{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T14:30:04Z","timestamp":1773930604595,"version":"3.50.1"},"reference-count":49,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T00:00:00Z","timestamp":1755388800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T00:00:00Z","timestamp":1755388800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Periodontology"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The relationship between periodontitis and erectile dysfunction (ED) has been poorly documented in Caucasian populations, particularly severe ED (SED) requiring penile prostheses. This study aimed to evaluate the association between periodontitis and SED in patients undergoing penile prosthesis implantation, and to identify clinical and biochemical periodontal variables associated with SED using multivariate analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An observational case\u2013control study was conducted on patients with SED (cases) and patients with other conditions, such as penile curvature and Peyronie's disease (controls). Periodontal clinical and biochemical variables were assessed, alongside histomorphometrical and immunohistochemical analyses of corporotomies from the corpora cavernosa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study included 81 patients: 24 with SED and 57 controls. Compared to controls, the SED group showed higher age (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), lower high density lipoproteins (HDL) levels (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.012), higher diabetes prevalence (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.036), fewer teeth (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), more sites with attachment loss\u00a0&gt;\u00a03\u00a0mm (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.014), and over 3 times greater Periodontal Inflammatory Severity Index modified (PISIM) (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Additionally, the SED group had fewer blood vessels\/mm\n                      <jats:sup>2<\/jats:sup>\n                      (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and lower endothelial nitric oxide synthase (eNOS) expression (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.043). Multivariate logistic regression showed that age\u00a0&gt;\u00a055 years (odds ratio [OR]\u00a0=\u00a05.9, 95% confidence interval [CI] 1.5\u201322.9,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.010), diabetes (OR\u00a0=\u00a07.0, 95%CI 1.3\u201337.9\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      =\u00a00.023), and PISIM scores\u00a0&gt;\u00a04 (OR\u00a0=\u00a013.9, CI 2.6\u201373.8,\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      =\u00a00.002) increased the likelihood of SED requiring prothesis implantation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Periodontitis is strongly associated with SED treated with penile prostheses, linked to lower eNOS expression in penile tissue. Diabetes and age were identified as additional independent risk factors for SED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain language summary<\/jats:title>\n                    <jats:p>Erectile dysfunction (ED) is a common condition where men have trouble achieving or maintaining an erection. In severe cases, surgery to implant a penile prosthesis is sometimes needed. This study explored whether gum disease (periodontitis), a condition that damages the tissues supporting the teeth, is linked to severe erectile dysfunction (SED). We compared two groups of patients: those with SED who required a penile implant and those with other penile conditions, such as curvature. We found that men with SED were more likely to have advanced gum disease, fewer teeth, and signs of poor oral health. They also showed lower levels of certain molecules, like nitric oxide, that help blood vessels work properly, including those in the penis. Diabetes and being older than 55 also increased the likelihood of SED. Our findings suggest that gum disease may play a role in SED, possibly by affecting blood vessel health. This highlights the importance of good oral hygiene and managing conditions like diabetes to support overall health. These results may help guide healthcare providers in preventing or treating erectile dysfunction in men with periodontitis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jper.11391","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T06:34:58Z","timestamp":1755498898000},"page":"313-325","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Periodontitis in patients with severe erectile dysfunction undergoing penile prosthesis implantation: Clinical and immunohistochemical study"],"prefix":"10.1002","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3993-3911","authenticated-orcid":false,"given":"Miguel \u00c1ngel","family":"Arrabal\u2010Polo","sequence":"first","affiliation":[{"name":"Urology Service San Cecilio University Clinical Hospital  Granada Spain"},{"name":"Bio\u2010sanitary Institute Granada (IBS Granada)  Granada 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