Electrocardiographic abnormalities in patients with organic erectile dysfunction: comparison with an age-matched control group.

AIMS: Our purpose was to determine the incidence of electrocardiographic (ECG) abnormalities in patients with organic erectile dysfunction (ED) and to compare the results with an age-matched control (potent) group. METHODS: A total of 218 men with ED of organic etiology formed our study group. A total of 210 age-matched men who had urologic disease other than ED served as control group. An experienced cardiologist who was blind to the primary diagnosis evaluated the ECGs in the entire group. The results were reported as either normal or abnormal according to the presence or absence of an abnormality suggestive for cardiovascular disease. RESULTS: The mean age of the study and control groups was 58 years (range for the study group 28-82 years and for the control group 28-80 years). Abnormal ECG rates among patients with ED and control subjects were comparable. The incidences of ECG abnormalities in the study and control groups were 21.1% and 17.1%, respectively (P = 0,298). No ECG abnormality was detected in males younger than 40 in either group. CONCLUSION: Middle-aged or older men with ED may carry potential risk for cardiovascular diseases in the absence of cardiovascular symptoms. However, patients with organic ED are not under increased risk for ECG abnormalities.

Characteristics of sildenafil erections in healthy young men.

AIM: To determine the effect of sildenafil citrate on the nocturnal penile erections (i.e. time to onset, the duration of erection, and the interval between first and second erections) of healthy young men. METHODS: Twenty-two potent men, 23-29 years old, were recruited for the study. All subjects completed three sessions over consecutive nights using the RigiScan monitoring device (Dacomed, Minneapolis, USA). After a first night of adaptation, night 2 records were their baseline values, and on night 3 they received 100 mg of sildenafil citrate. Statistical comparisons were done between the second and third night data. RESULTS: The mean time to onset of the first erection with sildenafil citrate was (34+/-18) min, whereas it was (74+/-24) min (P 0.0001) without sildenafil citrate. The number of erections observed during the first 5 h after sildenafil citrate medication was 3.6+/-0.5 in contrast to 2.4+/-0.5 with no medication (P=0.001). The interval between first and second erections was shorter with sildenafil citrate: (52+/-26) min vs. (85+/-34) min (P = 0.01). The duration of the last erection was statistically significantly longer with the sildenafil citrate: (64 +/-33) min vs. (42 +/-28) min (P 0.001). CONCLUSION: Healthy young men achieved erection within 34 min after sildenafil citrate administration, which is shorter than the 1 h interval proposed by the manufacturer. The interval between the first and second erections was shorter and the duration of the last nocturnal erection was longer.

Comparison of nocturnal penile tumescence monitoring and cavernosal smooth muscle content in patients with erectile dysfunction.

PURPOSE: Nocturnal penile tumescence monitoring was compared to cavernosal smooth muscle content in 48 cases of erectile dysfunction. MATERIALS AND METHODS: Pre-operatively nocturnal penile tumescence rigidity (NPTR) testing, colour Doppler sonography and if needed pharmaco cavernosometry-cavernosography were evaluated in 48 impotent patients before surgical intervention. The 40 patients whom all those diagnostic tools were abnormal constituted the first group. In the remaining 8 patients, which constitutes the second group, NPTR testing were normal but the other tests were abnormal. 10 potent patients with congenital penile curvature constituted the third group. Cavernous biopsies were obtained during the surgery and biopsies stained immunohistochemically to quantify smooth muscle cells (SMC) by anti-desmin and anti-SMA. RESULTS: We observed statistical significant difference of corporeal SMC content with regard to first Vs second group and first Vs third group (p < 0.05). However we did not observe statistically significant difference with regard to second vs third group (p > 0.05). CONCLUSION: NPTR testing appears to correlate well with corporeal SMC, which is the key structures of erection. We think that with taking into the consideration of its specific reservations, NPTR testing is still one of the best non-invasive tool in the differential diagnosis of erectile dysfunction.

Open prostatectomy is still a valid option for large prostates: a high-volume, single-center experience.

OBJECTIVES: To evaluate, in a retrospective, single-center trial, our open prostatectomy outcomes and complications in the past 12 years to emphasize the feasibility of open prostatectomy for large prostates. METHODS: A total of 1193 patients underwent open prostatectomy from 1995 to 2007. We retrospectively analyzed the data from 664 patients who had preoperative, operative, and postoperative data available. RESULTS: The mean patient age was 67.5 years (range 52-86). The mean preoperative prostate-specific antigen value was 9.6 ng/mL (range 1.65-45.6). The mean prostatic weight was 88.7 g (range 45-324) and was significantly different for the 1995-2001 and 2002-2007 groups (73.6 vs 98.2 g, respectively). Of the 664 patients, 208 (31%) had had an indwelling catheter before surgery. The average International Prostate Symptom Score was 21.7 (range 13-32) preoperatively and 10.6 (range 8-18) postoperatively (P <.005). The average hospitalization was 6.74 days (range 4-14). Blood transfusion was required in 12.7% of the patients either intraoperatively or postoperatively. Postoperatively, 82 patients (12.3%) had urinary tract infections, 22 (3.2%) had bladder neck obstruction, 5 (0.7%) had urinary incontinence, and 15 (2.3%) had a ureteral meatus stricture. CONCLUSIONS: Open prostatectomy is a feasible treatment option for patients with a large prostate and also for patients with additional bladder pathologic findings such as bladder calculi or diverticula for whom endoscopic treatment modalities are not appropriate. Consequently, open prostatectomy is still the primary option for patients with a prostate greater than 100 cm(3) and preserves its importance in urology practice, even in the presence of endoscopic innovations.

Long-term effect of experimental hypercholesterolemia on cavernosal tissues.

OBJECTIVES: To determine the effect of long-term experimental hypercholesterolemia on cavernosal tissues and to evaluate whether these alterations are reversible after improvement of hypercholesterolemia. METHODS: Thirty-seven New Zealand male rabbits with a mean age of 5 to 6 months and a weight of 2 to 2.5 kg were included in this study. The control group (group 1, n = 7) was fed with normal standard rabbit chow for 24 weeks, the hypercholesterolemia group (group 2, n = 17) was fed with a 1% pure cholesterol diet for 24 weeks, and the reversibility group (group 3, n = 13) was fed first with the 1% pure cholesterol diet for 24 weeks and then with normal standard rabbit chow for 12 weeks. The basal and 24-week serum lipid profiles of all groups and the 36-week serum lipid profiles of group 3 were measured. Core tissue samples 4 mm in diameter taken from formalin-fixed, paraffin-embedded tissue blocks of rabbit corpus cavernosum were examined for Masson trichrome histochemically and desmin and smooth muscle actin by the tissue array method using immunohistochemistry. RESULTS: Hypercholesterolemia was observed in groups 2 and 3 at 24 weeks compared with group 1. In group 3, at 36 weeks, the cholesterol levels were decreased. A statistically significant (P < 0.05) irreversible decrease was observed in smooth muscle actin level in group 3 (reversibility group) by immunohistochemical analysis. The decrease in desmin was reversible, and no significant difference was observed in collagen among the three groups. CONCLUSIONS: Long-term chronic effects of experimental hypercholesterolemia on cavernosal smooth muscles might be irreversible and this might alter erectile function.

The effect of diabetes mellitus treatment and good glycemic control on the erectile function in men with diabetes mellitus-induced erectile dysfunction: a pilot study.

INTRODUCTION: Erectile dysfunction (ED) is a common complication of diabetes mellitus (DM). However, efficacy and/or long-term satisfaction with most of those ED treatment options have been suboptimal. AIM: In this study we try to evaluate the effect of aggressive treatment and DM regulation on the erectile function in men with DM-induced ED (DMED). METHODS: Eight type 1 and 17 type 2 diabetic subjects were included into the study. All patients had a measurement of fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1(c)) levels, and completed three sessions of consecutive nights using the RigiScan Plus monitoring device before and after blood sugar control. Also International Index of Erectile Function (IIEF) questionnaire scores were obtained before and after blood sugar control. RESULTS: Significant improvement was noted in FPG and HbA1(c) levels throughout the treatment period (P < 0.001). However, no statistically significant difference was observed in both IIEF scores and nocturnal penile tumescence and rigidity (nptr) parameters after the dm regulation (p > 0.05). CONCLUSION: We suggest that there are probably other factors than aggressive treatment and DM regulation for treating DMED, and probably we must consider preventive strategies with pharmacological agents to prevent progressive decrease in erectile function in diabetic patients.

Alterations of intracorporeal structures in patients with erectile dysfunction.

OBJECTIVE: We sought to quantify intracavernosal smooth muscle content (SMC), endothelial cells (EC) and elastic fibres (EF) in both potent and impotent men. We compare the results in impotent men with regard to patient age, aetiology of impotence, presence or absence of diabetes mellitus and smoking. PATIENTS AND METHODS: Seventy penile biopsies were taken from 10 potent patients with congenital penile curvature (age 17-24 years, mean: 21 +/- 1.16) and from 60 impotent patients (age 28-64 years, mean: 46 +/- 7.64). Biopsies were stained immunohistochemically to quantify the percentage of SMC by anti-desmin and anti-SMA, anti-CD-34 for EC and Verhoeff's histochemical staining for EF. Statistical analyses were performed by using one-way Anova after square root transformation. RESULTS: We observed a statistically significant difference in the amounts of corporeal SMC, EC and EF with regard to the following subgroups: potent versus impotent men; men with arterial aetiology versus veno-occlusive aetiology; men under the age of 45 versus men over the age of 45; patients with diabetes mellitus versus non-diabetes mellitus, and smokers versus non-smokers. CONCLUSION: Quantification of intracavernosal structures appears to be important for either understanding the mechanism of impotence or deciding the appropriate treatment.

Prevalence and correlates of erectile dysfunction in Turkey: a population-based study.

OBJECTIVES: Epidemiologic data indicate that erectile dysfunction (ED) is a significant problem among men worldwide. However, data do not exist for Turkish men. This study was conducted to determine the prevalence and sociodemographic, medical, and lifestyle correlates of ED in Turkey. METHODS: Information was gathered via physician-conducted interviews using a validated questionnaire. Respondents self-rated their ED as "none," "minimal," "moderate," or "severe". Bivariate and multivariate analyses were performed on data from a stratified random sample of 1982 men aged > or = 40 years to quantify the associations between ED and potential covariates. RESULTS: The age-adjusted overall prevalence of ED in Turkey was 69.2% (mild 33.2%, moderate 27.5%, severe 8.5%) and increased with age, as did severity of ED. When we consider moderate + severe ED cases, the prevalence is 36%. In a multivariate model, increased prevalence of moderate or severe ED was significantly associated with age, residence in eastern Turkey; low educational level; unemployment; or underlying diabetes, hypertension, depression, prostate problems or lower urinary tract symptoms. Conversely, residence in southern Turkey, alcohol consumption, physical activity, and higher income were significantly associated with decreased prevalence. CONCLUSIONS: ED affects a high proportion of Turkish men aged > or = 40 years, is correlated with a number of serious medical conditions and the frequency increases with age.