The long-term outcome of urethrotomy for primary urethral strictures: a population-based analysis.

OBJECTIVE: To determine the long-term outcome of endoscopic urethrotomy for primary urethral strictures based on a population-based approach. PATIENTS AND METHODS: We analysed a nationwide database of all patients with urethral stricture disease who underwent endoscopic urethrotomy as a primary intervention between January 2006 and December 2007. All patients were followed individually for 7-9 years. Frequencies and types of surgical re-interventions were documented. Repeat surgical interventions were stratified into three treatment types: urethrotomy, urethroplasty, and end-to-end urethral anastomosis. RESULTS: A total of 1203 men underwent urethrotomy during the index period. The median (SD, range) patient age was 63 (15.7, 20-85) years. A total of 136 patients (11%) died during follow-up. Within the follow-up period, 932 patients (78%) received no further surgical re-intervention for recurrent disease, and 176 patients (14.6%) required one, 53 (4.5%) two, and 41 (3.4%) three or more procedures. The mean number of re-interventions was 1.5/patient and the lowest re-intervention rate was in patients aged ≥80 years (13.9%). In 236 cases (68%) at least one repeat urethrotomy was performed. An open reconstruction was performed in 87 cases (32%), with urethroplasty in 21 patients (24%), and end-to-end anastomosis in 66 patients (76%). The mean interval until re-intervention was 29.5 months. CONCLUSIONS: This long-term population-based study suggests that the invasive re-treatment rate in men following initial urethrotomy is 22% within 8 years and lowest in the advanced age cohort.

Is the metabolic syndrome an independent risk factor for erectile dysfunction?

PURPOSE: We determined the role of the metabolic syndrome as an independent risk factor for erectile dysfunction. MATERIALS AND METHODS: Men participating in a health screening project completed the International Index of Erectile Function-5. The metabolic syndrome was defined according to the 2005 International Diabetes Federation consensus definition. Multiple linear regression, ANOVA and chi-square tests were used to investigate the impact of the metabolic syndrome on erectile dysfunction. RESULTS: A total of 2,371 men with a mean age of 46.1 years (SD 9.9, range 30 to 69) were analyzed. Of the men 33.4% (652) had no erectile dysfunction (International Index of Erectile Function-5 score 22 to 25), 59.7% (1,166) had mild erectile dysfunction (International Index of Erectile Function-5 score 17 to 21) and 6.9% (134) had moderate to severe erectile dysfunction (International Index of Erectile Function-5 score 5 to 16). The metabolic syndrome was present in 33.8% (794). In a multiple linear regression analysis an increased waist-to-hip ratio (p = 0.01) and metabolic syndrome (p = 0.01) turned out to be independently associated with a decreased International Index of Erectile Function-5 score. When stratified according to age, the metabolic syndrome was correlated to erectile dysfunction only in men 50 years old or older with an increase of severe erectile dysfunction by 48% (p = 0.01). CONCLUSIONS: The metabolic syndrome and an increased waist-to-hip ratio are independently associated with a decreased International Index of Erectile Function-5 score. The metabolic syndrome in men older than 50 years is significantly associated with a higher proportion of moderate to severe erectile dysfunction.

Radical prostatectomy for localized prostate cancer in a liver transplant recipient.

The increasing length of survival of organ transplant recipients necessitates careful attention to the potential neoplastic complications of life-long immunosuppressive therapy. Due to the rarity of prostate cancer after liver transplantation there are no guidelines for its management. In our case, prostate biopsy revealed prostate cancer in a 59-year-old man after an uncomplicated 5-year post-transplant course. After meticulous lymph node dissection, we performed radical retropubic prostatectomy. The postoperative period was uneventful and the prostate-specific antigen value 18 months after surgery was <0.1 ng/ml. We believe that radical retropubic prostatectomy is technically feasible in patients after liver transplantation and should be offered as a treatment option for every patient with good graft function.

Prevalence and risk factors for erectile dysfunction in 2869 men using a validated questionnaire.

PURPOSE: To assess prevalence and risk factors for erectile dysfunction (ED) by using the International Index of Erectile Function- 5 (IIEF-5) in men undergoing a health investigation. METHODS: Men aged 20-80 years participating in a health-screening project in the area of Vienna completed the IIEF-5 for evaluation of ED. In parallel, all men underwent a detailed health examination including physical assessment, evaluation of various life-style factors, medical history and a blood analysis. RESULTS: A total of 2869 men were analysed. According to the IIEF-5 score, 32.2% reported on any degree of ED (IIEF-5 score <22), 23.7% had mild ED (IIEF-5 score 17-21), 5.0% mild to moderate ED (IIEF-5 score 12-16), 2.2% moderate ED (IIEF-5 score 8-11) and 1.3% severe ED (IIEF-5 score 5-7). The proportion of men with ED remained stable from 20 to 50 years (26-29%) and increased thereafter to 37.5% (51-60 years) and to 71.2% in those 71-80 years of age. Severe ED (IIEF-5 score 5-7) increased from 0.4% (20-30 years) to 0.5% (41-50 years), 1.3% (51-60 years) and to 9.6% in those aged 71-80 years. Risk factors for ED were age, diabetes (OR: 3.0; 95%CI: 1.53-5.87), hyperlipidemia (OR: 2.29; 95%CI: 1.42-3.7), lower urinary tract symptoms (OR: 2.2; 95%CI: 1.76-2.76), hypertension (OR: 2.05; 95%CI: 1.61-2.6), psychological stress (OR: 1.68; 95%CI: 1.43-1.98) and low physical activity (OR: 1.35; 95%CI: 1.15-1.6) (all, p < 0.05). CONCLUSION: Overall, 32.2% of men in our study had ED according to the IIEF-5. Apart from age, most important risk factors for ED were diabetes, hyperlipidemia, lower urinary tract symptoms, hypertension and psychological stress.

Prevalence and risk factors for erectile dysfunction in Austria--analysis of a health screening project.

PURPOSE: The aim of this study was to determine prevalence and risk factors for erectile dysfunction (ED) in men undergoing a health investigation. METHODS: Men aged 30-69 yrs participating in a health screening project in the area of Vienna completed a 11-item questionnaire on ED which was extracted from the international index of erectile function (IIEF). In parallel, all men underwent a detailed health examination including physical assessment, evaluation of various life-style factors and a blood analysis with 14 parameters. RESULTS: Within the total study population (n = 832; 45.3 +/- 9.8 yrs), 8.2% reported no sexual intercourse during the previous four weeks, 5.1% reported moderate/severe ED, 13.1% mild and 73.6% no ED. ED, defined as any problem in maintaining erection until the end of sexual intercourse, increased from 12.5% in those aged 30-39 yrs to 15.3% at 40-49 yrs, 27.4% at 50-59 yrs and 45.2% in men 60-69 yrs. In parallel, the percentage of men without sexual intercourse during the previous four weeks increased from 7.4% at 30-39 yrs to 8.8% at 50-59 yrs and 17.0% at 60-69 yrs. By far the strongest correlate for ED was age; other factors were cardiovascular diseases, physical activity and diabetes mellitus. CONCLUSIONS: This study provides the first estimate of the prevalence of ED in different life decades of men in Vienna, and identifies a number of risk factors for this highly prevalent disorder in ageing men.