009
Post-treatment 39 (97.5%) 15 (68.1%) 0.0011
Change in SEP-2 20 (50%) 3 (13.6%) 0.0049
p<0.0001 p=0.3599
“Yes” responses, SEP-3, n (%); baseline 14 (35%) 6 (27.2%) 0.5328
Post-treatment 37 (92.5%) 9 (40.9) <0.0001
Change in SEP-3 23 (57.5%) 3 (13.6%) 0.0009
p<0.0001 p=0.3432
Severe ED patients (n=42) n=24 n=12 p values
Age, years±SD 57.1±8.9 56.5±9.3 0.8521
IIEF-EF score; baseline score 8.7±2.4 8.9±2.3 0.8126
Post-treatment 12.3±2.7 9.5±2.4 0.0046
Change in IIEF score 3.6±2.1 0.6±2.0 0.0002
p<0.0001 p=0.5382
“Yes” responses, SEP-2, n (%); baseline 9 (37.5%) 5 (41.6%) 0.8145
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muscle cell proliferation, and a reduction in proinflamma-
tory mediators [14, 28].
Some experimental studies have also reported benefi-
cial effects of aspirin on erectile function. In diabetic rats,
aspirin has been found to normalize the diminished mean
intracavernosal pressure/mean arterial blood pressure ratio
required to recuperate erectile function [16]. Argiolas etal.
[3] reported that aspirin had beneficial effects on erectile
function at the peripheral but not central level. In exvivo
studies, aspirin has been shown to improve arterial blood
flow and to prevent hypercoagulation in the penis of the
Chacma baboon during erection [6].
In vitro studies show that aspirin can protect and restore
ED. This has been indicated by an improved relaxation
response to acetylcholine, improvements in electrical field
stimulation, and the presence of sodium nitroprusside in cor-
pus cavernosum strips [16]. These vasoactive responses are
mediated through the local generation of nitric oxide, acety-
lation of endothelial nitric oxide synthetase, and increased
levels of neuronal nitric oxide synthase in penile vessels, and
all are independent of the levels of cyclooxygenase I or II
and the intracellular or extracellular calcium level. Interest-
ingly, the concentration of aspirin that increases endothelial
nitric oxide generation is compatible with the therapeutic
range in humans. Therefore, aspirin is expected to improve
vascular and neurogenic ED in therapeutic doses. This ben-
efit is reflected by ED improvement in patients with bipolar
disorder being treated with lithium, which can impair the
NO-mediated relaxation of cavernosal tissue [13].
This benefit of aspirin has also been shown clinically. In a
randomized double-blind placebo-controlled trial of 32 male
patients with “stable” bipolar disorder, significant advan-
tages of aspirin over placebos were observed in reducing
overall sexual dysfunction and improving erectile function
[26]. Aspirin (240mg/day) significantly improved the over-
all and intercourse satisfaction when compared to placebo
treatment (63.9 vs. 14.4%) in 6weeks after treatment with-
out causing changes in the blood lithium level or disease
severity. Aspirin improved all sexuality-related outcomes,
scores in all domains, the severity category of erectile dys-
function, and the proportion of patients who had experienced
MCID in the erectile function domain. However, the larg-
est effect of aspirin was observed in the erectile function
domain, which is probably the main target of lithium. The
authors of this study interpreted these findings as evidence
for the safety and efficacy of aspirin in the treatment of sev-
eral domains of lithium-induced sexual dysfunction in male
patients with bipolar affective disorder [26].
There is also indirect evidence for the beneficial effects
of aspirin on erectile function from a study that assessed the
effectiveness of a progressive treatment program for ED in
patients with cardiovascular diseases. In this study of 453
ED patients with vascular risk factors who received anti-ED
treatment, 48 patients (10.7%) achieved spontaneous erec-
tion 2years later, of whom 46 (95.8%) were taking aspi-
rin. No association was found between aspirin and adverse
effects, with no differences were noted between patients tak-
ing or not taking aspirin [17].
Furthermore, Tauseef etal. [28] suggested that ASA
with antioxidant activity ameliorated endothelium-depend-
ent vasorelaxation because of the raised bioavailability of
NO. Bornman etal. [6, 7] reported that platelets might play
a significant role in hypercoagulability and fibrin deposi-
tion during erection and could be an important factor in the
pathogenesis of aging impotence, and more importantly,
aspirin might delay penile atherosclerosis. Hafez etal. [16]
also suggested that ASA might be used in the prophylactic
treatment of diabetic ED to preserve the erection capacity
of patients.
Interestingly, despite the experimental studies report-
ing positive effects of aspirin on penile erection, and more
importantly, despite studies reporting the increased platelet
activation in VED patients [2, 5, 10, 15, 19, 22, 27], to date,
there has been no study on the effect of aspirin on VED. The
antiplatelet effect of aspirin has been known for many years,
and MPV, a potential marker of platelet reactivity, is used
routinely in inpatient and outpatient settings at a relatively
low cost [9, 19]. This is the first study to investigate the
efficacy of aspirin in VED.
Minhas etal. [20] investigated the interaction of endothe-
lium-derived NO and PGs in regulating the corporal smooth
muscle tone in rabbit corpus cavernosum, and they reported
Table 3 (continued)
Severe ED patients (n=42) n=24 n=12 p values
Post-treatment 13 (54.1%) 6 (50%) 0.8148
Change in SEP-2 4 (16.6%) 1 (8.3%) 0.5026
p=0.2534 p=0.4672
“Yes” responses, SEP-3, n (%); baseline 4 (16.6%) 2 (16.6%) 1.000
Post-treatment 7 (29.1%) 3 (25%) 0.7984
Change in SEP-3 3 (12.5%) 1 (8.3%) 0.7092
p=0.3075 p=0.6860
International Urology and Nephrology
1 3
that there was a tonic release of NO which did not appear
to be inhibited by a vasoconstrictor prostanoid. Endothelium-
dependent relaxation to acetylcholine results in the dual pro-
duction of NO and a cyclooxygenase-derived endothelium
contracting factor, which acts in opposition to NO; this factor
is unlikely to act on PGH2/TXA2 receptors.
Nitric oxide is synthesized by neuronal (nNOS) and
endothelial NO synthase (eNOS) and plays an important role
in the cavernosal smooth muscle relaxation with the NO/cyclic
guanosine monophosphate (cGMP) cascade [3]. Hafez etal.
[16] detected a significantly increased expression in nNOS lev-
els in ASA-treated diabetic rats. According to them, increased
nNOS expression might be an important factor in improving
ED in ASA-treated diabetic rat penises. They also reported
that the intracavernosal pressure (ICP)/mean arterial blood
pressure (MAP) ratio in the ASA-treated diabetic group was
significantly higher than that of diabetic rats in invivo stud-
ies. Most importantly, this normalized effect shows the protec-
tive effect of ASA in diabetes. They said that based on these
findings, ASA might be a novel therapeutic option in diabetic
ED and might even be used for the prophylactic treatment of
diabetic ED to preserve the erection capacity of patients [16].
PGs, which seem to play a role in regulating penile erec-
tion, also interact with NO in several ways. Importantly, the
release of a COX-dependent contracting factor by the corpus
cavernosa, as shown by Minhas etal., can explain why aspi-
rin improves erectile dysfunction [20, 26].
This is the first clinical study investigating the effect of
aspirin in VED. Although there are some experimental stud-
ies investigating the relationship between aspirin and penile
erection, there has been no clinical study on patients with
VED. The present study demonstrates that aspirin may be
an effective and safe therapeutic option for the treatment of
VED, especially in patients with elevated MPV. The sample
size in this study provided at least 95% power in detecting
clinically significant treatment differences (change from
baseline score between subjects, treated with aspirin 100mg
vs. placebo) in IIEF-EF, SEP-2, and SEP-3. But this study
has some limitations. For example, subjects were relatively
young and a highly select patient population. Many potential
ED patients, including elderly men with comorbidities such
as diabetes and hypertension, were not included in the study
due to rather strict exclusion criteria. As a result, the number
of subjects was limited and the patient population was selec-
tive. For this reason, similar studies should be performed
with larger and more diverse patient groups.
Conclusions
Aspirin is an effective and safe therapeutic option for
patients with VED, especially for patients with a high
MPV. Low-dose aspirin may be used in patients with ED
for treatment purposes or for delaying penile atheroscle-
rosis. However, there is a need for more extensive studies
on this subject.
Compliance with ethical standards
Conflict of interest Both authors declare that they have no conflict of
interest.
Ethical standards All procedures performed in studies involving
human participants were in accordance with the ethical standards of
the institutional and/or national research committee and with the Dec-
laration of Helsinki (1964) and its later amendments or comparable
ethical standards.
Human and animal rights statement This article does not contain any
studies with animals performed by any of the authors.
Informed consent Informed consent was obtained from all individual
participants included in the study.
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... In this regard, aspirin is a medicine available over the counter, is less expensive, and with negligible, minor, and rare side effects; it also has the potential to treat vasculogenic ED along with CVD (Bayraktar & Albayrak, 2018;Saroukhani et al., 2013;Taubert, 2008). Aspirin increases blood flow in the vessels by not only inhibiting platelet aggregation activity but also by directly stimulating the activity of endothelial NO synthase to increase the production of NO for smooth muscle relaxation (Dzeshka et al., 2016). ...
... After removing duplicates, a total of 41 records were screened by their titles and abstracts. Finally, the full texts of two RCTs were assessed (Bayraktar & Albayrak, 2018;Saroukhani et al., 2013; Figure 1). ...
... One of the RCTs was supported by educational grants (Saroukhani et al., 2013). The other did not receive any funding (Bayraktar & Albayrak, 2018). Table 1 summarizes the characteristics of the included trials. ...
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One of the major causes of erectile dysfunction (ED) is an endothelial vascular disorder. This meta-analysis is performed to determine the efficacy of aspirin on erectile function in men with vasculogenic ED. For this purpose, CENTRAL, MEDLINE, and reference lists of articles up to November 2019 were searched. Randomized controlled trials (RCTs) were selected that compared aspirin with placebo in men of any ethnicity with vasculogenic ED. A total of 58 trials were retrieved. Finally, two trials of 214 men fulfilled our selection criteria. High selection and detection bias were identified for one trial. The participants showed a significant improvement in erectile function when they took aspirin (mean difference: 5.14, 95% CI [3.89, 6.40], and I ² = 0%). Although the present meta-analysis suggested that aspirin has a significant effect on the improvement of erectile function, there were limited RCTs available on this topic and doses of aspirin varied. Additional studies are needed to support findings from this meta-analysis. Aspirin needs to be considered by practitioners when prescribing drugs for vasculogenic ED.
... In this regard, aspirin is a medicine available over the counter, is less expensive, and with negligible, minor, and rare side effects; it also has the potential to treat vasculogenic ED along with CVD (Bayraktar & Albayrak, 2018;Saroukhani et al., 2013;Taubert, 2008). Aspirin increases blood flow in the vessels by not only inhibiting platelet aggregation activity but also by directly stimulating the activity of endothelial NO synthase to increase the production of NO for smooth muscle relaxation (Dzeshka et al., 2016). ...
... After removing duplicates, a total of 41 records were screened by their titles and abstracts. Finally, the full texts of two RCTs were assessed (Bayraktar & Albayrak, 2018;Saroukhani et al., 2013; Figure 1). ...
... One of the RCTs was supported by educational grants (Saroukhani et al., 2013). The other did not receive any funding (Bayraktar & Albayrak, 2018). Table 1 summarizes the characteristics of the included trials. ...
... Aspirin has also been evaluated as a potential treatment for ED, given its antiplatelet action. In a paper by Bayraktar and Albayrak [159], 184 patients with vasculogenic ED were randomized to take aspirin 100 mg daily for 6 weeks or placebo. They found significant differences in IIEF-EF (+ 7.2 vs + 2, p < 0.0001), and in the SEP 2 and 3. ...
... In the last 5 years, the effect on EF of several drugs used for the treatment of other pathologies has been studied. Published papers include mirabegron [156,157], aspirin [159,160], bupropion [161,162], cabergoline [163], and levothyroxine [164]. Most of the studies, although they analyzed different and special populations, found a significant difference in the improvement of ED. ...
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Purpose of Review This study aimed to review recent evidence on conservative non-surgical options for erectile dysfunction (ED) in men. A narrative review of the literature was performed. A comprehensive search in the MEDLINE, Embase, and Cochrane databases was done. Papers in English language, published from May 2017 until May 2022, were included. Papers reporting basic research or animal research were excluded, as long as reviews or meta-analyses. Congress reports, clinical cases, or clinical trials protocols with no results were also excluded. Recent Findings We found a multitude of different treatment modalities for ED. We must take into account the type of patient, their comorbidities, the origin of their ED, and its severity in order to reproduce effective results using these therapies. Some of the treatments show good results with a good level of evidence (new IPDE5 formulations, intracavernous injections, shock wave therapy, hormonal theraphy, psycho-sexual theraphy). However, others (some new molecules, stem cell theraphy, platelet-rich plasma injections, oxygenation-based therapy, nutraceuticals), although some of them present promising results, require randomized studies with a larger number of patients and a longer follow-up time to be able to establish firm recommendations. Summary Regarding the conservative treatment of erectile dysfunction, in recent years, some therapies have been consolidated as effective and safe for certain types of patients. On the other hand, other treatment modalities, although promising, still lack the evidence and the necessary follow-up to be recommended in daily practice.
... В експериментальному дослідженні вживання ацетил-саліцилової кислоти чинив протективний ефект щодо ЕД у щурів з діабетом [19]. В одному з досліджень у чоловіків вживання препаратів ацетилсаліцилової кислоти підвищував індекс еректильної функції у пацієнтів з васкулогенною ЕД за даними Міжнародного індексу еректильної функції (МІЕФ) [20]. ...
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As early as in the middle of the twentieth century, obesity became one of the most important medical and social problems in the world, especially among the population of developed countries due to its high prevalence and the enormous cost of overcoming its consequences. One of the complications of obesity is sexual dysfunction in men. The objective: to evaluate the effectiveness of udenafil in the form of 200 mg tablets in the treatment of erectile dysfunction in obese patients. Materials and methods. The clinical efficacy of udenafil PDE-5 inhibitor in 125 patients with ED and obesity was studied. The mean age of the patients was 47.4±6.7 years. When dividing patients into groups in order to objectively assess the results of different types of therapy, the groups were homogeneous in age, severity of obesity and ED, and then randomized patients into groups. Group I included 37 patients with ED and obesity who received therapy to normalize erectile function (healthy lifestyle, modification of individual risk factors, local negative pressure therapy, phosphodiesterase type 5 inhibitor udenafil) and obesity treatment aimed at weight loss; diet therapy, physical therapy, pharmacotherapy according to the indications, adequate level of physical activity). Group II – 56 patients with ED and obesity who received similar therapy to normalize erections. Group III 32 patients with ED and obesity treated with obesity without the use of phosphodiesterase type 5 inhibitors. The follow-up was 12 weeks. Criteria for assessing the clinical effectiveness of treatment: the dynamics of the International Erectile Function Index (ICEF). The diagnosis of ED was established by the total of points in the answers to questions 1–5, 15; which is 26 or less. The severity was assessed as severe – 1–10 points, moderate – 11–16 points, mild – 17–25 points; assessment of changes in cavernous hemodynamics according to Doppler data of cavernous vessels; assessment of body mass index and waist circumference; dynamics of lipid parameters (total cholesterol, triglycerides and atherogenic factor); dynamics of hormonal background indicators (testosterone, estradiol, LH, FSH, prolactin); Characteristics of the rate of onset of the effect of maximum erection and duration of action of udenafil. Statistical data processing was performed using the application package Statistica for Windows v. 6.0. Results. After 3 months, the following results were obtained. In group I, the average total ICEF score (questions 1–5, 15) increased from 17.3±3.8 to 26.7±5.3 points, ie 1.54 times (p<0.05). In group II – increased 1.33 times – from 16.4±3.2 to 21.8±4.6 points (p<0.05). In the third group – increased from 15.8±2.7 to 17.9±3.8 points, ie 1.13 times (p>0.05). BMI decreased in group I from 38.7±4.7 kg/m2 to 35.3±3.8 kg/m2 (p>0.05); in the second group of patients – from 36.4±4.3 kg/m2 to 35.0±3.9 kg/m2 (p>0.05); in group III BMI also did not undergo significant changes. (decrease from 36.4±4.3 kg/m2 to 32.4±3.4 kg/m2) (p>0.05) As a result of treatment, the indicators of total cholesterol, triglycerides, atherogenic coefficient and HDL levels improved, especially in patients of groups I and III, but they did not acquire signs of reliability. The increase in testosterone levels also did not achieve a statistically significant difference. In the study of cavernous blood flow, peak systolic velocity increased from 24.3±2.2 cm/s to 32.3±2.6 cm/s in the penis during erection (1.5-fold increase) in patients of the first group. p<0.05). In patients of the second and third groups, respectively, from 21.7±2.5 cm/s to 28.8±2.8 cm/s (p<0.05) and from 23.2±2.2 cm/s to 24,3±2.1 cm/s (p>0.05). Conclusions. According to the patients from the first and second groups taking udenafil, 74 (79.6%) of 93 patients rated the effectiveness of the drug as «excellent», 12 (12.9%) of 93 patients as «good», 4 (4.3%) as «satisfactory». The final evaluation of the effectiveness of therapy revealed «excellent» and «good» results in 95.7% of patients. Changes of indicators such as BMI, total cholesterol, triglycerides and atherogenic factor, testosterone levels, did not achieve a statistically significant difference because the observation period was too short. Udenafil can be considered a first-line drug in the treatment of erectile dysfunction in obese patients.
... 2 The etiologies of ED include neurogenic, vasculogenic, endocrine, psychogenic, and drug induced. 3 Tadalafil is one of Oral phosphodiesterase type 5 inhibitors (PDE5i) (sildenafil, tadalafil, vardenafil and avanafil). The first-line treatment for ED is PDE5i. ...
... Some researchers consider that ED may be a manifestation of cardiovascular disease, and certain similarities in pathology exist. A recent study used the antiplatelet drug aspirin (acetylsalicylic acid) in men with vasculogenic ED and a high mean platelet volume (associated with platelet activation); this study concluded that taking 100 mg aspirin daily significantly reduced the symptoms of ED [79]. However, daily aspirin therapy is associated with enhanced bleeding risks, which raises the question of whether a dietary antiplatelet could be similarly successful. ...
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Our understanding of platelet functionality has undergone a sea change in the last decade. No longer are platelets viewed simply as regulators of haemostasis; they are now acknowledged to be pivotal in coordinating the inflammatory and immune responses. This expanded role for platelets brings new opportunities for controlling a range of health conditions, targeting platelet activation and their interactions with other vascular cells. Antiplatelet drugs may be of wider utility than ever expected but often cause platelet suppression too strong to be used out of clinical settings. Dietary antiplatelets represent a nutritional approach that can be efficacious while safe for general use. In this review, we discuss potential new uses for dietary antiplatelets outside the field of cardiovascular health, with specific reference to the water-soluble tomato extract Fruitflow ®. Its uses in different aspects of inflammation and immune function are discussed, highlighting exercise-induced inflammation, mediating the effects of air pollution, and controlling thrombotic aspects of the immune response. Potential future developments in women's health, erectile dysfunction, and the allergic response indicate how broad the utility of dietary antiplatelets can be.
... Some researchers consider that ED may be a manifestation of cardiovascular disease, and certainly similarities in pathology exist. A recent study has used the antiplatelet drug aspirin (acetylsalicylic acid) in men with vasulogenic ED and a high mean platelet volume (associated with platelet activation); this study concluded that taking 100mg aspirin daily significantly reduced the symptoms of ED [68]. However, daily aspirin therapy is associated with enhanced bleeding risks, and this raises the question, would a dietary antiplatelet be similarly successful? ...
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Understanding platelet functionality has undergone a sea change in the last decade. No longer are platelets viewed simply as regulators of haemostasis; they are now acknowledged to be pivotal in coordinating the inflammatory and immune responses. This expanded role for platelets brings new opportunities for controlling a range of health conditions, targeting platelet activation and their interactions with other vascular cells. Antiplatelet drugs may be of wider utility than ever expected but often cause too strong a platelet suppression to be used out of clinical settings. Dietary antiplatelets represent a nutritional approach that can be efficacious while safe for general use. Here we review potential new uses for dietary antiplatelets outside the field of cardiovascular health, with specific reference to the water-soluble tomato extract Fruitflow®. Uses in different aspects of inflammation and immune function are discussed, highlighting exercise-induced inflammation, mediating the effects of air pollution, and controlling thrombotic aspects of the immune response. Potential future developments in women’s health, erectile dysfunction, and the allergic response give an indication of how wide-ranging the utility of dietary antiplatelets can possibly be.
... Un recente studio ha mostrato Fig. 1 Possibile strategia di trattamento per i pazienti con disfunzione erettile su base arteriosa e alti livelli di volume piastrinico medio tenendo conto della presenza o assenza delle comorbidità tipicamente associate alla patologia che pazienti con DE vascolare e alti livelli di VPM, in assenza delle tipiche comorbidità associate alla patologia, beneficiano in maniera importante della somministrazione di ASA a basse dosi (100 mg). Questa evidenza, oltre a prospettare un ruolo per l'ASA nel trattamento di questi pazienti, sembra rafforzare ancora di più il ruolo del VPM come fattore di rischio vascolare indipendente (Fig. 1) [20]. ...
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... 31 Complex vascular and neural interactions cause the relaxation of the cavernosal smooth muscle, which controls penile erection. 32,33 One prospective randomized controlled study indicated that antiplatelet therapy (in the form of aspirin) significantly ameliorated erectile dysfunction by inhibiting platelet activity 34 SSRIs play a similar role in reducing platelet activity and may improve erectile function. 35 The findings of the present study on the association between depression and the potential increased risk of sexual dysfunction in men with DM are consistent with those of other studies. ...
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Purpose: This study explored and compared the effects of depression and antidepressants on sexual dysfunction in men with diabetes mellitus (DM). Patients and methods: Patients older than 18 years who had been newly diagnosed with DM (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 250) between 1999 and 2010 were identified from Taiwan's National Health Insurance Research Database and were followed up until 2013. Patients with preexisting depression or sexual dysfunction were excluded. A total of 636,210 patients with DM were enrolled. These patients were divided into two groups: DM with comorbid depression and a matched cohort without depression. The groups were followed up until the end of 2010 for the first diagnosis of sexual dysfunction (ICD-9-CM codes 302.70, 302.71, 302.72, 302.74, 302.75, 302.76, 302.79, 607.84, and V417). A Cox proportional hazard model and a Cox regression model with time-dependent covariates were applied. Results: Patients with DM and depression had a higher risk of sexual dysfunction than those with DM without depression (hazard ratio [HR] = 1.44; 95% confidence interval [CI], 1.33-1.55). The risk of sexual dysfunction was lower in the subgroup who used antidepressants (per 28 cumulative defined daily doses [cDDDs]), HR = 0.96; 95% CI, 0.94-0.97). A significantly lower incidence of sexual dysfunction was also associated with the use of selective serotonin reuptake inhibitors (SSRIs, per 28 cDDD). The adjusted HR was 0.95 (95% CI, 0.93-0.97). Subgroup analysis indicated that SSRI use was significantly associated with an amelioration of erectile dysfunction (per 28 cDDD), with an HR of 0.95 (95% CI, 0.92-0.97). Conclusion: Male patients with DM and depression are at increased risk of sexual dysfunction. Antidepressant use had a small inverse association with the risk of sexual dysfunction in men with DM and depression. Antidepressants, in particular SSRIs, did not increase the risk of sexual dysfunction in this population.
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Background Erectile dysfunction (ED) is an evolving health problem in the aging male population. Chronic lowgrade inflammation is a critical component of ED pathogenesis and a probable intermediary of endothelial dysfunction, especially in metabolic diseases, with the inclusion of obesity, metabolic syndrome, and diabetes. Objective This review will present an overview of preclinical and clinical data regarding common inflammatory mechanisms involved in the pathogenesis of ED associated with metabolic diseases and the effect of antiinflammatory drugs on ED. Methods A literature search of existing pre-clinical and clinical studies was performed on databases [Pubmed (MEDLINE), Scopus, and Embase] from January 2000 to October 2019. Results Low-grade inflammation is a possible pathological role in endothelial dysfunction as a consequence of ED and other related metabolic diseases. Increased inflammation and endothelial/prothrombotic markers can be associated with the presence and degree of ED. Pharmacological therapy and modification of lifestyle and risk factors may have a significant role in the recovery of erectile response through reduction regarding inflammatory marker levels. Conclusion Inflammation is the least common denominator in the pathology of ED and metabolic disorders. The inflammatory process of ED includes a shift in the complex interactions of cytokines, chemokines, and adhesion molecules. These data have provided that anti-inflammatory agents could be used as a therapeutic opportunity in the prevention and treatment of ED. Further research on inflammation-related mechanisms underlying ED and the effect of therapeutic strategies aimed at reducing inflammation is required for a better understanding of the pathogenesis and successful management of ED.
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Objective: The aim of this study was to investigate the platelet activity in patients with vasculogenic erectile dysfunction (ED). Materials and methods: The total blood count, including hemoglobin (Hgb), white blood cell (WBC), red blood cell (RBC), platelet (PLT) and mean platelet volume (MPV) parameters were measured in the patient (n = 70) and control groups (n = 50). Results: The average age was 48.1 ± 11.7 and 47.6 ± 12.3 in the patient and control groups (p = 0.8217), respectively. MPV was higher in the patient group and there was a statistically significant difference between two groups (11.27 ± 0.56 and 9.8 ± 0.91, p < 0.0001). PLT counts were lower in the patient group but there was not a statistically significant difference (196.23 ± 37.01 and 209.07 ± 36.71, p = 0.0626). In terms of haemoglobin, WBC and RBC values, there was no difference in the patient and control groups. Conclusions: Finding high MPV, which reflects the platelet activity, in the patient group shows that platelets also have a role in the VED etiopathogenesis. In the case of the confirmation of this result with additional studies, the efficiency of anti-platelet therapy in the vasculogenic ED should also be researched.
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Article
Blood count parameters of patients referring with erectile dysfunction (ED) were examined in this study and it was investigated whether eosinophil count (EC), platelet count (PC), and mean platelet volume values among the suspected predictive parameters which may play a role in especially penile arteriogenic ED etiopathogenesis had a contribution on pathogenesis. Patients referring with ED complaint were evaluated. Depending on the medical story, ED degree was determined by measuring International Index of Erectile Function. Penile Doppler ultrasonography was taken in patients suspected to have vasculogenic ED. According to penile Doppler ultrasonography result, patients with arterial deficiency were included in the penile arteriogenic ED group and the patients with normal results were included in the nonvasculogenic ED group. A total of 36 patients participated in the study from the penile arteriogenic ED group and 32 patients from the nonvasculogenic ED group. Compared with the nonvasculogenic ED group, the penile arteriogenic ED group’s low International Index of Erectile Function score, high EC, mean platelet volume and PC values were detected to be statistically significant (p < .001, p = .021, p = .018, p = .034, respectively). No statistically significant difference was observed among the two groups when age, white blood cells, red blood cells, and hemoglobin values were considered. Pansystolic volume velocities were detected as statistically significantly low compared with the nonvasculogenic ED group in the measurements made in 5th, 10th, 15th, and 20th minutes on the right and left sides in the penile arteriogenic ED group. High MPV value and PC is a significant predictive factor for penile arteriogenic ED and vasculogenic ED and high EC is specifically predictive of arteriogenic ED.
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Article
Purpose: Increased eosinophil count (EC), mean platelet volume (MPV), and platelet count (PC) are important in vascular disorders which are main factors resulting in endothelial dysfunction. We aimed to investigate the association between MPV, and EC, with erectile dysfunction (ED). Materials and methods: Two hundred thirty participants (130 patients with ED, and 100 healthy controls) were enrolled in this study. A detailed psychosexual history obtained, and physical, and laboratory examination were performed. International Index of Erectile Function (IIEF)-5 questionnaire was used to evaluate the erectile status objectively. IIEF-5 score was applied to all patients, and IIEF-5 score under 22 was considered as ED. The MPV, PC, and EC were compared between the two groups. Results: The mean age of the patients with ED and control group was 55.62 ± 8.90 years and 54.19 ± 4.10 years, respectively. MPV and PC levels were significantly higher in ED group (8.51± 1.00 fL and 8.16 ± 0.94 fL; 244.59 ± 57.3 cells/µL and 230.17 ± 48.44 cells/µL, respectively (P < .05). EC and white blood cell count were not significantly different between study and control groups. Conclusions: In our study a relationship was found between elevated MPV, and PC with ED. MPV and PC may be used as a biomarker in patients with ED. &nbsp.
Article
Objective: Previous study conducted by the Turkish Society of Andrology in 1999 reported the prevalence of erectile dysfunction (ED) as 69.2% in men of ≥40 years of age, using a single-item non-validated question. This rate seemed to be higher compared to the studies reported worldwide. So, there was a need to carry out another epidemiological study by using validated questionnaires. Our aim was to investigate ED prevalence, severity, and its correlates in men aged ≥40 years using validated tools. Material and methods: This cross-sectional, observational, population-based field survey was carried out in randomly selected males of ≥40 years from 19 provinces of Turkey. All participant completed a survey included with socio-demographic and socio-economic characteristics, medical and sexual history, associated physical and medical comorbidities. Erectile function was assessed by the International Index of Erectile Function (IIEF) questionnaire based on a total score of 30. The prevalence of ED, its severity and correlates in men aged ≥40 years were determined for main outcome measures. Data sets were statistically compared and p<0.05 was considered as significant. Results: Median age of 2.760 males was 54.2 years. The median prevalence of ED was calculated as 33% among all males of ≥40 years of age. When subjects were stratified by age; median ED prevalence rates were 17% for 40-49 years, 35.5% for 50-59 years, 68.8% for 60-69 years, and 82.9% for ≥70 years. Among all ED men, 76.9% reported mild, 16.3% moderate, and 5.7% severe ED. At logistic regression analyses; age, diabetes, hypertension, atherosclerosis, dyslipidemia, lower urinary tract symptoms, educational status and monthly income were found to be independent risk factors for having ED. Conclusion: This population-based survey in Turkish men of ≥40 years of age reported the prevalence of ED as 33%. Besides, this study reported age as the main predictor for presence and severity of ED.
Article
Mean platelet volume (MPV) and Platelet distribution width (PDW) are potential markers in platelet activation. In present study, we aimed to evaluate MPV and PDW as potential severity markers for those patients who are complaining erectile dysfunction (ED). A total of 358 participants were enrolled in this study. The whole cohort was asked to complete the International Index of Erectile Function-5 (IIEF-5) questionnaire. The participants were classified into 3 groups: control group (n = 120), mild ED (n = 118) and severe ED (n = 120). We found in our cohort MPV and PDW were significantly higher in both mild ED group and severe ED group than control group (9.24 ± 0.70 and 9.71 ± 0.80 versus 8.56 ± 0.62 for MPV; 14.48 ± 1.29 and 14.98 ± 1.60 versus 12.86 ± 1.13 for PDW respectively). The MPV and PDW increased as the disease progressed. In the mild and severe ED groups, a significant inverse correlation was detected between the mean values of IIEF-5 score and PDW. Furthermore, in the receiver operating characteristic curve analysis, the area under the curve of the MPV and PDW to predict severe ED was 0.818 and 0.848 respectively. Our study establishes a dose-dependent association between the PDW and ED. Therefore, the PDW can serve as a potential marker for predicting the severity of ED.
Article
We evaluated and compared blood total platelet count, mean platelet volume (MPV) and platelet distribution width (PDW) values of patients with erectile dysfunction (ED) and control subjects. A total 57 male patients (mean age 49.7 ± 12 years) with ED and 59 control men (mean age 49.7 ± 10.7 years) were included in the study. All patients were evaluated using medical history with International Index of Erectile Function (IIEF) scores, physical examination and routine blood analysis. Total blood count, including white blood cell (WBC), total platelet counts, MPV and PDW parameters, were recorded in both groups. MPV values were detected to be significantly higher in patients with ED than control group: 10.7 ± 1 and 9.72 ± 1.5, respectively (P = 0.001). Similarly, PDW values were significantly higher in patients with ED than control group: 14.6 ± 2.8 and 12.9 ± 1.9, respectively (P = 0.001). However, mean platelet and mean WBC counts were similar in both groups (P = 0.45). We demonstrated that MPV and PDW values significantly increased in patients with ED compared with the control group. According to these findings, platelet function might play an important role in patients with ED that warrants further research. © 2015 Blackwell Verlag GmbH.
Article
Objective Lithium treatment remains an important part of the management of many patients with bipolar disorder, but the incidence of treatment-emergent sexual dysfunction with lithium is uncertain, and little is known about how it might be managed.Method Systematic computerised literature search of preclinical and clinical studies.ResultsThirteen relevant papers were identified. Preclinical studies suggest lithium can reduce testosterone levels and impair nitric oxide mediated relaxation of cavernosal tissue. Clinical reports suggest lithium may reduce sexual thoughts and desire, worsen erectile function and reduce sexual satisfaction. Concomitant benzodiazepine prescription with lithium is associated with an increased risk of sexual dysfunction. Sexual dysfunction during lithium treatment appears significantly associated with a lower level of overall functioning and may reduce compliance.Conclusion The findings of this systematic review reveal the paucity of information about the incidence, associated factors and management of sexual dysfunction with lithium treatment and highlight the need for well-designed studies in this area. Copyright © 2015 John Wiley & Sons, Ltd.
Article
Arterial erectile dysfunction (ED) is commonly associated with classic cardiovascular and metabolic risk factors, such as smoking, hypertension, diabetes mellitus, dyslipidaemia and obesity. However, some patients with arterial ED do not present any cardiovascular risk factor. As mean platelet volume (MPV) has been shown to be directly related to the cardiovascular risk and the percentage of platelets expressing the vitronectin receptor (αVβ3), involved in the early stages of platelet adhesion, is higher in patients with ED, the present study was undertaken to evaluate MPV and αVβ3 in 15 patients with arterial ED not associated with any cardiovascular risk factor. Their MPV and αVβ3 values were compared with those of men with normal penile haemodynamic. Patients with arterial ED had a mean value of MPV (11.25 vs. 9.88 fL; p < 0.001) and a percentage of platelets expressing the αVβ3 (7.39 vs. 2.07%; p < 0.001) significantly higher compared to controls. A negative correlation was observed between peak systolic velocity and MPV (r = 0.916; p < 0.001) or αVβ3 (r = 0.930; p < 0.001), whereas MPV and αVβ3 correlated positively (r = 0.908; p < 0.001). In conclusion, this study showed for the first time that MPV and the percentage of platelet expressing αVβ3 are significantly higher in patients with arterial ED compared to controls. We speculate that these parameters of platelet function may be envisaged as markers of cardiovascular risk in patients with arterial ED.