Worry, desire, and sexual satisfaction and their association with severity of ED and age.

INTRODUCTION: This study evaluates worry about sexual and relationship functioning, sexual desire, and sexual satisfaction as indicators of sexual quality of life in men of different age groups suffering from mild to severe erectile dysfunction (ED). AIM: To increase insight in the mechanisms of some key indicators of sexual quality of life in different age groups. METHODS: The study sample consisted of 904 men with mild to severe ED. Mean age was 60.7 years (standard deviation [SD] = 12.4) and mean erectile function (EF) (International Index of Erectile Function [IIEF]) score was 14.5 (SD = 8.9). Multivariate analyses of variance were conducted to test the differences in outcomes among two age groups (65 65) and two levels of ED (16 16). MAIN OUTCOME MEASURES: We analyzed age, severity of ED, and interrelated indicators of sexual quality of life as worry about sexual or relationship functioning, sexual desire, and overall sexual satisfaction. Beyond, we aimed to see on which of these measures their interaction had specific independent effects. RESULTS: Younger men at a higher level of ED reported higher levels of worry about sexual and relationship functioning than older men with high ED. Older men reported slightly less sexual desire than younger men; also, more ED was associated with lower sexual desire. Finally, men with less severe ED reported higher sexual satisfaction than men with more severe ED, whereas at all levels of ED severity, older men reported more sexual satisfaction than younger men. CONCLUSIONS: Indicators of sexual quality of life among men with ED are poorer in those with more severe ED. However, younger men with severe ED worries concerning sexual functioning were more pronounced than among their older counterparts. Independent of the degree of severity of ED, older men indicated lower sexual desire but higher overall sexual satisfaction. Observed age-group differences were very small, however.

Body mass index (BMI) and mutations of tumor suppressor gene p53 (TP53) in patients with urinary bladder cancer.

OBJECTIVE: Obesity is estimated to account for up to 20% of all cancer deaths. Mutations of TP53 are frequently correlated with tumor development and progression. We evaluated the effect of body mass index (BMI) and mutation status of tumor suppressor gene p53 (TP53) on patients with urinary bladder cancer. MATERIALS AND METHODS: Clinical samples were used from 75 patients with tumors of the urinary bladder. Mutation status in TP53 exons 5, 6, 7, and 8 was analyzed by temperature gradient gel electrophoresis of exon-specific PCR products and by sequence analysis. Statistical analysis included Pearson's correlation. RESULTS: For noninvasive bladder cancer, the mutation frequency in TP53 was 44.6%, while for invasive bladder cancer the mutation frequency in TP53 was 84.2%. Normal weight, overweight, and patients with obesity had a TP53 mutation frequency of 68.4%, 44.8%, and 25%, respectively (P < 0.05). CONCLUSIONS: TP53 mutation frequently occurs in higher stages of bladder tumors. Body mass index is not associated with a higher TP53 mutation frequency in our study, but BMI should be included for collecting data of bladder cancer risk profile.

TP53 gene mutations as an independent marker for urinary bladder cancer progression.

This study evaluates the influence of the TP53 genetic status on tumour recurrence and progression with a highly effective electrophoretic technique. DNA from tissue of 75 non-invasive urinary bladder cancers was PCR amplified in the TP53 exons 5-8 and run on horizontal polyacrylamide gels under defined temperature conditions to yield specific gel shifts. Kaplan-Meier and Cox-Regression analysis were performed with tumour progression. The overall tumour recurrence in our patient population was 76.0% (57/75). Tumour recurrence frequency was 69.4% (34/49) in patients with TP53 wild-type, and 88.5% (23/26) in patients with TP53 mutation. There was no statistically significant difference with regard to recurrence frequency and time to recurrence. The progression-free survival was significantly shorter in patients with TP53 mutations, and the frequency of tumour progression was significantly higher in mutated as compared to wild-type tumours. Cox-Regression analysis showed a significant and independent influence of TP53 mutation on tumour progression in comparison with tumour grade, stage and history of prior bladder cancer. If segregated by exons, mutations in the DNA binding region of exon 8 seem to have a particular high influence on tumour progression. We conclude that genetic analysis of TP53 can select patients at high risk of bladder tumour progression that should be followed closely and may benefit from early radical surgical procedures.

TP53 mutation in prostate needle biopsies--comparison with patients follow-up.

BACKGROUND: The predictive value of TP53 mutations and prostate-specific antigen (PSA) was assessed in prostate needle biopsies of samples without signs of malignancy for later affliction by prostate cancer (PCa). Comparison of mutation frequency and PSA level in prostate needle biopsies with data of patients with benign prostate hyperplasia (BPH) treated by transurethral resection (TURP), patients with prostatic intraepithelial neoplasia (PIN), and patients with PCa, was made. MATERIALS AND METHODS: A total of 466 samples were analysed from patients with benign and malignant diseases of the prostate, including 52 samples of needle biopsies of the prostate with repeated benign histopathological diagnosis. Analysis of TP53 state by temperature gradient gel electrophoresis of TP53 exon-specific PCR products of exons 5, 6, 7 and 8 was performed. Clinical follow-up of 100 patients with benign diseases of the prostate and with PIN was available. RESULTS: Needle biopsy samples with repeated benign diagnosis resemble BPH specimens taken by TURP in TP53 mutation frequency (TURP: 16.1%, needle biopsy: 21.2%) and later affliction by PCa (TURP: 3/32 = 9.4%, needle biopsy: 8/51 = 15.7%, p = 0.409). Patients with TP53 mutations in needle biopsy samples showed a significantly reduced disease-free survival time for affliction by PCa (log rank: p = 0.0149). This significance is raised by computing exon 6 mutations only with respect to affection by PCa (p = 0.0002). In TURP patients, exon 7-mutations were also significant (p = 0.0086). Needle biopsy TP53 mutations (p = 0.029) had significant predictive values for later affliction by PCa in multivariate analysis. PSA level and patient age had no predictive value for PCa. CONCLUSION: TP53 mutations reduce the PCa-free survival time in patients with needle biopsy of the prostate and primary benign diagnosis. Exon 6 mutations enhance the risk of being affected by PCa 32-fold.

Transrectal broadband-Doppler sonography with intravenous contrast medium administration for prostate imaging and biopsy in men with an elevated PSA value and previous negative biopsies.

UNLABELLED: THE AIM of this study was to determine the prostate cancer detection rate of targeted biopsy using contrast-enhanced ultrasound (US) in patients with elevated prostate specific antigen (PSA) levels and previous negative biopsy. PATIENTS AND METHODS: A total of 114 patients initially underwent ultrasonography using transrectal ultrasound (TRUS) and power Doppler. All the patients had at least one previous biopsy series negative for prostate carcinoma. Ninety-five of the patients were examined with a new broadband Doppler technique, advanced dynamic flow (ADF), after i.v. injection of the echo enhancer (2.4 ml, SonoVue). The systematic biopsies were also obtained supplemented by removal of two targeted tissue cores in all the patients with a suspicious area in the inflow phase or late phase. RESULTS: Histology confirmed prostate cancer in 30 of the 95 patients. Sensitivity for the detection of prostate cancer by contrast-enhanced US was 100% and specificity was 48%. Suspicious areas were identified in 48 cases including 40 hypervascularized areas and 14 hypoechoic areas after 60 sec. Targeted biopsy identified 24 of the 30 carcinomas. Randomized octant biopsy identified only 8 of the 30 carcinomas. All 65 patients with negative histology were prostate cancer free at 12-month follow-up. The ADF US scans were degraded by fewer artifacts than the power Doppler images. CONCLUSION: Contrast-enhanced ADF Doppler allows reliable differentiation of prostate cancer and normal prostate tissue with a high sensitivity in patients with previous negative biopsy and fewer artifacts than power Doppler images, thus providing a good basis for targeted prostate biopsy instead of systematic biopsy.

Four tumour markers for urinary bladder cancer--tissue polypeptide antigen (TPA), HER-2/neu (ERB B2), urokinase-type plasminogen activator receptor (uPAR) and TP53 mutation.

PURPOSE: Tissue polypeptide antigen (TPA) is present in the proteolytic fragments of cytokeratins 8, 18 and 19 as a component of the cytoskeleton of nonsquamous epithelia. HER-2/neu protein is a transmembrane tyrosine kinase cell surface growth factor receptor that is expressed on normal epithelial and some cancer cells. The urokinase-type plasminogen activator receptor (uPAR) is a GPI-linked single-chain glycoprotein. Mutations of the tumour suppressor gene P53 (TP53) are frequently correlated with tumour development and progression. We compared TPA, HER-2/neu and uPAR, and TP53 mutation in tumour-free and bladder cancer patients. MATERIALS AND METHODS: Clinical samples were used from 60 patients with tumours of the urinary bladder and from 9 patients with benign urological diseases. TPA was analyzed by the immunoluminometric assay LIA-mat TPA-MProlifigen. HER-2/neu was measured using the Bayer Oncoprotein test. uPAR was measured with the IMUBIND Total uPAR ELISA Kit. Mutation status in TP53 exons 5, 6, 7 and 8 was analyzed by temperature gradient gel electrophoresis of exon-specific PCR products and by sequence analysis. Statistical analysis included ROC, Mann-Whitney U-test and Pearson's correlation. RESULTS: Pathological concentrations of TPA, HER-2/neu and uPAR are detectable in the serum and in urine of bladder cancer patients. The calculated diagnostic sensitivity for TPA in serum was 68.37%, for TPA in urine 33.3%, for HER-2/neu 86.7% and for uPAR 79.5%. Pathological levels of TPA in serum (p=0.001) and HER-2/neu (p =0.001) were significantly higher in patients with bladder cancer in comparison to the control group. For superficial bladder cancer, the mutation frequency in TP53 was 50%, while for invasive bladder cancer the mutation frequency in TP53 was 100%. Elevated TPA, HER-2/neu and uPAR levels were associated with all grades and stages of bladder cancer. CONCLUSION: TPA, HER-2/neu or uPAR can differ between bladder cancer patients and the control group, but not between superficial and invasive bladder cancer. TP53 mutation frequently occurs in higher stages of bladder tumours.

Tissue polypeptide antigen (TPA) in comparison with mutations of tumour suppressor gene P53 (TP53) in patients with bladder cancer.

BACKGROUND: Tissue polypeptide antigen (TPA) is a circulating complex of polypeptide fragments from cytokeratins 8, 18 and 19. It is a tumour-related protein. TPA is an indicator of higher cell proliferation. One function of TP53 is the suppression of apoptosis. TP53 mutations are frequently correlated with tumour development in bladder cancer. One function of TP53 is the suppression of apoptosis. We compared TPA expression and TP53 mutation analysis in tumour-free and bladder cancer patients. MATERIALS AND METHODS: We examined 93 patients with bladder cancer, 24 patients with benign urological diseases and a control group of 18 healthy individuals. TPA concentration was measured by immunoluminometric assay with LIA-mat TPA-M Prolifigen. The normal cut-off value was defined at 47 U/I for serum and at 60 U/mmol for creatinine. Screening for TP53 mutations in tissue and urine sediment, amplification of the TP53 gene by polymerase chain reaction (PCR) for the exons 5, 6, 7 and 8 and temperature gradient gel electrophoresis (TGGE) were used to analyse the mutations. Statistical analysis included ROC, Mann-Whitney U-Test and Pearson's correlation. RESULTS: For superficial bladder cancer the mutation frequency in TP53 was 44.8%. We found elevated TPA levels in 45.5% in serum and 36.1% in urine. For invasive bladder cancer the mutation frequency in TP53 was 79.2%. Elevated TPA levels were found in 57.7% in serum and in 58.3% in urine. TPA has a sensitivity of 48.9% in serum and 40.4% in urine; the specificity of TPA is 83% in serum and 100% in urine in comparison with healthy individuals. We found no correlation between TPA level and the inflammation status of the patient. CONCLUSION: This study demonstrated that TP53 mutation frequently occurs in higher stages of bladder tumours. There was no TPA level difference between superficial and invasive bladder cancer. TPA is significantly higher in serum (p = 0.012) and in urine (p = 0.002) in patients with bladder cancer in comparison with control group. TPA in serum is significantly higher in patients with mutation of TP53 (p = 0.046) but not in urine (p = 0.173) in comparison with patients with wild-type TP53.

TP53 gene mutations in prostate cancer progression.

BACKGROUND: We assessed the predictive value of TP53 mutations and prostate-specific antigen (PSA) for tumor progression in prostate cancer (PCa) patients. MATERIALS AND METHODS: Ninety tumor tissue samples of patients with PCa from radical prostatectomy were used. Tumor progression was estimated biochemically by the PSA level (> 0.2 microg/l) or by detection of metastases. Screening for TP53 mutations was performed by temperature gradient gel electrophoresis (TGGE) in exon-specific manner. Follow-up data were collected from medical protocols. Statistical analysis was performed by uni- and multivariate techniques. RESULTS: In 32 out of 90 patients (35.6%), TP53 mutations were detected. Thirteen out of 32 patients (40.6%) with TP53 mutations and nine out of 58 patients (15.5%) with TP53 wild-type showed tumor progression after 25 and 45 months, respectively. CONCLUSION: TP53 mutations in exon 7 and exon 8 are factors of tumor progression in PCa. Their contribution to tumor recurrence is more significant than tumor stage and pretherapeutic PSA level.

Acute partial segmental thrombosis of the corpus cavernosum: imaging findings on ultrasound, computed tomography, and magnetic resonance imaging.

Partial segmental thrombosis of the corpus cavernosum is a rare disease of unknown etiology; the thrombosis is always located in the proximal part of the corpus cavernosum, usually unilaterally. Typical clinical presentation with perineal pain and swelling in combination with cross-sectional imaging allows one to confidentially establish this diagnosis.

Erectile dysfunction, discrepancy between high prevalence and low utilization of treatment options: results from the 'Cottbus Survey' with 10 000 men.

OBJECTIVE: To investigate the age-stratified prevalence of erectile dysfunction (ED) and its comorbidities, and to assess the population's knowledge, utilization, and general attitude towards the treatment for ED. SUBJECTS AND METHODS: In all, 10 000 men received a 35-item questionnaire including the International Index of Erectile Function (IIEF) and sociodemographic questions regarding life style, comorbidities, quality of sexual life and knowledge or experience of ED therapy. In all, 3124 responses were included (31.2%), 2499 men lived in well established partnerships and were assessed as the basic study group. RESULTS: In the entire population the prevalence rate of ED was 40.1%. However, although known, medical treatment for ED is used only by a minority of affected men. The prevalence of ED was independently associated with age, peripheral arterial occlusive disease, hypertension, ischaemic heart disease, diabetes mellitus, and liver diseases. Correlations between sexual quality of life (QoL) and ED were statistically significant (P < 0.01) and moderate to strong (absolute values: Spearman's rho 0.35-0.76). Although 96% of the study population knew at least one phosphodiesterase type 5 (PDE5) inhibitor by name, only 53% considered taking the medication and only 9% of the men with ED had had experience with available PDE5 inhibitors. CONCLUSIONS: The sexual QoL was significantly reduced by ED. Despite high levels of awareness and general acceptance of oral medication for ED, experience with PDE5 inhibitors was low. Further investigation is required to evaluate the general impact of ED on sexual QoL and the need or wish for treatment.

MR imaging-guided prostate biopsy with a closed MR unit at 1.5 T: initial results.

The authors evaluated a magnetic resonance (MR) imaging-compatible biopsy device comprising a needle guide that can be visualized with MR imaging and manipulated mechanically from outside the MR unit. With approval from the local ethics committee and patient consent, this device was tested in 12 patients by using a closed 1.5-T MR unit and a body phased-array coil. Patients had elevated prostate-specific antigen levels (6-60 ng/mL) and one or more areas in the prostate that were suspicious for carcinoma at prebiopsy MR imaging. Biopsy was performed with transrectal access and with the patient prone. A 16-gauge MR imaging-compatible needle was successfully positioned with the device, and between six and nine tissue cores were obtained in each patient. In one patient, two suspicious basal areas could not be reached with the device. Histologic analysis showed prostate cancer in five patients and prostatitis in six. No complications were observed. The device enabled MR imaging-guided core-needle biopsy of prostate areas suspicious for cancer on MR images.

EAU guidelines for the management of genitourinary tuberculosis.

Nearly one third of the world's population is estimated to be infected with Mycobacterium tuberculosis. Moreover, tuberculosis is the most common opportunistic infection in AIDS patients. Genitourinary tuberculosis is not very common but it is considered as a severe form of extra-pulmonary tuberculosis The diagnosis of genitourinary tuberculosis is made based on culture studies by isolation of the causative organism; however, biopsy material on conventional solid media may occasionally be required. Drug treatment is the first line therapy in genitourinary tuberculosis. Treatment regimens of 6 months are effective in most of the patients. Although chemotherapy is the mainstay of treatment, surgery in the form of ablation or reconstruction may be unavoidable. Both radical and reconstructive surgery should be carried out in the first 2 months of intensive chemotherapy.

Late complication of Boari bladder flap.

A very rare late complication of Boari bladder flap repair with development of pseudodiverticulum and recurrent genitourinary tract infection secondary to vesicoureteral reflux is presented. Radiologic evaluation of the patient comprised intravenous pyelography (IVP), micturating cystourethrogram, cystoscopy, and multislice computed tomography (MSCT).

Patients with a history of elevated prostate-specific antigen levels and negative transrectal US-guided quadrant or sextant biopsy results: value of MR imaging.

PURPOSE: To determine the role of magnetic resonance (MR) imaging performed with a combined endorectal body phased-array coil for patients with elevated prostate-specific antigen (PSA) levels or suspicious free-to-total PSA ratios in whom prior transrectal ultrasonographically (US) guided biopsy findings were negative for prostate cancer. MATERIALS AND METHODS: Forty-four patients with PSA levels greater than 4 ng/mL or free-to-total PSA ratios lower than 15% but negative biopsy findings were examined with T1- and T2-weighted MR imaging at 1.5 T with a combined endorectal body phased-array coil. All patients underwent digital rectal examination (DRE) and transrectal US. Thirty-eight patients underwent repeat biopsy after MR imaging. The accuracy of MR imaging for detection of prostate cancer was assessed prospectively. Retrospectively, MR imaging findings were correlated with individual biopsy site findings. MR imaging and biopsy results were correlated by using a cross table to calculate sensitivity, specificity, and positive predictive value (PPV). Retrospective analysis results were evaluated with receiver operating characteristic analysis. A P value of less than.05 indicated significance (chi(2) test according to Pearson). RESULTS: At prospective analysis, MR imaging had a sensitivity of 83% and a PPV of 50% for detection of prostate cancer; these values were 33% and 67%, respectively, for DRE and 33% and 57%, respectively, for transrectal US. At retrospective site-by-site analysis, MR imaging results did not correlate significantly with individual biopsy site findings (P =.126); sensitivity was 65% and PPV was 12%. CONCLUSION: In this patient population, MR imaging has higher sensitivity for detection of prostate cancer than DRE or transrectal US.

Sildenafil response is influenced by the G protein beta 3 subunit GNB3 C825T polymorphism: a pilot study.

PURPOSE: Sildenafil is the oral phosphodiesterase-5 inhibitor that revolutionized treatment for erectile dysfunction. We investigated a potential association of the G protein beta 3 subunit (GNB3) C825T polymorphism, a determinant of intracellular signal transduction, with the drug response to sildenafil in patients with erectile dysfunction. MATERIALS AND METHODS: In 113 men with erectile dysfunction and 111 healthy male controls genotype status of the GNB3 C825T polymorphism was determined by polymerase chain reaction and restriction analysis. Patients with erectile dysfunction received sildenafil at a dose of 25 to 100 mg. according to the individual erectile response. Drug response was measured by interviewing the patient according to the erection scale of 0 to 5. RESULTS: The GNB3 genotype distribution of patients with erectile dysfunction exactly matched that of healthy controls. Analysis of the response to sildenafil revealed a significant association of C825T allele status with the erectile response to sildenafil. In the group with TT genotype we observed a 90.9% response but only a 50.9% and 48.9% response in patients with the CC and TC genotype, respectively. The odds ratio for a positive erectile response was 10.0 (95% CI 1.2 to 81.1) for patients with the TT versus the TC/CC genotype (p = 0.01). CONCLUSIONS: The response to sildenafil is significantly associated with GNB3 C825T genotype status in patients with erectile dysfunction.