Collagen content in the bladder of men with LUTS undergoing open prostatectomy: A pilot study.

AIMS: To evaluate the collagen content in the bladder wall of men undergoing open prostate surgery. METHODS: From July 2014 to August 2016, men aged ≥ 50 years, presenting LUTS and undergoing open prostate surgery due to benign prostatic enlargement (BPE) or prostate cancer were prospectively enrolled. Preoperative assessment included validated questionnaires (IPSS and OAB-V8), lower urinary tract ultrasound, and urodynamics. Bladder biopsies were obtained during open prostatectomy for determination of collagen content (sirius red-picric acid stain; polarized light analysis). Collagen to smooth muscle ratio (C/M) in the detrusor was measured and its relationship with preoperative parameters was investigated. The level of significance was P < 0.05. RESULTS: Thirty-eight consecutive patients were included in this pilot study. Mean age was 66.36 ± 6.44 years and mean IPSS was 11.05 ± 8.72 points. Men diagnosed with diabetes mellitus (DM2) were found to have higher collagen content in the bladder wall when compared to non-diabetic patients (17.71 ± 6.82% vs 12.46 ± 5.2%, respectively; P = 0.024). Reduced bladder compliance was also marker for higher collagen content (P = 0.042). Bladder outlet obstruction (BOO) was not a predictor of increased collagen deposition in the bladder wall (P = 0.75). Patients with PVR ≥ 200 mL showed a higher collagen to smooth muscle ratio in the bladder wall (P = 0.036). CONCLUSIONS: DM2 and urodynamic parameters, such as increased PVR and reduced bladder compliance, were associated with higher collagen content in the bladder wall of men with LUTS.

Neck circumference and central obesity are independent predictors of coronary artery disease in patients undergoing coronary angiography.

Excess of adiposity is a risk factor for coronary artery disease, but it remains unclear if the distribution of fat is an effect modifier or if the risk is mediate by hypertension, diabetes and dyslipidemia. We investigated the association of central in addition to general obesity with coronary artery disease (CAD). A case-control study was conducted in 376 patients, aged 40 years or more, with chronic coronary disease, undergoing elective coronary angiography. Excess of adiposity was evaluated by the Body Mass Index (BMI), waist circumference, waist-hip ratio, and neck circumference. Cases (n=155) were patients referred for coronary angiography with at least 50% of coronary stenosis in at least one epicardial vessels or their branches, with diameter greater than 2.5 mm. Controls (n=221) were patients referred for coronary angiography without significant coronary disease. Odds ratios and 95%CI for significant coronary stenosis were calculated using multiple logistic regression, controlling for age, sex, years at school, smoking, hypertension, HDL-cholesterol, diabetes mellitus, and an adiposity index. There was a predominance of men and individuals older than 50 years among cases. The waist-hip ratio increased four times the chance of CAD, even after the control for confounding factors, including BMI. Neck circumference above the 90(th) Percentile doubled the chance of CAD, after adjustment for traditional risk factors. Neck circumference and waist-hip ratio are independent predictors of CAD, even taking into account traditional risk factors for CAD. These findings highlight the need of anthropometric assessment among patients with suspected coronary artery disease.

Erectile dysfunction and coronary artery disease: an association of higher risk in younger men.

INTRODUCTION: The association between erectile dysfunction (ED) and coronary artery disease (CAD) has been described in various settings, but it is unclear if there is an independent interaction with age. AIM: To investigate the interaction of age in the association between ED and CAD. METHODS: This case-control study was conducted among 242 patients referred for elective coronary angiography. One hundred fourteen patients with significant CAD were identified as cases and 128 controls without significant CAD. ED was evaluated by the erectile function domain of the International Index of Erectile Function (IIEF) questionnaire, determined by a score ≤ 25 points. MAIN OUTCOME MEASURES: Significant CAD was based on stenosis of 50% or greater in the diameter in at least one of the major epicardial vessels or their branches. The analysis was conducted in the whole sample and according to the age strata, controlling for the effects of cardiovascular risk factors, testosterone, and C-reactive protein. Results. Patients had on average 58.3 ± 8.9 years. CAD and ED were associated exclusively in patients younger than 60 years (ED in 68.8% of patients with CAD vs. 46.7% of patients without CAD, P = 0.009). The association was independent of cardiovascular risk factors, testosterone and C-reactive protein (risk ratio 2.3, 95% confidence interval from 1.04 to 5.19). Severity of CAD was higher in patients younger than 60 years with ED. CONCLUSIONS: Men with less than 60 years of age who report ED presented a higher risk of having chronic CAD and more severe disease diagnosed by coronary angiography.

Antibiotics and observation have a similar impact on asymptomatic patients with a raised PSA.

OBJECTIVES: • To compare the influence of a 4-week course of empirical antimicrobial therapy or observation on the prostate-specific antigen (PSA) levels of asymptomatic patients with a raised baseline PSA. • To identify whether a decrease in PSA can predict the risk of prostate cancer (PCa) detection on prostate biopsy. PATIENTS AND METHODS: • Patients were referred to our ambulatory centre because of a raised PSA level (>2.5 ng/mL) with a normal digital rectal examination. A 12-core prostate biopsy was indicated in these patients and they were offered antibiotic treatment with levofloxacin 500 mg daily for 30 days. • Patients who did not agree to use antibiotics but who still showed interest in participating underwent simple observation, serving as controls. • Total and free PSA levels at baseline and after 45 days were measured. Variation in PSA level was calculated. • All patients underwent a 12-core prostate biopsy 6 weeks after the initial visit. RESULTS: • In all, 245 men were enrolled, but 43 were lost due to follow-up. A total of 145 patients who used antibiotics and 57 controls were included in the analysis. • The median baseline PSA levels were 7.6 and 7.7 ng/mL in the antibiotic and control groups, respectively, with median follow-up levels of 6.8 and 7.0 ng/mL. The follow-up PSA level was significantly lower than the initial PSA level (P = 0.009). • Mean absolute and percentage variation in PSA level were similar in both groups (P = 0.828 and 0.128, respectively). • The overall PCa detection rate was 15.8%, and did not differ among the groups (P = 0.203). Regarding the percentage variation in PSA level, patients diagnosed with PCa tended to have their PSA level increased (22.4 vs -5.3%; P = 0.001). Indeed, a decrease of 20% in PSA was not predictive of a negative prostate biopsy (P = 0.41). • The area under the receiver operating characteristic curve for percentage PSA variation as a predictor of PCa was 0.660. CONCLUSIONS: • PSA levels tend to fall when repeated after 45 days, regardless of antibiotic use. • Despite being associated with the chance of PCa, no percentage PSA variation threshold value exhibits satisfactory discriminatory properties.

Diabetes mellitus is associated with subnormal serum levels of free testosterone in men.

OBJECTIVE: To evaluate the relationship between diabetes mellitus (DM) and serum levels of free (FT) and total (TT) testosterone. PATIENTS AND METHODS: A cross-sectional study was carried out including 746 men, of whom 116 (15.6%) were diabetics. Both groups, diabetic and nondiabetic, were paired according to age. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated, and a stratification analysis correlating DM and elevated BMI (>25 kg/m(2)) and WHR (>1) with the presence of subnormal FT and TT levels was performed. RESULTS: FT and TT serum levels were subnormal in 46% and 34% of diabetics, respectively, and in 24% and 23% of nondiabetics. Subnormal FT levels were strongly correlated with DM (odds ratio (OR) 2.7; 95% confidence interval (CI) 1.8-4.1) but not with elevated BMI (OR 1.4; 95% CI 1.0-2.0). Subnormal TT levels were more strongly associated with elevated BMI and WHR (OR 2.6; 95% CI 1.7-3.9 and 2.0; 1.4-2.9) than with DM (1.7; 1.1-2.6 and 2.0; 1.3-3.2). CONCLUSION: These data strongly suggest that DM is associated with subnormal FT levels, and that TT levels are influenced more by obesity and central adiposity.

Glycosylated haemoglobin levels and the severity of erectile function in diabetic men.

OBJECTIVE: To evaluate the association between the levels of glycosylated haemoglobin (HbA1c) and the severity of erectile dysfunction (ED) in men with diabetes mellitus (DM). PATIENTS AND METHODS: This cross-sectional study included sexually active men with a diagnosis of DM attending a urological medical centre from January 2000 to December 2001. The 115 men with ED (95%) completed the International Index of Erectile Function questionnaire, and fasting serum glucose and HbA1c serum levels were measured. The relationship between the severity of ED and serum HbA1c levels was assessed. RESULTS: Of men with HbA1c levels of < 8%, half had mild, and 18% and 32% had moderate and severe ED, respectively (P = 0.038); of men with HbA1c levels of > or = 8%, 25%, 29%, and 46% had mild, moderate and severe ED, respectively (P = 0.008). In addition, men with HbA1c levels of > or = 11% had a statistically higher prevalence of severe ED (P = 0.002). There was no difference in severity of ED in the HbA1c subgroups when the duration of DM was < or = 5 years (P = 0.87), but most men with HbA1c levels of > or = 8% and a history of DM of 6-10 or > 10 years had severe ED (P < 0.03). CONCLUSION: This study suggests that the severity of ED is associated with increasing HbA1c levels in diabetic men.

Effects of the chronic use of dehydroepiandrosterone (DHEA) on testicular weight and spermatogenesis: experimental study in rats.

AIM: The complete biological effects of chronic use of dehydroepiandrosterone (DHEA), reported as a weak androgen, are not completely understood. The aim of the present study is to evaluate the effects of chronic administration of DHEA on the spermatogenesis in rats. METHODS: Male Wistar rats, 4 months old, were selected for the study. The animals were divided into two groups. Group 1 (n = 9) received placebo (saline solution) 0.5 ml/day and Group 2 (n = 15) received DHEA 5 mg/kg/day. Both the groups received the respective treatments 5 days a week during 10 months. At the end of the exposure, the rats were sacrificed and the testes removed, weighed and processed for histologic analysis. Spermatogenesis was evaluated as the mean number of seminiferous tubules with and without spermatids in maturation phase in their lumen, in five random fields on the same slide. RESULTS: The median levels of serum total testosterone and dehydroepiandrosterone sulfate was measured in the two groups. Significant higher concentrations in total testosterone (2.06 +/- 0.4 vs. 0.80 +/- 0.2; p < 0.05) and DHEAS (222.1 +/- 41.5 vs. 2.0 +/- 0.3) were observed in the group treated with DHEA as compared to the control group. The mean weights of the right testes were 1.59 +/- 0.3 in group 1 and 1.58 +/- 0.2 g in group 2 (p > 0.05). These values for the left testes were 1.57 +/- 0.3 and 1.55 +/- 0.3 g, respectively (p > 0.05). The histologic analysis showed a mean of 13.5 +/- 1.5 and 12.8 +/- 1.8 seminiferous tubules per field in the groups 1 and 2, respectively (p > 0.05). The same analysis demonstrated that in the control group 0.06 +/- 0.1 of the tubules presented without spermatids in maturation phase and in the DHEA group this was observed in 0.22 +/- 1.2 of the tubules (p > 0.05). CONCLUSION: Chronic administration of DHEA in the present dose did not show any detectable effect on the quantitative and qualitative analyses of spermatogenesis in rats.

Value of prostate specific antigen in predicting the existence of bone metastasis in scintigraphy

OBJECTIVE: Evaluate the ability of serum concentration of prostate specific antigen (PSA) between 2 cutting points to predict the existence of bone metastasis confirmed by bone scintigraphy in man with prostate cancer. MATERIALS AND METHODS: Two hundred and fourteen consecutive patients with prostate cancer were evaluated during the present study in the period from 1998 to 2001. From all patients, PSA serum concentrations and bone scintigraphy were obtained. For the study, 2 cutting points of PSA (10 and 20 ng/mL) were adopted to predict the existence of bone metastasis. RESULTS: From the 214 patients, 35 (16.3 percent) presented positive scintigraphic examinations for the presence of bone metastasis. No patient presented bone metastasis in scintigraphy if having PSA < 10 ng/mL, and in only 1 patient (0.46 percent) with bone metastasis PSA concentration was < 20 ng/mL. Therefore, when the cutting point adopted for PSA serum concentration was 10 ng/mL, a negative predictive value for bone metastasis was 100 percent with sensitivity rates of 100 percent. Nevertheless, the positive predictive value and the specificity of the method were, respectively, 24.5 percent and 39.7 percent. When the cutting point of PSA serum concentration was 20 ng/mL, an increment was observed in rates of positive predictive value and specificity (41.5 percent and 73.2 percent), respectively, without substantial changes in negative predictive value (99.2 percent) and sensitivity (97.1 percent) of the method. CONCLUSIONS: Data of present study allow for the conclusion that PSA serum concentration over 20 ng/mL was a more accurate cutting point than PSA serum concentration over 10 ng/mL to predict the presence of bone metastasis in scintigraphy

Value of prostate specific antigen in predicting the existence of bone metastasis in scintigraphy.

OBJECTIVE: Evaluate the ability of serum concentration of prostate specific antigen (PSA) between 2 cutting points to predict the existence of bone metastasis confirmed by bone scintigraphy in man with prostate cancer. MATERIALS AND METHODS: Two hundred and fourteen consecutive patients with prostate cancer were evaluated during the present study in the period from 1998 to 2001. From all patients, PSA serum concentrations and bone scintigraphy were obtained. For the study, 2 cutting points of PSA (10 and 20 ng/mL) were adopted to predict the existence of bone metastasis. RESULTS: From the 214 patients, 35 (16.3 x 0025;) presented positive scintigraphic examinations for the presence of bone metastasis. No patient presented bone metastasis in scintigraphy if having PSA < 10 ng/mL, and in only 1 patient (0.46 x 0025;) with bone metastasis PSA concentration was < 20 ng/mL. Therefore, when the cutting point adopted for PSA serum concentration was 10 ng/mL, a negative predictive value for bone metastasis was 100 x 0025; with sensitivity rates of 100%. Nevertheless, the positive predictive value and the specificity of the method were, respectively, 24.5 x 0025; and 39.7 x 0025;. When the cutting point of PSA serum concentration was 20 ng/mL, an increment was observed in rates of positive predictive value and specificity (41.5 x 0025; and 73.2 x 0025;), respectively, without substantial changes in negative predictive value (99.2 x 0025;) and sensitivity (97.1 x 0025;) of the method. CONCLUSIONS: Data of present study allow for the conclusion that PSA serum concentration over 20 ng/mL was a more accurate cutting point than PSA serum concentration over 10 ng/mL to predict the presence of bone metastasis in scintigraphy.

Efeito de drogas antiinflamatórias e antifibrosantes sobre aderências intra-abdominais pós-operatórias, em um modelo animal / Effect of anti-inflammatory and antifibrotic agents on postoperative intraabdominal adhesions, in an animal model

Neste estudo experimental comparou-se o efeito de drogas antiinflamatórias e antifibrosantes sobre as aderências peritoneais pós-operatórias. Foram utilizados 32 ratos machos Wistar, que foram divididos em 4 grupos de oito, que receberam as seguintes soluçöes: grupo I) soluçäo fisiológica; grupo II) prednisona; grupo III) colchicina; grupo IV) diclofenaco sódico. A dose utilizada de todas as soluçöes foi de 1ml/Kg. A operaçäo realizada foi uma laparotomia mediana, com remoçäo de serosa de intestino grosso e abrasäo do peritôneo. As drogas utilizadas nos grupos II e III mostraram-se mais efetivas em inibir a neoformaçäo vascular e fibrose, quando comparadas à do grupo IV (p<0,05). Um modelo animal que permite o estudo da patogênese das bridas pós-operatórias foi desenvolvido