Management of erectile dysfunction and premature ejaculation: The perspective of Spanish urologists. Results of the PANDORA Project (Part II) / Manejo de la disfunción eréctil y la eyaculación precoz: la perspectiva de los urólogos españoles. Resultados del Proyecto PANDORA (Parte II)

Introduction: ED and PE are the most common male sexual dysfunctions, although they remain underdiagnosed and undertreated. Aim: To ascertain how a group of Spanish urologists currently address ED and PE. Methods: Descriptive study based on a self-designed questionnaire about the clinical practice in ED and PE upon diagnosis, treatment and monitoring, patient–physician relationship and the role of the patient's partner. Results: The survey was completed by 188 experienced urologists. Most patients went to the urologist's office without a previous diagnosis (92% of the urologists found <10 PE-diagnosed patients in public settings). The diagnosis of ED and/or PE was mainly carried out by the current urologist and not by another professional, particularly in private centres as opposed to public centres (78.8% vs 57.0% for ED; 82.0% vs 62.6% for PE). Most urologists believed that these disorders are underdiagnosed and deemed them as general health issues. 38% of urologists acknowledged using validated questionnaires to diagnose ED. PE was considered a subjective problem rather than a true disease and the use of PRO-based diagnosis of PE was not generally accepted (14%). Treatment options of both disorders were chosen as expected. Referral to the andrologist is usually scheduled in moderate-to-severe PE or severe ED. The cohort seemed to be mostly neutral (50%–75% for ED and 40%–55% for PE) regarding patient reluctancy to talk about their sexual problem. Patients’ partners play an important role in helping men seeking treatment. (AU)

Introducción: A pesar de que, la DE y la EP son las disfunciones sexuales masculinas más frecuentes, siguen estando infradiagnosticadas e infratratadas. Objetivo: Conocer cómo es el abordaje actual de la DE y la EP, a partir de un grupo de urólogos españoles. Método: Estudio descriptivo, mediante un cuestionario predefinido, con relación a la práctica clínica de la DE y la EP, incluyendo su diagnóstico, su tratamiento y su seguimiento, la relación médico-paciente y el papel de la pareja. Resultados: Ciento ochenta y ocho urólogos expertos dieron respuesta al cuestionario predefinido. La mayoría de los pacientes acudieron a la consulta del urólogo sin un diagnóstico previo (el 92% de los urólogos hallaron <10 pacientes diagnosticados de PE en el ámbito público). El diagnóstico de la DE y/o la EP fue realizado mayoritariamente por el urólogo, y no por otro profesional, especialmente en el ámbito privado frente al público (78,8 frente al 57,0% para la DE; 82,0 frente al 62,6% para la EP). La gran mayoría de los urólogos señalaron que ambas disfunciones estaban siendo infradiagnosticadas y, por tanto, las consideraron como un problema de salud general. El 38% de los urólogos indicó utilizar cuestionarios validados para el diagnóstico de la DE. La EP se percibió como un problema subjetivo más que como una verdadera enfermedad, y el uso de PRO en el diagnóstico de la EP no fue generalmente aceptado (14%). La elección de las opciones de tratamiento de ambas disfunciones aconteció según lo esperado. Se consideró la derivación a andrología en los casos de la EP moderada-grave o en los casos de la DE grave. En cuanto a la reticencia de los pacientes a hablar de su problema sexual, la respuesta fue mayoritariamente neutra (50-75% para la DE y 40-55% para la EP). Las parejas de los pacientes desempeñan un papel importante en el momento que estos buscan opciones de tratamiento. (AU)

An observational, national and multicentric study to describe the detection, diagnosis and treatment of erectile dysfunction and premature ejaculation from the patient's perspective / Estudio observacional, nacional y multicéntrico, para describir la detección, el diagnóstico y el tratamiento de la disfunción eréctil y la eyaculación precoz desde la perspectiva del paciente

Introduction and objectives: To examine the opinions, attitudes and perceptions of patients regarding the diagnosis and treatment protocols of erectile dysfunction (ED) and premature ejaculation (PE) and their interaction with the urology specialists. Material and methods: Observational, national and multicentric study based on a self-designed online questionnaire in which ED and PE patients described their perception of ED and PE at diagnosis and during treatment and monitoring, the patient-physician relationship and the role of the patient's partner in the course of the disease. Results: 306 ED and 70 PE participants were recruited. After the occurrence of the first symptoms, the time elapsed until the patient decided to go to the doctor was 28.6 months for PE and 14.0 months for ED (p<0.001). ED patients saw physicians more frequently (especially those aged between 60 and 69 years: 60.7%, p<0.001) than PE patients (52.1% vs 36.8%, respectively; p<0.001) and discussed this problem with their partner more (34.0% vs 22.8%, p<0.001). These disorders were mainly diagnosed at the urologist's office (ED: 74.8% vs 42.5%; PE: 75.7% vs 34.3%; diagnosis vs detection). One third of all participants reported that the sexual problem was not the main reason for the visit. The time elapsed between the first consultation for related symptoms and therapy was 8.7 months (oral drugs) and 7.6 months (dapoxetine) for ED and PE, respectively. ED patients and their partners felt particularly better once treatment had started (p<0.001). PE patients presented the highest degree of sexual dissatisfaction (78%). 50% of the patients agreed with the statement that initiating a discussion about sexual concerns was regarded as taboo and most of them did not say that their partner had encouraged them to seek medical advice. (AU)

Introducción y objetivos: Analizar las opiniones, actitudes y percepciones de los pacientes respecto a los protocolos de diagnóstico y tratamiento de la disfunción eréctil (DE) y la eyaculación precoz (EP) así como su interacción con los especialistas en urología. Material y métodos: Estudio observacional, nacional y multicéntrico, a través de un cuestionario online predefinido, en el que los pacientes con DE y EP describieron su percepción acerca de la DE y la EP, en el diagnóstico, durante el tratamiento y seguimiento, así como la relación médico-paciente y el papel de la pareja en el trascurso de la enfermedad. Resultados: Se incluyeron 306 participantes con DE y 70 con PE. El tiempo transcurrido, desde la aparición de los primeros síntomas hasta que el paciente decidió acudir al médico, fue de 28,6 meses para la EP y de 14,0 meses para la DE (p < 0,001). Los pacientes con DE acudieron al médico con mayor frecuencia (especialmente en edades entre 60 y 69 años: 60,7%, p < 0,001) respecto a los pacientes con EP (52,1 vs. 36,8%, respectivamente; p < 0,001) y comentaron más el problema con su pareja (34,0 vs. 22,8%, p < 0,001). El diagnóstico de ambas disfunciones se llevó a cabo principalmente en consultas de urología (DE: 74,8 vs. 42,5%; EP: 75,7 vs. 34,3%; diagnóstico vs. detección). Una tercera parte de todos los participantes indicó que el problema sexual no motivó principalmente la visita. El tiempo transcurrido, desde la primera consulta motivada por síntomas relacionados y el establecimiento de terapia, fue de 8,7 meses (fármacos orales) y 7,6 meses (dapoxetina) para la DE y la EP, respectivamente. Los pacientes con EP presentaron mayor grado de insatisfacción sexual (78%). De los pacientes estudiados, 50% mostró acuerdo con la afirmación de que iniciar una conversación sobre las preocupaciones sexuales se consideraba un tabú y la mayoría reconoció que su pareja no le había animado a la hora de buscar consejo médico. (AU)

Management of erectile dysfunction and premature ejaculation: The perspective of Spanish urologists. Results of the PANDORA Project (Part II).

INTRODUCTION: ED and PE are the most common male sexual dysfunctions, although they remain underdiagnosed and undertreated. AIM: To ascertain how a group of Spanish urologists currently address ED and PE. METHODS: Descriptive study based on a self-designed questionnaire about the clinical practice in ED and PE upon diagnosis, treatment and monitoring, patient-physician relationship and the role of the patient's partner. RESULTS: The survey was completed by 188 experienced urologists. Most patients went to the urologist's office without a previous diagnosis (92% of the urologists found <10 PE-diagnosed patients in public settings). The diagnosis of ED and/or PE was mainly carried out by the current urologist and not by another professional, particularly in private centres as opposed to public centres (78.8% vs 57.0% for ED; 82.0% vs 62.6% for PE). Most urologists believed that these disorders are underdiagnosed and deemed them as general health issues. 38% of urologists acknowledged using validated questionnaires to diagnose ED. PE was considered a subjective problem rather than a true disease and the use of PRO-based diagnosis of PE was not generally accepted (14%). Treatment options of both disorders were chosen as expected. Referral to the andrologist is usually scheduled in moderate-to-severe PE or severe ED. The cohort seemed to be mostly neutral (50%-75% for ED and 40%-55% for PE) regarding patient reluctancy to talk about their sexual problem. Patients' partners play an important role in helping men seeking treatment. CONCLUSION: Urologists should show more proactivity during anamnesis and routine visits to improve management of ED and PD.

An observational, national and multicentric study to describe the detection, diagnosis and treatment of erectile dysfunction and premature ejaculation from the patient's perspective.

INTRODUCTION AND OBJECTIVES: To examine the opinions, attitudes and perceptions of patients regarding the diagnosis and treatment protocols of erectile dysfunction (ED) and premature ejaculation (PE) and their interaction with the urology specialists. MATERIAL AND METHODS: Observational, national and multicentric study based on a self-designed online questionnaire in which ED and PE patients described their perception of ED and PE at diagnosis and during treatment and monitoring, the patient-physician relationship and the role of the patient's partner in the course of the disease. RESULTS: 306 ED and 70 PE participants were recruited. After the occurrence of the first symptoms, the time elapsed until the patient decided to go to the doctor was 28.6 months for PE and 14.0 months for ED (p<0.001). ED patients saw physicians more frequently (especially those aged between 60 and 69 years: 60.7%, p<0.001) than PE patients (52.1% vs 36.8%, respectively; p<0.001) and discussed this problem with their partner more (34.0% vs 22.8%, p<0.001). These disorders were mainly diagnosed at the urologist's office (ED: 74.8% vs 42.5%; PE: 75.7% vs 34.3%; diagnosis vs detection). One third of all participants reported that the sexual problem was not the main reason for the visit. The time elapsed between the first consultation for related symptoms and therapy was 8.7 months (oral drugs) and 7.6 months (dapoxetine) for ED and PE, respectively. ED patients and their partners felt particularly better once treatment had started (p<0.001). PE patients presented the highest degree of sexual dissatisfaction (78%). 50% of the patients agreed with the statement that initiating a discussion about sexual concerns was regarded as taboo and most of them did not say that their partner had encouraged them to seek medical advice. CONCLUSION: A concerted effort is called for to expand ED and PE patients' proactivity in taking care of their own and their partner's sexual health. Current therapies would appear to have a benefit in couples' sexual relationships.

Physiopathology of the Priapism Secondary to Tamsulosin: Clinical Cases of Our Hospital and Literature Review.

OBJECTIVE: To describe two cases of man with the diagnosis of ischemic priapism after the intake of tamsulosin and to revise the scientific literature. METHODS: We present two cases of men that developed an ischemic priapism after the intake of tamsulosin prescribed for STUI and were treated in our hospital. We described the two cases, from the diagnosis until the surgery that was performed. Also, we review the scientific literature about this topic. RESULTS: In one hand, a 67 years old man with the previous diagnosis of diabetes mellitus, hypertension and dyslipidemia that take a one single dosis of tamsulosin and developed a priapism of 9 hours of duration. He was diagnosticated of low-flow priapism that was reverted after the use of intracavernosal phenylephrine. On the other hand, a 61 years old man without any medical condition. He developed a priapism after the intake of also one single dosis of tamsulosin and came to the hospital after 48 hours of the beginning of the erection. In this case, the use of intracavernosal phenylephrine wasn´t effective so we decided to performed a distal shunt between cavernosal and spongy body according to the techniques of Winter, Ebbehoj and Al-Ghorab. All of them without results. At the end, we tried a proximal shunt according Quackles technique, also ineffective. The patient declined another surgery for implantation of a pennis prothesis and went home after four days of hospitalization with the disappearance of the pain. CONCLUSIONS: The tamsulosin is a drug well known by urologist that have a safety profile probed with the years. Nevertheless, it's association with a disease like the priapism forced us to explain to our patients this rare adverse effect.

Infección por SARS-CoV-2: implicaciones para la salud sexual y reproductiva. Una declaración de posición de la Asociación Española de Andrología, Medicina Sexual y Reproductiva (ASESA) / SARS-CoV-2 infection: implications for sexual and reproductive health. A position statement of the Asociación Española de Andrología, Medicina Sexual y Reproductiva (ASESA)

OBJETIVO: El objetivo de esta revisión es resumir la evidencia disponible sobre los posibles efectos adversos del SARS-CoV-2 en el sistema reproductor masculino y proporcionar una declaración de posición oficial de la Asociación Española de Andrología, Medicina Sexual y Reproductiva (ASESA). MÉTODOS: Se realizó una búsqueda exhaustiva en las bibliotecas Pubmed, Web of Science, Embase, Medline, Cochrane y MedRxiv. RESULTADOS: No se ha confirmado la orquitis como una posible complicación de la infección por SARS-CoV-2. Un estudio informó que el 19% de los hombres con COVID-19 presentaban molestias escrotales sugestivas de orquitis viral, que no se pudo confirmar. Es posible que el virus no infecte los testículos directamente, si no que desencadene una respuesta autoinmune secundaria y que cause una orquitis autoinmune. COVID-19 se ha asociado con anormalidades en la coagulación por lo que la orquitis podría ser el resultado de una vasculitis segmentaria. Los datos disponibles sobre la presencia del virus en semen son contradictorios. Sólo un estudio informó de la presencia de ARN en el 15,8% de enfermos de COVID-19. La presencia de ácido nucleico o antígeno en el semen no implica la existencia de virus con capacidad de replicación o infección. En hombres con COVID-19 se ha observado un incremento significativo de LH en suero y una drástica disminución de la ratio T/LH y FSH/LH, congruente con un hipogonadismo subclínico. CONCLUSIONES: Los datos disponibles y los hallazgos de los estudios recientes se basan en tamaños de muestra pequeños y proporcionan informaciones contradictorias. Existe la posibilidad teórica de que pueda producirse daño testicular y posterior infertilidad después de la infección por COVID-19, por lo que especialmente para aquellos hombres en edad reproductiva, se debe sugerir consulta y evaluación de la función gonadal y análisis de semen. En cuanto a la posibilidad de transmisión sexual, no hay evidencia suficiente para respaldar la necesidad de que las parejas asintomáticas eviten las relaciones sexuales para protegerse contra la transmisión del virus. Se necesita más investigación para comprender los impactos a largo plazo del SARS-CoV-2 en la función reproductiva masculina, incluidos sus posibles efectos sobre la fertilidad y la función endocrina testicular

OBJECTIVE: The main objective of this revision is to summarize the current existing evidence of the potential adverse effects of SARS-CoV-2 on the male reproductive system and provide the recommendations of the Asociación Española de Andrología, Medicina Sexual y Reproductiva (ASESA) concerning the implications of COVID-19 infection in the management of male infertilty patients and testicular endocrine dysfunction. METHODS: A comprehensive systematic literature search of the databases of PubMed, Web of Science, Embase, Medline, Cochrane and MedRxiv, was carried out. RESULTS: The presence of orchitis as a potential complication of the infection by SARS-CoV-2 has not yet been confirmed. One study reported that 19% of males with COVID-19 infection had scrotal symptoms suggestive of viral orchitis which could not be confirmed. It is possible that the virus, rather than infecting the testes directly, may induce a secondary autoimmune response leading to autoimmune orchitis. COVID-19 has been associated with coagulation disorders and thus the orchitis could be the result of segmental vasculitis. Existing data concerning the presence of the virus in semen are contradictory. Only one study reported the presence of RNA in 15.8% of patients with COVID-19. However, the presence of nucleic acid or antigen in semen is not synonyms of viral replication capacity and infectivity. It has been reported an increase in serum levels of LH in males with COVID-19 and a significant reduction in the T/LH and FSH/LH ratios, consistent with subclinical hypogonadism. CONCLUSIONS: The findings of recent reports related to the potential effects of COVID-19 infection on the male reproductive system are based on poorly designed, small sample size studies that provide inconclusive, contradictory results. Since there still exists a theoretical possibility of testicular damage and male infertilty as a result of the infection by COVID-19, males of reproductive age should be evaluated for gonadal function and semen analysis. With regard to the sexual transmission of the virus, there is not sufficient evidence to recommend asymptomatic couples to abstein from having sex in order to protect themselves from being infected by the virus. Additional studies are needed to understand the long-term effects of SARS-CoV-2 on male reproductive function, including male fertility potential and endocrine testicular function

El diagnóstico y el tratamiento de disfunción eréctil en España: la opinión del médico de atención primaria. Proyecto «Atlas de la disfunción eréctil en España» / Diagnosis and treatment of erectile dysfunction in Spain: the opinion of primary care physicians. «Atlas of the erectile dysfunction in Spain» project

Objetivo. Analizar la actitud del médico de atención primaria (AP) de España hacia el abordaje, el diagnóstico y el tratamiento de la disfunción eréctil (DE). Material y método. Estudio descriptivo basado en 2 cuestionarios cumplimentados por 544 médicos de AP que tratan habitualmente pacientes con DE donde expusieron su percepción acerca de aspectos relativos al diagnóstico y tratamiento de la DE, y sobre cómo mejorar su infradiagnóstico y el infratratamiento. Las preguntas fueron valoradas mediante una escala Likert continua del 1 al 7. Resultados. Entre varones ≥ 20 años de los que se disponía de un registro de la DE, la prevalencia de DE fue de 4,4%. La DE se considera un aspecto de salud importante y un síntoma centinela. No suele estar incluida en la historia clínica (26,5%) y se aborda con más frecuencia ante factores de riesgo, sobre todo ante la toma concomitante de medicamentos. El médico varón tendría más empatía hacia el hombre con DE, pero no parece diagnosticar mucho más que las mujeres. La edad no influenciaría el diagnóstico. La falta de tiempo y de formación son las principales barreras para un correcto abordaje. La formación es necesaria para mejorar el infradiagnóstico. La DE suele tratarse desde la AP cuando se asocia a trastornos manejados en este nivel asistencial. Conclusiones. Es necesario emprender acciones que contribuyan a mejorar el diagnóstico de la DE en España, lo que permitirá a su vez la detección precoz de comorbilidades subyacentes y mejorar la salud y calidad de vida del paciente (AU)

Objective. To analyze the attitude of primary care (PC) physicians in Spain regarding the approach, diagnosis and treatment of erectile dysfunction (ED). Material and method. Descriptive study based on two questionnaires filled out by 544 PC physicians who regularly treat patients with ED where they shared their perception about issues relating to the diagnosis and treatment of ED, and how to improve its underdiagnosis and undertreatment. Questions were rated using a continuous 1 to 7 Likert scale. Results. Among males aged ≥ 20 for whom there was a record of ED, prevalence of the condition was 4.4%. ED is considered a very important health issue and a sentinel symptom. ED is not usually included in the medical record (26.5%) and physicians address the condition more often in the presence of risk factors, especially with the concomitant intake of drugs. Male doctors appear to have more empathy for men with ED, but they do not appear to diagnose the condition with more frequency than their women counterparts. Age does not appear to influence diagnosis. The lack of time and training are the main barriers for a correct approach. Training is required to improve the underdiagnosis. ED is usually treated when it is associated to disorders at this level of healthcare. Conclusions. Actions are needed to help improve the diagnosis of ED in Spain, which in turn will allow early detection of underlying comorbidities and improve the health and quality of life of the patient (AU)

Prevalencia del síndrome de déficit de testosterona entre varones con disfunción sexual: de la sospecha a la realidad. Un estudio descriptivo transversal / Prevalence of the testosterone deficiency syndrome in males with sexual dysfunction: From suspicion to reality. A descriptive transversal study

Objetivo: Analizar la prevalencia del síndrome de déficit de testosterona (SDT) entre varones asistentes a conferencias de la campaña «Los hombres cambian. A partir de los 40 toca revisión», con signos/síntomas sexuales como sospecha. Objetivo secundario: analizar la relación del déficit de testosterona con la edad, obesidad, comorbilidades, disfunción eréctil (DE) y síntomas. Presentamos los resultados del estudio piloto. Material y método: Estudio descriptivo transversal en varones ≥ 18 años. Se recogieron datos antropométricos, clínicos y de laboratorio, incluida la testosterona total. Se valoró la DE mediante el International Index of Erectile Function (IIEF-5) y los síntomas mediante la escala Aging Males’ Symptoms (AMS). Se calcularonodds ratio para déficit de testosterona (testosterona total ≤ 12 nmol/l) mediante modelos de regresión logística. Resultados: Participaron 450 varones con una edad media de 54,3 ± 9,3 años. El 53,7% presentaba DE y el 19,8% déficit de testosterona. La prevalencia de SDT bioquímico y sintomático fue del 15%. Presentar obesidad o DE dobló la probabilidad de padecer déficit de testosterona; presentar diabetes, depresión/ansiedad o enfermedad coronaria la triplicó. El déficit de testosterona se relacionó con valores inferiores de colesterol HDL y superiores de glucosa y triglicéridos, puntuaciones superiores global y de subdominios del AMS, y mayor frecuencia de síntomas globales y somáticos. Diez de los 17 síntomas fueron más frecuentes. Conclusión: La prevalencia de SDT entre varones ≥ 30 años con sospecha de disfunción sexual es del 15%. Ambos, SDT y DE, estaban infradiagnosticados. El déficit de testosterona se relacionó con un peor estado de salud y más sintomatología. Son necesarias campañas de concienciación (AU)

Objective: the main objective was to assess the prevalence the testosterone deficiency syndrome (TDS) in males attending conferences included in the campaign «Men change as they age. Over 40 it is time for a check up»” based on sexual signs/symptoms as warning signals. The secondary objective was to assess the relationship of testosterone deficiency with age, obesity, co-morbidities, erectile dysfunction (ED) and symptoms. Results of the pilot study are presented. Material and method: descriptive, crossover study among men aged≥18 years. Anthropometric, clinical and laboratory data, including total testosterone values, were collected. The ED and TDS symptoms were assessed using the International Index of Erectile Function (IIEF-5) score and the Aging Males’ Symptoms (AMS) scale, respectively. Logistic regression analyses were performed to calculate the odds ratio for testosterone deficiency (total testosterone≤12nmol/L). Results: a total of 450 men participated in the study. Mean age was 54.3±9.3 years, and ED was present in 53.7%. Prevalence of testosterone deficiency was 19.8%, and that of TDS (biochemical and symptomatic) was 15%. Having obesity or ED doubled the likelihood of testosterone deficiency, while diabetes, depression/anxiety or cardiac disease tripled it. Testosterone deficiency was significantly associated with lower HDL-cholesterol, higher fasting glucose and triglyceride values, higher global and sub-domain AMS scores, and the presence of global and somatic symptoms. Ten out of the 17 AMS symptoms were also more prevalent. Conclusion: prevalence of TDS among men aged ≥30 with a suspicion of sexual dysfunction was 15%. Both TDS and ED were under-diagnosed. Men with testosterone deficiency presented worse health status and more symptoms. Awareness campaigns are needed

Importancia de la rehabilitación precoz de los cuerpos cavernosos tras prostatectomía radical / Importance of early rehabilitation of the corpus cavernosum after radical prostatectomy

Objetivos: Primario: evaluar la importancia de una rehabilitación precoz de los cuerpos cavernosos sobre la función eréctil tras prostatectomía radical. Secundario: analizar los factores asociados a una mejor respuesta. Material y método: Estudio retrospectivo en pacientes tratados con inyecciones intracavernosas tras prostatectomía radical entre el 1 de enero de 2006 y el 31 de diciembre de 2008. Se incluyeron enfermos sin antecedentes de disfunción eréctil previa a la cirugía, no respondedores a inhibidores de la 5-fosfodiesterasa. En todos se realizó ecodoppler color tras inyección de prostaglandina E1 10-20 mg. Se compararon 2 grupos en función de la precocidad del inicio de la rehabilitación tras la cirugía (precoz, < 6 meses, o tardía, > 6 meses). Resultados: Se incluyeron 82 pacientes. En el análisis multivariante, fueron factores predictores de buena respuesta al tratamiento: inicio precoz de la rehabilitación (OR: 0,06; IC 95%: 0,014- 0,26), mayor velocidad pico sistólica durante el test (OR: 1,01; IC 95%: 1,01-1,1) y estadio anatomopatológico favorable (OR: 0,15; IC 95%: 0,036-0,6). El ecodoppler color tras inyección de prostaglandina E1 presentó valores anormales con mayor frecuencia en el grupo de inicio tardío frente al precoz (89,5% [n = 34] vs. 65,9% [n = 29]; p = 0,01). El 40,2% (n = 33) de los sujetos presentaron fracaso del mecanismo corporovenooclusivo, presentando valores más elevados el grupo de inicio tardío (5,53 ± 1,4 cm/seg) frente al precoz (4,75 ±1,03 cm/seg) (p = 0,005). La presencia de erecciones funcionales a los 18 meses del seguimiento fue mayor en el grupo de inicio precoz (p < 0,001). Conclusiones: Según el presente estudio, en pacientes tras prostatectomía radical la rehabilitación farmacológica precoz de la erección presenta mejores resultados comparada con la tardía (AU)

Objectives: Primary: to evaluate the importance of early rehabilitation of the corpus cavernosum on erectile function after radical prostatectomy. Secondary: to analyse the factors associated with better response. Material and method: Retrospective study in patients treated with intracavernous injections after radical prostatectomy between 1 January 2006 and 31 December 2008. We included patients lacking a history of erectile dysfunction prior to surgery, not responding to phosphodiesterase-5 inhibitors. All patients underwent colour echo-doppler after injection of prostaglandin E1 10-20 mg. The outcomes of these 2 groups were then compared according to how early rehabilitation began after surgery (early, < 6 months, or late, > 6 months). Results: There were 82 patients included in the study. In the multivariate analysis, predictive factors of good response to treatment were: early onset of rehabilitation (OR: 0.06; 95% CI: 0.014-0.26), higher peak systolic velocity during the test (OR: 1.01; 95% CI: 1.01-1.1) and favourable histopathological stage (OR: 0.15; 95% CI 95%: 0.036-0.6). The colour echo-doppler procedure after prostaglandin E1 injection showed abnormal values more frequently in the lateonset than in the early group (89.5% [n = 34] vs. 65.9% [n = 29]; P = .01). Corporal veno-occlusive dysfunction was presented by 40.2% (n = 33) of subjects, with the late-onset group presenting higher values (5.53 ± 1.4 cm/sec) than the early group (4.75 ± 1.03 cm/sec) (P = .005). The presence of functional erections at 18 months’ follow-up was higher in the early onset group (P < .001). Conclusions: According to this study, early erectile dysfunction rehabilitation after radical prostatectomy achieves better results than late rehabilitation in patients (AU)

Hemangioma cavernoso intraescrotal; una enfermedad poco frecuente / Intrascrotal cavernous hemangioma: An uncommon disease

El hemangioma cavernoso intraescrotal es una enfermedad muy rara que debe tenerse en cuenta cuando se realiza el diagnóstico diferencial de las masas vasculares. Un paciente de 26 años de edad fue remitido al Servicio de Urología para la evaluación de malestar y una sensación de masa en el hemiescroto derecho. La ecografía doppler mostró una malformación vascular y el paciente fue sometido a resección de la masa por vía inguinal derecha. El examen anatomopatológico reveló el diagnóstico de hemangioma cavernoso. No hubo complicaciones durante la cirugía y no se ha producido recurrencia de la misma. A pesar de su baja incidencia, es importante tenerlo en cuenta al realizar el diagnóstico diferencial de masas vasculares. Para su diagnóstico, el examen físico y el uso de técnicas de ultrasonido doppler son esenciales (AU)

Intrascrotal cavernous hemangioma is a very rare disease which should be taken into account when making a differential diagnosis of vascular masses. A 26-year-old male patient was referred to the Urology Department for evaluation of discomfort and sensation of having a mass in his right hemiscrotum. Doppler ultrasound imaging showed a vascular malformation and the patient underwent excision of the mass through an inguinal incision. Anatomical and pathologic examination revealed cavernous hemangioma. There were no complications during the surgery and no recurrence afterwards. Despite its low incidence, it is important to keep this in mind when making differential diagnoses of vascular masses. Physical examinations and the use of doppler ultrasound techniques are essential for its diagnosis (AU)

La pareja del hombre con disfunción eréctil: la opinión del médico de Atención Primaria acerca de su papel en el diagnóstico y el tratamiento de la disfunción eréctil en España / The partner of the male with erectile dysfunction: the Primary Care physician's opinion of the role of the partner in erectile dysfunction diagnosis and treatment in Spain

Objetivo. Analizar diversos aspectos sobre la integración de la mujer en el diagnóstico y el tratamiento de la disfunción eréctil (DE) en España. Material y método. Estudio descriptivo basado en una encuesta a 544 médicos de Atención Primaria que tratan habitualmente pacientes con DE y que expusieron su percepción sobre aspectos relativos al diagnóstico y tratamiento de la DE para determinar diferencias entre las comunidades autónomas (CCAA). Se incluyeron preguntas acerca del papel de la mujer, que se presentan aquí. Las preguntas fueron valoradas mediante una escala Likert continua del 1 al 7. Resultados. El 52% de los médicos tenía registrada la DE de sus pacientes. La prevalencia global de DE fue de 5,6%, con diferencias entre las CCAA. No parece frecuente que el hombre comparta el problema con su pareja, ni que acuda a consulta impulsado por ella. La implicación de la mujer en el diagnóstico y el tratamiento es baja, y presenta diferencias significativas entre las CCAA. En un 22,3% de las ocasiones el hombre acude a consulta con su pareja, en un 67,2% lo hace solo, y en un 10,5% lo hace la mujer sola, observándose diferencias significativas entre las CCAA en estos 2 últimos aspectos. La mujer suele fomentar el tratamiento, más que impedirlo. Conclusiones. La integración de la mujer en la DE en España es baja. Es necesario educar a ambos miembros de la pareja sobre la importancia de la comunicación y de la participación conjunta en la toma de decisiones sobre la DE (AU)

ObjectiveTo analyse different aspects regarding integrating of women in the diagnosis and treatment of erectile dysfunction (ED) in Spain.Material and methodDescriptive study to determine differences across Spain based on a survey administered to 544 Primary Care physicians that regularly treat patients with ED who provided their perception about aspects related to the diagnosis and treatment of ED. Questions about the role of women were included in the survey and are presented here. Questions were assessed using a continuous Likert scale from 1 to 7.ResultsFifty-two percent of the physicians had registered their patients’ ED in the patient file. Overall prevalence of ED was 5.6%, with differences across autonomous communities (AACC). Men do not appear to share their problem with their partner frequently nor do they seek consultation prompted by their partner's request. The involvement of women in the diagnosis and treatment of the condition is low and shows significant differences among AACC. In 22.3% of visits, men come to the consultation office with their partner; in 67.2% of visits, men come for consultation alone; and in 10.5% it is the women that come alone. There are significant differences across AACC regarding these last 2 groups. Women usually encourage treatment rather than preventing it.ConclusionsThe integration of women in the management of ED in Spain is low. It is necessary to educate both members of the couple on the importance of communication and joint participation in ED decision-making (AU)

[Current recommendations about the diagnosis and treatment of testosterone deficit syndrome: Clinical guidelines]. / Recomendaciones actuales sobre el diagnóstico y tratamiento del SDT: Guías de practica clínica.

Testosterone deficit syndrome (TDS) is a clinical and biochemical syndrome associated with advanced age and characterized by some typical symptoms and decrease in serum testosterone levels, which can affect multiple organs and systems, deteriorating the quality of life of the males who suffer it. Due to the low specificity of the clinical picture, as well as that of the commonly used questionnaires, when there is a diagnostic suspicion, serum testosterone determination is necessary, without a current universally accepted determination method. The increased survival of males in the western world and their demand of a better quality of life,including the preservation of sexual activity, up to increasingly more advanced ages: together with the appearance of new ways of testosterone delivery, make this entity, clinical-biochemical, acquirean increasingly greater importance. From a therapeutic point of view, testosterone replacement therapy has precise indications, with individualized evaluation in each patient on the basis of risk/benefit, and with an adequate, well defined follow up, that will allow the control of possible adverse events. TRT is recommended in patients with diminished testosterone associated with muscle mass and strength loss, decrease of bone density of the lumbar spine or diminished libido and quality of erection. Contraindications for therapy would include active or non treated prostate cancer, PSA >4 ng/ml before evaluation, breast cancer, severe sleep apnea, infertility, hematocrit over 50% or severe LUTS due to BPH.

Recomendaciones actuales sobre el diagnóstico y tratamiento del SDT: Guías de práctica clínica / Current recommendations about the diagnosis and treatment of testosterone deficit syndrome: Clinical guidelines

El síndrome de déficit de testosterona, es un síndrome clínico y bioquímico asociado a la edad avanzada y caracterizado por unos síntomas típicos y disminución de las concentraciones de testosterona sérica, que puede afectar a múltiples órganos y sistemas, deteriorando la calidad de vida del varón que lo padece. Debido a la baja especificidad tanto de la clínica, como de los cuestionarios comúnmente utilizados, ante la sospecha clínica, es necesario la determinación de la testosterona sérica, sin que en la actualidad, exista un método de determinación universalmente aceptado. El aumento de la supervivencia de los varones en el mundo occidental y la demanda por éstos de una mejor calidad de vida, hasta edades cada vez más avanzadas, lo que incluye el mantenimiento de la actividad sexual; junto con la aparición de nuevas formas de administración de testosterona, hace que esta entidad, clínico-bioquímica, adquiera cada vez mayor importancia. Desde el punto de vista terapéutico, el tratamiento sustitutivo con testosterona, tiene indicaciones precisas, con valoración individualizada en cada paciente en razón del riesgo/beneficio, y con un seguimiento adecuado y bien definido, que permitirán controlar los posibles efectos adversos. Se recomienda el tratamiento sustitutivo con testosterona en pacientes con disminución de la misma y que asocien pérdida de masa muscular y fuerza, descenso de la densidad ósea en columna lumbar o disminución de la libido y la calidad de la erección. Las contraindicaciones para el tratamiento incluirían el cáncer de próstata activo o no tratado, el PSA > 4 ng/ml pendiente de valoración, el cáncer de mama, la apnea de sueño severa, la infertilidad, el hematocrito por encima de 50% o los síntomas severos del tracto urinario inferior debidos a hipertrofia prostática benigna (AU)

Testosterone deficit syndrome (TDS) is a clinical and biochemical syndrome associated with advanced age and characterized by some typical symptoms and decrease in serum testosterone levels, which can affect multiple organs and systems, deteriorating the quality of life of the males who suffer it. Due to the low specificity of the clinical picture, as well as that of the commonly used questionnaires, when there is a diagnostic suspicion, serum testosterone determination is necessary, without a current universally accepted determination method. The increased survival of males in the western world and their demand of a better quality of life, including the preservation of sexual activity, up to increasingly more advanced ages; together with the appearance of new ways of testosterone delivery, make this entity, clinical-biochemical, acquirean increasingly greater importance. From a therapeutic point of view, testosterone replacement therapy has precise indications, with individualized evaluation in each patient on the basis of risk/benefit, and with an adequate, well defined follow up, that will allow the control of possible adverse events.TRT is recommended in patients with diminished testosterone associated with muscle mass and strength loss, decrease of bone density of the lumbar spine or diminished libido and quality of erection. Contraindications for therapy would include active or non treated prostate cancer, PSA > 4 ng/ml before evaluation, breast cancer, severe sleep apnea, infertility, hematocrit over 50% or severe LUTS due to BPH (AU)

¿A qué nivel se produce la fragmentación del ADN en pacientes infértiles con varicocele? / Analysis of the site of DNA fragmentation in infertile men with varicocele

Objetivo: Establecer a qué nivel se produce la fragmentación del ácido desoxirribonucleico (FADN), intratesticular o en la vía seminal, en varones infértiles con varicocele. Material y métodos: Análisis preliminar sobre 15 sujetos en estudio por infertilidad de un año de evolución con varicocele como causa más probable de su alteración. Realizamos FADN en semen previo a la varicocelectomía quirúrgica. Durante la intervención, se obtuvo una muestra testicular mediante biopsia (TESE), para la medición de FADN en espermatozoides intratesticulares, con el objetivo de establecer sus valores y si había diferencias respecto al semen. Resultados: Quince pacientes fueron intervenidos de varicocele izquierdo. En el seminograma, la alteración más frecuente fue la oligoastenozoospermia. Presentaron ADN fragmentado en semen 9 pacientes con una media de 47,8% (rango 38,8-59,2%), y en 6 fueron normales (media 27,4%; rango 12,7-35,3%). La FADN en testículo presentó valores más elevados que en el semen, estando alterados en 14 de los 15 pacientes (media 62,3%, rango 39,0-83,3%). Conclusiones: La FADN parece tener un papel importante en la fisiopatología actual del varicocele y aumenta en el semen de varones infértiles con esta alteración. Derivado de nuestros resultados, podríamos deducir que el mecanismo más importante de fragmentación se situaría a nivel intratesticular, en contra de lo que actualmente se postula. Confirmar esta hipótesis con mayor número de casos supondría un avance significativo en el conocimiento y aplicaciones clínicas en cuanto a esta patología (AU)

Objective: To establish the site at which intratesticular or seminal DNA fragmentation (DNAF) occurs in infertile men with varicocele. Material and Methods: A preliminary analysis was performed in a 1-year study of 15 patients in whom the suspected cause of infertility was varicocele. Analysis of DNAF was performed in semen prior to surgical varicocelectomy. To measure DNAF in intratesticular sperm, testicular samples were obtained by biopsy during the intervention. Results: Fifteen patients had left varicocele surgery. The most frequent abnormality observed in the semen was oligoasthenozoospermia. Nine patients had DNAF (average: 47.8%, range: 38.8-59.2%), and six were normal (average; 27.4%, range: 12.7-35.3%). DNAF levels were higher in testicular tissue samples than in semen (average: 62.3%, range: 39.0-83.3%). Only one of these patient samples did not reveal DNAF. Conclusions: DNAF seems to be related to the physiopathology of varicocele and is present at higher levels in the semen of infertile men with this alteration. In view of these results, we deduce that DNA fragmentation will primarily occur in the testes, which is contrary to current understanding. Testing this hypothesis in studies that include more patients would allow important advances to be made in the knowledge and treatment of this alteration (AU)

Epidemiología de la disfunción eréctil. Factores de riesgo / Epidemiology of erectile dysfunction. Risk factors

En 1993, la conferencia de consenso sobre la impotencia del NIH (Nacional Institute of Health), define la Disfunción Eréctil (DE) como “la incapacidad permanente para iniciar o mantener una erección suficiente como para permitir una relación sexual satisfactoria”.La Disfunción Eréctil (DE), es un trastorno frecuente que afecta negativamente a la calidad de vida de los varones que la padecen. Su prevalencia varía entre diferentes países, culturas y razas.Los primeros estudios poblaciones publicados, datan de principios de los 90 y conservan aún su vigencia.Todos reflejan la influencia que la edad tiene sobre la prevalencia de esta patología, así como su estrecha relación con las enfermedades cardiovasculares.Dependiendo de la definición utilizada y del diseño del estudio, la prevalencia varía entre el 10 y el 52%, en particular en hombres entre 40 y 70 años, con una incidencia en occidente de 25-30 nuevos casos por 1000 habitantes y año(AU)

In 1993 the NIH (National Institute of Health) Consensus Conference on Impotence defined erectile dysfunction as the permanent incompetence to start or maintain an erection enough to enable satisfactory sexual intercourse.Erectile dysfunction (ED) is a frequent disorder that affects negatively quality of life of males suffering it. Its prevalence varies between different countries, cultures and races.The first population studies published date from early 90`s and still keep their validity.All of them show the influence of age on prevalence of ED, as well as its close relationship with cardiovascular diseases.Depending on the definition used and study design prevalence varies from 10 to 52%, mainly in men between 40-70 years, with an incidence in western countries between 25-30 new cases per 1000 inhabitants year(AU)

[New epidemiologic patterns and risk factors in renal cancer]. / Nuevos patrones epidemiológicos y factores de riesgo en cáncer renal.

Incidence of renal carcinoma, one of the most fatal solid neoplasms, has steadily increased in Western society. Moreover, these tumors are being increasingly detected in their early stages. As with most cancers, the underlying causes of the disease remain unknown. However, understanding of pathogenesis of this tumor is rapidly advancing, and will allow for new treatments for advanced disease. Understanding of the influence of easily avoidable risk factors may allow for prevention of thousands of deaths caused by renal cancer.

[Paired kidneys in transplant]. / Riñones parejos en trasplante.

OBJECTIVES: Many factors affect the graft and patient survival on the renal transplant outcome. These factors depend so much of the recipient and donor. We accomplished a study trying to circumvent factors that depend on the donor. We checked the paired kidneys originating of a same donor cadaver. PATIENTS AND METHOD: We examined the risk factors in the evolution and follow-up in 278 couples of kidney transplant. We describe their differences, significance, the graft and patient survival, their functionality in 3 and 5 years and the risk factors implicated in their function. We study immunogenic and no immunogenic variables, trying to explain the inferior results in the grafts that are established secondly. We regroup the paired kidneys in those that they did not show paired initial function within the same couple. RESULTS: The results yield a discreet deterioration in the graft and patient survival for second group establish, superior creatinina concentration, without obtaining statistical significance. The Cox regression study establishes the early rejection (inferior to three months) and DR incompatibility values like risk factors. CONCLUSIONS: This model of paired kidneys would be able to get close to best-suited form for risk factors analysis in kidney transplant from cadaver donors, if more patients examine themselves in the same way. The paired kidneys originating from the same donor do not show the same function in spite of sharing the same conditions of the donor and perioperative management.

Nuevos patrones epidemiológicos y factores de riesgo en cáncer renal / New epidemiologic patterns and risk factors in renal cancer

El carcinoma renal constituye una de las neoplasias sólidas más letales. En la sociedad occidental se ha producido un constante aumento de la incidencia de este tumor, además de un incremento en la detección de tumores en estadíos precoces. Como ocurre en la mayoría de los cánceres, las causas de la enfermedad permanecen en gran medida desconocidas. Sin embargo, el conocimiento sobre la patogenia última de este tumor avanza rápidamente, permitiendo nuevos tratamientos para la enfermedad avanzada. El conocimiento de la influencia de factores de riesgo fácilmente evitables puede permitir evitar miles de muertes causadas por el cáncer renal (AU)

Incidence of renal carcinoma, one of the most fatal solid neoplasms, has steadily increased in Western society. Moreover, these tumors are being increasingly detected in their early stages. As with most cancers, the underlying causes of the disease remain unknown. However, understanding of pathogenesis of this tumor is rapidly advancing, and will allow for new treatments for advanced disease. Understanding of the influence of easily avoidable risk factors may allow for prevention of thousands of deaths caused by renal cancer (AU)