ABSTRACT
SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) metamorphosed our medical practice. In early June 2020, more than 6,400,000 COVID-19 (coronavirus-19 disease) cases were diagnosed across the world and more than 380,000 deaths were linked to COVID-19. Many medical symptoms of COVID-19 were reported. We will focus, here, on potential impacts of COVID-19 on men's andrological health. Our society (French-speaking society of andrology, SALF) also emitted some recommendations in the andrological management of men infected by SARS-CoV-2. First, considering the fever and the potential presence of SARS-CoV2 in semen, SALF recommends waiting for 3 months (duration of one spermatogenesis cycle and epididymal transit) before re-starting ART in the case of men diagnosed COVID-19 positive. Whatever the nature of testosterone and COVID-19 relationships, we recommend an andrological examination, sperm parameters, and hormonal evaluation at the time of the COVID-19 is diagnosed, and several months later. Furthermore, we are concerned by the potential morbid-mortality of the COVID-19, which mainly affects men. This "andrological bias", if proven, must be reduced by specific andrological diagnosis, therapeutic and prophylactic measures. Research in this direction must be substantiated and financially supported over the next few months (years).
Le SRAS-CoV-2 (nouveau coronavirus ou coronavirus numéro 2 responsable du syndrome respiratoire aigu sévère) a métamorphosé notre pratique médicale. Début juin 2020, plus de 6,400,000 cas de COVID-19 (maladie à coronavirus 2019) ont été diagnostiqués dans le monde et plus de 380,000 décès ont été reliés à cette maladie. De nombreux symptômes médicaux de cette infection virale ont été signalés. Nous nous concentrerons, ici, sur les impacts potentiels de COVID-19 sur la santé andrologique des hommes. Notre société (Société d'andrologie de langue Française, SALF) émet ici quelques recommandations dans la prise en charge andrologique des hommes infectés par le SRAS-CoV-2. Tout d'abord, compte tenu de la fièvre et de la présence potentielle du SRAS-CoV2 dans le sperme, la SALF recommande d'attendre 3 mois (durée d'un cycle de spermatogenèse et transit épididymaire) avant de recommencer les techniques d'assistance médicale à la procréation pour les hommes diagnostiqués COVID-19 positifs. Quelle que soit la nature des relations entre la testostérone et l'infection à SARS-CoV-2, nous recommandons un examen andrologique, un examen des paramètres du sperme et une évaluation hormonale au moment du diagnostic de l'infection, ainsi qu'à distance (36 mois plus tard). De plus, nous sommes préoccupés par la morbidité et la mortalité potentielles de l'infection COVID-19, qui touche principalement les hommes. Ce "biais andrologique", s'il est. prouvé, doit être réduit par un diagnostic andrologique spécifique et des mesures thérapeutiques et prophylactiques. La recherche dans ce sens doit être étayée et soutenue financièrement au cours des prochains mois (années).
ABSTRACT
INTRODUCTION: Phosphodiesterase type 5 inhibitors (PDE5i) are the first-line treatment of erectile dyfunction (ED). Cost of PDE5i is not covered by health insurance company in France. Few studies have examined the potential impact of the introduction of generic products of PDE5i on price non-compliance. The aim of the study was to compare the non-compliance rate because of price among patients treated for DE with generics of PDE5i and those treated with brand-name medications. METHOD: A multi-centre, cross-sectional, study that analyzed the answers to a questionnaire distributed to consultations in four hospitals for a period of twenty-eight months. Patients were included if they had DE treated for at least 3 months. The proportions between the two groups were compared with a non-inferiority test Wilcoxon-Mann-Whitney. RESULTS: One hundred and seventy-seven questionnaires were analyzed. Patients treated with generic PDE5i were significantly (α<0.05) as non-compliant because of price as patients treated with treated with brand-name PDE5i, respectively 34% (28/82) and 38% (36/95). The main causes of non-compliance were: high treatment costs, a lower than expected effect, lack of opportunity or sexual desire. The proportion of patients splitting the PDE5i tablet to achieve savings was 19% (33/177). To find the lowest price, 57% (101/177) of patients had consulted several pharmacies. These patients consulted 2.4±1.5 pharmacies. In the study population, 44% (78/177) of patients compared prices on commercial websites on the Internet. CONCLUSION: Patients treated with generic PDE5i are as unobservant as those treated with brand-name PDE5i. LEVEL OF EVIDENCE: 3.
Subject(s)
Commerce , Drugs, Generic/economics , Drugs, Generic/therapeutic use , Erectile Dysfunction/drug therapy , Medication Adherence/statistics & numerical data , Phosphodiesterase 5 Inhibitors/economics , Phosphodiesterase 5 Inhibitors/therapeutic use , Cross-Sectional Studies , Humans , Male , Middle AgedABSTRACT
PURPOSE: Review of various publications on stem cell therapy to treat erectile dysfunction of diabetic origin. MATERIAL AND METHODS: Bibliographic search in PUBMED performed using the keywords cell therapy strain/erectile dysfunction associated with diabetes. Among the 51 articles obtained from the PUBMED research, we selected 16 articles for their specificity of studying erectile dysfunction (DE) related to diabetes. RESULTS: Different types of stem cells have been studied: adipose derived mesenchymal stem cells/bone marrow derived mesenchymal stem cells as well as progenitor endothelial cells. The experimental protocols are quite similar from one study to the next with nevertheless some specifications concerning the studied cells and the monitoring of the latter. Intracavernous pressure (ICP) measured after the injection of stem cells into the corpus cavernosum was always significantly higher than the control populations. The addition of certain growth factors to stem cells by gene transfection improve the efficacy of the cells. No ideal tracking markers of the cells have been identified. CONCLUSION: The positive effect of the injection of stem cells on the ICP belongs to the cellular trans-differentiation effect but especially to the paracrine effects which have not yet been completely elucidated.
