[Congenital penile curvature: Guidelines from the Andrology and Sexual Medicine Committee of the French Association of Urology (CAMS-AFU)]. / Courbures congénitales du pénis : recommandations du Comité d'andrologie et de médecine sexuelle de l'Association française d'urologie.

INTRODUCTION: Guidelines regarding congenital penile curvature (CPC) are lacking, and this pathology has not been the subject of French recommendations to date. The Andrology and Sexual Medicine Committee (CAMS) of the French Association of Urology (AFU) propose a series of clinical practice recommendations (CPR) by answering five clinical questions concerning the diagnosis and treatment of this pathology. MATERIALS AND METHODS: After a bibliographic research between 2000 and 2021, followed by a critical reading according to the CRP method. These recommendations were written to answer five questions: (1) What are the different types of CPC? (2) What are the reasons for consultation? (3) What are the assessment methods for CPCs and their consequences? (4) What are the indications for CPCs treatment? (5) What are the corrective modalities for the treatment of CPC? RESULTS: There are two main phenotypes: CPC type 4 (the most common) and chordee without hypospadias. The diagnosis of CPC is clinical and established through enquiry and clinical examination associated with photos of the erect penis. Support can be offered if the curvature is responsible for a disability and/or sexual dissatisfaction linked to a deformation making penetration difficult and/or in the event of significant psychological impact. Only surgical treatments have demonstrated their effectiveness. For type 4 CPCs, corporoplasty (excisional, incisional, or incisionless techniques) is the gold standard. CONCLUSION: These recommendations provide support for the management of patients consulting with CPC.

[Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of andrological and sexual medicine pathologies during the COVID-19 crisis]. / Recommandations du Comité d'andrologie et de médecine sexuelle de l'AFU concernant la prise en charge andrologique et en médecine sexuelle en contexte et en sortie de crise sanitaire liée au COVID-19.

OBJECTIVE: To assist urologists in the management of andrological and sexual medicine pathologies during the COVID-19 crisis. MATERIAL AND METHOD: Use of the formalized consensus method. RESULTS: The medical and surgical management of patients in andrology and sexual medicine must be adapted. Consultations should, as far as possible, be carried out by tele-consultation. For operative procedures, the delay between the operative decision and the date of (re)scheduling of the procedure will depend on: (1) the level of criticality of the clinical situation; (2) the type of intervention; (3) the functional and psychological repercussions, including quality of life while waiting for the procedure; (4) the notion of losing the chance of having an optimal outcome; (5) the risk of potential complications from delaying a procedure for too long; and (6) taking into account the patient's risk factors for severe forms of COVID-19. The protection of urologists from COVID-19 should be considered. Each urologist must make the best decision for the patient, taking into account the acceptable time frame and quality of life impact before surgical management, the COVID risk parameters, the technical and anesthetic feasibility and the structural possibility of the health care institution to ensure a specific dedicated pathway during the COVID-19 health crisis. CONCLUSION: The management of andrological and sexual medicine pathologies must be adapted to the COVID-19 crisis context. Some patients may require surgery, including in emergency. These recommendations are transitional and will end with the COVID-19 crisis.

[Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of Varicocele]. / Recommandations du Comité d'Andrologie et de Médecine Sexuelle de l'AFU concernant la prise en charge de la Varicocèle.

The diagnosis of varicocele is clinical, carried out in supine and standing position and in Valsalva maneuver. Only clinical varicoceles have to be treated. A scrotal ultrasound with Doppler is generally performed as part of the infertile man's evaluation or in case of examination difficulties. The main indication for varicocele treatment is the adult man with clinical varicocele and abnormalities of sperm parameters, in a context of infertility of couple, with a partner having a satisfactory ovarian reserve and no cause of female infertility or a curable infertility cause. The decision to treat varicocele must therefore be taken after evaluation of the two partners of the couple. Adults with symptomatic varicocele and those with spermogram abnormalities may also be offered a cure for their varicocele even in the absence of a paternity plan, as well as adolescents with reduced testicular growth, an ipsilateral decrease testicular volume, or a size gradient between the 2 testes. The cure of varicocele can be carried out by surgery or by percutaneous embolization. Microsurgery (inguinal or subinguinal) offers lower rates of recurrence and complications than high surgical approaches (laparoscopic or not) and surgeries without magnification. It is therefore the reference surgical technique. Percutaneous retrograde embolization is a minimally invasive alternative to microsurgery offering satisfactory outcomes with rare and often benign complications. The cure for varicocele results in an improvement in sperm parameters and recent data seem to confirm that it increases the natural pregnancy rate. These results appear after a delay of 3 to 9 months (at least 1 to 2 cycles of spermatogenesis). When the sperm involvement was severe (azoospermia, severe oligospermia), the improvement of the spermogram allow (1) to avoid surgery testicular sperm extraction or (2) perform intrauterine insemination rather than ICSI.

[French Urological Association (AFU) guidelines for Peyronie's disease assessment and treatment]. / Recommandations pour l'évaluation et la prise en charge de la maladie de Lapeyronie : rapport du comité d'andrologie et de médecine sexuelle de l'AFU.

INTRODUCTION: Peyronie's disease is a common cause for consultation in urology. Many controversies surround its treatment. No French Guidelines have been published so far. The Committee of Andrology and Sexual Medicine of the French Association of Urology therefore offers a series of evidence-based recommendations. MATERIALS AND METHODS: These recommendations are made according to the ADAPTE method, based on European (EAU, ESSM), American (AUA, ISSM) and Canadian (CAU) recommendations, integrating French specificities due to the availability of treatments, and an update of the recent bibliography. RESULTS: The assessment of the disease is clinical. Patients with functional impairment or significant psychological repercussions may be offered treatment. The benefits and drawbacks of each treatment should be explained to the patient. Regarding non-surgical treatments, no available treatment has market authorization in France. Vitamin E is not recommended. Analgesic (oral or low-intensity shock waves) or proerectile treatments may be offered as needed, as well as traction therapy. Due to the unavailability of collagenase injections, verapamil injections may be offered. Surgical treatments are to be considered in the stabilized phase of the disease, and consist of performing a plication, an incision-graft or the placement of a penile implant according to the patient's wishes, the curvature and the penis size, as well as erectile function. Combination treatments can be offered. CONCLUSION: The management of Peyronie's disease is complex, and the levels of evidence for treatments are generally low. The success of treatment will depend on the quality of the initial assessment, the patient's information and understanding of the expected effects, and the practitioner's experience.

[Non-surgical management of Peyronie's disease: State of current knowledge]. / Les thérapeutiques non chirurgicales de la maladie de Lapeyronie : état des lieux des connaissances actuelles.

BACKGROUND: Peyronie's disease is an inflammatory disorder of the penis, where scar tissue creates a plaque at the level of the albuginea, limits its extension, and leads to a bent and shorter penis during erections. There are no international standards for the evaluation and the treatment of the disease. The aim of this article is to review the current knowledge about the management of Peyronie's disease and to suggest an algorithm to help physicians evaluate and manage this condition. MATERIAL AND METHODS: A literature review was conducted through PubMed database following PRISMA guidelines using the Mesh terms: Peyronie, disease, treatment and diagnosis. Results are presented in a descriptive manner. RESULTS: Multiple treatment strategies have been proposed, but no conclusive randomized clinical trial is done to assess their efficacies. The oral treatment was shown to be more beneficial in the setting of a multi-modal approach to treat the acute phase. The non-steroidal anti-inflammatories and the potassium para-aminobenzoate are superior to the other molecules of oral therapy for pain management. Local treatment with topical verapamil, iontophoresis and intra-lesional injection of verapamil, interferon alfa-2b and collagenase clostridium histolyticum (CCH) revolutionized the management of the disease by the modification of the plaque size and angulation. Alternative treatments using extra-corporeal shock wave or traction devices are promising. Intra-lesional injection of CCH is the only therapy approved by the Food and Drug Administration for this condition after the stabilization of the disease. The channeling of the plaque before CCH injections is making better results than the initial protocol, concerning angulation improvement. CONCLUSION: Multiple therapeutic strategies exist for the management of the Peyronie's disease, but they lack evidence based data. Further randomized clinical trials are needed to evaluate the current practices and to study more efficient treatments.

New protocol in the treatment of Peyronie's disease by combining platelet-rich plasma, percutaneous needle tunneling, and penile modeling: Preliminary results.

INTRODUCTION: Intra-lesional injections of collagenase (Xiapex®) were the only non-invasive treatment option for Peyronie's disease (PD), until their withdrawal from the European market. OBJECTIVE: To evaluate the feasibility, efficacy, and safety of a combined treatment of percutaneous needle tunnelling (PNT) with penile modelling (PM) and the injection of platelet-rich plasma (PRP) under general anesthesia in the treatment of PD. PATIENTS AND METHOD: A prospective case series study included patients with PD in a stable phase who underwent this procedure between March 2020 and January 2023. The main outcome was an improvement in curvature. RESULT: Thirty-six patients underwent this novel approach for the treatment of PD. The pretreatment mean±standard deviation (SD) curvature degree was 57.5±20.61° (range 20-90°). After the protocol, the mean curvature degree was 40.86±25.13° (range 0-90°). The curvature angle improved significantly (P=0.0001), with a mean improvement difference of 16.85±14.81° (range 0-50°) and a mean improvement percentage of 47.7±40.29% (range 0-100%). CONCLUSION: Our preliminary experience suggests that PNT and PRP injections with PM are effective and safe for the treatment of penile deformity of PD. LEVEL OF EVIDENCE: 4: case series study.

[Mini-sling for management of stress urinary incontinence in women: a literature review]. / Mini-bandelettes pour le traitement de l'incontinence urinaire d'effort féminine : revue de la littérature.

AIM: To conduct a review about the use of single incision mini-slings (SIMS) to manage non-neurogenic stress urinary incontinence in women. METHODS: Literature search in Pubmed/MEdline database until june 2013. TVT-Secur™ was excluded because this device is not anymore marketed. RESULTS: Ajust™ and Mini-Arc™ were the two main SIMS evaluated in the literature. Studies about Mini-Arc™ generated heterogeneous results, with a success rate between 44% and 91% after 1 year. Ajust™ was the most promising device with 80% efficacy after mid-term follow-up. All evaluated SIMS had a low rate of immediate complications. Two randomized controlled trials comparing SIMS and traditional mid-urethral slings were identified, as well as one meta-analysis; they all concluded to non-superiority or inferiority for the mini-sling versus traditional slings. CONCLUSION: Due to short follow-up, limited evidence and heterogeneous data, SIMS are not yet standard of care and further research is warranted.

Molecular characterization of a new D- - haplotype in a Comorian man.

The D- - phenotype is a genetic variant of the Rh blood group system. It expresses D antigen but lacks C, c, E and e antigens. In D- - phenotype, the RHCE coding region is extensively modified by RHD sequence replacement, nucleotide deletion or splice-site changes. This article reports the identification of a new D- - haplotype in a Comorian man. It exhibits a hybrid gene in which RHCE gene exons 3-8 have been replaced by RHD sequences on the RHCE * C allele background. This allele is associated with no expression of c/C and e/E antigens and overexpression of RhD antigen.

[Role of hypofractionated radiotherapy in the treatment of prostate cancer: a review]. / Place de l'hypofractionnement dans la radiothérapie des cancers de la prostate : revue de la littérature.

BACKGROUND: Radiotherapy of prostate cancers, over the last few years, has been an alternative choice to radical prostatectomy in the case of localised cancers as well as being the preferred treatment in both advanced localised cancers and those of the elderly. A conventional course of prostate radiotherapy consisting of four to five sessions a week, lasts between 7 and 8 weeks plus about one week of preparation. MATERIALS AND METHODS: A systematic review of the scientific literature based on Pubmed, along with an exhaustive review of randomised studies presented at international congresses, have made it possible to analyse the numerous therapeutic regimens available other than the conventional normofractioned one (i.e. with doses per session ranging between 1.8 and 2.2 grays). RESULTS: Five randomised trials reported since 2005, plus several thousand patients treated by stereotaxic radiotherapy, have given rise to numerous scientific questions; these alternative hypofractioned courses (dose per fraction higher than 2.2 grays) have a potentially enhanced antitumoral efficacity along with the practical advantages of a shortened duration of radiotherapy. CONCLUSION: The aim of this analysis of the scientific literature on hypofractioning in prostate cancer radiotherapy is to gather all the scientific evidence we currently have at our disposal. Further mature results of future randomised trials will have to be examined before modifying current practice.

[Initial experience combinating transobturator male sling and penile implant after radical prostatectomy]. / Chirurgie combinée par bandelette transobturatrice Advance et prothèse pénienne après prostatectomie totale: une première expérience.

PURPOSE: Stress urinary incontinence (SUI) and erectile dysfunction (ED) are two major complications following radical prostatectomy (RP). In case of failure of medical treatment, Advance™ retrourethral male sling and penile implant are validated options to manage respectively SUI and ED. Our goal was to assess the feasibility and results of the combination of these two devices. PATIENTS AND METHODS: Four patients were treated for SUI and DE following RP in our institution by retrourethral sling and penile prosthesis, after failure of medical management. Each patient was preoperatively evaluated by age, complete medical history, ASA score, endoscopy, pad-test, and urodynamics. The first two patients were implanted with the two devices in a two-stage procedure: retrourethral sling then penile prosthesis for one, and penile prosthesis then retrourethral sling for the other. The two other patients underwent a one-stage procedure: one received the two devices, and the other had retrourethral sling implantation and replacement of a penile prosthesis. Post-operative follow-up was focused on complications and efficacy (evaluated by pad use and PGI-I questionnaire for continence, and patient auto-evaluation for sexual function). RESULTS: No perioperative complication occurred. After a minimum of 6 months follow-up, all the four patients were pad-free with no leakage reported, feeling very much better after the procedure according to the PGI-I. The four patients were fully satisfied of the penile implant device. CONCLUSIONS: According to our initial experience, surgery combining the transobturator Advance male sling and a penile prosthesis is feasible, successively or simultaneously, and leads to excellent functional results with no complications.

[Erectile dysfunction after radical prostatectomy: pathophysiology, evaluation and treatment]. / Dysfonction érectile après prostatectomie totale : physiopathologie, évaluation et traitement.

Radical prostatectomy (RP) is the gold standard treatment for localized prostate cancer; yet erectile dysfunction (ED) in selected series is still reported as high as 80% after this surgery. Patient selection and surgical technique (i.e., preservation of neurovascular bundles) are the major determinants of postoperative ED. Pharmacological treatment of postoperative ED, using either oral or local approaches, is effective and safe. Thus, most men need adjuvant treatments to be sexually active following RP. These include intracorporeal injections of vasoactive drugs, vacuum constriction devices and transurethral dilators, all of which have reported response rates of 50 to 70%. Unfortunately, long-term compliance is sub-optimal, with a discontinuation rate of nearly 50% at 1year. These non-oral options should be offered on an individual basis to patients who have failed oral therapy (IPDE5) since efficacy and compliance vary. Also, these options should be considered in the early postoperative period to enhance sexual activity and penile oxygenation, which may prevent corporeal fibrosis. Early penile rehabilitation with intracavernosal injections is the gold standard for partients over 60years old and those who underwent non-sparing surgery. In younger patients and/or when preservation of nerve tissue was feasible, oral IPDE5 may be effective in promoting an earlier return of erectile function. Recent studies have shown that pharmacological prophylaxis early after RP can significantly improve the rate of erectile function recovery after surgery. Use of on-demand treatments for treatment of ED in patients subjected to RP has been shown to be highly effective, especially in cases of properly selected young patients treated with a bilateral nerve-sparing approach by experienced urologists.

[Pathophysiology and management of Peyronie's disease in adult patients: an update]. / Physiopathologie et prise en charge de la maladie de La Peyronie.

Peyronie's disease (PD) is due to a fibrotic plaque forms in the tunica albuginea layer of the penis. It is responsible of penile pain, angulation, and erectile dysfunction. Even though the aetiology remains unknown, the knowledge of the pathophysiology has evolved in recent years. Recent studies indicate that PD has prevalence of 3 to 9% in adult men. During the initial acute phase (6 to 18 months), the condition may progress, stabilize or regress in 20%. Therefore, a conservative treatment approach has been advocated. An initial discussion about evaluation, information, and reassurance is necessary in most cases. The most commonly employed oral therapies include tocopherol (vitamin E), and para-aminobenzoate (Potaba), which have failed to demonstrate efficiency. Intralesional injection therapies with interferon alpha-2B, verapamil are frequently used as a first-line treatment modality, and can provide an improvement in decreasing penile pain and penile curvature. Current literature has shown that extracorporeal shock wave lithotripsy was only active on the pain. Regarding penile curvature, there are discrepancies in the published series. The surgical approach is restricted to men unresponsive to nonoperative therapies (i.e., 10% of patients). In such cases, plication, grafting or even penile prosthesis implantation are conceivable management options.

[Teaching and perception of urology by medical students at the end of the second cycle: an appraisal]. / Enseignement et perception de l'urologie à la fin du deuxième cycle des études médicales: état des lieux.

OBJECTIVES: Our purpose was to determine how the medical students from the second cycle perceived urology and what their learning methods were. MATERIAL AND METHODS: An e-questionnaire was sent to 1600 students in 16 teaching faculties during the last year of their second cycle. RESULTS: Overall, we obtained 590 answers (36.8%). In our population, 70.2% of the students were women. Of them, 24.1% had been already enrolled in an academic urology unit. Urology was defined as a medical, surgical and medico-surgical discipline by 3.7%, 37.8% and 58% of the students, respectively. Urology was considered as very important, important, not very important and not important at all by 5.1%, 54.4%, 37.5% and 2.4% of the students. The teaching methods used to learn urology were duplicated-notes for ENC preparation (45.3%), conferences for ENC (French national ranking exam) preparation (43.7%), courses of the national urology college (38.6%) and courses of the faculty (32%). The best mastered items were lithiasis disease (86.3%), voiding dysfunction (76.3%) and urological cancers (56.7%). On the contrary, only 34.7% and 28% considered their knowledge sufficient on the erectile dysfunctions and on renal transplantation. Lastly, 7.3% intended to become urologists. Having a work experience in a urology unit was significantly associated to the feeling of being prepared to become an intern (p<0.001) and to the project of becoming a urologist (p<0.001). CONCLUSION: Urology was considered like an important discipline by half of the students at the end of the second cycle even though it is under-represented in the national teaching programme for ENC. A third of the students used courses from the faculty to learn urology and a quarter of them had a work experience in a urology unit during their second cycle.

[Etiology and management of erectile dysfunction in patients with diabetes mellitus]. / Etiologie et prise en charge de la dysfonction érectile chez le patient diabétique.

Prevalence of erectile dysfunction (ED) has a higher incidence in patients treated for diabetes mellitus as it concerns more than 30% of them. ED's physiopathology is complex and multifactorial, involving a combination of classical risk factors (endothelial dysfunction), specific factors (e.g., diabetic neuropathy) and psychological factors. ED is most often forewarning a cardiovascular disease. Therefore, it needs to be detected by the physician who is taking care of the diabetic patient. ED is responsible for a deterioration of the quality of life. Therapeutic management relies, on one hand, on specific measures such as prevention of diabetic complications and, on the other hand, on psychological accompaniment of the patient. Phosphodiesterase-5 inhibitors have become the first-line treatment as they are efficient and safe in most cases. As a second line, intracavernous injections remain a gold-standard treatment but the vacuum can be proposed as well. In case of failure, penile prosthesis can even be considered. The psychological dimension of ED has to be considered as much as organic matters.

[Erectile dysfunction and renal chronic insufficiency: etiology and management]. / Etiologie et prise en charge de la dysfonction érectile chez l'insuffisant rénal chronique.

Erectile dysfunction (ED) has a higher incidence in patients treated for chronic renal insufficiency or in patients who underwent kidney transplanation as it concerns more than 50% of them. Its severity is directly linked with the seriousness of the renal disease. ED is responsible of a deterioration of the quality of life. ED's physiopathology is complex and multifactorial, involving a combination of classical risk factors (endothelial dysfunction), specific factors (e.g., chronic hyperuremia and co-morbidities) and psychological factors. Management of ED must take into account both sides of the disease in order to propose appropriate treatment; i.e, psychological concerns and organic matters. Although literature remains poor in this area, phosphodiesterase-5 inhibitors are increasingly used for these patients as they are safe and efficient most of the time. Pharmacokinetics of phosphodiesterase-5 inhibitors can be disturbed by the simultaneous use of immunosuppressor. As a second line, intra-cavernous injections remain a gold-standard treatment. In case of failure, penile prosthesis can even be considered in case of renal chronic insufficiency and in transplanted patients.

[Prospective evaluation of urology residents' interest in andrology]. / Evaluation prospective de l'intérêt des urologues en formation pour l'andrologie.

OBJECTIVE: To evaluate the interest carried in andrology within the community of the urology residents. MATERIAL AND METHODS: Between June and October 2008, all urology residents received an anonymous questionnaire by e-mail estimating their interest for andrology. The following elements were reported: age, sex, current status, future activity, participation in theoretical learning and training courses practices, interest for the speciality and the opinion on the current formation. The statistical analysis was performed with the SEM software. RESULTS: Seventy-seven of the 238 urology residents (32.4%) answered the sent questionnaire. The mean age was 29.2 years (25-36). Thirty-two of them were from a Parisian center (41.6%) and 45 (58.4%) from another city. There are 40.3% of urology residents who wished work on the hospital, 27.3% wished develop an exclusive liberal activity. There are 81.8% of the urology residents who declared to be interested in andrology and 29.9% were registered or wished to join the diplôme d'études spécialisées complémentaires (DESC) of Andrology. Concerning the current formation, only 4% of the participants considered that the theoretical education of the andrology was sufficient and only 6.6% of them considered to have acquired a sufficient practical training in andrology during the cursus. CONCLUSION: The andrology is a particularly attractive speciality for the urology residents and the current modalities of formation are considered insufficient by most of them.

[Evidence-based medicine and French medical students: an appraisal]. / Evidence-based medicine et étudiants en médecine français : état des lieux.

INTRODUCTION: Nowadays, evidence-based medicine (EBM) is essential to learn and to practice medicine. The aim of the current study was to investigate the baseline level of knowledge of French students regarding EBM. MATERIALS AND METHODS: Between April and May2008, a questionnaire was sent by e-mail to 900students in their last year of medical study. RESULTS: On 327 answers, 297 (91%), 94 (29%) and 85 (26%) students declared they read, write and speak medical English. Ninety (28%) read an article of a French medical review once a month and 43 (13%) read an article of an international medical review once a month. Three hundred and eleven (95%) knew the bases of medical research on the Internet and 219 (67%) used them. Twenty-four (7%) had already participated in a editorial staff of a medical article, 7 (2%) had been co-authors. Two hundred and seventy-two (83%) had made an oral presentation during a medical staff and 3 (1%) during a congress. Finally, 237 (73%) understood the interest of the critical analysis of an article at the ECN and 70 (21%) thought they were prepared. CONCLUSION: The incapacity of learning EBM is one of the limits of the French medical training system. The introduction of the reading critical of an article at the ECN is the concrete beginning of an answer to this problem.

[Elevation of PSA after prostate radiotherapy: rebound or biochemical recurrence?]. / Elévation du PSA après irradiation prostatique : rebond ou récidive biologique?

The fact that external beam radiotherapy and brachytherapy are now considered to be curative techniques has led to major review of the modalities of follow-up after radiotherapy for prostate cancer. The problem concerns both the diagnosis of recurrence, rapidly announced by elevation of prostatic-specific antigen (PSA), usually at a subclinical stage, and the validity of criteria of biochemical recurrence to allow comparison of various study. Physicians involved in follow-up should be aware of the potential of bounce in PSA follow-up after external beam radiotherapy or brachytherapy. The PSA bounce phenomemon was defined by a rise of PSA values (+0.1 -0.8 ng/ml) with a subsequent fall. Biochemical failure after external beam radiotherapy or brachytherapy (with or without hormonotherapy) was defined by Phoenix criteria by a rise of 2 ng/ml above an initial PSA nadir. This definition was more correlated to PSA bounce phenomenon.

[Management of premature ejaculation in adults]. / Prise en charge de l'éjaculation prématurée chez le sujet adulte.

Premature ejaculation is a very frequent form of sexual dysfunction characterized by loss of control of ejaculation, inducing performance anxiety and, consequently, impaired quality of life of patients and their partners. The pathophysiology of this symptom is often both psychogenic and organic. The various organic causes must be systematically investigated. Several drug treatments are used with varying degrees of efficacy and their adverse effects must be taken into account when choosing a molecule. Psychological management is an essential complement to drug treatment.

[Prevalence and severity of erectile dysfunction in a population with coronary insufficiency: monocentric study]. / Prévalence et sévérité de la dysfonction érectile dans une population d'insuffisants coronariens : étude monocentrique.

PURPOSE: To study prevalence and severity of erectile dysfunction (ED) in a population of men treated in emergency for a coronaropathy. MATERIAL: The files of 200 patients who underwent a coronarography in urgency before the 1st of January 2007 were reviewed retrospectively. The following data were collated: epidemiological data and detailed breakdown of affected coronary arteries. The following patients were excluded from the current study: age over 65, past history of prostate surgery or pelvic external beam radiation therapy. The international index of erectile function (IIEF-5) questionnaire was sent by regular mail. Patients were classified according to the severity of ED: "no ED" between 21 and 25 inclusive, "mild ED" less than 21, "moderate ED" less than 17 and "strong ED" less than 10. RESULTS: Overall, 78 patients were included with a median age of 58 years. Prevalence of DE was 0.82 and median length of evolution was 9 months before coronary syndrome. Forty-nine patients (62.8%) had an ED classified between moderate and strong. ED was significantly associated with the group of patients smoking more than 20 cigarettes a day for at least 10 years (N = 44; P = 0.01) and with the group of patients older than 60 years (N = 38; P = 0.02). There was an association between the severity of the coronary disease and an ED classified between moderate and strong (P = 0.03). CONCLUSION: This study corroborates the existence of a strong link between ED and coronary disease, notably in patients under 65 years of age. In addition, it seems that the severity of ED is directly related with the anatomical severity of coronary disease.