Zongyao Hao

Prevalence of premature ejaculation and its correlation with chronic prostatitis in Chinese men.

OBJECTIVES Chronic pelvic pain syndrome is a common and serious health problem affecting the quality of life of men. We evaluated the prevalence of premature ejaculation (PE) in Chinese men with chronic pelvic pain syndrome and studied its correlation to chronic prostatitis. METHODS A total of 15,000 men (aged 15-60 years) were randomly recruited to take part in a survey to provide questionnaire-elicited information for sociodemographics, sexual function, National Institutes of Health-Chronic Prostatitis Symptom Index, and International Index of Erectile Function 5-item questionnaire. The eligible subjects of the present investigation were married with sexual activity. RESULTS Responses were collected from 12 743 men (84.95%). Of these men, 1071 (8.4%) reported having prostatitis-like symptoms. The incidence of chronic prostatitis was 4.5% (n = 571) for the entire group. Of the 7372 eligible men, the incidence of prostatitis-like symptoms, chronic prostatitis, and PE was 10.5% (n = 771), 5.0% (n = 370), and 15.3% (n = 1127), respectively. The group with PE had worse National Institutes of Health-Chronic Prostatitis Symptom Index scores (P < .05) and lower International Index of Erectile Function 5-item questionnaire scores (P < .05) than the patients without PE. Also, the percentage of prostatitis-like symptoms in the PE group was greater than that in the non-PE group (P < .05). The prevalence of PE was 64.1% and 36.9% in the prostatitis-like symptom and chronic prostatitis group, respectively, of the 7372 eligible men. CONCLUSIONS The results of our study showed a high prevalence of PE in patients with chronic prostatitis. An examination of the prostate, physically and microbiologically, should be considered during the assessment of patients with PE.

Distribution and Factors Associated with Four Premature Ejaculation Syndromes in Outpatients Complaining of Ejaculating Prematurely

INTRODUCTION Because available definitions of premature ejaculation (PE) were unable to encompass the various forms of PE, Waldinger et al. proposed a new classification that distinguished four PE syndromes. However, few studies have examined the prevalence rates of these four PE syndromes. AIMS The study aims to analyze the prevalence of and factors associated with four PE syndromes in outpatients who complained of ejaculating prematurely. METHODS Between December 2009 and December 2011, outpatients who complained of PE completed a detailed verbal questionnaire regarding their demographic data and medical and sexual history. Each patient was classified as having one of four PE subtypes: lifelong PE (LPE), acquired PE (APE), natural variable PE (NVPE), or premature-like ejaculatory dysfunction (PLED). MAIN OUTCOME MEASURES Based on the new classification scheme, PE was classified into four subtypes. The anxiety/depression status of patients was assessed by the Zung self-rating anxiety/depression scales, and erectile function was assessed by the International Index of Erectile Function-5 instrument. RESULTS This study included 1,988 male outpatients who complained of PE, with mean ages and body mass index (BMI) scores of 35.52 ± 10.38 years and 25.34 ± 4.51 kg/m(2), respectively. Prevalence rates of PE syndromes were 35.66% for LPE, 28.07% for APE, 12.73% for NVPE, and 23.54% for PLED. Patients with APE had the highest mean ages and BMI scores, and they more frequently reported several comorbidities, including sexual desire disorder, hypertension, diabetes mellitus, chronic prostatitis, and erectile dysfunction. The PLED group had a lower mean frequency of sexual intercourse than other groups and higher rates of anxiety and depression. CONCLUSION The prevalence of LPE was higher than that of other PE subtypes in an outpatient setting. Several comorbidities were more common in patients with APE and PLED. In particular, a lower frequency of intercourse and higher frequencies of anxiety and depression were found in patients with PLED.

The Prevalence of Erectile Dysfunction and Its Relation to Chronic Prostatitis in Chinese Men

This study was performed to evaluate the prevalence of erectile dysfunction (ED) and to explore its correlation to chronic prostatitis in China. A cross-sectional investigation from a large cohort study of Chinese men was used in this survey. A questionnaire consisting of general information regarding socio-demographics, chronic disease history, sexual function, the National Institutes of Health-Chronic Prostatitis Symptom Index, and the International Index of Erectile Function-5 (IIEF-5) was administered to 15 000 Chinese men aged from 15 to 60. The prevalence of ED was determined from the patients self-evaluation and IIEF-5 score. The eligible individual both was married and had intercourse experience. In total, there were 12 743 respondents, giving a response rate of 84.95%. Among 7372 eligible men, ED prevalence as assessed by self-report and IIEF-5 score was 12.0% and 17.1%, respectively. Among 771 men with prostatitis-like symptoms, ED prevalence as assessed by self-report and IIEF-5 score was 39.3% and 30.1%, respectively. Among 370 men suffering from chronic prostatitis, ED prevalence as assessed by self-report and IIEF-5 score was 40.5% and 35.1%, respectively. The prevalence of self-reported and IIEF-5 score-assessed ED had high correlation with increasing age among all eligible men, men with prostatitis-like symptoms, and men with chronic prostatitis (P(t) < .05, P(s) < .05, P(cp) < .05). ED prevalence as assessed by both self-report and IIEF-5 score was higher in men with prostatitis-like symptoms and with chronic prostatitis than in the general group (P(s) < .05, P(cp) < .05). The prevalence of ED was higher in the prostatitis population than in the general population with either self-reported or IIEF-5 score assessment. The prevalence was higher with self-reported than with IIEF-5 assessment in men with prostatitis. Estimates of ED prevalence among men with prostatitis should not rely on self-reporting alone in that this is likely to overestimate the true prevalence.

Relationship between Sexual Dysfunction and Psychological Burden in Men with Infertility: A Large Observational Study in China

INTRODUCTION Although infertility is known to be associated with psychological and sexual problems, the relationship between these two aspects in infertile men has not been well investigated. AIM To investigate the incidence of sexual dysfunction and psychological burden, and their possible associations in infertile men. METHODS From June 2009 to June 2012, a total of 1,468 infertile men and 942 fertile men were evaluated. Premature ejaculation (PE) and erectile dysfunction (ED) were measured by the PE diagnostic tool (PEDT), the intravaginal ejaculatory latency time (IELT) and the international index of erectile function (IIEF)-5. Anxiety and depression, which reflect the degree of psychological burden, were measured by the self-rating anxiety scale (SAS) and self-rating depression scale (SDS), respectively. MAIN OUTCOME MEASURES PE and ED were measured by the PEDT, IELT, and IIEF-5. Anxiety and depression were measured by the SAS and SDS, respectively. RESULTS The incidences of PE and ED in the infertile group were significantly higher than those in the fertile group (PE: 19.01% vs.10.93%, P < 0.001; ED: 18.05% vs. 8.28%, P < 0.001). In addition, anxiety and depression were more prevalent in infertile than fertile men (Anxiety: 38.01% vs. 26.65%, P < 0.001; Depression: 15.74% vs. 10.08%, P < 0.001). Furthermore, after adjusting for age in the infertile group, the PEDT score was positively associated with anxiety (adjusted r = 0.57; P < 0.001) and depression (adjusted r = 0.54; P < 0.001). Moreover, the IELT were negatively associated with anxiety (adjusted r = -0.40; P < 0.001) and depression (adjusted r = -0.52; P < 0.001). Similar negative relationships were also observed between the IIEF-5 score and anxiety (adjusted r = -0.49; P < 0.001) or depression (adjusted r = -0.50; P < 0.001). CONCLUSION This is the first study to systematically evaluate the incidence of sexual dysfunction and psychological burden, and their possible associations in infertile men in China. Further in-depth studies are needed to confirm and extend these results.

Treatment of chronic prostatitis in Chinese men.

The aim of this study is to assess the status of treatment of chronic prostatitis (CP) in Chinese men. A population-based cross-sectional survey was performed, in which 15 000 men aged between 15 and 60 years were randomly selected to receive a questionnaire designed to assess National Institutes of Health Chronic Prostatitis Symptoms Index (NIH-CPSI) status, therapeutic efficacy and 28 other items. A total of 12 743 men (84.95%) completed the questionnaire, of whom 1 071 (8.4%) were identified as having prostatitis-like symptoms and 517 (4.5%) were diagnosed with CP according to NIH-CPSI criteria and prostatitis-like symptomatology. Of the CP patients, 372 (65%) underwent long-term routine treatment 12 times per year. Additionally, 217 (72.8%) patients received antibiotic therapy and 215 (79.3%) men showed therapeutic effects. The treatment cost USD 1 151 (8 059 yuan) per person per year on average. Most CP patients received routine treatment, in most cases with antibiotics. Treatment was costly and most CP patients were not satisfied with its effectiveness. Antibacterial treatment might have been effective primarily in patients with bacterial disease.

The Impact of Intravaginal Ejaculatory Latency Time and Erectile Function on Anxiety and Depression in the Four Types of Premature Ejaculation: A Large Cross‐Sectional Study in a Chinese Population

INTRODUCTION A new classification of premature ejaculation (PE) has been proposed, including the categories of lifelong PE (LPE), acquired PE (APE), natural variable PE (NVPE), and premature-like ejaculatory dysfunction (PLED). AIM The aim of this study was to evaluate the impact of intravaginal ejaculation latency time (IELT) and erectile function on anxiety and depression among patients with PE in general and according to the four types of PE. METHODS Between September 2011 and September 2012, we conducted a cross-sectional study in the Anhui province of China. We enrolled 4,000 men aged over 18 years, each of whom had been in a stable, monogamous, heterosexual relationship with the same partner for at least 6 months. MAIN OUTCOME MEASUREMENTS Self-estimated IELT, the International Index of Erectile Function-5 (IIEF-5) and the Zung Self-Rating Anxiety and Depression Scales (SAS/SDS) were used to measure PE, erectile dysfunction (ED), anxiety, and depression, respectively, among the entire study population. RESULTS Of the 3,016 men evaluated, 25.80% complained of PE. Distribution of the four types of PE among men with PE was as follows: LPE, 12.34%; APE, 18.77%; NVPE, 44.09%; PLED, 24.81%. Men with PE presented lower IIEF-5 scores and higher SAS and SDS scores vs. men without PE (P < 0.001 for all). Similar findings were observed in men with APE when compared with other PE syndromes. After adjustment for age in men with PE, IELT was negatively associated with SAS and SDS scores (SAS, adjusted r = -0.42, P < 0.001; SDS, adjusted r = -0.45, P < 0.001). IIEF-5 score was negatively associated with SAS and SDS scores (SAS, adjusted r = -0.54, P < 0.001; SDS, adjusted r = -0.50, P < 0.001). These negative relationships were strongest in men with PLED (IELT vs. SAS: adjusted r = -0.63, P < 0.001; IELT vs. SDS, adjusted r = -0.60, P < 0.001; IIEF-5 vs. SAS: adjusted r = -0.57, P < 0.001; IELT vs. SDS, adjusted r = -0.55, P < 0.001). CONCLUSIONS APE patients reported higher rates of ED, anxiety, and depression than men with other types of PE. The negative relationships between IELT/IIEF-5 and SAS/SDS were strongest in men with PLED.

The Relationship between Self‐Estimated Intravaginal Ejaculatory Latency Time and International Prostate Symptom Score in Middle‐Aged Men Complaining of Ejaculating Prematurely in China

INTRODUCTION Some factors associated with the four premature ejaculation (PE) syndromes have been studied, but the association between International Prostate Symptom Score (IPSS) and the four PE syndromes has not been investigated. AIMS We performed this study to evaluate the association between IPSS and intravaginal ejaculatory latency time (IELT) in men with the four PE syndromes. METHODS From June 2012 to January 2014, a total of 690 men aged 40-59 years complaining of ejaculating prematurely and another 452 male healthy subjects of the same age without these complaints were included in this study. Men with the complaints of ejaculating prematurely were classified as one of the four PE syndromes: lifelong PE, acquired PE (APE), variable PE, and subjective PE. Each of them completed a detailed questionnaire including information on demographics, medical and sexual history (e.g., self-estimated IELT), IPSS, and International Index of Erectile Function-5. MAIN OUTCOME MEASURES Associations between IPSS and self-estimated IELT in middle-aged men with the four PE syndromes. RESULTS Men complaining of ejaculating prematurely reported higher IPSS (11.2 ± 6.0 vs. 5.5 ± 3.3 ) and shorter self-estimated IELT (2.1 ± 1.6 minutes vs. 4.8 ± 3.3) than men without complaints (P < 0.001 for each). By unilabiate analysis, self-estimated IELT in men with the four PE syndromes showed significant correlations with IPSS (P < 0.001 for all). After adjusting for age, self-estimated IELT was negatively associated with IPSS in men with PE complaints (adjusted r = -0.378, P < 0.001). Also, the association was stronger in men with APE (adjusted r = -0.502, P < 0.001). CONCLUSIONS Men complaining of ejaculating prematurely reported worse IPSS than men without these complaints. Self-estimated IELT was negatively associated with IPSS in men complaining of ejaculating prematurely, and the correlation was the strongest in men with APE.

Combination of Sertraline and Sildenafil versus Sertraline Monotherapy in the Treatment of Acquired Premature Ejaculation without Concomitant Diseases

Objective: To determine the efficacy and safety of sertraline monotherapy and combination therapy with sertraline and sildenafil in the treatment of APE without concomitant diseases. Methods: The study was conducted in 120 outpatients diagnosed with APE but without concomitant diseases. These patients were randomly divided into two groups: group A was treated with 50 mg sertraline daily; group B was treated with 50 mg sertraline daily and 50 mg sildenafil as needed. Assessment of the efficacy and safety of the two therapies was performed after 4 and 8 weeks. Patient or partner reports of Intravaginal Ejaculatory Latency Time (IELT), Premature Ejaculation Profile (PEP), Clinical Global Impression of Change (CGIC), and Treatment-Emergent Adverse Events (TEAEs) were assessed in this study. All the assessments were compared in the two groups after the treatment period. The efficacy was assessed by IELT, PEP and CGIC. On the other hand, safety was assessed by TEAEs. Results: 112 participants completed the study voluntarily. The two groups were similar regarding demographics. At the end of study period, both groups had significant improvements in IELT and PEP measures compared with pretreatment (P<0.001). Compared with group A, group B had significantly greater values of IELT (7.20 ± 2.93 vs. 5.04 ± 2.79), PEP measures, and CGIC (subjects reporting at least ‘better’: 58.2% vs. 35.8%) (P<0.05 for all). Adverse effects including headache, flushing, etc. were found in both groups, and the total incidence was higher in group B than group A (31.7% vs. 23.3%, respectively), but the difference was not significant. All the adverse effects were mild and tolerated. Conclusion: Both sertraline monotherapy and combination therapy with sildenafil and sertraline were efficacious and safe in the treatment of APE without concomitant diseases. The combination therapy had a higher efficacy than sertraline monotherapy without more adverse effects.

ASIC1a contributes to the symptom of pain in a rat model of chronic prostatitis

This study aims to validate our hypothesis that acid-sensing ion channels (ASICs) may contribute to the symptom of pain in patients with chronic prostatitis (CP). We first established a CP rat model, then isolated the L5-S2 spinal dorsal horn neurons for further studies. ASIC1a was knocked down and its effects on the expression of neurogenic inflammation-related factors in the dorsal horn neurons of rat spinal cord were evaluated. The effect of ASIC1a on the Ca2+ ion concentration in the dorsal horn neurons of rat spinal cord was measured by the intracellular calcium ([Ca2+]i) intensity. The effect of ASIC1a on the p38/mitogen-activated protein kinase (MAPK) signaling pathway was also determined. ASIC1a was significantly upregulated in the CP rat model as compared with control rats. Acid-induced ASIC1a expression increased [Ca2+]i intensity in the dorsal horn neurons of rat spinal cord. ASIC1a also increased the levels of neurogenic inflammation-related factors and p-p38 expression in the acid-treated dorsal horn neurons. Notably, ASIC1a knockdown significantly decreased the expression of pro-inflammatory cytokines. Furthermore, the levels of p-p38 and pro-inflammatory cytokines in acid-treated dorsal horn neurons were significantly decreased in the presence of PcTx-1, BAPTA-AM, or SB203580. Our results showed that ASIC1a may contribute to the symptom of pain in patients with CP, at least partially, by regulating the p38/MAPK signaling pathway.