[Safety and efficacy of China-made sildenafil citrate in the treatment of erectile dysfunction].

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 (ï¼»47.2±11.32ï¼½ yr vs ï¼»46.67±13.08ï¼½ 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.

Medical management of erectile dysfunction in aging males: is it too late to treat?

Erectile dysfunction (ED) is a common disorder among aging males. However, most aging males refuse to seek medical help and believe that ED is an irreversible event in the aging process. The purpose of this study was to describe the current medical management of ED in aging males and to examine whether it is too late to treat this disorder in these elderly men. From 2007 to 2008, 4507 patients diagnosed with ED were gathered from 46 centers in China; 4241 completed the study, 3837 of whom were treated with sildenafil. The 3837 patients were divided into five groups based on age (group A: 20-30 years; group B: 31-40 years; group C: 41-50 years; group D: 51-60 years; and group E: >60 years). After comparing pre- and posttreatment International Index of Erectile Function-Erectile Function domain (IIEF-EF) questionnaires, Erection Hardness Scale (EHS), and IIEF Q13 ("How satisfied have you been with your overall sex life?"), we discovered that the aging males had worse erectile function, erection hardness, and sexual satisfaction than the younger males (P < 0.001). After treatment, the improvement rates in the IIEF-EF, EHS, and IIEF Q13 scores were 107.0%, 83.1%, and 116.5%, respectively. The magnitude of these changes demonstrated significant differences among groups (P < 0.001). Accordingly, aging males are likely to benefit more from medical treatment. We propose that aging males should be informed that age is not a limiting factor for medical ED management, and it is never too late to treat.

Association of depression/anxiety with lower urinary tract symptoms and erectile dysfunction in Chinese men aged from 22 to 50 years.

OBJECTIVE: To examine the relationships among lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and mental health in Chinese men aged from 22 to 50. METHODS: The subjects were 907 men aged between 22 and 50 years. The symptoms of mental distress were evaluated by the Zung Self-rating Depression Scale questionnaires and Zung Self-rating Anxiety Scale questionnaires. The symptoms of chronic prostatitis/chronic pelvic pain syndrome (CPPS), LUTS and ED were assessed by the US National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function 5 (IIEF-5) score. RESULTS: In the study, 894 subjects had their complete data. Their mean NIH-CPSI score was higher for the men with depression and anxiety than for those without (6.2±6.2 vs. 5.0±5.8, P=0.015; 8.7±8.1 vs. 4.7± 5.3, P<0.001), with the mean IPSS score (5.9±6.6 vs. 4.7±5.8, P=0.029; 8.4±8.0 vs. 4.4±5.5, P<0.001). The mean IIEF-5 score was lower for the men with depression and anxiety than for those without (18.3±4.4 vs. 20.2±3.5; 17.2±4.1 vs. 20.1±3.6, both P<0.001). The proportion of total ED was higher for the men with depression and anxiety than for those without (69.7% vs. 57.8%, P=0.002; 81.1% vs. 57.0%, P<0.001). CONCLUSION: Our study reveals associations among depression, anxiety, and CPPS, LUTS and ED in Chinese men aged 50 years and younger.

Andrology in China: current status and 10 years' progress.

Andrology has a long history in traditional Chinese medicine. There are records of male sexual health, male sexual dysfunction and male infertility from over thousands of years ago. Modern andrology in China had a late start, with the Chinese Andrology Association founded in 1995. Within last decade, andrology in China has grown rapidly. In this review article, we summarized the progress of andrology in last 10 years and outlined the current status of Chinese andrology with a special focus on progress in male erectile dysfunction, prostate diseases, male infertility and male hormonal contraception.

[Benefits of tadalafil to ED patients].

OBJECTIVE: To gain a deeper insight into the benefits of oral tadalafil for patients with erectile dysfunction (ED). METHODS: From January 2008 to June 2009, we conducted a nationwide survey on the quality of male erectile function among the outpatients under the direction of the Chinese Association of Andrology. A total of 205 ED patients were prescribed oral tadalafil and accomplished a questionnaire investigation after 4 weeks of medication. We compared various parameters of the patients before and after the treatment. RESULTS: Four weeks of oral tadalafil medication achieved a total rate of effectiveness of 85.9% (176/205). The proportion of those with moderate to severe ED was decreased from 67.8% (139/205) before medication to 16.6% (34/205) after it. Those who enjoyed sexual life were increased from 21.5% (44/205) before medication to 84.9% (174/205) after it. Only 1.0% (2/205) of the patients could achieve grade 4 penile hardness before the treatment, as compared with 60.5% (124/205) after it. And the frequency of sexual intercourse was significantly increased, over 4 times in 90.2% (159/205) of the patients. CONCLUSION: Oral tadalafil, with its sure effectiveness on ED, can bring great benefits to the sexual life of ED patients.

[Analysis of serum electrolytes in urolithiasis patients].

OBJECTIVE: To define the difference of serum calcium (Ca), phosphorus (P), potassium (K), sodium (Na), chlorine (Cl), carbon dioxide combining power (CO2CP), hydrogen ion concentration (pH) of urine and urine specific gravity (SG) between those patients suffering from urolithiasis and non-urolithiasis at the same time period. METHODS: Data from 1 164 patients admitted to the Department of Urology, Peking University People's Hospital from January, 2005 to July, 2007 were retrospectively reviewed. Seven hundred fourteen patients suffered from urolithiasis, and 450 patients were diagnosed as non-urolithiasis. Blood and urine were taken from the patient the next morning after admission. Serum levels of Ca, P, K, Na, Cl, CO2CP and urine pH and SG were checked by automatic biochemistry analyzer. The data were analyzed by software SPSS 13.0. RESULTS: Patients' ages in urolithiasis group varied from 5 to 87 years and the male to female ratio was 1.8:1. The patients in non-urolithiasis group aged from 12 to 94 years and the male to female ratio was 3.8:1. There was difference in the levels of serum Na, K, Cl, CO2CP, Ca and P between urolithiasis and non-urolithiasis groups (P<0.05). In male patients, serum Na, Ca and P levels in urolithiasis group were higher than those in non-urolithiasis group(P<0.05), serum K and urine pH levels were lower in urolithiasis group than those in non-urolithasis group (P<0.05). In female patients, serum Na level was higher in urolithiasis group than that in non-urolithiasis group (P=0.080). Logistic regression analysis showed that beta value of serum Na level in male and female group was 0.10 (P<0.01) and 0.09 (P=0.054) respectively. CONCLUSION: There was difference in serum electrolyte levels between urolithiasis group and non-urolithiasis group. The chang of serum Na level may play role in pathogenesis of urolithiasis.

[Epidemiological changes of ED patients: investigations in 11 Chinese cities during the past 5 years].

OBJECTIVE: To investigate the epidemiological changes of erectile dysfunction (ED) patients in the past five years. METHODS: In 2003 and 2008, we conducted two questionnaire investigations on the epidemiological changes of ED outpatients in 11 Chinese cities in such aspects as age, disease course, ED severity, smoking and drinking habits, accompanying hypertension, diabetes and coronary heart disease (CHD), and sexual intercourse satisfaction. RESULTS: According to the valid copies of the questionnaire collected (808 in 2003 and 858 in 2008), the age pattern of the ED patients hardly changed in the past five years, over 60% aged 30 - 50 years. Compared with the results obtained in 2003, the second investigation showed obvious increases in the following numbers of the ED patients: by 13% in those with longer disease courses (5 - 10 yr), from 24.1 to 42.9% in those with moderate ED, from 20.4 to 29.9% in those with severe ED, by at least 10% in those with smoking and drinking habits, from 11.5 to 16.2% in those with hypertension, from 9.4 to 13.5% in those with diabetes, and from 57.6 to 73.3% in those without sexual satisfaction, while the number of those with CHD did not change significantly. CONCLUSION: Increased unhealthy living habits and erectile function impairing diseases have added to the incidence and severity of ED. There is still much work to be done in the prevention and early treatment of ED.

Early and delayed castrations confer a similar survival advantage in TRAMP mice.

The most appropriate time to introduce androgen deprivation therapy for prostate cancer remains controversial. Our aim was to evaluate the effects of early versus delayed surgical castration on prostate cancer progression and survival in the transgenic adenocarcinoma of the mouse prostate (TRAMP) model. TRAMP mice were randomly divided into three groups: the early castration group (on which castration was performed at the age of 4 weeks), the delayed castration group (on which castration was performed when abdominal tumours could be palpated), and the sham-castrated group. Mice were monitored daily throughout their lives until cancer-related death or the development of an obviously moribund appearance, at which time the individual mouse was killed. Androgen receptor expression in prostate tumours was also evaluated. The results shows that the average lifespan in early castration, delayed castration and sham-castrated groups were 54.1 weeks, 59.9 weeks and 39.1 weeks, respectively. Both early castration and delayed castration conferred a statistically significant survival advantage when compared with the sham-castrated group (P<0.001). However, the difference in lifespan between the early castration group and the delayed castration group was not statistically significant (P=0.85). The increase in lifespan in the TRAMP mice that received either early or delayed castration correlated with lower G/B value (genitourinary tract weight/body weight) at death than the sham-castrated mice. In conclusion, early and delayed castrations in TRAMP mice prolonged survival to a similar extent. This finding may provide a guide for clinical practice in prostate cancer therapy.

[A decade's evidence review of sildenafil citrate].

Erectile dysfunction (ED) is one of the most popular and disturbing sexual problems, which impairs patients' health and affects their quality of life. Sildenafil citrate, the first oral PDE-5 inhibitor in the world, has established its efficacy and safety credit in both doctors and ED patients. The authors reviewed the results of related studies in the last decade and made deeper insights into the use of sildenafil citrate in such aspects as the general drug tolerance and its influence on the cardiovascular system, potentiality of concomitant diseases with co-administration of other drugs, long-term safety, and ocular and genital safety.

Clinical observation of loupe-assisted intussusception vasoepididymostomy in the treatment of obstructive azoospermia (analysis of 49 case reports).

To evaluate the clinical outcomes of loupe-assisted intussusception vasoepididymostomy (VE) in the treatment of epididymal obstructive azoospermia (EOA), we retrospectively analyzed data from 49 patients with EOA who underwent two-suture longitudinal intussusception vasoepididymostomy (LIVE) between 2000 and 2007. The data included the surgical method, postoperative motile sperm count per ejaculation, percentage of progressive motile sperm and patency and pregnancy outcomes. There were a total of 49 men undergoing scrotal exploration, and epididymal obstruction was found in all cases. Bilateral or unilateral anastomoses were performed in 40 and 6 men, respectively. The postoperative courses of 42 patients were followed up for more than 6 months, and the courses of 38 patients were followed up for more than 1 year. The overall patency and pregnancy rates were 71.4% and 26.3%, respectively. Moreover, progressive motile sperm was more frequently present in those patients who had undergone anastomosis at cauda than at corpus or caput. Pregnancy was achieved only in those patients who had undergone anastomosis at least on one side of the cauda epididymis. We think that the loupe-assisted method, with a lower overall cost and a simplified surgical procedure, can achieve satisfactory patency outcomes and pregnancy results. Data from this paper also suggest that paternity outcomes occur more frequently after anastomoses at cauda than at corpus or caput.

[Multi-centered clinical trial of Fufang Xuanju capsule for oligoasthenospermia].

OBJECTIVE: To observe the efficacy of Fufang Xuanju Capsule in the treatment of oligoasthenospermia. METHODS: Using a multi-centered, open and self-controlled clinical trial, we treated 120 patients with oligoasthenospermia, with Fufang Xuanju Capsule for 12 weeks, and evaluated the efficacy of the capsule with sperm concentration and vitality (a + b) as the primary and the number of grade a sperm, sperm motility (a + b + c) and semen volume as the secondary therapeutic indexes. RESULTS: A total of 107 patients accomplished the clinical trial. Compared with pre-treatment, sperm density, vitality and motility were significantly improved after 4, 8 and 12 weeks of Fufang Xuanju treatment (P < 0.01). At 12 weeks, sperm concentration was increased by 63.28%, with 73 cases (68.22%) restored to normal, sperm vitality by 63. 17%, with 39 (36.45%) restored to normal, sperm motility by 44.36%, with 77 (71.96%) restored to normal, and the semen volume by 18.13%. CONCLUSION: Fufang Xuanju Capsule can evidently improve the seminal quality of oligoasthenospermia patients.

[Prostatic abscess: a report of 2 cases and meta-analysis of domestic literature in recent 10 years].

OBJECTIVE: To report 2 cases of prostatic abscess and review the current characteristics of prostatic abscess in China. METHODS: Two cases of prostatic abscess were reported, and a meta-analysis was made of the literature from the Chinese National Knowledge Infrastructure database and Wanfang Data in recent 10 years. RESULTS: Both the cases had a high glucose level, and one of them had received instrumental examination of the lower urinary tract prior to the problem, both with difficult defecation, severe perineal pain and high fever, with normal peripheral white blood cell count and negative urine routine. One case of abscess was confirmed by MRI, ruptured into urethra and cured by antibiotics. The other case was confirmed by transrectal ultrasound and CT and cured by transrectal ultrasound guided needle aspiration. Meta-analysis showed that the predisposed factors were diabetes mellitus, the indwelling catheter and instrumentation of the lower urinary tract. Major pathogens were staphylococci aureus and Escherichia coli. For most patients, the diagnosis was mainly established by ultrasonography and the treatment included needle aspiration or surgery. CONCLUSION: The clinical symptoms of prostatic abscess are not typically presented and the differential diagnosis may be difficult. Imaging investigation is helpful, and transrectal ultrasonography can be used for both diagnosis and treatment.

[Chinese men's attitudes to life events and sexuality: prevalence of erectile dysfunction and related health concerns among Chinese men in Asian MALES study].

OBJECTIVE: The aims of Asian Men's Attitudes to Life Events and Sexuality (Asian MALES)-China study were to identify the prevalence of erectile dysfunction (ED) and related health concerns in the general male population in China, and to examine the attitudes and behaviors of men in relation to these health issues. METHODS: A total of 2055 men aged 20-75 years were included in Phase-I MALES study using a standardized questionnaire, and another 225 recruited from the sub-sample of Phase-I MALES participants with reported ED and some ED patients from other sources were involved in Phase-II Asian MALES- China study, with the prevalence of ED and men's associated attitudes as the main measure. RESULTS: The overall rate of ED in the Asian MALES-China sample was 5.9%. The rate of self-reported ED rose with age increase. A higher rate of ED was reported in men with co-morbid medical conditions and risk factors, including cardiovascular disease, hypertension, dyslipidemia, and depression, and so were the rates of these co-morbid conditions in ED patients. Data from Phase-II Asian MALES-China indicated that among men with reported ED, only 17% would seek treatment. CONCLUSION: The rate of ED is high in Chinese men and it is associated with co-morbid conditions. For Chinese men, it is necessary to know more about ED and to seek safe and effective treatment of its symptoms.

Efficacy and safety of on-demand tadalafil for the treatment of erectile dysfunction in South-East Asian men.

AIM: Tadalafil is an inhibitor of phosphodiesterase type 5 used for the treatment of erectile dysfunction (ED). The efficacy and safety of tadalafil have been evaluated extensively in Western populations. Our aim was to assess the efficacy and safety of on-demand tadalafil for the treatment of ED in South-East Asian men. METHODS: This was a randomized, double-blind, placebo-controlled study of men with mild to severe ED of various etiologies randomized to receive placebo (n = 122), tadalafil 10 mg (n = 120), or tadalafil 20 mg (n = 125), taken as needed (maximum once daily) for 12 weeks. Efficacy assessments included the International Index of Erectile Function (IIEF), the Sexual Encounter Profile (SEP) diary, and a Global Assessment Question (GAQ). RESULTS: Men from China, Singapore, and the Philippines participated in this trial (n = 367). Compared with placebo, tadalafil significantly improved erectile dysfunction on all efficacy outcomes (P < 0.001). Patients receiving tadalafil 10 mg and 20 mg experienced a significant mean improvement of 8.1 and 8.7, respectively, in the IIEF Erectile Function (IIEF-EF) domain score from baseline (vs placebo 2.4, P < 0.001). In patients receiving tadalafil 10 mg and 20 mg, the mean per-patient success rate for intercourse attempts (SEP3) was 62% and 70%, respectively, compared with 32% for the placebo group (P < 0.001). Of patients who received tadalafil 10 mg and 20 mg, 81% and 86% reported improved erections at endpoint (GAQ) compared with 44% in the placebo group (P < 0.001). The most common adverse events reported by patients were headache, back pain, dyspepsia, and dizziness. CONCLUSIONS: Tadalafil was an effective and well-tolerated treatment for South-East Asian men with ED.

[Aildenafil citrate: a new potent and highly selective phosphodiesterase type 5 inhibitor for the treatment of erectile dysfunction].

OBJECTIVE: To evaluate the efficacy and safety of aildenafil citrate, an oral phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction. METHODS: Integrated analyses were made of 8-week, randomized, double-blind, placebo-controlled phase 2 clinical trials involving 250 men with mild-to-severe erectile dysfunction of various etiologies who received aildenafil citrate 30 or 60 mg (n = 167) or placebo (n = 83). RESULTS: The statistic results of International Index of Erectile Function, Patient Sexual Encounter Profile (SEP) diaries and Global Assessment Question (GAQ) were significantly higher in the aildenafil citrate patients than in the placebo controls. The main drug-related adverse events were flushing, headache, dizziness and naupathia, which were mild and could be self-relieved. CONCLUSION: The aildenafil citrate therapy significantly ameliorated erectile function and was well tolerated by a wide range of patients with erectile dysfunction.

[Study on the knowledge of and attitude to sexual dysfunction in aged men].

OBJECTIVE: To investigate the knowledge of and attitude to sexual dysfunction in aged men, and to discuss the status and needs of male healthcare. METHODS: Two thousand seven hundred and twenty-eight men (40-70 years old) were surveyed on sexual dysfunction using the randomized questionnaire in Xicheng District, Beijing. RESULTS: The prevalence of erectile dysfunction (ED) was 41.2%, and only 12.1% ED patients were to see the doctor. 52.4% aged men thought the sexual life was important or very important during the life, and 55.6% thought ED would exert negative impact on the quality of life and the partner relationship. Although 27.4% knew that ED was a kind of disease, 49.0% thought ED was a nature rule. Compare to the 41.2% ED prevalence, only 9.7% male were dissatisfied with their sexual life, and later ratio was 14.1% among the partner. CONCLUSION: In China, the status of the knowledge of and attitude to sexual dysfunction in aged men was unsatisfactory to some extent. There is a lot of work to do especially in sexual healthcare education and improvement on diagnostic and treatment of sexual dysfunction.

[Outline of diagnosis and treatment on male sexual dysfunction].

Sexual dysfunction is common among male adults. Here we summarized the recent papers and provided the outline of diagnosis and treatment on male sexual dysfunction.

[Advances in the treatment of erectile dysfunction by viagra].

Viagra has become the first line drug for the treatment of erectile dysfunction since it was first introduced in 1998. Its efficacy and safety have been sidely acclaimed as being definite. This article presents a brief review about the advances in the studies of Viagra, including its therapeutic effect and safety, its protection of penile health, and its promotion of self-esteem and sexual relationship.

Prevalence and risk factors of erectile dysfunction in three cities of China: a community-based study.

AIM: To determine the age-adjusted prevalence of erectile dysfunction (ED) in 3 big cities of China and to explore its potential sociodemographic, medical and lifestyle correlates. METHODS: A cross-sectional, population-based survey was conducted in three cities of China. Structured questionnaires were administered to 2 226 men, aged 20 - 86 years, by trained interviewers. RESULTS: The age-adjusted prevalence of ED was 28.34 % (mild 15.99 %, moderate 7.14 %, severe 5.21 %). In the men above 40, the prevalence was 40.2 %. Age was positively correlated with ED (P<0.01). Education was negatively correlated with ED (P<0.01). Spouse companionship, living condition were positively correlated with ED (P<0.01). Histories of cardiovascular disease, diabetes, and hyperlipidemia were positively correlated with ED (P<0.01). Cigarette smoking was not correlated with ED (P>0.05), while the cigarette consumption and duration were positively correlated with ED (P<0.01). Alcohol drinking is negatively correlated with ED (P<0.01). The duration of drinking was positively correlated with ED (P<0.01). Weekly alcohol consumption was not correlated with ED (P>0.05). CONCLUSION: The prevalence of ED increased with age. Cardiovascular disease, diabetes and hyperlipidemia were positively correlated with the increased prevalence. Sociodemographic and lifestyle factors, such as education, spouse companionship, living condition, cigarette and alcohol consumption or duration also have association with the prevalence of ED.