Frailty and Erectile Dysfunction: An Understudied Correlation

The area of geriatrics and the study of the aged are gaining prominence all over the world. In the US, the population of peopleover 65 years old is expected to reach 71 million in 10 years. Men are projected to account for approximately 43% of thepopulation. Owing to their more complex physiological and pathological state, elderly men face many challenges. Erectile functionmay diminish in elderly and vulnerable people owing to ageing, physical conditions, psychological stress, or a combinationof these factors. This propensity is more common in elderly men. This article reviews the literature on frailty syndrome anderectile dysfunction (ED) to better understand them. Complete MEDLINE/PubMed review of non-systematic literature from1990 to May 2023 was included. This topic is thoroughly researched using “frailty”, “low muscle mass”, “erectile dysfunction”,and “elderly”. Individuals with frailty tend to experience more pronounced instances of ED compared with those who are ingood health primarily owing to the anomalies present in their physiological composition. This poses challenges for individualswith physical vulnerabilities to engage in intimate relationships. ED may potentially exert a substantial influence on the mentalwell-being of older individuals or those who are otherwise vulnerable. Research demonstrates that implementing testosterone replacementtherapy (TRT) can effectively enhance erectile function among elderly individuals. This phenomenon persists despitethe knowledge that TRT is not devoid of potential adverse effects. The present investigation has revealed a significant association of frailty, exacerbated by advancing age, with the occurrence of ED. Our findings lead to the conclusion that the condition of frailty becomes more pronounced as individuals advance in age. (AU)

Frailty and Erectile Dysfunction: An Understudied Correlation.

The area of geriatrics and the study of the aged are gaining prominence all over the world. In the US, the population of people over 65 years old is expected to reach 71 million in 10 years. Men are projected to account for approximately 43% of the population. Owing to their more complex physiological and pathological state, elderly men face many challenges. Erectile function may diminish in elderly and vulnerable people owing to ageing, physical conditions, psychological stress, or a combination of these factors. This propensity is more common in elderly men. This article reviews the literature on frailty syndrome and erectile dysfunction (ED) to better understand them. Complete MEDLINE/PubMed review of non-systematic literature from 1990 to May 2023 was included. This topic is thoroughly researched using "frailty", "low muscle mass", "erectile dysfunction", and "elderly". Individuals with frailty tend to experience more pronounced instances of ED compared with those who are in good health primarily owing to the anomalies present in their physiological composition. This poses challenges for individuals with physical vulnerabilities to engage in intimate relationships. ED may potentially exert a substantial influence on the mental well-being of older individuals or those who are otherwise vulnerable. Research demonstrates that implementing testosterone replacement therapy (TRT) can effectively enhance erectile function among elderly individuals. This phenomenon persists despite the knowledge that TRT is not devoid of potential adverse effects. The present investigation has revealed a significant association of frailty, exacerbated by advancing age, with the occurrence of ED. Our findings lead to the conclusion that the condition of frailty becomes more pronounced as individuals advance in age.

Giant Bladder Stone: A Case Report.

Giant bladder stones, weighing more than 100 g, are a rare entity in western practice, usually associated with bladder outlet obstruction, urinary tract infections, or the presence of intravesical foreign bodies. We present a case of a 53-year-old man with a giant bladder stone weighing 600 g. He underwent suprapubic cystolithotomy, had no major surgical complications, and was discharged with a significantly improved urine flow stream.

PI3K/AKT pathway genetic alterations and dysregulation of expression in bladder cancer.

PURPOSE: To examine the involvement of specific components of the PI3K/AKT pathway in urinary bladder cancer development. METHODS: Samples from 65 tumors and 13 normal bladder tissues were collected. Genomic DNA isolation from snap-frozen and paraffin-embedded laser-microdissected tissues was followed by Sanger sequencing, whereas total RNA was purified for use in RT-PCR analyses. Immunohistochemistry was carried out on sections of paraffin-embedded biopsy material. RESULTS: Three pathogenic mutations (two missense and one frameshift) were identified in exon 20 of PIK3CA {c.3140A>G (p.His1047Arg), c.[3172A>T(;)3174C>T] (p.lle1058Phe), c.3203dupA (p.Asn1068Lysfs*5)} after laser capture microdissection, whereas PTEN mRNA expression was found to be downregulated in bladder cancer tissues compared to normal bladder urothelium. Upregulation of cytoplasmic and nuclear p-AKT expression was detected in low grade tumors, whereas in infiltrating carcinomas p-AKT was shown to be downregulated and confined to the cytoplasm. PTEN expression was weak and mainly cytoplasmic in superficial tumors, but stronger and nuclear in the infiltrating tumors. CONCLUSIONS: PI3K/AKT pathway activation is crucial for bladder cancer initiation and progression. In this context, PIK3CA, p-AKT and nuclear PTEN could be used along with other biomarkers for prognosis and selection of appropriate therapy in the clinical management of bladder cancer.

Penile fractures: immediate surgical approach with a midline ventral incision.

OBJECTIVES: To present our experience with immediate surgical treatment of penile fractures, using a midline ventral incision, as the choice of either immediate surgical or conservative treatment in penile fractures, as well as the type of surgical incision, remains controversial. PATIENTS AND METHODS: In a period of 5 years (2002-2006) eight patients were treated in our department for a penile fracture. The diagnosis was established by a history and clinical examination. In six patients ultrasonography before surgery located the fracture in the right corpus cavernosum, distally from the penoscrotal junction. All patients had immediate surgery using a midline ventral incision and were followed for a mean of 1 year. RESULTS: All patients presented with a penile haematoma, while five and two had concomitant scrotal and perineal haematomas, respectively. Penile urethral rupture was associated with corporal cavernosal rupture in one patient. In all patients a 5-cm midline ventral incision was made at the penile raphe. There was unilateral rupture of the corpus cavernosum in seven patients and bilateral rupture with concomitant urethral rupture in one. The fascial defect was sutured in all patients and an end-to-end anastomosis made if there was urethral rupture. The early and late periods after surgery were uneventful. Erectile function was unaffected during the follow-up. CONCLUSION: Immediate intervention for penile fractures, using a midline ventral incision, achieves good early and late results. Our technique has the advantage of direct access to both corpora cavernosa and the anterior urethra, with a minimal skin incision.