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      Characteristics of patients with erectile dysfunction in a family physician-led erectile dysfunction clinic: Retrospective case series

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          Abstract

          Objectives:

          1. To examine the characteristics of patients with erectile dysfunction in a family physician led erectile dysfunction clinic;

          2. To review association of chronic disease spectrum and erectile dysfunction;

          3. To review initial treatment pattern and outcome.

          Design: Retrospective case series review.

          Subjects: All consecutive patients seen in a regional hospital family physician led erectile dysfunction clinic from April 2014 to March 2015.

          Main outcome measures:

          1. The severity of erectile dysfunction, based on International Index of Erectile Function (IIEF-5).

          2. The associated chronic comorbidities of patients.

          3. Treatment patterns and patient outcomes.

          Results: One hundred and eighty three patients presented with erectile dysfunction (ED) with mean age 58.7 (range 23 to 82) years old were seen during the study period. One hundred and twenty seven patients (69.4%) had comorbidity of chronic diseases, including 50.8% had hypertension, 38.8% had diabetes mellitus and 33.9% had hyperlipidaemia. Their mean body mass index was 25.2 kg/m 2, the mean blood pressure was 137.3/79.5 mm Hg (1 mm Hg = 0.133 kPa). According to IIEF-5 score, 50.3%, 30.6% and 18.6% had severe, moderate and mild erectile dysfunction respectively. The average duration of ED before seeking medical help was 3.9 years. Phosphodiesterase 5 (PDE5) inhibitors were prescribed to 119 patients (65%), and 57.1% of them achieved good response. Twenty nine patients (15.8%) were referred to other specialty for further management, including 27.6% had contraindication for PDE5 inhibitor.

          Conclusion: High proportion of erectile dysfunction patients had comorbitiy of chronic diseases. 57.1% of those patients receiving PDE5 inhibitors showed good response.

          Most cited references19

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          The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis.

          Erectile dysfunction (ED) shares similar modifiable risks factors with coronary artery disease (CAD). Lifestyle modification that targets CAD risk factors may also lead to improvement in ED. We conducted a systematic review and meta-analysis of randomized controlled trials evaluating the effect of lifestyle interventions and pharmacotherapy for cardiovascular (CV) risk factors on the severity of ED. A comprehensive search of multiple electronic databases through August 2010 was conducted using predefined criteria. We included randomized controlled clinical trials with follow-up of at least 6 weeks of lifestyle modification intervention or pharmacotherapy for CV risk factor reduction. Studies were selected by 2 independent reviewers. The main outcome measure of the study is the weighted mean differences in the International Index of Erectile Dysfunction (IIEF-5) score with 95% confidence intervals (CIs) using a random effects model. A total of 740 participants from 6 clinical trials in 4 countries were identified. Lifestyle modifications and pharmacotherapy for CV risk factors were associated with statistically significant improvement in sexual function (IIEF-5 score): weighted mean difference, 2.66 (95% CI, 1.86-3.47). If the trials with statin intervention (n = 143) are excluded, the remaining 4 trials of lifestyle modification interventions (n = 597) demonstrate statistically significant improvement in sexual function: weighted mean difference, 2.40 (95% CI, 1.19-3.61). The results of our study further strengthen the evidence that lifestyle modification and pharmacotherapy for CV risk factors are effective in improving sexual function in men with ED.
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            Erectile dysfunction.

            In the past 30 years, advances in basic science have been instrumental in the evolution of the male sexual health treatment paradigm from a psychosexual model to a new model, which includes oral and intracavernosal injection pharmacotherapy, vacuum constriction devices and penile prostheses for the treatment of erectile dysfunction. This progress has coincided with an increased understanding of the nature of male sexual health problems, and epidemiological data that confirm that these problems are widely prevalent and the source of considerable morbidity, both for individuals and within relationships.
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              Under-reporting of erectile dysfunction among men with unrelated urologic conditions.

              To evaluate the incidence of erectile dysfunction (ED) in men with unrelated urologic conditions paying special attention to the reasons for patient under-reporting. We asked 500 consecutive men over age 50 visiting their urologist's office for problems unrelated to ED, whether or not they had any difficulty with their potency. Those who gave a positive response were then asked to complete a questionnaire to assess their reasons for under-reporting and whether they had had any previous discussions with their primary-care physicians regarding their sexual function. Out of 500 men, 218 (44%) reported experiencing some degree of ED. Reasons for failure to discuss ED with their urologist included: 161 out of 218 (74%) were embarrassed; 27 out of 218 (12%) felt that ED was a natural part of aging; 20 out of 218 (9%) were unaware that urologists dealt with the problem of ED; and 10 out of 218 (5%) did not consider the problem worthy of attention. Only 48 of the 218 men with ED reported having previous discussions about their problem with their primary-care physicians. Of the 170 patients who did not report having such discussions, 140 (82%) reported that they would have liked their primary-care physician to have initiated a discussion of ED during their routine visits. In conclusion. a significant percentage of older men with some unrelated urologic complaint also suffer from some degree of ED and remain undiagnosed unless specifically questioned about this problem. By far, the most common reason for under-reporting of ED was patient embarrassment. While urologists are able to elicit information regarding erectile function on specific questioning, patients appear comfortable and willing to discuss their potency with primary-care physicians.
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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Compuscript (Ireland )
                2009-8774
                2305-6983
                May 2017
                May 2017
                : 5
                : 1
                : 85-91
                Affiliations
                [1] 1Family Medicine and General Outpatient Department, Kwong Wah Hospital, Mongkok, Hong Kong, China
                Author notes
                CORRESPONDING AUTHOR: Lap Kin Chiang, MBChB (CUHK), MSc (CUHK), MFM (Monash) Family Medicine and General Outpatient Department, Kwong Wah Hospital, 1/F, TTT Outpatient Building, Kwong Wah Hospital, 25 Waterloo Road, Mongkok, Hong Kong, China Tel.: +852-93075869 E-mail: chialk@ 123456ha.org.hk ; lapkinchiang@ 123456gmail.com ; lapkinchiang@ 123456yahoo.com.hk
                Article
                FMCH.2017.0114
                10.15212/FMCH.2017.0114
                ac308536-5320-4d03-93ef-d4fd3b7bc9dc
                Copyright © 2017 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 19 October 2016
                : 16 January 2017
                Categories
                China Focus

                General medicine,Medicine,Geriatric medicine,Occupational & Environmental medicine,Internal medicine,Health & Social care
                chronic diseases,family physician,Erectile dysfunction

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