Interactions between lower urinary tract symptoms and cardiovascular risk factors determine distinct patterns of erectile dysfunction: a latent class analysis.

PURPOSE: An epidemiological association between lower urinary tract symptoms and erectile dysfunction is well established. However, interactions among multiple risk factors and the role of each in pathological mechanisms are not fully elucidated MATERIALS AND METHODS: We enrolled 898 men undergoing prostate cancer screening for evaluation with the International Prostate Symptom Score (I-PSS) and simplified International Index of Erectile Function-5 (IIEF-5) questionnaires. Age, race, hypertension, diabetes, dyslipidemia, metabolic syndrome, cardiovascular disease, serum hormones and anthropometric parameters were also evaluated. Risk factors for erectile dysfunction were identified by logistic regression. The 333 men with at least mild to moderate erectile dysfunction (IIEF 16 or less) were included in a latent class model to identify relationships across erectile dysfunction risk factors. RESULTS: Age, hypertension, diabetes, lower urinary tract symptoms and cardiovascular event were independent predictors of erectile dysfunction (p<0.05). We identified 3 latent classes of patients with erectile dysfunction (R2 entropy=0.82). Latent class 1 had younger men at low cardiovascular risk and a moderate/high prevalence of lower urinary tract symptoms. Latent class 2 had the oldest patients at moderate cardiovascular risk with an increased prevalence of lower urinary tract symptoms. Latent class 3 had men of intermediate age with the highest prevalence of cardiovascular risk factors and lower urinary tract symptoms. Erectile dysfunction severity and lower urinary tract symptoms increased from latent class 1 to 3. CONCLUSIONS: Risk factor interactions determined different severities of lower urinary tract symptoms and erectile dysfunction. The effect of lower urinary tract symptoms and cardiovascular risk outweighed that of age. While in the youngest patients lower urinary tract symptoms acted as a single risk factor for erectile dysfunction, the contribution of vascular disease resulted in significantly more severe dysfunction. Applying a risk factor interaction model to prospective trials could reveal distinct classes of drug responses and help define optimal treatment strategies for specific groups.

Risk factors for male lower urinary tract symptoms: the role of metabolic syndrome and androgenetic alopecia in a Latin American population.

OBJECTIVE: To evaluate the association of male lower urinary tract symptoms (LUTS) with metabolic syndrome (MetS) and androgenetic alopecia in a Latin American population. METHODS: We enrolled 907 patients for prospective evaluation at a single institution. LUTS were evaluated with the International Prostate Symptom Score (IPSS). Subjects were evaluated with respect to hypertension, diabetes, dyslipidemia, previous cardiovascular events, body mass index (BMI), waist and hip circumference, and a laboratorial investigation including prostate-specific antigen (PSA), C-reactive protein (CRP), and gonadal steroids. Alopecia was classified according to the Norwood-Hamilton scale. RESULTS: Mean patient age was 61.0 years; 57.5% of subjects had moderate/severe LUTS; MetS was present in 17.2% of subjects and 53.9% were classified as bald. Age, hypertension, diabetes, dyslipidemia, alopecia, previous cardiovascular event, and elevated waist-to-hip ratio (WHR) were associated with moderate/severe LUTS and with storage symptoms (P <.05). On multivariable analysis, age (odds ratio [OR] 2.30, 95% confidence interval [CI] 1.63-3.25), cardiovascular events (OR 1.73, 95% CI 1.07-2.78), and WHR (OR 1.65, 95% CI 1.13-2.40) were independent predictors for LUTS. For storage symptoms, age (OR 1.80, 95% CI 1.28-2.54), cardiovascular event (OR 2.07, 95% CI 1.27-3.39), WHR (OR 1.54, 95% CI 1.06-2.25), and MetS (OR 1.70, 95% CI 1.01-2.86) were independent risk factors. Age and cardiovascular event were the only independent predictors for voiding symptoms. CONCLUSION: Components of the MetS were strongly associated with moderate and severe LUTS. WHR and cardiovascular events were independent predictors of voiding and storage symptoms, and MetS was an independent predictor of storage symptoms. Alopecia was not an independent predictor of LUTS.

Penile prosthesis implantation in an academic institution in Latin America.

PURPOSE: We performed a retrospective study to analyze the effectiveness of implantable penile prostheses in the treatment of erectile dysfunction. MATERIALS AND METHODS: This study included 249 patients who received implants between 2001 and 2008. A total of 139 patients who underwent penile prosthesis implantation were interviewed. RESULTS: Approximately half of patients had previously used oral drugs before implantation of the prosthesis. About 45% had diabetes, 25.9% had previously undergone radical prostatectomy (RP), and 64% had hypertension. Exchange was performed in 5.7% for fracture, inadequate size, or extrusion. A total of 24.5% of men had immediate postoperative pain, 7.9% had local infection, and 8.6% had other complications. Patients who had previously undergone RP were 3.2 times more likely to experience a postoperative complication than patients who had not (p = 0.061). Eighty-nine (64%) patients returned to having sex as they had before being diagnosed with ED. Ninety-two of the men (66.2%) had sexual intercourse one to two times per week. One hundred twenty patients (86.3%) rated their level of satisfaction as good, excellent or very good, which was similar to the percentage of partners. The mean follow-up was 40 months. CONCLUSION: Higher rates of postoperative infections and mechanical problems with the implant were found in this study as compared to other studies, which was probably associated with the relative lack of experience of the trainees who were performing the surgeries. Patients with a history of RP or diabetes mellitus prior to implantation were at higher risk of postoperative complications.

Penile prosthesis implantation in an academic institution in Latin America

PURPOSE: We performed a retrospective study to analyze the effectiveness of implantable penile prostheses in the treatment of erectile dysfunction. MATERIALS AND METHODS: This study included 249 patients who received implants between 2001 and 2008. A total of 139 patients who underwent penile prosthesis implantation were interviewed. RESULTS: Approximately half of patients had previously used oral drugs before implantation of the prosthesis. About 45 percent had diabetes, 25.9 percent had previously undergone radical prostatectomy (RP), and 64 percent had hypertension. Exchange was performed in 5.7 percent for fracture, inadequate size, or extrusion. A total of 24.5 percent of men had immediate postoperative pain, 7.9 percent had local infection, and 8.6 percent had other complications. Patients who had previously undergone RP were 3.2 times more likely to experience a postoperative complication than patients who had not (p = 0.061). Eighty-nine (64 percent) patients returned to having sex as they had before being diagnosed with ED. Ninety-two of the men (66.2 percent) had sexual intercourse one to two times per week. One hundred twenty patients (86.3 percent) rated their level of satisfaction as good, excellent or very good, which was similar to the percentage of partners. The mean follow-up was 40 months. CONCLUSION: Higher rates of postoperative infections and mechanical problems with the implant were found in this study as compared to other studies, which was probably associated with the relative lack of experience of the trainees who were performing the surgeries. Patients with a history of RP or diabetes mellitus prior to implantation were at higher risk of postoperative complications.

Erection induced by Tx2-6 toxin of Phoneutria nigriventer spider: expression profile of genes in the nitric oxide pathway of penile tissue of mice.

The peptides Tx2-5 and Tx2-6, isolated from the whole venom of "armed-spider"Phoneutria nigriventer venom, are directly linked with the induction of persistent and painful erection in the penis of mammals. The erection induced by Tx2-6 has been associated with the activation of nitric oxide synthases. There is a scarcity of studies focusing on the outcome of Tx2-6 at the molecular level, by this reason we evaluated the gene profile activity of this toxin at the nitric oxide (NO) pathway. After microarray analyses on cavernous tissue of mice inoculated with Tx2-6 we found that only 10.4% (10/96) of these genes were differentially expressed, showing a limited effect of the toxin on the NO pathway. We found the genes sparc, ednrb, junb, cdkn1a, bcl2, ccl5, abcc1 over-expressed and the genes sod1, s100a10 and fth1 under-expressed after inoculation of Tx2-6. The differential expressions of sparc and ednrb genes were further confirmed using real-time PCR. Interestingly, ednrb activates the L-arginine/NO/cGMP pathway that is involved in the relaxation of the cavernous body. Therefore the priapism induced by Tx2-6 is a consequence of a highly specific interference of this neurotoxin with the NO pathway.

The prevalence of erectile dysfunction among Brazilian men screened for prostate cancer.

OBJECTIVE: To determine the prevalence of erectile dysfunction (ED) in a large cohort of Brazilian men who were screened for prostate cancer, and to determine risk factors in this population, as there are large cultural differences among countries in reporting the frequency of ED, and it is likely that the prevalence of ED among men screened for prostate cancer cannot be generally applied across countries. SUBJECTS AND METHODS: The analysis focused on the baseline characteristics of 1008 consecutive South American men from Brazil with no known prostate disease who had routine screening for prostate cancer by urologists. The variables analysed were patient age, urinary symptoms, patient health-related quality of life (HRQL), prostate-specific antigen (PSA) levels, prostate volume and erectile function. To assess lower urinary tract symptoms (LUTS) and HRQL, we used the American Urological Association symptom score and its appended eighth question, respectively. Benign prostatic hyperplasia was defined as a prostate volume of >30 g. Sexual function was assessed using the five-item version of the International Index of Erectile Function questionnaire. Thus, ED was considered to absent for scores of 22-25, mild for 17-21, mild to moderate for 12-16, moderate for 8-11, or severe for 5-7. Obesity was defined by calculating the body mass index (BMI), and categorized as underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)) or obese (= 30 kg/m(2)). The mean (sd) PSA level was 4.3 (6.7) ng/mL and the mean prostate volume 37.8 (21.8) mL. The correlation of ED with these variables was estimated using unconditional logistic regression models. RESULTS: Information about erectile function was available for 908 patients. ED was considered to be absent, mild, mild to moderate, moderate and severe in 169 (18.6%), 210 (23.1%), 169 (18.6%), 138 (15.2%) and 222 (24.5%) patients, respectively. The ED was severe in 18.4%, 25.7% and 43.4% of patients with mild, moderate and severe LUTS, respectively (P < 0.001). The answer to the HRQL question was also significantly associated with ED; ED was severe in 16.5% of patients feeling delighted/pleased and in 35.8% of patients feeling unhappy/terrible (P < 0.001). The prostate volume was significantly related to ED. The BMI category showed that normal weight, overweight and obese patients had similar rates of ED (P = 0.415); ED was severe in about a quarter of the patients in each of these categories, and 50% and 24% of patients in the underweight and greater BMI groups had severe ED, respectively. CONCLUSIONS: Of men screened for prostate cancer in Brazil, approximately 40% have moderate or severe ED. Severe LUTS, higher HRQL scores, a large prostate volume, a low BMI and higher PSA levels might be associated with higher rates of ED. These variables should be considered when analysing the erectile function of patients screened for prostate cancer.

Preliminary findings from a new animal model for Peyronie's disease involving extracorporeal shock waves.

OBJECTIVE: To develop an experimental model in rabbits to analyse the efficiency of extracorporeal shock wave therapy (ESWT) for Peyronie's disease. MATERIALS AND METHODS: We used 15 adult male rabbits divided into three equal groups. In group 1 (no penile ESWT) rabbits had three sessions of ESWT with 2000 shocks each (15 kV), but a rubber mat was placed between the shock head and rabbit to protect the penis; the rabbits were killed at 7 days after the last session of ESWT. In group 2 the rabbits had three sessions of ESWT using the same parameters, and were killed immediately after the last session to analyse the penis. In group 3 the rabbits had three sessions of ESWT as before but were killed at 7 days after the last session, and the penile tissue analysed macroscopically and histologically. RESULTS: The results showed clearly that the model was efficient, creating a similar situation to that when applying ESWT in the human penis. All of the rabbits in groups 2 and 3 had haematomas and diffuse petechiae after ESWT, and only four had urethral and penile bleeding. Almost all macroscopic changes disappeared after 48 h and only one rabbit in group 3 after 7 days had a haematoma on the dorsal penile surface. The histology (assessed using haematoxylin and eosin staining) of the cavernous body of the penis showed: unchanged histology in group 1; in group 2 there was a dilated and congested vascular space in the cavernous body, with interstitial extensive bleeding in the dermis; and in group 3 there was an increase in interstitial fibrous tissue in the cavernous septum, with deposition of collagen fibres and thickening of the tunica albuginea. CONCLUSION: The present model was efficient in producing tissue injury in the normal penis when treated with ESWT, suggesting that this promising model should be considered for use future studies of Peyronie's disease.

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.

Escroto agudo / Acute scrotum

O escroto agudo, caracterizado pela presença de dor local intensa, edema e alteração da consistência das estruturas da bolsa testicular, constitui uma urgência urológica e corresponde a 0,5% dos atendimentos nos serviços de emergência. As causas mais frequentes de escroto agudo são os processos inflamatórios locais...

Acute scrotum always represents a clinical emergency and is seen in 0,5% of patients attending acute care units. The main cause of acute scrotum are inflammatory conditions of the testis or epididymis and testicular torsion. Based on clinical evaluation the diferential diagnosis between these two conditions can be...

Penile erection induced in vivo by a purified toxin from the Brazilian spider Phoneutria nigriventer.

OBJECTIVES: To verify the effect on erectile tissue of mice of two neuropeptides extracted from the poison of a spider, Phoneutria nigriventer, (Tx2-5 and -6, termed 'eretina') after direct injection into the corpus cavernosum, to assess the minimum dosage necessary for effect, the time for initiation of action, the local duration of the erection, histological effects and the presence of local and systemic side-effects. MATERIALS AND METHODS: When applied intraperitoneally, eretina promotes the relaxation of cavernous smooth muscle, thus causing penile erection. Thirty-five mice were divided in two groups; 10 control mice were injected 20 microL of saline solution, and in the treated group, 25 mice were divided into groups of five and each subgroup received eretina in decreasing doses (0.024, 0.012, 0.006, 0.003 and 0.0015 microg/kg) until the minimum dose that produced an erection was determined. After treatment all mice were monitored to determine the response and any collateral effects. RESULTS: The minimum dose producing an erection was 0.006 microg/kg, the five mice in this group having evidence of an erection at 35-45 min after injection. The histology of the cavernosum of mice treated with eretina showed dilatation and congestion of the vascular spaces with more blood than in controls. With the minimum dose there were no local or systemic collateral effects and the erection was lost after 120-140 min. CONCLUSION: The minimum dose of eretina producing an erection in mice was determined, and the agent was safe for this use as it did not produce any collateral toxic effects. These studies indicate a possible means of determining the mechanism of action of eretina.

The role of BPH, lower urinary tract symptoms, and PSA levels on erectile function of Brazilian men who undergo prostate cancer screening.

INTRODUCTION: Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are common problems in middle-aged and older men. Recently, epidemiologic studies have shown significant associations between severity of LUTS and male sexual dysfunction. AIM: We analyzed the role of prostate enlargement, LUTS, and prostate specific antigen (PSA) levels in the erectile function of Brazilian men who underwent prostate cancer (PCa) screening. METHOD: We analyzed data from 1,008 consecutive patients enrolled in a PCa screening program. Benign prostatic hyperplasia (BPH) was defined as a prostate weight greater than 30 g as defined by digital rectal examination. For statistical analysis, we used the chi-squared and analysis of variance tests. The odds ratios (OR) for correlation of ED with prostate volume LUTS and PSA were estimated using logistic regression models. MAIN OUTCOME MEASURE: The American Urological Association (AUA) symptom score for LUTS and the International Index of Erectile Function. RESULTS: Mean patient age was 61.2 years (45-87) and median PSA value was 1.9 ng/mL. BPH was identified in 48.5% of patients. Mild, moderate, and severe LUTS were found in 52.3%, 30.9%, and 16.8% of cases, respectively. ED was classified as absent, mild, mild to moderate, moderate, and severe in 18.6%, 23.1%, 18.6%, 15.2%, and 24.5%, respectively. While only 5.4% of the patients with no ED presented severe LUTS, this finding was observed in 27.1% of patients with severe ED (P < 0.001). Univariate logistic regression analysis demonstrated that age, prostate volume, AUA symptom score, and PSA levels were significant predictors of ED. However, when controlled for patient age, only LUTS remained as an independent predictor of ED. CONCLUSIONS: Controlling for patient age, LUTS are independent risk factors for the development of ED among Brazilian men who undergo PCa screening. Antunes AA, Srougi M, Dall'Oglio MF, Vicentini F, Paranhos M, and Freire GC. The role of BPH, lower urinary tract symptoms, and PSA levels on erectile function of Brazilian men who undergo prostate cancer screening.

Perineural invasion by transitional cell carcinoma of the bladder in patients submitted to radical cystectomy: what is the prognostic value?

OBJECTIVE: Determine the prognostic value of perineural invasion (PNI) in patients with transitional cell carcinoma (TCC) of the bladder treated with radical cystectomy. MATERIALS AND METHODS: From January 1993 to January 2005, 113 people were selected from 153 patients with TCC of the bladder treated with radical cystectomy. The association between the presence of PNI and other pathologic characteristics were analyzed through Fisher exact test. The Kaplan-Meier method was utilized to assess the survival curve and the statistical significance was determined by the Breslow test. The multivariate analysis was performed through the Cox regression model. RESULTS: The PNI was identified in 10 (8.8%) of the 113 patients. This variable significantly related to the microvascular invasion and to tumor staging. The mean segment after surgery was 31.7 +/- 28.5 months. Recurrence occurred in 5 (50%) and in 41 (39.8%) patients (p=0.363) and mortality occurred in 2 (20%) and 22 (21.9%) patients (p=0.606) with or without PNI respectively. In Cox regression analysis, patients with PNI presented with 1.53 times (IC 95% 0.60 to 3.91; p=0.371) and 1.60 times (IC 95% 0.37 to 6.95; p=0.532) the risk of recurrence and mortality when compared to patients without PNI. CONCLUSIONS: The PNI does not constitute an independent variable of disease-free and cancer specific survival in patients with TCC of the bladder treated with radical cystectomy.

Perineural invasion by transitional cell carcinoma of the bladder in patients submitted to radical cystectomy: what is the prognostic value?

OBJECTIVE: Determine the prognostic value of perineural invasion (PNI) in patients with transitional cell carcinoma (TCC) of the bladder treated with radical cystectomy. MATERIALS AND METHODS: From January 1993 to January 2005, 113 people were selected from 153 patients with TCC of the bladder treated with radical cystectomy. The association between the presence of PNI and other pathologic characteristics were analyzed through Fisher exact test. The Kaplan-Meier method was utilized to assess the survival curve and the statistical significance was determined by the Breslow test. The multivariate analysis was performed through the Cox regression model. RESULTS: The PNI was identified in 10 (8.8 percent) of the 113 patients. This variable significantly related to the microvascular invasion and to tumor staging. The mean segment after surgery was 31.7 ± 28.5 months. Recurrence occurred in 5 (50 percent) and in 41 (39.8 percent) patients (p = 0.363) and mortality occurred in 2 (20 percent) and 22 (21.9 percent) patients (p = 0.606) with or without PNI respectively. In Cox regression analysis, patients with PNI presented with 1.53 times (IC 95 percent 0.60 to 3.91; p = 0.371) and 1.60 times (IC 95 percent 0.37 to 6.95; p = 0.532) the risk of recurrence and mortality when compared to patients without PNI. CONCLUSIONS: The PNI does not constitute an independent variable of disease-free and cancer specific survival in patients with TCC of the bladder treated with radical cystectomy.

Study of the efficacy of Korean Red Ginseng in the treatment of erectile dysfunction.

AIM: To examine the treatment efficacy of Korean Red Ginseng (KRG) in impotent men with erectile dysfunction (ED). METHODS: A total of 60 patients presenting mild or mild to moderate ED were enrolled in a double-blind, placebo-controlled study in which the efficacies of KRG and a placebo were compared. The patients received either 1,000 mg (3 times daily) of KRG or a placebo. RESULTS: The five-item version of the International Index of Erectile Function (IIEF-5) score after the treatment was significantly higher in the KRG group compared with that before the treatment (from 16.4 +/- 2.9 to 21.0 +/- 6.3, P < 0.0001). In contrast, there was no difference before and after the treatment in the placebo group (from 17.0 +/- 3.1 to 17.7 +/- 5.6, P > 0.05). In the KRG group, 20 patients (66.6%), reported improved erection, significant in the global efficacy question (P < 0.01); in the placebo group there was no significance. Scores on questions 2 (rigidity), 3 (penetration), 4 and 5 (maintenance), were significantly higher for KRG than those for the placebo when those questions were answered after 12 weeks of each treatment (P < 0.01). When the score in the KRG group was compared to the placebo group after the treatment, there was a significant improvement in total score (IIEF-5 score) in questions 3 and 5 for the KRG-treated group (P < 0.001 and P < 0.0001, respectively). The levels of serum testosterone, prolactine and cholesterol after the treatment were not statistically significant different between the KRG and the placebo group (P > 0.05). CONCLUSION: Our data show that KRG can be an effective alternative to the invasive approaches for treating male ED.

Microvascular invasion is an independent prognostic factor in patients with prostate cancer treated with radical prostatectomy

OBJECTIVE: Current published data regarding the prognostic value of microvascular invasion (MVI) in patients with prostate cancer (PCa) have yielded mixed results. Furthermore, most important series had surgical procedures performed by multiple surgeons and surgical specimens analyzed by multiple pathologists. We determined the relation of MVI with other pathologic features and whether this finding can be used as an independent prognostic factor in patients with PCa. MATERIALS AND METHODS: We selected 428 patients with clinically localized PCa treated with radical prostatectomy (RP). MVI was correlated to other pathologic features. The Kaplan-Meier method was used to evaluate survival curves and statistical significance was determined by the log-rank test. Multivariate analysis was performed through a Cox proportional hazards regression model. RESULTS: Eleven percent out of the 428 patients presented MVI. Except for the lack of association with biopsy Gleason score, MVI was related to all clinical and pathologic features of RP specimens. Mean follow up after surgery was 53.9 ± 20.1 months. Patients with MVI presented a recurrence rate of 44.6 percent compared to only 20.2 percent for patients without MVI (Log-rank test - p < 0.001). After Cox regression analysis, MVI was an independent prognostic feature related to biochemical recurrence. CONCLUSIONS: MVI is associated to advanced pathologic features of PCa and is an important prognostic factor regarding disease recurrence in patients treated with RP. These findings support the recommendations to the routine evaluation of this variable in pathologic reports of RP specimens.

Salvage radical prostatectomy: an alternative treatment for local recurrence of radioresistant cancer.

OBJECTIVES: The treatment of recurrent prostate cancer after radiotherapy or brachytherapy through radical prostatectomy has been little indicated due to the concern over the procedure's morbidity. We present the experience of our service with postradiotherapy radical prostatectomy. MATERIALS AND METHODS: Between 1996 and 2002, 9 patients submitted to radiotherapy due to prostate cancer were treated with salvage surgery for locally recurrent disease. All patients had a biopsy of the prostate confirming the tumor recurrence, increase in the PSA levels and staging without evidence of a systemic disease. We have assessed the morbidity and the recurrence-free survival rate after salvage radical prostatectomy. RESULTS: Preradiotherapy PSA varied from 6.2 to 50 ng/mL (mean 17.3) and clinical staging T1, T2 and T3 in 33.3%, 44.4% and 22.2% of the patients respectively. The interval for the biopsy after conforming external beam radiotherapy or brachytherapy varied from 8 to 108 months (median: 36). Four patients received antiandrogenic therapy neoadjuvant to the surgery with a mean of 7 months (1-48) after radiotherapy. From the six patients potent before the surgery, three have presented erectile dysfunction. Urinary incontinence as well as bladder neck sclerosis occurred in two patients (22.2%). Biochemical recurrence occurred in two individuals (22.2%) 12 months after the surgery. Biochemical recurrence-free survival rate was 77.8% with median follow-up time of 30 months (8-102). CONCLUSION: Salvage radical prostatectomy is a safe and effective alternative for the treatment of locally recurrent prostate cancer after radiotherapy and brachytherapy.

Salvage radical prostatectomy: an alternative treatment for local recurrence of radioresistant cancer

OBJECTIVES: The treatment of recurrent prostate cancer after radiotherapy or brachytherapy through radical prostatectomy has been little indicated due to the concern over the procedure's morbidity. We present the experience of our service with postradiotherapy radical prostatectomy. MATERIALS AND METHODS: Between 1996 and 2002, 9 patients submitted to radiotherapy due to prostate cancer were treated with salvage surgery for locally recurrent disease. All patients had a biopsy of the prostate confirming the tumor recurrence, increase in the PSA levels and staging without evidence of a systemic disease. We have assessed the morbidity and the recurrence-free survival rate after salvage radical prostatectomy. RESULTS: Preradiotherapy PSA varied from 6.2 to 50 ng/mL (mean 17.3) and clinical staging T1, T2 and T3 in 33.3 percent, 44.4 percent and 22.2 percent of the patients respectively. The interval for the biopsy after conforming external beam radiotherapy or brachytherapy varied from 8 to 108 months (median: 36). Four patients received antiandrogenic therapy neoadjuvant to the surgery with a mean of 7 months (1-48) after radiotherapy. From the six patients potent before the surgery, three have presented erectile dysfunction. Urinary incontinence as well as bladder neck sclerosis occurred in two patients (22.2 percent). Biochemical recurrence occurred in two individuals (22.2 percent) 12 months after the surgery. Biochemical recurrence-free survival rate was 77.8 percent with median follow-up time of 30 months (8-102). CONCLUSION: Salvage radical prostatectomy is a safe and effective alternative for the treatment of locally recurrent prostate cancer after radiotherapy and brachytherapy.

Microvascular invasion is an independent prognostic factor in patients with prostate cancer treated with radical prostatectomy.

OBJECTIVE: Current published data regarding the prognostic value of microvascular invasion (MVI) in patients with prostate cancer (PCa) have yielded mixed results. Furthermore, most important series had surgical procedures performed by multiple surgeons and surgical specimens analyzed by multiple pathologists. We determined the relation of MVI with other pathologic features and whether this finding can be used as an independent prognostic factor in patients with PCa. MATERIALS AND METHODS: We selected 428 patients with clinically localized PCa treated with radical prostatectomy (RP). MVI was correlated to other pathologic features. The Kaplan-Meier method was used to evaluate survival curves and statistical significance was determined by the log-rank test. Multivariate analysis was performed through a Cox proportional hazards regression model. RESULTS: Eleven percent out of the 428 patients presented MVI. Except for the lack of association with biopsy Gleason score, MVI was related to all clinical and pathologic features of RP specimens. Mean follow up after surgery was 53.9 +/- 20.1 months. Patients with MVI presented a recurrence rate of 44.6% compared to only 20.2% for patients without MVI (Log-rank test - p < 0.001). After Cox regression analysis, MVI was an independent prognostic feature related to biochemical recurrence. CONCLUSIONS: MVI is associated to advanced pathologic features of PCa and is an important prognostic factor regarding disease recurrence in patients treated with RP. These findings support the recommendations to the routine evaluation of this variable in pathologic reports of RP specimens.

Pathological extension of prostate cancer as defined by Gleason score on biopsy.

INTRODUCTION: Based on the importance of the Gleason score on the behavior of prostate adenocarcinoma, this study attempts to predict the extension of prostate adenocarcinoma pre-operatively, as defined by the Gleason score on biopsy, in individuals who will undergo radical prostatectomy. MATERIALS AND METHODS: We selected 899 individuals who underwent retropubic radical prostatectomy from 1988 to 2004. Clinical and pathological data obtained in the preoperative period were retrospectively analyzed through digital rectal examinations of the prostate, initial serum PSA levels and pathological data provided by biopsy. The Gleason score on biopsy was assessed and divided into 3 groups: 2 to 6, 7, and 8 to 10, and correlated with the possibility of the disease being confined to the prostate. RESULTS: From the 899 selected patients, 654 (74%) showed Gleason scores of 2 to 6, 165 (18%) had a score of 7 and 80 (9%) had scores of 8 to 10 on biopsy. The likelihood of confined diseases, extraprostatic extensions, invasion of seminal vesicles and lymph nodal involvement were respectively: 74%, 18%, 8% and 0.8% for a Gleason score of 2 to 6, 47%, 30%, 19% and 4% for a Gleason score of 7, and 49%, 29%, 18% and 4% for a Gleason score of 8 to 10. CONCLUSION: In patients who will undergo radical prostatectomy due to prostate adenocarcinoma, a Gleason score of 7 on biopsy shows the same behavior as a Gleason score of 8 to 10 in relation to extension of disease.