A Survey of Erectile Dysfunction in Taiwan: Use of the Erection Hardness Score and Quality of Erection Questionnaire
Thomas I. S. Hwang, MD,* † ‡ Te-Fu Tsai, MD,*† Yi-Chia Lin, MD,*† Han-Sun Chiang, MD, PhD,*† and Luke S. Chang, MD.* * Division of Urology, Department of Surgery, Shin Kong WHS Hospital, Taipei, Taiwan
† School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
‡ School of Medicine, Taipei Medical University, Taipei, Taiwan
Introduction. There are currently no studies in the Asia Pacific region using the erection hardness score (EHS) and Quality of Erection Questionnaire (QEQ) to assess erectile dysfunction (ED).
Aims. To provide up-to-date data on the prevalence of ED in Taiwanese men and to validate the EHS and QEQ in this population.
Methods. A representative sample of 1,060 men aged ≥30 years completed a telephone interview. ED status was confirmed via direct questioning and using the abridged five-item version of the 15-item International Index of Erectile Function (IIEF-5). Responses regarding EHS, QEQ, marital and sexual satisfaction, and attitude to treatment were also recorded.
Main outcome measures. IIEF, EHS, QEQ.
Results. The prevalence of ED, as defined by IIEF-5, was 27% among all respondents and 29% among those aged ≥40 years. Although, the prevalence of ED increased with age, men of all ages tended to underestimate their erectile problems. Amongst men who indicated that they did not have ED, 25% were found to have mild to moderate ED according to the IIEF-5 assessment. An EHS of ≤3, indicating the presence of ED, was reported in 26% of men. The EHS was consistent with the QEQ: when the EHS was 4, the satisfaction of each domain of QEQ ranged from 85 to 90%. The QEQ score correlated well with the IIEF-5 score, and significantly affected both sexual and marital satisfaction (P<0.005).
Conclusions. These data indicate that EHS is a simple, practical tool for clinical use. QEQ scores appear to be independently associated with sexual and marital satisfaction, and may be of value in the assessment and monitoring of ED patients. While ED is a common health problem in Taiwan and the prevalence of ED increases with age, affected men lack awareness regarding the presence of erectile problems and the importance of initiating timely and effective treatment.
男性學論文獎基礎組
Determination of Human Penile Electrical Resistance and Implication on Safety for Electrosurgery of Penis.
Vincent F.S. Tsai, MD, MsBiomE, * † ‡ Hong-Chiang Chang, MD,† Shih-Ping Liu, MD,† Yuh-Chen Kuo, MD,†ξ
Jyh-Horng Chen, MD, †¶ Fu-Shan Jaw, PhD,*and Ju-Ton Hsieh, MD† * Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; †Department of Urology, National Taiwan University Hospital, Taipei, Taiwan; ‡Department of Urology, Ten-Chen General Hospital, Taoyuan, Taiwan; ξDepartment of Urology, Taipei City Hospital, Taipei, Taiwan;
¶Jyh-Horng Chen’s Urologic Clinic, Hsih-Chu city, Taiwan
Introduction: Electrosurgery has been a surgical application since the late 19th century. While many urologists take this daily application for granted, the effects of electrical treatment on penile nerves and vessels have not been well documented.
Aim: To investigate the electrical characteristics of the penis and erectile tissues and to discover the potential hazards of electrosurgery on the penis.
Methods: Measurement of the electrical characteristics of three human penises in order to create models to analyze the effect of electricity on penile nerves and vessels.
Main outcome measures: Electrical resistivity of the penile shaft, electrical current density, and electric field strength on penile nerves and vessels, proportion of generated heat on the penis and electrical current density of the electrosurgery return electrode.
Results: Electrical resistivity (ρ) of the penile shaft is 127.14Ω•cm at 500 kHz. Electrical current density (J) of the penis shaft is 71.06 mA/cm2, nerve (60.23 mA/cm2), vessel (67.93 mA/cm2), and return electrode (2.11 mA/cm2). Electrical field strength (E) of the whole penis shaft is 9.03 volt/cm. The proportion of generated heat on the penis is four times as much as on other body parts of the circuit.
Conclusions: Potential and subclinical injury to erectile tissue due to electrosurgery on the penis cannot be underestimated. The injury mechanism can be attributed to a thermal (electrical current) effect and a nonthermal (mainly electrical field) effect. Ways to avoid the electrosurgical injury are: using less power (W)/electrical field and less time, biopolar electrosurgery confining the injured area, ligation to achieve hemostasis, and new laser technologies.
輝瑞論文獎臨床組
The Potential Impact of Metabolic Syndrome on Erectile Dysfunction in Aging Taiwanese Males
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Introduction: Recently, metabolic syndrome (MtS) has received increasing attention. However, investigations regarding the potential impact of MtS and its components on erectile dysfunction (ED) have not been completely clarified.
Aim: To determine the potential impact of MtS on ED in aging Taiwanese males.
Main Outcome Measure: The definition of MtS was according to the modified criteria developed by the Bureau of Health Promotion in Taiwan. The presence and severity of ED were evaluated by International Index of Erectile Function 5 (IIEF-5) scores.
Methods: A total of 639 subjects with a mean age of 60.2 (range 40–83) years were enrolled during a free health screening. All the men had complete clinical data and questionnaires taken. Clinical variables were compared according to MtS and ED prevalence. Multiple logistic regression analysis was used to determine the independent predictors of ED and MtS
Results: Using age-adjusted multivariate logistic regression analysis, our results showed that subjects with ED had significantly higher prevalence of MtS (p<0.01, OR=2.30, 95% CI: 1.44~3.69). The presence of MtS had significant correlation with lower IIEF- 5 scores (p<0.01), which were associated with the increment of MtS components number (p<0.01). Among the MtS components, abnormal fasting blood glucose (FBG) was the most significantly independent factor of MtS for ED (P=0.01, OR=1.60, 95% CI: 1.09~2.35). Testosterone levels were significantly lower in subjects with MtS (P=0.05), while inversely correlated with number of MtS components (p<0.01).
Conclusions: In aging Taiwanese males, the presence of MtS is strongly associated with ED and abnormal FBG is the most independent predictor for ED. Low testosterone level might be viewed as another possible common denominator for various pathologies linking MtS to ED.
輝瑞論文獎基礎組
Parasympathetic Influence Plays an Independent and Significant Role in Inducing the Contraction of the Seminal Vesicle of the Rat
Ju-Ton Hsieh, Shih-Ping Liu, Hong-Chiang Chang, Yuh-Chen Kuo, Jyh-Horng Chen, Fu-Shan Jaw and Vincent FS Tsai
Objectives. The role of the parasympathetic pathway in seminal vesicle (SV) contraction has not been well described. The purpose of this study was to study parasympathetic effects, the dominant muscarinic receptors subtype(s), and nitric oxide (NO) effects for SV contraction.
Methods. In vivo, SV pressure of mature male Wistar rats were recorded after electric stimulation (ES) of each pelvic nerve (PN; parasympathetic pathway) alone; bilateral PNs simultaneously, the L6 and S1 branches of the left PN; the left PN after ablation of sympathetic influence; the lesser splanchnic nerve (LSN) after ablation of parasympathetic influence; and the LSN after pretreatment of 4 muscarinic receptor antagonists or a NO donor -3-Morpholinosydnonimine (SIN-1).
Results. ES to the left PN caused frequency-dependent SV contraction, with similar results after ES to the right PN and bilateral PNs. ES to the L6 branch of the left PN caused significantly greater SV response than to the S1 branch. Ablation of sympathetic influence did not affect SV response to parasympathetic stimulation and vice versa. The inhibitory effects of 4-DAMP (M3 antagonist) and atropine (nonselective muscarinic antagonist) on SV response to ES were similar and significantly greater than those of pirenzepine (M1 antagonist) and methoctramine (M2 antagonist). Pretreatment of SIN-1 partially suppressed the SV response of ES to left PN.
Conclusions. ES via the parasympathetic pathway independently induces contraction of rat SV. NO partially suppresses the SV pressure response to parasympathetic ES.
住院醫師組論文獎臨床組
The Impact of Irritative Lower Urinary Tract Symptoms on Erectile Dysfunction in Aging Taiwanese Males
1 Faculty of Medicine, Department of Urology,
2 Graduate Institute of Medicine, and
3 Departments of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
Objective. This study assessed the possible associations between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in aging Taiwanese males and investigated the impact of various aspects of LUTS on ED.
Methods. A free health screening for aging males (≥40 years old) was conducted in Kaohsiung Medical University Hospital. All the subjects had completed clinical data and answered questionnaires. ED and LUTS were assessed by validated symptom scales: the International Index of Erectile Function-5 (IIEF-5) and the International Prostate Symptom Score (IPSS). Results. A total of 339 eligible patients enrolled in this study with a mean age of 60.1 years old. In multiple logistic regression analysis, age and IPSS (p <0.001 and p =0.013, respectively) were significantly associated with ED after controlling other comorbidities. In a further age-adjusted multiple regression analysis, our results showed that the irritative symptoms (P =0.042) have a more significant association with ED than the obstructive symptoms (P =0.101).
Conclusions. Our results indicate that age and LUTS are the two most independent risk factors for ED. Aging Taiwanase males with LUTS are at increasing risk for ED, especially for those with significant irritative symptoms.