Review article: the safety of therapeutic drugs in male inflammatory bowel disease patients wishing to conceive.

BACKGROUND: Many therapeutic drugs are used by patients with inflammatory bowel disease, often around the time of conception. The pregnancy outcomes of males and females exposed to these therapeutics needs to be examined and this information is necessary to counsel patients appropriately. AIM: To review the literature describing male infertility and inflammatory bowel disease to educate practitioners of the impact of inflammatory bowel disease on male reproduction and the impact of therapeutics on pregnancy outcomes. METHODS: We performed a PubMed search using the search terms 'male infertility,' 'Crohn's disease,' 'inflammatory bowel disease,' 'ulcerative colitis,' 'ciprofloxacin AND infertility,' 'metronidazole AND infertility,' 'sulfasalazine AND infertility,' 'azathioprine AND infertility,' 'methotrexate AND infertility,' 'ciclosporin AND infertility,' 'corticosteroids AND infertility,' 'infliximab AND male fertility,' 'infliximab AND infertility,' 'infliximab AND foetus,' 'infliximab AND paternal exposure' and 'infliximab AND sperm.' References from selected papers were reviewed and used if relevant. RESULTS: Over half of male patients with IBD have some degree of infertility, compared to 8-17% of the general population. Semen parameters including total count, motility and morphology may be adversely affected by therapeutics. IBD medications in males do not increase foetal risk with the possible exception of azathioprine and mercaptopurine; however, increased foetal risk is seen in other drugs if taken by female patients. CONCLUSIONS: It is recognised that male infertility is often impacted with therapeutic drugs used to treat inflammatory bowel disease; however, the effects of the paternal drug exposure at the time of conception and exposure in utero should be considered to counsel patients appropriately.

COX-2 inhibition demonstrates potent anti-proliferative effects on bladder cancer in vitro.

PURPOSE: The purpose of this work was to determine the in vitro effect of Rofecoxib and specific COX 1 and COX 2 inhibitors in regards to cell growth and apoptotic and necrotic activity. INTRODUCTION AND OBJECTIVE: Rofecoxib (Vioxx) is a nonsteroidal anti-inflammatory agent (NSAID) that selectively inhibits cyclooxygenase-2 (COX-2). The inducible isoform of COX-2 is overexpressed in many gastrointestinal and genitourinary tract tumors. We hypothesized that in vitro treatment with both COX-1 and COX-2 inhibitors would significantly reduce cellular proliferation of bladder cancer cells by apoptotic pathways. MATERIALS AND METHODS: Two human bladder cancer cell lines were grown in culture using standard techniques and treated with Rofecoxib at doses ranging from 125 microg/well serially diluted down to 8.0 microg/well. Catechin (COX 1 inhibitor) and NS398 (COX 2 inhibitor) were used at doses of 50 and 100 microM. Cell viability was measured by MTT at 24 and 72 h. Apoptosis was evaluated by the Annexin V FITC Assay. Statistical analysis was performed by ANOVA. RESULTS: Rofecoxib, Catechin, and NS398 all exhibited significant inhibition of cell growth when compared to the nontreated controls. Significant changes in apoptotic activity were observed in all agents tested in both the T24 and the TCCSUP cells. CONCLUSIONS: Selective COX-2 inhibition, using the well-tolerated and commercially available Rofecoxib (VIOXX) and specific COX 1 and 2 inhibitors, reduced the growth of human bladder cancer in vitro by apoptotic mechanisms. Further in vivo and human studies are warranted to evaluate the safety and clinical utility of this agent in patients with bladder cancer.

Quality control in the screening of erectile dysfunction--results of a survey.

OBJECTIVES: To evaluate the screening patterns of primary care physicians with regard to erectile dysfunction (ED). METHODS: A prospective study was performed using an institutional review board-approved Sexual Health Inventory for Men questionnaire of male patients presenting to a university-based urology clinic. The data were compiled and analyzed with descriptive statistics using Statistical Package for Social Sciences, version 10.0, software. RESULTS: Of 140 patients, 102 completed and returned the survey. Of these patients, 93% were white. Twenty-five percent were between the ages of 40 and 50 years, 20% were between the ages of 51 and 60 years, and 24% were between the ages of 60 and 70 years. The average number of risk factors for ED identified in the patient population was 2.1. Fifty-six percent of patients had a Sexual Health Inventory for Men score of 21 or less, indicative of an element of ED. Eighty-three percent had primary care physicians; 23% of patients with a primary care physician were screened for ED. Of those screened, 58% of patients initiated the discussion with their physician. CONCLUSIONS: Screening for ED, using the Sexual Health Inventory for Men instrument, should be performed on patients with any identifiable risk factor. Screening is appropriate because effective treatment of ED is available and because ED can be associated with occult cardiac disease.

Efficacy and safety of oral sildenafil in men with erectile dysfunction and spinal cord injury.

OBJECTIVE: To assess the efficacy of sildenafil in men with spinal cord injury (SCI) and erectile dysfunction (ED). METHODS: Seventeen men with SCI were selected from February to September 1998 for sildenafil treatment of ED. The initial dose of 25 mg was increased by 25-mg increments as needed. Patients underwent baseline physical examination and answered questions from the abridged International Index of Erectile Function before and during therapy. RESULTS: Sixteen patients tolerated therapy; 1 developed hypotension and discontinued therapy. There was significant improvement in erectile function (P < .05) after 5.3 +/- 2.2 months when compared with baseline or previous therapies (P < .05). Of the 17 patients, 94% recommended sildenafil to others. Six of these 16 patients were available for long-term follow-up. There was further significant improvement in quality of erection (P < .05), but no change in satisfaction. CONCLUSION: Sildenafil is effective and well tolerated in men with SCI and ED.

Adenocarcinoma of the urachus masquerading as a right lower quadrant mass: a case report.

We report a patient who presented initially with a right lower quadrant mass which was attached to the anterior abdominal wall. The final pathological diagnosis was adenocarcinoma of the urachus, an exceedingly rare bladder tumor.

A simplified pharmacologic erection program for patients with spinal cord injury.

INTRODUCTION AND OBJECTIVES: Intracavernosal injection (ICI) of vasoactive agents has been successfully used in the treatment of erectile dysfunction (ED). The authors' pharmacologic erection program, using a fixed combination of prostaglandin E1 (PGE1) and papaverine, is notable for its simplicity and acceptance by patients who have suffered spinal cord injuries (SCIs). METHODS: Patients undergo baseline questionnaire, physical examination, and hormone profile followed by instruction and injection of a fixed combination of PGE1 and papaverine. On successive visits, the patient injects himself and the dosage is titrated until a satisfactory erection is obtained. Patients who do not respond to injection of 1.0 cc are considered treatment failures. Patients return periodically for routine follow-up. RESULTS: From May 1994 to March 1997, 37 patients with SCI underwent initial evaluation and 28 (76%) responded to injection therapy and were successfully using self-injection therapy at 3-month follow-up. Twenty-three patients are still on injection therapy. Five patients have dropped out for several reasons including a lack of a current sexual partner (60%) and pain with injection (40%). Patient age ranges from 24 to 72. The dosage range was 0.10 to 0.50 cc (mean = 0.29 cc). The average duration of erection was 43 minutes. At 3-month follow-up, 85% of the patients rated their erections as good or excellent. Forty-three percent of patients are using ICI 1 or more times per week. Seventy-seven percent of patients are moderately or extremely satisfied with their treatment and 89% said that they would recommend this program to a friend. CONCLUSIONS: This simplified pharmacologic erection program offers safe, well accepted, and effective therapy for ED to a SCI population with very high patient satisfaction.

Intracavernosal injection therapy and other treatment options for erectile dysfunction.

In the United States, almost 30 million men have complete or partial erectile dysfunction. This disorder occurs in approximately 52% of men between 40 and 70 years of age; 70% of affected men younger than 35 years of age have psychogenic causes, and 85% of men older than 50 years of age have organic impotence. Furthermore, erectile dysfunction is exacerbated by the presence of such conditions as heart disease, diabetes, and hyperlipidemia and the medications used to manage them. Thus, a widespread segment of the population is in need of a safe and effective treatment strategy for restoration of normal sexual function. The technique of intracavernosal injection therapy was initially described in the early 1980s. During the subsequent decade, the effectiveness of various drug combinations and the associated side effects were demonstrated. In 1995, prostaglandin E(1) was approved for intra-cavernosal pharmacotherapy. It has proved highly effective for neurogenic, vasculogenic, and psychogenic erectile dysfunction, with reported response rates of 75 to 92%. The major side effect (albeit uncommon) is corporal fibrosis. Other options for treatment of erectile dysfunction are vacuum-erection devices and penile prostheses.