Preliminary Study of the Relationship between Hypothyroidism and Erectile Dysfunction

甲状腺功能减退(HT)即甲状腺激素分泌不足的状态下,脂质代谢紊乱产生的高脂血症、血管内皮细胞功能障碍、血管平滑肌细胞舒张性下降等均可影响阴茎勃起功能.NO、CO、H2S及内皮素等在HT中起着重要作用.通过对高脂血症、高血糖、心血管病变的治疗及补充睾酮等,可明显改善阴茎勃起功能,因而积极治疗HT,对改善HT所致阴茎勃起功能障碍(ED)具有重要意义.内皮功能障碍被认为是ED的主要发病机制,因此治疗HT时同时改善内皮功能,也会对ED发挥治疗作用.同时HT引起的神经损伤也参与了ED.通过对这些物质、神经及其功能的深入研究,可为今后临床上治疗ED提供理论依据.     

血红素加氧酶1与子痫前期发病机制的研究进展

子痫前期是妊娠期最常见的疾病之一,其不仅能导致胎盘早剥、妊娠妇女肝肾功能受损、早产、胎儿生长受限等,也是孕产妇及围生儿死亡的常见原因,由于其严重危害母儿健康,其发病机制一直是产科领域的研究热点。子宫螺旋动脉重塑障碍、血管内皮受损、遗传、免疫失衡及炎症反应等与子痫前期关系密切,其中广泛的血管内皮受损是该病发生的关键环节。近年研究发现,氧化应激及可溶性血管内皮因子(s Eng)、可溶性血管内皮生长因子受体1(s Flt-1)升高是导致血管内皮受损的主要原因,而血红素加氧酶1(HO-1)是一种可诱导的抗氧化酶,HO-1及其催化代谢产物一氧化碳(CO)、胆红素不仅对正常妊娠的胎盘形成、胎盘功能的维持及胎儿的生长发育具有重要保护作用,还能通过激活胎盘保护型信号通路、合成还原型烟酰胺腺嘌呤二核苷酸磷酸(NADPH)还原酶来抑制子痫前期妇女体内的氧化应激以及通过降低血管内皮损伤因子如s Eng、s Flt-1对血管内皮的损害、促进血管内皮保护因子如血管内皮生长因子(VEGF)对血管的保护作用来抑制子痫前期的发生,推测HO-1及其催化代谢产物能够为子痫前期预防及治疗带来新的突破。     

他达那非治疗勃起功能障碍伴早泄患者的临床研究

目的:探讨他达那非治疗勃起功能障碍(ED)伴有早泄患者的临床疗效和安全性。方法:80例诊断为ED合并早泄患者,按每次服用他达那非20mg,共治疗12周。以阴道内射精潜伏期评价早泄治疗效果,并评估ED的总体疗效和治疗满意度,比较治疗前后的国际勃起功能指数评分5(IIEF-5)。结果:经过12周的治疗,早泄改善者共48例,有效率为60%。勃起功能改善者60例,总改善率为75%。不良反应共有10例(12.5%),均为轻度或中度,未经处理即自行缓解。结论:对ED合并早泄患者,他达那非能安全有效地改善其勃起功能,并能显著改善其早泄症状。     

真空负压勃起装置联合PDE5抑制剂治疗勃起功能障碍患者的疗效和安全性Meta分析

目的观察真空负压勃起装置(VED)联合PDE5抑制剂治疗男性勃起功能障碍(ED)的疗效。方法检索Cochrane Library、Medline、中国生物医学文献数据库、中国知网、维普以及万方数据库。检索时间从建库至2016年12月,纳入VED联合PDE5抑制剂治疗ED的随机对照治疗(RCTs)并进行方法学的质量评估。文献数据采用Rev Man5.3软件进行统计学分析,并根据异质性进行敏感性分析和发表偏倚风险评估。结果 10篇RCT文献纳入本项研究,累计病例1 327例。Meta分析结果显示:联合治疗组在改善患者满意度方面[RR=1.34,95%CI(1.17,1.54),P0.01]具有明显优势且差异具有统计学意义,并且单独应用VED亦可改善患者满意度[RR=1.27,95%CI(1.11,1.46),P0.01]。联合治疗组可明显提高患者的IIEF评分[WMD=4.52,95%CI(2.54,6.50),P0.01],而在单独应用VED提高患者IIEF评分方面[WMD=-2.07,95%CI(-6.17,2.03),P0.05],与对照组相比差异并无统计学意义。研究报道VED使用过程中未发生严重的不良反应,患者耐受性好。结论 VED联合PDE5抑制剂可更有效地改善ED患者的满意度,并显著提高IIEF-5评分,是治疗男性ED的有效方式,但仍需更多的大样本、高质量、多中心的随机对照实验加以远期验证。     

上海市某社区中老年男性勃起功能障碍与性激素的关系研究

目的:探索中老年男性勃起功能障碍(erectile dysfunction,ED)与多种性激素之间的关系。方法:对上海市某社区928名40~70岁中老年男性进行问卷调查,采用"勃起功能国际问卷-5(IIEF-5)"量表进行评估,并抽取空腹静脉血,采用免疫学方法测定血清总睾酮(TT)、游离睾酮(FT)、催乳素(PRL)、黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E2)及性激素结合球蛋白(SHBG)水平。按照各激素的四分位数点将对象分为4组(P0~P24组、P25~P49组、P50~P74组和P75~P100组),比较不同水平激素ED的患病风险。结果:40~50岁、51~60岁、61~70岁组的ED患病率分别为52.34%、73.14%、90.18%。调整潜在混杂因素后,FT水平的P0~P24组、P25~P49组、P50~P74组ED的患病危险性,比P75~P100组高,aOR分别为1.54、1.42、1.52,但其95%可信区间(95%CI)下限略小于1。PRL和FSH水平低的对象,患病风险较低;PRL水平在P0~P24组、P25~P49组、P50~P74组的aOR分别为0.61、0.79、0.58,除P25~P49组外,关联均有统计学意义;FSH水平在P0~P24组、P25~P49组、P50~P74组的aOR分别为0.55、0.48、0.60,除P50~P74组95%CI上限稍大于1外,关联均有统计学意义。而ED与TT、SHBG、LH、E2等的关联没有统计学意义。以上各激素与重度ED的关联均无统计学意义。结论:调整年龄及其他混杂因素后,ED与血清PRL、FSH水平存在统计学关联,与FT水平的关联较弱,与TT、LH、SHBG、E2水平的关联没有统计学意义。就现有研究结果,尚不能认为激素水平的变化对中老年人ED的发生起主要作用。     

甲状腺疾病与女性生殖

<正>常的甲状腺功能状态是维持女性生殖能力的一个重要因素;甲状腺激素直接或间接参与调节女性生殖功能。甲状腺机能障碍会影响性激素结合球蛋白(SHBG)和催乳素(PRL)水平,从而改变类固醇激素代谢和下丘脑-垂体-卵巢轴的功能,导致凝血功能障碍和各种生殖问题,如月经紊乱、排卵障碍、不孕、流产、早产等。甲状腺机能障碍通过适当的临床干预可能恢复正常的月经周期,并改善生殖功能。     

子痫前期患者凝血功能变化检测指标及其防治

子痫前期(PE)是一种严重影响母婴健康,引起孕产妇和围产儿病死率升高的产科常见并发症。凝血功能障碍与PE患者的临床表现和病情进展密切相关,对有高危因素的妊娠女性,应用阿司匹林和小剂量低分子肝素进行预防,应用凝血五项、血常规等常规实验室指标及血管性血友病因子(vWF)、组织因子(TF)、P-选择素(PS)和血栓弹力图等特异性指标进行早期筛查,发现血管内皮损伤,监控其凝血-抗凝-纤溶功能,对已发生的PE甚至慢性弥散性血管内凝血(DIC)及早进行抗凝治疗,能够降低产后出血等不良结局发生的风险。     

雌激素与女性认知功能关系的研究进展

随着女性平均预期寿命的延长及阿尔茨海默病(alzheimer disease,AD)的发病率明显上升,雌激素与女性认知功能的关系研究成为当今学术界研究的热点之一。细胞培养和动物实验数据已经证实,雌激素能通过多种途径保护认知功能相关区域的神经细胞,进而提高认知功能。但是学者们对雌激素水平和女性认知功能的相关性问题,及激素补充治疗(HRT)对围绝经期及绝经后女性认知功能是否有保护作用仍有争议。多数研究表明雌激素水平和女性认知功能是相关的,但是不同的人群,不同时期,不同的认知测试可能会有不同结果。激素补充治疗能否提高女性认知功能取决于研究人群、治疗时机、药物种类及个体化用药等。     

脱氢表雄酮在卵巢储备功能低下高龄患者体外受精/卵胞质内单精子注射-胚胎移植中的应用研究

目的探讨口服脱氢表雄酮(DHEA)辅助治疗在卵巢储备功能低下(DOR)高龄患者体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)中的临床疗效。方法选取行IVF/ICSI助孕治疗的DOR患者152例,所有患者均行2次及以上助孕周期,前一周期为未加用药周期(治疗前组),本次为用药周期(治疗后组),进行自身用药前后对照分析。比较口服DHEA后卵巢储备功能的变化情况,同时比较是否加用DEHA患者IVF/ICSI-ET的临床治疗参数、实验室参数及临床结局。结果 (1)口服DHEA后患者血清抗苗勒管激素(AMH)、硫酸脱氢表雄酮(DHEA-s)、睾酮(T)及窦卵泡计数(AFC)较用药前升高,卵泡刺激素(FSH)较前下降,差异有统计学意义(P0.05);(2)治疗后组h CG注射日E2及孕酮(P)水平、获卵数、受精率、可移植胚胎数、胚胎种植率及临床妊娠率高于治疗前组,Gn总用量、Gn使用时间、周期取消率低于治疗前组,差异有统计学意义(P0.05)。结论 DOR的高龄患者在进入IVF/ICSI周期前口服DHEA可改善其卵巢储备功能及助孕结局。     

血管内皮生长因子(VEGF)与黄体形成和功能关系的研究概况

黄体由卵巢排卵后的卵泡所形成，为一临时性内分泌器官，主要功能是产生孕酮和雌激素。无论是月经黄体还是妊娠黄体都要经历形成、维持与溶解的过程，该过程与血管新生、稳定和退化密切相关。血管内皮生长因子(vascular endothelial growth factor，VEGF)是近年被确认在调节新血管     

The Endothelial–Erectile Dysfunction Connection: An Essential Update

IntroductionThe endothelial monolayer plays a crucial role in the vasodilation and hemodynamic events involved in erection physiology. Due to its relevant functions, a close link has been established between endothelial integrity and erectile dysfunction (ED). Endothelial dysfunction is induced by the detrimental actions of vascular risk factors (VRFs), identified as common correlates for the development of cardiovascular disease and ED. It is currently recognized that ED is the early harbinger of a more generalized vascular systemic disorder, and, therefore, an evaluation of endothelial health in ED patients should be of prime relevance. Several noninvasive methods for endothelial function assessment have been proposed, including the Penile Nitric Oxide Release Test (PNORT).AimTo highlight the most recent gathered knowledge on basic and clinical mechanisms underlying loss of cavernosal endothelial function promoted by VRFs and to discuss local and systemic methods for endothelial function assessment in ED individuals, focusing on the PNORT.Main Outcome MeasuresA complete revision on the novel basic and clinical links between endothelial and ED.MethodsA systematic review of the literature regarding the aforementioned issues.ResultsRisk factor-associated cavernosal endothelial dysfunction is mostly induced by unifying mechanisms, including oxidative stress and impaired endothelial nitric oxide functional activities, which present clinically as ED. Several techniques to evaluate endothelial dysfunction were revised, with advantages and limitations debated, focusing on our detailed expertise using the PNORT method.ConclusionsThe established endothelial–erectile dysfunction connection was thoroughly revised, from basic mechanisms to the clinical importance of endothelial dysfunction assessment as diagnosis for generalized vascular disease. Further studies are required to disclose efficient approaches to repair disabled endothelium and both restore and prevent endothelial dysfunction. Costa C, and Virag R. The endothelial-erectile dysfunction connection: An essential update. J Sex Med 2009;6:2390–2404.     

Intracavernous Delivery of Stromal Vascular Fraction Restores Erectile Function Through Production of Angiogenic Factors in a Mouse Model of Cavernous Nerve Injury

IntroductionErectile dysfunction (ED) is a major complication of radical prostatectomy. Men with radical prostatectomy‐induced ED respond less positively to oral phosphodiesterase‐5 inhibitors.AimThe study aims to examine whether and how stromal vascular fraction (SVF) restores erectile function in mice with cavernous nerve injury (CNI).MethodsTwelve‐week‐old male C57BL/6J mice were used and the animals were distributed into five groups: sham operation group and CNI group receiving a single intracavernous injection of phosphate‐buffered saline (PBS) or SVF (1 × 10⁴, 1 × 10⁵, or 3 × 10⁵ cells/20 μL, respectively). SVF was isolated from epididymal adipose tissues of green fluorescence protein transgenic mice.Main Outcome MeasuresTwo weeks after injection, erectile function was measured by cavernous nerve stimulation. The penis was stained with antibodies to platelet/endothelial cell adhesion molecule‐1, phosphohistone H3, and phosphorylated endothelial nitric oxide synthase (phospho‐eNOS). We also performed Western blot for angiopoietin‐1 (Ang‐1), vascular endothelial growth factor‐A, hepatocyte growth factor, phospho‐eNOS, and eNOS in the corpus cavernosum tissue.ResultsLocal delivery of SVF restored erectile function in a dose‐dependent manner in CNI mice. The highest erectile response was noted at a dose of 3 × 10⁵ cells, for which the response was comparable with that in the sham operation group. Local delivery of SVF significantly increased the expression of angiogenic factor proteins and induced cavernous endothelial cell proliferation and eNOS phosphorylation compared with that in the PBS‐treated CNI group. SVF‐induced promotion of cavernous angiogenesis and erectile function was diminished in the presence of soluble antibody to Tie2, a receptor tyrosine kinase of Ang‐1.ConclusionSecretion of angiogenic factors from SVF is an important mechanism by which SVF induces cavernous endothelial regeneration and restores erectile function. These findings suggest that cavernous endothelial regeneration by using SVF may represent a promising treatment strategy for radical prostatectomy‐induced ED. Song K‐M, Jin H‐R, Park J‐M, Choi MJ, Kwon M‐H, Kwon K‐D, Batbold D, Yin GN, Kim WJ, Koh GY, Ryu J‐K, and Suh J‐K. Intracavernous delivery of stromal vascular fraction restores erectile function through production of angiogenic factors in a mouse model of cavernous nerve injury. J Sex Med 2014;11:1962–1973.     

Investigative models in erectile dysfunction: a state-of-the-art review of current animal models

IntroductionErectile dysfunction (ED) is a common male sexual disorder producing a significant negative impact on the physical and psychosocial health of men and their partners. The development of ED is frequently attributable to both psychogenic factors as well as physiological alterations in neural, vascular, hormonal, and endothelial function. While the complex nature of human sexual function cannot possibly be replicated fully, the use of animal models provides a valid alternative to the investigation and evaluation of sexual dysfunction.AimTo review the existing English literature pertaining to the use of experimental models (predominantly rodent models) for the evaluation of ED.Main Outcome MeasuresSummary of relevant animal models of ED and the advantages and disadvantages of each animal model.MethodsA Medline search using the key words “animal models of erectile dysfunction” was carried out and all relevant peer‐reviewed English language was evaluated.ResultsWhile larger animals such as dogs, monkeys, cats, and rabbits were used in the early period of investigation (1960–1990), in recent times, rodents have largely replaced other animals as the predominant animal model for investigating erectile function. The most frequently reported models of ED can be classified as traumatic (cavernous nerve injury and arterial ligation) and metabolic (diabetic, hypercholesterolemia/lipidemia, and castration). Other models that have been studied include organic (smoking, hypertension, and chronic renal failure) and nonorganic (psychological) models.ConclusionsThe development and utilization of the various rodent models has allowed for significant advances in the field of sexual dysfunction. Neurophysiological studies using the various animal models have provided important insights into human sexual dysfunction. At present, animal models play a significant role in evaluating novel therapeutics and surgical techniques and will likely continue to remain a vital research tool in the future. Chung E, De Young L, and Brock GB. Investigative models in erectile dysfunction: A state of art review of current animal models. J Sex Med **;**:**–**.     

Role of Nanotechnology in Erectile Dysfunction Treatment

IntroductionThe biological importance of nanotechnology-based delivery vehicles for in vivo tissue regeneration is gaining acceptance by the medical community; however, its relevance and incorporation into the treatment of sexual dysfunction are evolving and have not been well evaluated.AimTo provide scientific evidence examining the use of state-of-the-art nanotechnology-based delivery methodology in the treatment of erectile dysfunction (ED) in animal models and in patients.MethodsThis review assessed the current basic science literature examining the role of nanotechnology-based delivery vehicles in the development of potential ED therapies.ResultsThere are four primary areas where nanotechnology has been applied for ED treatment: (i) topical delivery of drugs for on-demand erectile function, (ii) injectable gels into the penis to prevent morphologic changes after prostatectomy, (iii) hydrogels to promote cavernous nerve regeneration or neuroprotection, and (iv) encapsulation of drugs to increase erectile function (primarily of phosphodiesterase type 5 inhibitors).ConclusionBasic science studies provide evidence for a significant and evolving role for nanotechnology in the development of therapies for ED and suggest that properly administered nano-based therapies might be advantageous for treating male sexual dysfunction.     

Medical Hypothesis: Loss of the Endocrine Function of the Prostate Is Important to the Pathophysiology of Postprostatectomy Erectile Dysfunction

IntroductionThree decades after the first nerve‐sparing radical prostatectomy, postoperative erectile dysfunction (ED) remains a challenging and common problem. Despite considerable advances and improvements in surgical techniques, full recovery of erectile function remains elusive even for young, potent men. This suggests, ipso facto, that factors other than surgical technique must be important to recovery of erectile function.AimThis study aims to review evidence that the prostate is an endocrine gland with contributions to local and systemic concentrations of 5α‐dihydrotestosterone (5α‐DHT), a potent androgen shown to be critical to penile physiology.MethodsLiterature review of human and animal studies related to endocrine role of prostate and postoperative recovery of erectile function.Main Outcome MeasuresEffect of 5α‐DHT on erectile function and recovery after surgical injury.ResultsWe advance the following hypothesis: “Loss of endocrine function of the prostate, specifically reduced local 5α‐DHT concentration plays a major role in the failure of full recovery of erectile function following anatomic nerve‐sparing radical prostatectomy.”ConclusionsWe propose two separate, yet interrelated, mechanisms whereby the loss of 5α‐DHT interferes with postoperative recovery of erectile function: (i) 5α‐DHT contributes to cavernous nerve integrity and its ability to recover from surgical insult. (ii) 5α‐DHT is important to the structural/functional integrity of penile tissues and erectile physiology. Kacker R, Morgentaler A, and Traish A. Medical hypothesis: Loss of the endocrine function of the prostate is important to the pathophysiology of postprostatectomy erectile dysfunction. J Sex Med 2014;11:1898–1902.     

Glycosylated serum protein may improve our ability to predict endothelial and erectile dysfunction in nonorganic patients

IntroductionEarly prediction of erectile dysfunction (ED) is critical in the treatment of impotence. Underlying pathogenesis may be the reason for ED without organic causes in young men.AimWe evaluated the early predictive value of glycosylated serum protein (GSP) in young patients whose ED was diagnosed as “nonorganic” in origin according to general criteria.MethodsA total of 150 young men with ED and 27 healthy men without ED were evaluated, including International Index of Erectile Function‐5 (IIEF‐5), causes of ED, influential or risk factors for ED, vascular parameters, and serum biochemical markers. Fifty‐two ED patients aged 20–40 years without known etiology and 22 age‐matched normal subjects were enrolled. The further assessment of two groups focused on vascular endothelial function and glycometabolic state.Main Outcome MeasuresRelationships among the IIEF‐5 scores, flow‐mediated dilation (FMD), and GSP were analyzed in cases vs. controls, using Pearson's correlation and multiple linear regression analysis.ResultsNo significant differences in baseline characteristics, cardiovascular risks, and conventional biomarkers were found between testing and control groups, except fasting blood glucose level (4.69 ± 0.50 vs. 4.29 ± 0.48, P = 0.003). FMD values were significantly reduced in cases compared with controls and correlated positively with IIEF‐5 scores (r = 0.629, P < 0.001). GSP levels were significantly increased in the ED cases compared with controls and correlated negatively with IIEF‐5 scores (r = ?0.504, P < 0.001) and FMD values (r = ?0.469, P < 0.001). These parameters independently predicted ED presence. The positive predictive value of FMD > 11.55% for excluding ED and of GSP > 210.50 mg/L for diagnosing ED were 86.4% (area under the curve [AUC]: 0.942, specificity: 88.4%) and 84.5% (AUC: 0.864, specificity: 72.7%), respectively.ConclusionsUnderlying glycometabolic disorder and subclinical endothelial dysfunction may be served as early markers for organic ED in young ED patients without well‐known related risk factors. GSP level may improve our ability to predict endothelial dysfunction and erectile dysfunction. Huang Y, Sun X, Liu G, Yao F, Zheng F, Dai Y, Tu X, Xie X, Deng L, Zhang D, Zhang Y, Bian J, Gao Y, Ye Y, Deng C, and Zhang Y. Glycosylated serum protein may improve our ability to predict endothelial and erectile dysfunction in non‐organic patients. J Sex Med 2011;8:840–850.     

Effect of Intracavernous Administration of Angiopoietin‐4 on Erectile Function in the Streptozotocin‐Induced Diabetic Mouse

IntroductionErectile dysfunction (ED) is a highly prevalent complication of diabetes, and the severity of endothelial dysfunction is one of the most important factors in reduced responsiveness to oral phosphodiesterase type 5 inhibitors.AimTo study the effects of human angiopoietin‐4 (Ang‐4) protein on erectile function in diabetic mice.MethodsDiabetes was induced by intraperitoneal injection of streptozotocin into 8‐week‐old C57BL/6J male mice. At 8 weeks after the induction of diabetes, the animals were divided into four groups: control nondiabetic mice and diabetic mice receiving two successive intracavernous injections of phosphate buffered saline (days ?3 and 0), a single intracavernous injection of Ang‐4 protein (day 0), or two successive intracavernous injections of Ang‐4 protein (days ?3 and 0).Main Outcome MeasuresOne week after treatment, we measured erectile function by electrical stimulation of the cavernous nerve. The penis was harvested and stained with hydroethidine or antibodies to Ang‐4, platelet/endothelial cell adhesion molecule‐1, and phosphorylated endothelial nitric oxide synthase (eNOS). We also determined the differential expression of Ang‐4 in cavernous tissue in the control and diabetic mice. The effect of Ang‐4 protein on the phosphorylation of Tie‐2, Akt, and eNOS was determined in human umbilical vein endothelial cells (HUVECs) by Western blot.ResultsThe cavernous expression of Ang‐4 was downregulated in diabetic mice; Ang‐4 was mainly expressed in endothelial cells. Local delivery of Ang‐4 protein significantly increased cavernous endothelial content, induced eNOS phosphorylation, and decreased the generation of superoxide anion and apoptosis in diabetic mice. Ang‐4 protein strongly increased the phosphorylation of Tie‐2, Akt, and eNOS in HUVECs. Repeated intracavernous injections of Ang‐4 induced significant restoration of erectile function in diabetic mice (87% of control values), whereas a single intracavernous injection of Ang‐4 protein elicited modest improvement.ConclusionsCavernous endothelial regeneration by use of Ang‐4 protein may have potential for the treatment of vascular disease‐induced ED, such as diabetic ED. Kwon M‐H, Ryu J‐K, Kim WJ, Jin H‐R, Song K‐M, Kwon K‐D, Batbold D, Yin GN, Koh GY, and Suh J‐K. Effect of intracavernous administration of angiopoietin‐4 on erectile function in the streptozotocin‐induced diabetic mouse. J Sex Med 2013;10:2912–2927.     

Bicycle Riding and Erectile Dysfunction: A Review

IntroductionFor many years, reports in the literature have implicated bicycle riding as causing increased risk of erectile dysfunction (ED). Perineal compression during cycling has been associated with the development of sexual complications.AimTo review current literature on the rationale for ED from bicycle riding and outcome of bicycle riding on erectile function and to present available research on preventative measures specifically regarding bicycle riding.MethodsA systematic comprehensive literature review.ResultsThere is a significant relationship between cycling-induced perineal compression leading to vascular, endothelial, and neurogenic dysfunction in men and the development of ED. Research on female bicyclists is very limited but indicates the same impairment as in male bicyclists. Preventative measures including use of a properly fitted bicycle, a riding style with a suitable seat position and an appropriate bicycle seat can help prevent impairment of erectile function.ConclusionsThere is a need for further research on safe bicycle and bicycle seat design and investigations that address the underlying mechanisms leading to cycling-related sexual dysfunction in both male and female bicyclists. Sommer F, Goldstein I, and Korda JB. Bicycle riding and erectile dysfunction: A review.     

Therapeutic Effect of Adipose‐Derived Stem Cells and BDNF‐immobilized PLGA Membrane in a Rat Model of Cavernous Nerve Injury

IntroductionCavernous nerve injury is the main reason for post‐prostatectomy erectile dysfunction (ED). Stem cell and neuroprotection therapy are promising therapeutic strategy for ED.AimTo evaluate the therapeutic efficacy of adipose‐derived stem cells (ADSCs) and brain‐derived neurotrophic factor (BDNF) immobilized Poly‐Lactic‐Co‐Glycolic (PLGA) membrane on the cavernous nerve in a rat model of post‐prostatectomy ED.MethodsRats were randomly divided into five groups: normal group, bilateral cavernous nerve crush injury (BCNI) group, ADSC (BCNI group with ADSCs on cavernous nerve) group, BDNF‐membrane (BCNI group with BDNF/PLGA membrane on cavernous nerve) group, and ADSC/BDNF‐membrane (BCNI group with ADSCs covered with BDNF/PLGA membrane on cavernous nerve) group. BDNF was controlled‐released for a period of 4 weeks in a BDNF/PLGA porous membrane system.Main Outcome MeasuresFour weeks after the operation, erectile function was assessed by detecting the ratio of intra‐cavernous pressure (ICP)/mean arterial pressure (MAP). Smooth muscle and collagen content were determined by Masson's trichrome staining. Neuronal nitric oxide synthase (nNOS) expression in the dorsal penile nerve was detected by immunostaining. Phospho‐endothelial nitric oxide synthase (eNOS) protein expression and cyclic guanosine monophosphate (cGMP) level of the corpus cavernosum were quantified by Western blotting and cGMP assay, respectively.ResultsIn the ADSC/BDNF‐membrane group, erectile function was significantly elevated, compared with the BCNI and other treated groups. ADSC/BDNF‐membrane treatment significantly increased smooth muscle/collagen ratio, nNOS content, phospho‐eNOS protein expression, and cGMP level, compared with the BCNI and other treated groups.ConclusionsADSCs with BDNF‐membrane on the cavernous nerve can improve erectile function in a rat model of post‐prostatectomy ED, which may be used as a novel therapy for post‐prostatectomy ED. Piao S, Kim IG, Lee JY, Hong SH, Kim SW, Hwang T‐K., Heang S, Lee JH, Ra JC, and Lee JY. Therapeutic effect of adipose‐derived stem cells and BDNF‐immobilized PLGA membrane in a rat model of cavernous nerve injury. J Sex Med 2012;9:1968–1979.