What are the Main Risk Factors Associated with Erectile Dysfunction in the Elderly? A Cross-Sectional Study of 2436 Brazilian Elderly Men.

Background: Erectile dysfunction (ED) is a multifactorial medical disorder often neglected in clinical practice between elderly men, defined as the inability to achieve and/or maintain a penile erection sufficient for satisfactory sexual intercourse and a common clinical entity among men and associated with impaired quality of life and cardiovascular diseases in elderly men. The aim of this study is to evaluate the association between ED and clinical, demographic and behavioral parameters in elderly men. Methods: A total of 2436 males aged 60 years and over who participated in the health screening between January 2008 and December 2018 were included in this study. Laboratory exams, clinical and behavior profiles were analyzed. Logistic regression models were used. Results: Men with ED were older (65.87±5.49 vs. 63.85±4.05 years old. p<0.001), higher prevalence of physical inactivity (23.8 vs. 19%, p = 0.039) and had a higher body mass index (BMI; 28.36±4.06 vs. 27.72±3.89 kg/m2. p<0.001) than men without ED. The multivariate model shown that hypertension (p = 0.001), diabetes mellitus (p<0.001), lower urinary tract symptoms (LUTS), depressive symptoms (p<0.001) and age (p<0.001), were strongly associated with ED. Conclusion: The main risk factors associated with ED in elderly men were hypertension, diabetes mellitus, LUTS, depressive symptoms and age.

Effect of unilateral renal ischemia on the contralateral kidney assessed by Caspase 3 expression.

BACKGROUND: Studies have demonstrated with histological analysis and Doppler flow measurement analysis that unilateral renal ischemia, which is performed in some surgeries, interfered with the contralateral kidney, identifying the phenomenon of kidney-kidney crosstalk. OBJECTIVES: To identify the effects on the ischemic and contralateral kidney of renal ischemia induced by two types of clamping technique by analyzing the volume of kidney cells positive for Caspase 3. METHODS: Sixteen pigs were divided into 2 groups, as follows: A (n = 8) - clamping of left renal artery only and AV (n = 8) - clamping of left renal artery and vein. Immunohistochemical analyses (anti Caspase 3) were conducted with biopsy specimens collected from the ischemic and contralateral kidney at 0, 30, 60, and 90 minutes of ischemia and morphometric analysis was performed, taking the mean to represent the volume of the Caspase 3 positive area (%). RESULTS: Morphometric analysis of specimens collected at 30, 60, and 90 minutes of ischemia showed that the mean area marked for Caspase 3 was statistically larger in the contralateral kidney than the ischemic kidney in both groups: clamped renal artery (A) and clamped renal artery and vein (AV). Comparing the ischemic and contralateral kidney, there was no statistically significant difference in the area marked for Caspase 3 between the two types of clamping. CONCLUSIONS: In the experimental model of unilateral renal ischemia, the non-ischemic kidney exhibited cell damage, demonstrated by Caspase 3 expression. The type of hilum clamping does not appear to influence the area marked for Caspase 3.

Efeito da isquemia renal unilateral no rim contralateral avaliada pela expressão de Caspase 3 / Effect of unilateral renal ischemia on the contralateral kidney assessed by Caspase 3 expression

Resumo Contexto Estudos demonstraram, por análise histológica e Dopplerfluxométrica, a interferência da isquemia renal unilateral, realizada em algumas cirurgias, sobre o rim contralateral, identificando o fenômeno de kidney-kidney crosstalk. Objetivos Identificar o efeito da isquemia de duas estratégias de oclusão da vasculatura renal esquerda sobre o rim contralateral através do volume de células renais positivas para Caspase 3. Métodos Suínos foram divididos em 2 grupos: A (n = 8), artéria renal esquerda clampeada, e AV (n = 8), artéria e veia renais esquerdas clampeadas. Foi realizado o estudo imuno-histoquímico (anti-Caspase 3), com o material de biópsias coletadas do rim isquêmico e contralateral em 0, 30, 60 e 90 minutos de isquemia, e análise morfométrica, sendo que a média representou o volume de área de Caspase 3 positiva (%). Resultados A análise morfométrica do rim contralateral nos tempos 30, 60 e 90 minutos de isquemia mostrou que a média da área marcada por Caspase 3 foi estatisticamente superior à média do rim isquêmico nos dois grupos: artéria renal clampeada (A) e artéria e veia renais clampeadas (AV). Comparando o rim isquêmico e contralateral nos dois tipos de clampeamento, não houve diferença estatisticamente significante da área marcada por Caspase 3. Conclusões No modelo experimental de isquemia renal unilateral, o rim não isquêmico apresentou dano celular, demonstrado pela expressão da Caspase 3 de forma aguda em decorrência da isquemia contralateral. O tipo de clampeamento do hilo não parece ter influência sobre o volume de área marcada por Caspase 3.

Abstract Background Studies have demonstrated with histological analysis and Doppler flow measurement analysis that unilateral renal ischemia, which is performed in some surgeries, interfered with the contralateral kidney, identifying the phenomenon of kidney-kidney crosstalk. Objectives To identify the effects on the ischemic and contralateral kidney of renal ischemia induced by two types of clamping technique by analyzing the volume of kidney cells positive for Caspase 3. Methods Sixteen pigs were divided into 2 groups, as follows: A (n = 8) - clamping of left renal artery only and AV (n = 8) - clamping of left renal artery and vein. Immunohistochemical analyses (anti Caspase 3) were conducted with biopsy specimens collected from the ischemic and contralateral kidney at 0, 30, 60, and 90 minutes of ischemia and morphometric analysis was performed, taking the mean to represent the volume of the Caspase 3 positive area (%). Results Morphometric analysis of specimens collected at 30, 60, and 90 minutes of ischemia showed that the mean area marked for Caspase 3 was statistically larger in the contralateral kidney than the ischemic kidney in both groups: clamped renal artery (A) and clamped renal artery and vein (AV). Comparing the ischemic and contralateral kidney, there was no statistically significant difference in the area marked for Caspase 3 between the two types of clamping. Conclusions In the experimental model of unilateral renal ischemia, the non-ischemic kidney exhibited cell damage, demonstrated by Caspase 3 expression. The type of hilum clamping does not appear to influence the area marked for Caspase 3.

Study of kidney morphologic and structural changes related to different ischemia times and types of clamping of the renal vascular pedicle

ABSTRACT Purpose This study aimed to study morphological and renal structural changes in relation to different ischemic times and types of renal vascular pedicle clamping. Methods Sixteen pigs were divided into two groups (n = 8): Group AV - unilateral clamping of the renal artery and vein and Group A - unilateral clamping of the renal artery only, both with the contralateral kidney used as control. Serial biopsies were performed at 0, 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after clamping. Results there is a correlation between the occurrence of renal damage as a function of time (p <0.001), with a higher frequency of Group A lesions for cellular alterations (vascular congestion and edema, interstitial inflammatory infiltrate, interstitial hemorrhage and cell degeneration), with the exception of in the formation of pigmented cylinders that were evidenced only in the AV Group. Conclusion the number of lesions derived from ischemia is associated with the duration of the insult, there is a significant difference between the types of clamping, and the AV Group presented a lower frequency of injuries than Group A. The safety time found for Group A was 10 minutes and for Group AV 20 minutes.

Study of kidney morphologic and structural changes related to different ischemia times and types of clamping of the renal vascular pedicle.

PURPOSE: This study aimed to study morphological and renal structural changes in relation to different ischemic times and types of renal vascular pedicle clamping. METHODS: Sixteen pigs were divided into two groups (n = 8): Group AV - unilateral clamping of the renal artery and vein and Group A - unilateral clamping of the renal artery only, both with the contralateral kidney used as control. Serial biopsies were performed at 0, 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after clamping. RESULTS: there is a correlation between the occurrence of renal damage as a function of time (p < 0.001), with a higher frequency of Group A lesions for cellular alterations (vascular congestion and edema, interstitial inflammatory infiltrate, interstitial hemorrhage and cell degeneration), with the exception of in the formation of pigmented cylinders that were evidenced only in the AV Group. CONCLUSION: the number of lesions derived from ischemia is associated with the duration of the insult, there is a significant difference between the types of clamping, and the AV Group presented a lower frequency of injuries than Group A. The safety time found for Group A was 10 minutes and for Group AV 20 minutes.

Incidentally detected tuberculous prostatitis with microabscess

ABSTRACT Tuberculous prostatitis is a rare and often overlooked entity that may mimic prostatic adenocarcinoma on imaging exams, especially multiparametric magnetic resonance imaging (MRI) of the prostate. Detection of a prostatic abscess is a clue to the correct diagnosis.

Deep infiltrating colorectal endometriosis treated with robotic-assisted rectosigmoidectomy.

BACKGROUND AND OBJECTIVE: Deep infiltrating pelvic endometriosis with bowel involvement is one of the most aggressive forms of endometriosis. Nowadays, robotic technology and telemanipulation systems represent the latest developments in minimally invasive surgery. The aim of this study is to present our preliminary results and evaluate the feasibility of robotic-assisted laparoscopic colorectal resection for severe endometriosis. METHODS: Between September 2009 and December 2011, 10 women with colorectal endometriosis underwent surgery with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). We evaluated the following parameters: short-term complications, clinical outcomes and long-term follow-up, pain relief recurrence rate, and fertility outcomes. RESULTS: Extensive ureterolysis was required in 8 women (80%). Ovarian cystectomy with removal of the cystic wall was performed in 7 women (70%). Torus resection was performed in all women, with unilateral and bilateral uterosacral ligament resection in 1 woman (10%) and 8 women (80%), respectively. In addition to segmental colorectal resection in all cases, partial vaginal resection was necessary in 2 women (20%). An appendectomy was performed in 2 patients (20%). The mean operative time with the robot was 157 minutes (range, 90-190 minutes). The mean hospital stay was 3 days. Six patients had infertility before surgery, with a mean infertility time of 2 years. After a 12-month follow-up period, 4 women (67%) conceived naturally and 2 (33%) underwent in vitro fertilization. CONCLUSION: We show that robotic-assisted laparoscopic surgery for the treatment of deep infiltrating bowel endometriosis is feasible, effective, and safe.

Optimal freeze cycle length for renal cryotherapy.

PURPOSE: To our knowledge the optimal freeze cycle length in renal cryotherapy is unknown. Ten-minute time based freeze cycles were compared to temperature based freeze cycles to -20C. MATERIALS AND METHODS: Laparoscopic renal cryotherapy was performed on 16 swine. Time based trials consisted of a double 10-minute freeze separated by a 5-minute thaw. Temperature based trials were double cycles of 1, 5 or 10-minute freeze initiated after 1 of 4 sensors indicated -20C. A 5-minute active thaw was used between freeze cycles. Control trials consisted of cryoneedle placement for 25 minutes without freeze or thaw. Viability staining and histological analysis were done. RESULTS: There was no difference in cellular necrosis between any of the temperature based freeze cycles (p = 0.1). Time based freeze cycles showed more nuclear pyknosis, indicative of necrosis, than the 3 experimental freeze cycles for the renal cortex (p = 0.05) but not for the renal medulla (p = 0.61). Mean time to -20C for freeze cycle 1 was 19 minutes 10 seconds (range 9 to 46 minutes). In 4 of 21 trials (19%) -20C was never attained despite freezing for 25 to 63 minutes. CONCLUSIONS: There was no difference in immediate cellular necrosis among double 1, 5 or 10-minute freeze cycles. Cellular necrosis was evident on histological analysis for trials in which -20C was attained and in freeze cycles based on time alone. With a standard 10-minute cryoablation period most treated parenchyma 1 cm from the probe never attained -20C. Cell death appeared to occur at temperatures warmer than -20C during renal cryotherapy.

Current status of metal stents for managing malignant ureteric obstruction.

Obstruction of the ureters caused by extrinsic compression from a primary tumour or retroperitoneal lymph node masses is not unusual in the course of advanced pelvic malignancies. Most of the cases are of gynaecological or gastrointestinal origin, and the situation can be aggravated by peri-ureteric fibrosis, a long-term adverse event of previous chemotherapy or radiotherapy. Undoubtedly upper urinary tract decompression and maintenance of ureteric patency, even as a palliative measure, is important in managing these patients. Options for upper tract decompression include percutaneous nephrostomy, retrograde stenting and open urinary diversion. Plastic stents have long been used for managing malignant ureteric obstruction, but their overall success remains limited. Plastic stents often fail to be placed correctly, require regular exchange, and are faced with a high incidence of encrustation and migration. For these reasons plastic stents have been unsuccessful for long-term maintenance of ureteric patency. To overcome these limitations metal stents were introduced and recently developed in an effort to ensure better long-term patency of the obstructed ureter, fewer hospital admissions for stent change and better overall quality of life. In the present review the clinical applications of different types of metal stents are discussed, with a specific focus on the latest advances and the future options for managing malignant ureteric obstruction.

Skin treatment and tract closure for tubeless percutaneous nephrolithotomy: University of California, Irvine, technique.

BACKGROUND AND PURPOSE: After percutaneous nephrolithotomy (PCNL), a nephrostomy tube has been routinely placed to ensure hemostasis, provide drainage, and maintain access to the collecting system should a second-look procedure be necessary. Recently, efforts have been expended to either reduce the size of the nephrostomy tube or eliminate it altogether. We describe the tubeless technique of closure and skin treatment after PCNL using FloSeal as a sealant for tubeless PCNL. TECHNIQUE: A 7F 11.5-mm occlusion balloon catheter is passed retrograde over the through-and-through guidewire. Next, under endoscopic guidance, with a rigid or flexible nephroscope, the 30F Amplatz sheath is pulled back to the torn edge of the calix through which the nephrostomy tract enters the kidney. Under endoscopic guidance, the balloon is inflated at the torn edge. Next, the long metal laparoscopic FloSeal applicator is passed through the 30F sheath until it encounters resistance from the occlusion balloon catheter. FloSeal is injected down the sheath as the sheath is slowly withdrawn simultaneously with the FloSeal applicator until both have cleared the nephrostomy incision. The through-and-through guidewire is pulled per the urethra under fluoroscopic control until its tip is in the renal pelvis. A 7F double pigtail stent is passed retrograde over the through-and-through guidewire. A bladder catheter is placed. A running subcuticular suture of 4-0 poliglecaprone is placed, and cyanoacrylate adhesive is used to close the skin. No dressing is applied. CONCLUSION: For patients who have been rendered completely stone free during uncomplicated PCNL, administration of hemostatic gelatin matrix to the nephrostomy tract may achieve immediate hemostasis and eliminate the need for placement of a nephrostomy tube. Although there have not been any clinical reports of urinary obstruction caused by the application of hemostatic sealants in the PCNL tract, we recommend using an occlusion balloon and subsequent placement of an indwelling ureteral stent to ensure maximum safety.

Cavernous nerve reconstitution with the use of bone marrow stem cells and erectile function evaluation: an experimental animal study / Avaliação da função erétil após a reconstituição do nervo cavernoso com o uso de células-tronco de medula-óssea: estudo experimental em ratos

Objective: To assess the influence of adult stem cells from bone marrow of rats in the regeneration of cavernous nerve, taking the return of erectile function as a parameter in animals subjected to the apomorphine-induced test of erection. Methods: Forty-eight male Wistar-EPM rats, aged between nine and ten weeks, and weighing approximately 250 g were used. They were randomly divided into four study Groups containing 12 animals each, as follows: Group I: surgical exposure of the cavernous nerves bilaterally without injury; Group II: bilateral surgical injury of the cavernous nerve of approximately 3 mm, without reconstruction; Group III: bilateral surgical injury of the cavernous nerves of approximately 3 mm, and bilateral reconstruction with silicone guiding tubes containing saline solution inside; Group IV: bilateral surgical injury of the cavernous nerves of approximately 3 mm, and bilateral reconstruction with silicone guiding tubes filled with adult stem cells. Four weeks after surgery, the animals were injected with apomorphine for induction of erection. Results: In Group I there was complete erectile response in all animals (100% ? 12 out of 12). On the other hand, none of the animals in Group II presented erection after the use of apomorphine. Five of the twelve animals of Group III (41.7%) and nine of the 12 animals of Group IV (75%) had erections after the stimulus. When we compared the frequency of restoration of erection in the four Groups, Group IV was shown to have a similar performance to Group I (p = 0.217), while Group III animals had a frequency of erections inferior to those in Group I (p = 0.005). Moreover, comparison of results of Groups III and IV versus Group II showed that the frequency of erections was statistically higher in the first two Groups (p = 0.037 and p < 0.001, respectively). Finally, Group IV presented a tendency to a larger number of erections when compared to Group III (75 versus 41.7%) but this difference was not statistically significant (p = 0.098). Conclusion: This study shows that adult stem cells from bone marrow, filling silicone guiding tubes, may promote the regeneration of cavernous nerves and restore erectile function in an animal model.

Objetivo: Avaliar a influência de células-tronco adultas da medula óssea de ratos na regeneração do nervo cavernosos lesado, tomando-se como parâmetro o retorno da função erétil nos animais submetidos ao teste de ereção induzido pela apomorfina. Métodos: Quarenta e oito ratos Wistar-EPM machos, com idades entre nove e dez semanas, pesando aproximadamente 250 g, foram usados e randomicamente subdivididos em quatro grupos de estudo contendo 12 animais cada. Os grupos experimentais foram divididos em: Grupo I: exposição cirúrgica bilateral do nervo cavernoso sem lesão do mesmo. Grupo II: lesão cirúrgica bilateral do nervo cavernoso de aproximadamente 3 mm, sem reconstrução. Grupo III: lesão cirúrgica bilateral dos nervos cavernosos de aproximadamente 3 mm, e reconstrução bilateral com sondas-guia de silicone contendo solução salina em seu interior. Grupo IV: lesão cirúrgica bilateral dos nervos cavernosos de aproximadamente 3 mm, e reconstrução bilateral com sondas-guia de silicone semeadas com células-tronco adultas em seu interior. Quatro semanas após a cirurgia, os animais foram injetados com apomorfina para indução da ereção. Resultados: No grupo I observou-se resposta erétil completa em todos os animais (100% ? 12 em 12). Por outro lado, nenhum dos animais do grupo II apresentou ereções após a administração de apomorfina. Cinco dos doze animais do grupo III (41,7%) apresentaram ereções, enquanto nove dos 12 animais do grupo IV (75%) evidenciaram ereções após o estímulo. Quando foram comparadas as frequências de restauro de ereção nos quatro grupos, demonstrou-se que Grupo IV teve um comportamento semelhante ao Grupo I (p = 0,217), ao passo que os animais do Grupo III apresentaram frequência de ereções inferiores aos do Grupo I (p = 0,005). Por outro lado, a comparação dos resultados entre os Grupos III e IV versus o Grupo II demostrou que a frequência de ereções foi estatisticamente superior nos dois primeiros Grupos (p = 0,037 e p < 0,001, respectivamente). Finalmente, o Grupo IV apresentou tendência a maior número de ereções quando comparado ao Grupo III (75 versus 41,7%), mas essa diferença não foi estatisticamente significante (p = 0,098). Conclusão: O presente estudo demonstra que células-tronco adultas da medula óssea, semeadas em sondas-guia de silicone, favorecem a regeneração dos nervos cavernosos e promovem o restabelecimento da função erétil em um modelo animal.

Avaliação da função erétil após a reconstituição do nervo cavernoso com o uso de células tronco de medula-óssea: estudo experimental em ratos / Cavernous nerve reconstitution with the use of bone marrow stem cells and erectile function evaluation: an animal experimental study

Introdução: Atualmente a prostatectomia radical retropúbica tem sido responsável por grande parte dos casos de disfunção erétil de causa neurogênica. O desenvolvimento de técnicas como a cirurgia com preservação do feixe vásculo-nervoso, eletro-estimulação intra-operatória o uso de enxertos autólogos para se reestabelecer a comunicação dos nervos cavernosos têm minimizado o grau de lesão neuronal. Entretanto, faz-se necessária a criação de novos métodos de restauração do nervo cavernoso. Neste estudo, investigaremos o uso e a aplicação de células tronco adultas de medula óssea de ratos e sua capacidade para regeneração do nervo cavernoso lesado e para restauração da função erétil em ratos. Objetivo: Avaliar a influência de células tronco adultas da medula óssea de ratos na regeneração do nervo cavernosos lesado, tomando-se como parâmetro o retorno da função erétil nos animais submetidos ao teste de ereção induzido pela apomorfina. Material e Método: Quarenta e oito ratos Wistar-EPM machos, com idades entre 9 e 10 semanas, pesando aproximadamente 250 gramas foram usados e randomicamente subdivididos em quatro grupos de estudo contendo 12 animais cada. Os grupos experimentais foram divididos em: Grupo I: exposição cirúrgica bilateral nervo cavernoso sem lesão do mesmo. Grupo II: lesão cirúrgica bilateral do nervo cavernoso de aproximadamente 3 mm, sem reconstrução. Grupo III: lesão cirúrgica bilateral dos nervos cavernosos de aproximadamente 3 mm, e reconstrução bilateral com sondas guias de silicone contendo solução salina em seu interior. Grupo IV: lesão cirúrgica bilateral dos nervos cavernosos de aproximadamente 3 mm, e reconstrução bilateral com sondas guias de silicone semeadas com células-tronco adultas em seu interior. Quatro semanas após a cirurgia, os animais foram injetados com apomorfina para indução da ereção. Resultados: No grupo I observou-se resposta erétil completa em todos os animais (100% - 12 em 12)....

Objective: To assess the influence of adult stem cells from bone marrow of rats in the regeneration of cavernous nerve, taking as a parameter the return of erectile function in animals subjected to the test of erection induced by apomorphine. Methods: Forty-eight WISTAR-EPM male rats, aged between 9 and 10 weeks, weighing approximately 250 grams were used and randomly divided into four groups of study containing 12 animals each. The experimental groups were divided into: Group I: surgical exposure of bilateral cavernous nerves without injury. Grupo II: surgical bilateral lesion of cavernous nerve with approximately 3 mm, without reconstruction. Group III: surgical bilateral lesion of cavernous nerves of approximately 3 mm, and bilateral reconstruction with silicone tube containing saline solution inside. Group IV: surgical bilateral lesion of cavernous nerves of approximately 3 mm, and bilateral reconstruction with silicone tube containing adult stem-cells inside. Four weeks after surgery, the animals were injected with apomorphine for induction of erection. Results: In Group I there was complete erectile response in all animals (100% - 12 in 12). On the other hand none of the animals in Group II presented erection after the use of apomorphine. Five of the twelve animals of group III (41.7%) had erections while nine of the 12 animals of Group IV (75%) showed them after the stimulus. When we compared the frequency of restoration of erection in the four groups, it was shown that group IV had similar performance to the group I (p = 0,217), while the animals in Group III had a frequency of erections inferiors to the Group I (P = 0,005). Moreover, comparison of results between the group III and IV versus the group II, showed that the frequency of erections was statistically higher in the first two groups (p = 0,037 p < 0,001, respectively). Finally, the group IV presented trend the largest number of erections when compared to Group III (75% versus 41.7%)...

Could a rural lifestyle decrease the prevalence of erectile dysfunction?

OBJECTIVE: To determine the prevalence of erectile dysfunction (ED) in a specific population and explore potential correlates with lifestyle. SUBJECTS AND METHODS: This prospective observational study, covering a population of a very small rural town, included 2000 men aged > or = 20 years from a total population of 121 831 (51% female and 49% male). The International Index of Erectile Function was completed by each of the 2000 men at their homes over a 1-year period. Another questionnaire assessing socio-economic status and health-related determinants of ED were also completed. RESULTS: All 2000 men completed the questionnaires; overall, only 34 reported ED (1.7%). The frequency of mild, mild to moderate, moderate and severe ED was 12%, 29%, 20% and 38%, respectively. Significantly more men aged > 51 years had ED than those aged <41 years (0.05% and 0.45%, respectively; P < 0.001). There was no difference in ED with salary levels. CONCLUSION: The prevalence of ED in this particular rural population of Brazil was very low, at only 1.7%. Although ED increases with age, this association was not apparent for all age groups. It seems that several others factors, e.g. lifestyle, culture and diet, could be important for the onset of ED.