Satisfacción y adherencia al tratamiento en disfunción eréctil a medio y largo plazo / Satisfaction and treatment adherence in erectile dysfunction in the medium and long term

Introducción: El objetivo ha sido mostrar la satisfacción y adherencia al tratamiento en disfunción eréctil (DE) a medio y largo plazo. Material y métodos: Estudio descriptivo y comparativo llevado a cabo en 2 centros mediante entrevistas telefónicas a pacientes que realizaron una primera visita entre 2012 y 2014 por DE. Se realizó una anamnesis completa sobre el uso y abandono del tratamiento. En caso de uso actual se cumplimentaron los cuestionarios EDITS y GAQ, y en caso de uso pasado solo el GAQ. Para el análisis estadístico se utilizaron el test exacto de Fisher para las comparaciones de porcentajes y el test de Kruskal-Wallis para comparar medias. Resultados: Doscientos cincuenta pacientes incluidos, habiendo recetado a un 20,8% alprostadilo intrauretral (AL-IU), a un 17,2% alprostadilo intracavenoso (AL-IC), a un 92,8% un primer IPD5, y a un 24,8% al menos un segundo IPD5. El abandono del tratamiento fue del 62,07% en el primer IPD5 utilizado, del 41,94% en el último IPD5 probado, del 69,23% en el AL-IU y del 65,11% en el AL-IC (p = 0,007). La principal razón de abandono en los IPD5 fue la falta de respuesta (32,76% de individuos que los toman). En el caso del AL-IU y AL-IC, además de esta destacan las reacciones adversas (28,85% y 11,63% respectivamente). La media de utilización hasta el abandono fue de 4,3 meses en IPD5, 2,2 meses en AL-IU y 5,5 meses en AL-IC (p = 0,064). Las puntaciones del GAQ y EDITS más favorables se observaron en los IPD5 (EDITS de 74). Sildenafilo y tadalafilo tienen los tiempos más largos de uso (media mayor de 5 meses). Conclusiones: El porcentaje de abandono en el tratamiento de la DE es alto, con tiempos cortos de uso de pocos meses, siendo las principales causas de abandono la falta de respuesta y las reacciones adversas. Los fármacos que aportan mayor satisfacción son los IPD5, sin existir diferencias significativas en el tiempo medio de uso entre los diferentes tipos y en aspectos como la media de uso hasta el abandono o los porcentajes de abandono

Introduction: The aim of this study was to show the satisfaction and treatment adherence in erectile dysfunction (ED) in the medium and long term.Material and methods: A descriptive, comparative study was conducted in 2 centres through telephone interviews with patients who came for an initial visit between 2012 and 2014 for ED. A complete case history review was conducted on the use of and withdrawal from treatment. For current use, the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and the Global Assessment Questionnaire (GAQ) were filled out; for past use, only the GAQ was filled out. For the statistical analysis, we employed Fisher's exact test for comparisons of percentages and the Kruskal-Wallis test to compare means. Results: The study included 250 patients; 20.8% were prescribed intraurethral alprostadil (ALP-IU), 17.2% were prescribed intracavernous alprostadil (ALP-IC), 92.8% were prescribed a first IPD5, and 24.8% were prescribed at least a second IPD5. The treatment withdrawal rate was 62.07% for the first IPD5, 41.94% for the last IPD5, 69.23% for the ALP-IU and 65.11% for the ALP-IC (P = .007). The main reason for withdrawal for the IPD5 was a lack of response (32.76% of those who took IPD5). In addition to withdrawal, there were adverse reactions for ALP-IU and ALP-IC (28.85% and 11.63%, respectively). The mean duration of use until withdrawal was 4.3 months for IPD5, 2.2 months for ALP-IU and 5.5 months for ALP-IC (P = .064). The most favourable GAQ and EDITS scores were observed for IPD5 (EDITS score of 74). Sildenafil and tadalafil had the longest usage times (mean >5 months). Conclusions: The withdrawal rate for treating ED is high, with short usage times of a few months. A lack of response and adverse reactions were the main causes for withdrawal. The drugs that provide greater satisfaction are the IPD5, although there are no significant differences in the mean usage time between the different types and in aspects such as the mean usage time to withdrawal or the withdrawal rates

Satisfaction and treatment adherence in erectile dysfunction in the medium and long term. / Satisfacción y adherencia al tratamiento en disfunción eréctil a medio y largo plazo.

INTRODUCTION: The aim of this study was to show the satisfaction and treatment adherence in erectile dysfunction (ED) in the medium and long term. MATERIAL AND METHODS: A descriptive, comparative study was conducted in 2 centres through telephone interviews with patients who came for an initial visit between 2012 and 2014 for ED. A complete case history review was conducted on the use of and withdrawal from treatment. For current use, the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and the Global Assessment Questionnaire (GAQ) were filled out; for past use, only the GAQ was filled out. For the statistical analysis, we employed Fisher's exact test for comparisons of percentages and the Kruskal-Wallis test to compare means. RESULTS: The study included 250 patients; 20.8% were prescribed intraurethral alprostadil (ALP-IU), 17.2% were prescribed intracavernous alprostadil (ALP-IC), 92.8% were prescribed a first IPD5, and 24.8% were prescribed at least a second IPD5. The treatment withdrawal rate was 62.07% for the first IPD5, 41.94% for the last IPD5, 69.23% for the ALP-IU and 65.11% for the ALP-IC (P=.007). The main reason for withdrawal for the IPD5 was a lack of response (32.76% of those who took IPD5). In addition to withdrawal, there were adverse reactions for ALP-IU and ALP-IC (28.85% and 11.63%, respectively). The mean duration of use until withdrawal was 4.3 months for IPD5, 2.2 months for ALP-IU and 5.5 months for ALP-IC (P=.064). The most favourable GAQ and EDITS scores were observed for IPD5 (EDITS score of 74). Sildenafil and tadalafil had the longest usage times (mean >5 months). CONCLUSIONS: The withdrawal rate for treating ED is high, with short usage times of a few months. A lack of response and adverse reactions were the main causes for withdrawal. The drugs that provide greater satisfaction are the IPD5, although there are no significant differences in the mean usage time between the different types and in aspects such as the mean usage time to withdrawal or the withdrawal rates.

Relación entre los niveles de hormonas sexuales en varones por encima de los 50 años y composición corporal, calidad ósea y calidad de vida / Relationships between Sex Hormone Levels in Men over 50 Years of Age and Body Composition, Bone Quality, and Quality of Life

Objetivo: Determinar la relación existente entre los niveles de hormonas sexuales y la composición corporal, la salud ósea y la calidad de vida en hombres por encima de los 50 años. Material y métodos: Estudio transversal en el que se incluyen 230 pacientes. Se determina la composición corporal utilizando parámetros antropométricos directos como el peso, la talla, la circunferencia de la cintura, la circunferencia del brazo dominante, el pliegue cutáneo tricipital, el pliegue en brazo dominante y el pliegue subcapsular. Se calculan parámetros antropométricos indirectos. Se realizan medidas cuantitativas de densidad ósea mediante ecografía del calcáneo, así como marcadores de recambio óseo (N-telopéptidos de excreción urinaria y relación calcio/ creatina). La calidad de vida se evalúa mediante el cuestionario abreviado de calidad de vida SF-36. Los análisis sanguíneos incluyen la determinación de testosterona total, globulina transportadora de hormonas sexuales (SHBG), testosterona libre calculada (TLc), sulfato de dehidroepiandrosterona (S-DHEA), androsteriona, 17-β-estradiol y gonadotropinas. Resultados: La TLc se asocia con un incremento muscular y una disminución del contenido graso, aun ajustándolo por edad (p<0,05). La densidad ósea sólo se relaciona con los niveles de estradiol y su fracción biodisponible (p<0,05). El S-DHEA y la TLc están asociadas a algunas subescalas del SF-36 (p<0,05). Conclusiones: La TLc es la hormona que mejor se relaciona con los cambios corporales asociados a la edad; sin embargo, los niveles de andrógenos no están asociados a la densidad ósea. Un descenso en la TLc y el S-DHEA podría estar relacionado con un descenso en la calidad de vida (AU)

Objetive: To determine whether there was a relationship between sex hormone levels and body composition, bone health, and health-related quality of life in men over 50 years of age. Material and methods: Transversal study carried out in 230 Spanish male outpatients. Body composition was studied using direct anthropometric measures: height, weight, waistline circumference, dominant arm circumference, tricipital skinfold, dominant arm skinfold, subscapular skinfold. Calculated anthropometric parameters were obtained. Quantitative ultrasound measurements of the calcaneus were performed and bone turnover markers were determined (N-telopeptides urinary excretion and calcium/creatinine urinary rate). Quality of life was studied using the short form 36 questionnaire (SF-36). Blood tests included total testosterone, sex hormone binding-globulin, calculated free testosterone (cFT), dehydroepiandrosterone sulphate (DHEA-S), androstenedione, 17-β-estradiol and gonadotrophins. Results: cFT was associated with increased muscle and to decreased in fat content, even after adjusting for age (p<0.05). Bone density was only related to estradiol and its bioavailable fraction (p<0.05). DHEA-S and cFT were related (p<0.05) to some SF-36 subscales. Conclusions: cFT level is most associated with body changes that accompany aging. Androgen levels are not related to bone density. Decline in cFT and DHEA-s levels might be related to decreased quality of life (AU)

[Relationships between sex hormone levels in men over 50 years of age and body composition, bone quality, and quality of life]. / Relación entre los niveles de hormonas sexuales en varones por encima de los 50 años y composición corporal, calidad ósea y calidad de vida.

OBJECTIVE: To determine whether there was a relationship between sex hormone levels and body composition, bone health, and health-related quality of life in men over 50 years of age. MATERIAL AND METHODS: Transversal study carried out in 230 Spanish male outpatients. Body composition was studied using direct anthropometric measures: height, weight, waistline circumference, dominant arm circumference, tricipital skinfold, dominant arm skinfold, subscapular skinfold. Calculated anthropometric parameters were obtained. Quantitative ultrasound measurements of the calcaneus were performed and bone turnover markers were determined (N-telopeptides urinary excretion and calcium/creatinine urinary rate). Quality of life was studied using the short form 36 questionnaire (SF-36). Blood tests included total testosterone, sex hormone binding-globulin, calculated free testosterone (cFT), dehydroepiandrosterone sulphate (DHEA-S), androstenedione, 17-ß-estradiol and gonadotrophins. RESULTS: cFT was associated with increased muscle and to decreased in fat content, even after adjusting for age (p<0.05). Bone density was only related to estradiol and its bioavailable fraction (p<0.05). DHEA-S and cFT were related (p<0.05) to some SF-36 subscales. CONCLUSIONS: cFT level is most associated with body changes that accompany aging. Androgen levels are not related to bone density. Decline in cFT and DHEA-s levels might be related to decreased quality of life.

[Changes in sexual hormones in a male population over 50 years of age. Frequency of low testosterone levels and risk factors]. / Cambios en las hormonas sexuales en varones mayores de 50 años. Prevalencia de niveles bajos de testosterona y factores de riesgo.

OBJECTIVES: To investigate the changes in sexual hormones in a selected male population older than 50 years of age. To assess the frequency of biochemical hypogonadism and which factors are related to testosterone levels. PATIENTS AND METHODS: A Cross-sectional study was carried out on 230 Spanish men older than 50 years of age. Blood tests were performed including: total testosterone, SHBG, calculated free testosterone, dehidroepiandrosterone sulfate, androstendione, estradiol, bioavailable estradiol, FSH, LH, and prolactin. Clinical and socio-demographic backgrounds were investigated. The frequency of biochemical hypogonadism was established using total and free testosterone levels as diagnostic criteria. Factors that may influence testosterone levels were evaluated by univariate and multivariate statistical analysis, and a logistic regression model was used to determine which factors can predict biochemical hypogonadism according to free testosterone levels. RESULTS: Age was associated with a significant decrease (p < 0.05) in total testosterone (0.6% per year), free testosterone (1.3% per year), dehydroepiandrosterone sulfate (1.8% per year) and bioavailable estradiol (0.69% per year). Moreover, an increase in SHBG, LH, and FSH was observed (p < 0.05). According to total testosterone levels, 4.8% of the men were hypogonadal, whereas 24.8% were hypogonadal when free testosterone was considered. In the univariate analysis, obesity, diabetes mellitus and hyperlipemia were related to lower total testosterone levels, while free testosterone levels were lower in men with sedentary life, lower levels of education, obesity or diabetes mellitus. In the multivariate analysis age, diabetes mellitus and obesity were inversely related to total and free testosterone levels. Free testosterone was also inversely related to hyperlipemia. For biochemical hypogonadism, simple logistic regression analysis selected age, sedentary life, obesity and diabetes mellitus. In the multivariate analysis age, obesity and diabetes mellitus had significant independent prognostic value. CONCLUSIONS: Starting from 50 years of age, a significant age-related decrease in total testosterone, free testosterone, dehydroepiandrosterone sulfate and bioavailable estradiol is observed. The frequency of biochemical hypogonadism is higher when free testosterone levels are used for diagnosis. Total testosterone levels were related to age, diabetes mellitus and obesity. Free testosterone was related to age. diabetes mellitus, obesity and hyperlipemia. The probability of suffering low free testosterone levels increases with age, diabetes mellitus and/or obesity.

Cambios en las hormonas sexuales en varones mayores de 50 años. Prevalencia de niveles bajos de testosterona y factores de riesgo / Changes in sexual hormones in a male population over 50 years of age. Frequency of low testosterone levels and risk factors

Objetivos: Evaluar los cambios en las hormonas sexuales en una población masculina mayor de 50 años, conocer la frecuencia de hipogonadismo bioquímico y qué factores se relacionan con los niveles de testosterona. Pacientes y método: Estudio transversal en 230 varones sanos mayores de 50 años. Se realizaron determinaciones de testosterona total, testosterona libre, testosterona biodisponible, sulfato de de hidroepiandrosterona, estradiol total y biodisponible, LH, FSH y prolactina y se averiguaron los antecedentes clínicos y sociodemográficos. Determinamos la frecuencia de hipogonadismo bioquímico. Analizamos los factores que podían influir en los niveles de testosterona total y libre mediante análisis uni y multivariante y realizamos un análisis de regresión logística para conocer los factores que pueden predecir el hipogonadismo bioquímico en base a la testosterona libre. Resultados: A medida que incrementa la edad de los sujetos evaluados, se observan niveles significativamente más bajos (p<0,05) de los niveles de testosterona total (0,6% anual), testosterona libre (1,3% anual), sulfato de de hidroepiandrosterona (1,8% anual) y estradiol biodisponible (0,69% anual), mientras que se observó un incremento de la SHBG, la LH y la FSH (p>0,05).La prevalencia de niveles bajos de testosterona total fue del 4,8%, alcanzando el 24,8% cuando utilizamos como referencia la testosterona libre. La media de los niveles plasmáticos de testosterona total fue significativamente inferior en los varones con obesidad, diabetes mellitus o dislipemia, mientras que la de los niveles de testosterona libre fue menor en aquellos con estilo de vida sedentario, bajo nivel de estudios, obesos o con diabetes mellitus. En el análisis multivariante, la edad, la diabetes y la obesidad se relacionaron inversamente con los niveles de testosterona total. Con la testosterona libre se relacionan los mismos factores además de la dislipemia. En el análisis de regresión logística multivariante para el hipogonadismo bioquímico, la edad, la obesidad y la diabetes fueron las variables con valor predictivo independiente. Conclusión: A partir de los 50 años se produce un descenso significativo de testosterona total, testosterona libre, sulfato de de hidroepiandrosterona y estradiol biodisponible relacionado con la edad. La prevalencia de hipogonadismo bioquímico es mayor si utilizamos la testosterona libre. Los niveles de testosterona total se relacionan además de con la edad, con la diabetes y la obesidad, añadiéndose la dislipemia para la testosterona libre. La probabilidad presentar niveles bajos de testosterona libre aumenta con la edad y es mayor cuando existen antecedentes de diabetes mellitus y/u obesidad (AU)

Objectives: To investigate the changes in sexual hormones in a selected male population older than 50 years of age. To assess the frequency of biochemical hypogonadism and which factors are related to testosterone levels. Patients and methods: A Cross-sectional study was carried out on 230 Spanish men older than 50 years of age. Blood tests were performed including: total testosterone, SHBG, calculated free testosterone, dehidroepiandrosterone sulfate, androstendione, estradiol, bioavailable estradiol, FSH, LH, and prolactin. Clinical and socio-demographic backgrounds were investigated. The frequency of biochemical hypogonadism was established using total and free testosterone levels as diagnostic criteria. Factors that may influence testosterone levels were evaluated by univariate and multivariate statistical analysis, and a logistic regression model was used to determine which factors can predict biochemical hypogonadism according to free testosterone levels. Results: Age was associated with a significant decrease (p<0.05) in total testosterone (0.6% per year), free testosterone (1.3% per year),dehidroepiandrosterone sulfate (1.8% per year) and bioavailable estradiol (0.69% per year). Moreover, an increase in SHBG, LH, and FSH was observed (p<0.05). According to total testosterone levels, 4.8% of the men were hypogonadal, whereas 24.8% were hypogonadal when free testosterone was considered. In the univariate analysis, obesity, diabetes mellitus and hyperlipemia were related to lower total testosterone levels, while free testosterone levels were lower in men with sedentary life, lower levels of education, obesity or diabetes mellitus. In the multivariate analysis age, diabetes mellitus and obesity were inversely related to total and free testosterone levels. Free testosterone was also inversely related to hyperlipemia. For biochemical hypogonadism, simple logistic regression analysis selected age, sedentary life, obesity and diabetes mellitus. In the multivariate analysis age, obesity and diabetes mellitus had significant independent prognostic value. Conclusions: Starting from 50 years of age, a significant age-related decrease in total testosterone, free testosterone, dehidroepiandrosterone sulfate and bioavailable estradiol is observed. The frequency of biochemical hypogonadism is higher when free testosterone levels are used for diagnosis. Total testosterone levels were related to age, diabetes mellitus and obesity. Free testosterone was related to age, diabetes mellitus, obesity and hyperlipemia. The probability of suffering low free testosterone levels increases with age, diabetes mellitus and/or obesity (AU)