Radiation-associated impotence. A clinical study of its mechanism

Goldstein, Irwin

doi:10.1001/jama.251.7.903

Cited by 101 publications

(56 citation statements)

References 12 publications

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“…Furthermore, this increased ET-1 level could, in part, be responsible for the accelerated atherosclerosis seen in the pelvic vasculature of RAI patients. 3 These ®ndings are consistent with ®nd-ings obtained in patients evaluated by angiogram. This increased ET-1 level could be involved in the atherosclerotic lesion development by acting as an autocrine growth factor for smooth muscle cells in the corpus cavernosum and pelvic vasculature.…”

Section: Discussionsupporting

confidence: 88%

“…13,14 It is also known that other vascular risk factors such as cigarette smoking, hypertension, atherosclerotic diet, diabetes, and family history are important factors that could increase the incidence of post-radiation impotence. 3 Our in vivo model shows an improvement of erection following injection of the ETa receptor antagonist.…”

Section: Discussionmentioning

confidence: 69%

“…The association between erectile dysfunction and radiotherapy has been reported in a number of studies. 3,6,7 Radiationassociated impotence (RAI) varies from 22% to 84%. Two characteristics of RAI are variable onset and irreversibility.…”

Section: Introductionmentioning

confidence: 99%

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New insights into the role of endothelin-1 in radiation-associated impotence

et al. 2001

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The objectives of this work were to: (1) Determine if prostate and penile tissue levels of endothelin-1 (ET-1) are increased in a rat following pelvic irradiation. (2) Determine if an ETa receptor antagonist (BQ-123) potentiates erectile function in these irradiated animals. Rats were divided into three study groups: control, 1000 cGy and 2000 cGy. The experimental groups received a single dose of radiation to the pelvic region. A time course was established to measure the effects of irradiation on prostate and penile tissue levels of endothelin-1 (ET-1)-like immunoreactivity. The effect of intracavernous injection of BQ-123 (25 m mga30 m ml) was evaluated by measuring intracavernous pressure (ICP) following cavernous nerve electrical ®eld stimulation. In the 2000 cGy group, a signi®cant rise in ET-1-like immunoreactivity tissue levels was observed at 20 days. A signi®cant decrease in ICP was recorded in the 1000 and 2000 cGy irradiated rats compared to the control group. Only the 2000 cGy group had a signi®cant improvement in erectile function following BQ-123 administration. A signi®cant improvement was observed 20 min postadministration, lasted 90 min, and was back to pre-administered levels at 120 min. The conclusion made was that radiation-induced impotence in irradiated rats is associated with an increased production of ET-1. Preliminary results are suggestive that ETa receptor antagonist may be of use to reverse such radiation-induced impotence in these irradiated animals.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 69%

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New insights into the role of endothelin-1 in radiation-associated impotence

et al. 2001

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“…32 Prospective studies of prostate cancer patients found erectile dysfunction after radiotherapy, 36 which was attributed to vascular damage from irradiation. 37,38 Among women, gonadal failure after exposure to TBI is well known, 39,40 yet exposure to TBI was not associated with sexual dysfunction in the current study, even after adjusting for hormone replacement. Thus, we conjecture that differential effects of TBI may be due to inherent For personal use only.…”

mentioning

confidence: 45%

Longitudinal trajectory of sexual functioning after hematopoietic cell transplantation: impact of chronic graft-versus-host disease and total body irradiation

Wong¹,

Francisco²,

Togawa³

et al. 2013

Blood

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• Before HCT 61% of men and 37% of women were sexually active; the 3-year prevalence declined to 54% for men but increased to 52% for women.• Chronic GVHD in both sexes and TBI in men contribute to sexual dysfunction and dissatisfaction over the 3 years following HCT.This prospective study described the trajectory of sexual well-being from before hematopoietic cell transplantation (HCT) to 3 years after in 131 allogeneic and 146 autologous HCT recipients using Derogatis Interview for Sexual Function and Derogatis Global Sexual Satisfaction Index. Sixty-one percent of men and 37% of women were sexually active pre-HCT; the prevalence declined to 51% (P 5 .01) in men and increased to 48% (P 5 .02) in women at 3 years post-HCT. After HCT, sexual satisfaction declined in both sexes (P < .001). All sexual function domains were worse in women compared with men (P £ .001). Orgasm (P 5 .002) and drive/relationship (P < .001) declined in men, but sexual cognition/fantasy (P 5 .01) and sexual behavior/ experience (P 5 .01) improved in women. Older age negatively impacted sexual function post-HCT in both sexes (P < .01). Chronic graft-versus-host disease was associated with lower sexual cognition/fantasy (P 5 .003) and orgasm (P 5 .006) in men and sexual arousal (P 5 .05) and sexual satisfaction (P 5 .005) in women. All male sexual function domains declined after total body irradiation (P < .05). This study identifies vulnerable subpopulations that could benefit from interventional strategies to improve sexual well-being. (Blood. 2013;122(24):3973-3981)

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“…Medications for diabetes, hypertension and cardiovascular disease are other major risk factors. In addition, there is a higher prevalence of erectile dysfunction among men who have undergone radiation or surgery for prostate cancer, 4,5 or who have a lower spinal cord injury. 6 The psychological correlates of erectile dysfunction include depression and anger.…”

mentioning

confidence: 99%

The process of care model for evaluation and treatment of erectile dysfunction

Rosen

1999

Int J Impot Res

131

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This paper addresses pertinent issues concerning the role of physicians in the assessment and treatment of men with complaints of erectile dysfunction. With the availability of safe and effective oral drug therapy, the ®eld of erectile dysfunction has expanded rapidly to encompass multiple disciplines and specialties. Recognizing the need for evidence-based standards and guidelines in the management of this common disorder, a multidisciplinary panel of experts was convened to examine existing literature and practice standards. This panel employed a modi®ed Delphi methodology to develop consensus on de®nition and classi®cation, rational utilization of diagnostic and therapeutic options, and clinical guidelines for the management of erectile dysfunction in a primary care setting. A`Process of Care Model for Erectile Dysfunction' was thus developed, incorporating a step-wise decision making approach, de®ned in terms of relevant processes, actions and outcomes. According to this method, initial assessment should include a careful clinical history, focused physical examination and selected laboratory tests. Subsequent management should be goal-oriented, taking into account patient and partner needs and preferences. The stepwise treatment algorithm is based on the selection criteria of ease of administration, reversibility, relative invasiveness and cost. In addition, common referral indications for specialized diagnostic testing and treatment are provided. By assisting the primary physician in selecting appropriate assessment tools and treatment interventions, the proposed guidelines are intended to optimize care of the patient with erectile dysfunction.The panel strongly recommends further research into the causes and associated risk factors for erectile dysfunction, prevention and the role of lifestyle modi®cation, and the critical issue of partner-related sexual dysfunction. Considering the strong relationship between sexual dysfunction and overall quality of life, it is incumbent upon physicians to address the sexual needs of their patients in a sensitive and informed manner.Erectile dysfunction is a signi®cant and common medical problem. 1 In the Massachusetts Male Aging Study (MMAS), a community-based survey of men between the ages of 40 and 70 y, 2 52% of respondents reported some degree of erectile dif®culty. Complete erectile dysfunction, de®ned as the total inability to obtain or maintain erections during sexual stimulation, as well as the absence of nocturnal erections, occurred in 10% of respondents. Lesser degrees of mild and moderate erectile dysfunction occurred in 17% and 25%, respectively. In the National Health and Social Life Survey (NHSLS), a nationally representative probability sample of men and women aged 18±59 y, 3 10.4% of men reported being unable to achieve or maintain an erection during the past year (corresponding to the proportion of men in the MMAS reporting complete erectile dysfunction). Both studies observed a strong relationship to age. Although the prevalence of mild erectile dysfu...

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Radiation-associated impotence. A clinical study of its mechanism

Cited by 101 publications

References 12 publications

New insights into the role of endothelin-1 in radiation-associated impotence

New insights into the role of endothelin-1 in radiation-associated impotence

Longitudinal trajectory of sexual functioning after hematopoietic cell transplantation: impact of chronic graft-versus-host disease and total body irradiation

The process of care model for evaluation and treatment of erectile dysfunction

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