Aims To present the longitudinal data of the SUBITO-DE study, a prospective survey involving male patients with new or recently diagnosed type 2 diabetes mellitus (T2DM) (<24 months). Materials and Methods Sexual function was assessed in male patients with T2DM at baseline (phase 1) and after a mean follow-up of 18 months (phase 2). Standard metabolic parameters and sexual and depressive symptoms were evaluated. Results Six of the 499 enrolled patients died of different causes during phase 1. Of the 493 surviving men invited to participate in phase 2, 450 (mean age 59.0±9.0 years) (90.2%) accepted and 43 (8.2%) were lost to follow-up. As compared to baseline, the proportion of the men who reported improvement in erectile dysfunction (ED) at follow-up was nearly double that of the men who reported worsening of ED (22.6% vs. 12.8%). The increase in frequency of sexual activity the men reported at follow-up assessment indicates that many never treated before baseline were taking an ED drug during the study period (106 subjects). Phosphodiesterase type 5 inhibitors (PDE5i) were the ED drugs most commonly taken at both baseline and follow-up. An overall improvement over baseline values was observed in metabolic targets for T2DM and depressive symptoms. Conversely, no change in lifestyle behaviors was recorded during the study. Conclusions Sexual dysfunction is a major concern in men with T2DM. The SUBITO-DE study demonstrates that, when combined with adequate counseling and tailored PDE5i therapy, an integrated approach to achieving metabolic targets in men with T2DM can improve sexual function as well as depressive symptoms.

Interest in the role of dietary patterns has been consistently emerging in recent years due to much research that has documented the impact of metabolism on erectile dysfunction (ED) and/or benign prostatic hyperplasia (BPH). We conducted a non-systematic review of English articles published from 1964 to September 2021. The search terms were: (“dietary patterns” OR “diet”) AND/OR (“erectile dysfunction”) AND/OR (“benign prostatic hyperplasia”). In the present review, we have highlighted how the association between dietary patterns and two of the most frequent pathologies in urology, namely erectile dysfunction and benign prostatic hyperplasia, is present in the literature. The data suggested that a diet that is more adherent to the Mediterranean diet or that emphasizes the presence of vegetables, fruits, nuts, legumes, and fish or other sources of long-chain (n-3) fats, in addition to reduced content of red meat, may have a beneficial role on erectile function. At the same time, the same beneficial effects can be transferred to BPH as a result of the indirect regulatory effects on prostatic growth and smooth muscle tone, thus determining an improvement in symptoms. Certainly, in-depth studies and translational medicine are needed to confirm these encouraging data.

Abstract Background: To verify which phosphodiesterase type 5 inhibitors (PDE5is) strategy is better for erectile dysfunction (ED) following nerve-sparing radical prostatectomy (NSRP). Methods: This systematic literature search was conducted in MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials database to identify eligible studies from the startup of these databases to 1 November, 2019. The ED recovery rate was the main outcome. Traditional pair-wise meta-analysis and multivariate random-effects network meta-analysis (NMA) were performed to explore direct and indirect comparisons, respectively. The surface under the cumulative ranking (SUCRA) probabilities was used to evaluate the efficacy of treatments. Results: A total of 14 randomized controlled trials with four kinds of PDE5is were included. Further pooled evidence suggested that PDE5is followed by NSRP had a benefit for penile rehabilitation compared to placebo using traditional pair-wise meta-analyses. Our NMA showed that Avanafil 200 mg on demand might be most likely to be the best treatment option according to the first rank of SUCRA both in NMA (SUCRA 83.5) and sensitivity analysis (SUCRA 90.2). Conclusion: Avanafil 200 mg on demand has the highest probability of being the best intervention among PDE5is in treating ED following NSRP. However, more randomized controlled trials are needed to validate this in consideration of the published data regarding Avanafil is relatively small scale.

Male infertility is a prevalent global health issue, with urological disorders representing some of the most common and correctable causes. Key conditions such as varicocele, obstructive azoospermia, erectile dysfunction and Peyronie's disease impair fertility through distinct pathophysiological mechanisms, including disrupted spermatogenesis, reproductive tract obstruction and failed sperm delivery. The effective management of these conditions hinges on a systematic diagnostic evaluation, which integrates clinical history, physical examination, semen analysis and specialized imaging. Modern management follows a logical progression, beginning with foundational lifestyle modifications, advancing to targeted medical or surgical interventions, and culminating, when necessary, in assisted reproductive technologies. Treatment strategies are therefore highly targeted, ranging from medical management and surgical correction-such as varicocelectomy or microsurgical reconstruction-to sperm retrieval techniques. Furthermore, evidence-based lifestyle modifications and a multidisciplinary clinical approach are fundamental to optimizing reproductive outcomes for affected couples. A comprehensive understanding of these urological etiologies is therefore essential for guiding appropriate intervention and improving the prospects of achieving pregnancy.

Background: Multiple systematic reviews explore the effect of phosphodiesterase type 5 (PDE5) inhibitors on erectile dysfunction (ED), with each study addressing specific outcomes. However, physicians and policymakers require a holistic approach of this topic.Objective: To summarize the current evidence regarding the efficacy and safety of PDE5 inhibitors for the management of ED through an overview of systematic reviews.Methods: Studies were identified by searching PubMed, Web of Science, Cochrane Library and Scopus databases, as well as sources of grey literature until June 12, 2021 (PROSPERO: CRD42020216754). We considered systematic reviews, meta-analyses or network meta-analyses of randomized trials that provided outcomes about the efficacy and safety of any approved PDE5 inhibitor (avanafil, sildenafil, tadalafil and vardenafil). We constructed forest plots for meta-analytic effects regarding the change in erectile function, adverse events and dropouts after administration of PDE5 inhibitors in the general population and in specific patient groups.Results: We included 23 studies with 154,796 participants and a total of 258 meta-analytic effects. Sildenafil 25 mg [Weighted Mean Difference (WMD): 13.08, 95% Confidence Interval (CI): 10.1-16.06] seemed to be statistically superior to all interventions in improving erectile function compared to placebo, but studies with low-dose sildenafil are lacking. Moreover, comparing among different PDE5 inhibitors, sildenafil 50 mg or

Erectile dysfunction (ED) is one of the most frequent complications following radical prostatectomy, with substantial implications for quality of life, psychological well-being, and interpersonal relationships. The pathophysiology involves a combination of cavernous nerve injury, vascular insufficiency, and structural alterations such as corporal fibrosis. Phosphodiesterase type 5 inhibitors (PDE5i) are recommended as first-line therapy; however, their effectiveness in post-prostatectomy ED remains variable and influenced by multiple clinical factors. The objective to systematically evaluate the effectiveness of PDE5 inhibitors in improving erectile function in patients with ED following radical prostatectomy. This systematic review was conducted in accordance with PRISMA guidelines. Literature searches were performed in PubMed, Scopus, and Google Scholar for studies published between 2017 and 2025. Randomized controlled trials and observational studies evaluating PDE5 inhibitors (sildenafil, tadalafil, vardenafil) in post-prostatectomy ED were included. Primary outcomes were erectile function scores (International Index of Erectile Function/IIEF) and recovery rates. The results twenty studies met inclusion criteria. PDE5 inhibitors demonstrated consistent improvement in erectile function scores across most studies (1–3). However, treatment outcomes varied significantly depending on nerve-sparing status, baseline erectile function, patient comorbidities, and timing of therapy initiation (4–7). Early initiation as part of penile rehabilitation showed potential benefits in preserving erectile function, although findings were not uniform (6,8). PDE5 inhibitors are effective in improving erectile function after radical prostatectomy, but their effectiveness is influenced by multiple interacting factors. A personalized and multimodal treatment approach is essential to optimize outcomes

<h4>Background</h4>Erectile dysfunction (ED) is highly prevalent among men with type 2 diabetes mellitus (T2DM) and reflects systemic vascular and metabolic dysfunction. Shared mechanisms include endothelial dysfunction, oxidative stress, inflammation, autonomic neuropathy, and hypogonadism. Therefore, ED may function not only as a complication of T2DM but also as an early clinical marker of cardiometabolic disease.<h4>Objective</h4>This narrative review summarizes current evidence on the epidemiology, mechanisms, and cardiometabolic implications of ED in men with T2DM, and evaluates the impact of major cardiometabolic therapies on erectile function. A real-world cohort study was conducted using the TriNetX Global Collaborative Network, a large federated electronic health record database comprising healthcare organizations across multiple countries.<h4>Content</h4>ED is closely linked with hypertension, obesity, dyslipidaemia, heart failure, ischemic heart disease, and stroke in men with T2DM, reflecting shared microvascular and macrovascular diseases. Cohort and real-world studies indicate a strong bidirectional relationship: poor cardiometabolic control worsens erectile function, whereas improvements in glycaemia, weight, blood pressure, and lipids are associated with higher International Index of Erectile Function (IIEF) scores. Using data from the TriNetX Global Collaborative Network, large-scale real-world analyses further demonstrate that the coexistence of ED and T2DM substantially increases cardiovascular risk. In a propensity-score-matched cohort (>200,000 individuals per group), men with ED and T2DM had higher risks of ischemic heart disease (15.7% vs. 11.5%, OR: 1.44; 95% CI 1.41-1.46), stroke (OR 1.45; 95% CI 1.42-1.48), peripheral artery disease (OR 1.38; 95% CI 1.35-1.41), and heart failure (8.4% vs. 4.9%, OR 1.78; 95% CI 1.74-1.81). Conversely, among individuals with T2DM, the presence of ED was associated with increased ischemic heart disease, stroke, and peripheral artery disease. Mechanistic and clinical data suggest heterogeneous treatment effects: GLP-1 receptor agonists and SGLT2 inhibitors show promising vascular benefits with mixed erectile outcomes, whereas ARBs and finerenone appear favorable compared with older agents associated with sexual adverse effects.<h4>Conclusion</h4>ED in T2DM should be regarded as a clinically relevant marker of systemic vascular disease. Routine assessment may enhance cardiovascular risk stratification and motivate earlier, comprehensive risk-factor intervention. Future prospective and randomized studies with erectile function as a predefined endpoint are needed.

Erectile dysfunction (ED) and premature ejaculation (PE) often have underlying musculoskeletal abnormalities. Despite this, traditional management has focused on pharmaceutical prescription. To investigate the efficacy of pelvic floor muscle training in treating ED and PE. A computerized literature search of CINAHL®, Cochrane, InFormit, Ovid Medline, Pedro, and Scopus (from inception until January 2018) was conducted of type of dysfunction and intervention. Secondary search strategies included Medical Subject Headings expansion, hand searching of conference abstracts, key authors, reference lists and forward citation searching via Web of Science. All studies where participants were males greater than 18years with ED or PE, with no history of neurological injury or previous major urological surgery were included. Two independent reviewers assessed methodological quality using the Crowe Critical Appraisal Tool. Disagreements between reviewers were resolved by consensus. Ten trials were included for review. Among the measures of ED, all trials showed comparative improvement and cure rates in response to treatment. Within PE outcomes, the majority of trials showed comparative improvement rates, with a greater range in overall cure rates in response to treatment. Training protocols varied significantly in overall therapist contact, concurrent interventions, intervention length, training frequency and intensity. The included studies were of low to moderate methodological quality with discrepancies in reporting. Study heterogeneity was not conducive to data pooling. Pelvic floor muscle training appears effective in treating ED and PE; however, no optimal training protocol has been identified. PROSPERO CRD42016047261.

Infertility is common and associated with distress, anxiety, and depression, all of which can result in sexual dysfunction. This stress-related erectile dysfunction can be effectively treated with oral phosphodiesterase type 5 inhibitors. A review of the current literature suggests that phosphodiesterase type 5 inhibitors have no detrimental effects on human semen parameters or hormonal milieu. Physicians treating infertile couples should be aware of the association between erectile dysfunction and infertility and be proactive in inquiring and treating infertility-induced erectile dysfunction.

history, obesity, type 2 diabetes, not enough exercise, and erectile dysfunction. Medications like pseudoephedrine, anticholinergics, and calcium channel Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss of bladder control. Complications can include urinary tract infections, bladder stones, and chronic kidney problems. The cause is unclear. Risk factors include Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss of bladder control. Complications can include urinary tract infections, bladder stones, and chronic kidney problems. The cause is unclear. Risk factors include a family history, obesity, type 2 diabetes, not enough exercise, and erectile dysfunction. Medications like pseudoephedrine, anticholinergics, and calcium channel blockers may worsen symptoms. The underlying mechanism involves the prostate pressing on the urethra thereby making it difficult to pass urine out of the bladder. Diagnosis is typically based on symptoms and examination after ruling out other possible causes. Treatment options include lifestyle changes, medications, a number of procedures, and surgery. In those with mild symptoms, weight loss, decreasing caffeine intake, and exercise are recommended, although the quality of the evidence for exercise is low. In those with more significant symptoms, medications may include alpha blockers such as terazosin or 5α-reductase inhibitors such as finasteride. Surgical removal of part of the prostate may be carried out in those who do not improve with other measures. Some studies have suggested that certain plant extracts may help mitigate symptoms of BPH. Examples include saw palmetto (Serenoa repens), stinging nettle (Urtica dioica) root, beta-sitosterol from African star grass (Hypoxis rooperi), and pygeum (extracted from the bark of Prunus africana). However, meta-analyses have called these conclusions into question, highlighting methodological problems showing no difference from a placebo, and lack of support from larger scale trials. As of 2019, about 94 million men aged 40 years and older are affected globally. BPH typically begins after the age of 40. The prevalence of clinically diagnosed BPH peaks at 24% in men aged 75–79 years. Based on autopsy studies, half of males aged 50 and over are affected, and this figure climbs to 80% after the age of 80. Although prostate-specific antigen levels may be elevated in…

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