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1.
J Assoc Physicians India ; 68(11): 57-61, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33187038

RESUMO

Erectile dysfunction (ED) is defined as the inability to achieve or maintain penile erection sufficient to permit satisfactory sexual activity. The prevalence increases with age. Basic and clinical research is identifying the neurovascular and humoral control of the mechanisms. The initial evaluation should differentiate erectile dysfunction from premature ejaculation and loss of libido. Myocardial insufficiency, hypogonadism and peripheral neuropathy should be looked for. Initial laboratory investigations should be restricted to identifying previously undetected medical illness that may directly contribute to erectile dysfunction. Discussing the available options with the couple is an important aspect. If erectile dysfunction is secondary to other treatable disorders these should be treated simultaneously. When other diseases that require intervention are ruled out and if there are no contraindications, therapy may be initiated with a phosphodiesterase inhibitor. In selected cases, psychosexual therapy may be beneficial. If phosphodiesterase inhibitors are contraindicated, vacuum constriction devices may be tried. Further options include intracavernosal injection, intraurethral instillation, penile revascularization and prosthesis. The availability of effective and well-tolerated oral medications has dramatically changed the clinical approach to erectile dysfunction. Pharmacotherapy is the preferred cost-effective first-line therapy in the vast majority of patients. A stepped-care approach is followed in the primary care and family practice settings. Appropriate urological, endocrine and psychiatric referrals, and shared decision-making with the couple will enable effective treatment of men with erectile dysfunction.


Assuntos
Disfunção Erétil , Disfunção Erétil/diagnóstico , Disfunção Erétil/epidemiologia , Disfunção Erétil/terapia , Humanos , Índia/epidemiologia , Masculino , Inibidores de Fosfodiesterase , Prevalência , Resultado do Tratamento
2.
BMJ ; 371: m3503, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028540

RESUMO

OBJECTIVE: To assess treatment related changes in quality of life up to 15 years after diagnosis of localised prostate cancer. DESIGN: Population based, prospective cohort study with follow-up over 15 years. SETTING: New South Wales, Australia. PARTICIPANTS: 1642 men with localised prostate cancer, aged less than 70, and 786 controls randomly recruited from the New South Wales electoral roll into the New South Wales Prostate Cancer Care and Outcomes Study (PCOS). MAIN OUTCOME MEASURES: General health and disease specific quality of life were self-reported at seven time points over a 15 year period, using the 12-item Short Form Health Survey scale, University of California, Los Angeles prostate cancer index, and expanded prostate cancer index composite short form (EPIC-26). Adjusted mean differences were calculated with controls as the comparison group. Clinical significance of adjusted mean differences was assessed by the minimally important difference, defined as one third of the standard deviation (SD) from the baseline score. RESULTS: At 15 years, all treatment groups reported high levels of erectile dysfunction, depending on treatment (62.3% (active surveillance/watchful waiting, n=33/53) to 83.0% (non-nerve sparing radical prostatectomy, n=117/141)) compared with controls (42.7% (n=44/103)). Men who had external beam radiation therapy or high dose rate brachytherapy or androgen deprivation therapy as primary treatment reported more bowel problems. Self-reported urinary incontinence was particularly prevalent and persistent for men who underwent surgery, and an increase in urinary bother was reported in the group receiving androgen deprivation therapy from 10 to 15 years (year 10: adjusted mean difference -5.3, 95% confidence interval -10.8 to 0.2; year 15: -15.9; -25.1 to -6.7). CONCLUSIONS: Patients receiving initial active treatment for localised prostate cancer had generally worse long term self-reported quality of life than men without a diagnosis of prostate cancer. Men treated with radical prostatectomy faired especially badly, particularly in relation to long term sexual outcomes. Clinicians and patients should consider these long term quality of life outcomes when making treatment decisions.


Assuntos
Antagonistas de Androgênios , Braquiterapia , Efeitos Adversos de Longa Duração , Prostatectomia , Neoplasias da Próstata , Qualidade de Vida , Idoso , Antagonistas de Androgênios/efeitos adversos , Antagonistas de Androgênios/uso terapêutico , Austrália/epidemiologia , Braquiterapia/efeitos adversos , Braquiterapia/métodos , Estudos de Coortes , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Humanos , Efeitos Adversos de Longa Duração/epidemiologia , Efeitos Adversos de Longa Duração/etiologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/psicologia , Neoplasias da Próstata/terapia , Risco Ajustado , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia
5.
Vasc Health Risk Manag ; 16: 231-239, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32606719

RESUMO

Erectile dysfunction (ED) is defined as a man's consistent or recurrent inability to attain and/or maintain penile erection enough for successful vaginal intercourse. ED affects a large part of the population, increasing its incidence with age and comorbidities. It is estimated by the year 2025, 322 million men will suffer from ED. Incidence of ED has been related not only to chronic diseases such as diabetes mellitus, metabolic syndrome, hyperlipidemia, psychiatric diseases or urinary tract diseases, but also to hypertension and especially to antihypertensive treatments. This review summarizes current knowledge about the management of ED in hypertensive men and its role as cardiovascular disease predictor.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Disfunção Erétil/terapia , Hipertensão/tratamento farmacológico , Ereção Peniana/efeitos dos fármacos , Inibidores da Fosfodiesterase 5/uso terapêutico , Anti-Hipertensivos/efeitos adversos , Tomada de Decisão Clínica , Disfunção Erétil/diagnóstico , Disfunção Erétil/epidemiologia , Disfunção Erétil/fisiopatologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Inibidores da Fosfodiesterase 5/efeitos adversos , Fatores de Risco , Resultado do Tratamento
6.
J Sex Med ; 17(8): 1495-1508, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32622766

RESUMO

BACKGROUND: Approximately 43% of Spanish men report experiencing premature ejaculation (PE) at some point in their lives and 12.1% suffer from erectile dysfunction (ED), of whom only 16.5% have seen a doctor. Despite this, ED and PE remain undiagnosed among a supposedly healthy segment of the population. AIM: To assess the general knowledge of a representative population of healthy Spanish males of the symptoms, treatment, and expectations related to ED and PE. METHODS: This was a descriptive study based on an online questionnaire in which 2,515 males aged 25-75 years with no history of ED and/or PE presented their perception of aspects related to symptoms, diagnosis, treatment, and expectations in ED and PE. MAIN OUTCOME MEASURES: The study provided an evaluation of the knowledge, attitude, and underdiagnosis of ED and/or PE in healthy males and the approach taken by urology specialists and other disciplines. RESULTS: The survey was completed by 2,515 healthy males, including over 80% of those who had completed secondary or higher education. 60% of the sample had never seen a urologist and 59% and 62% of the participating men responded correctly to the statements about PE and ED, respectively. Their lack of knowledge of the therapeutic alternatives was clear (74% and 76% of the panel were unaware of the existence of effective treatments for ED and PE, respectively). Despite the initiative shown by some participants in seeking information about each condition (10.3% for ED; 16.7% for PE), only 4.7% of them had been questioned about ED by a medical practitioner (1.9% for PE). The underdiagnosis rate stood at 3.5% for ED (5.6% participants >65 years) and at about 10% for PE. CLINICAL IMPLICATIONS: These results will represent a point of departure for establishing some recommendations to improve the detection and treatment of these disorders. STRENGTHS & LIMITATIONS: This is the first study of its kind in Spain to analyze the underdiagnosis of ED and/or PE inferred from data reported by a population of healthy males. Screening for ED was performed with a validated questionnaire. However, the rest of the research was conducted using adaptations of validated questionnaires or a self-designed questionnaire based on and in consultation with a group of experienced andrologists. CONCLUSION: People need to have greater knowledge of both the conditions and the related false myths to make sure that they are familiar with the existence of drug treatments and socio-sanitary interventions. Primary care physicians and urologists should also be more proactive in routine visits in order to achieve better management of ED and PE. Prieto-Castro R, Puigvert-Martínez AM, Artigas-Feliu R, et al. Opinions, Attitudes, and Perceptions in Relation to Erectile Dysfunction and Premature Ejaculation in the Undiagnosed Spanish Male Population. Results of the PANDORA Project. J Sex Med 2020;17:1495-1508.


Assuntos
Disfunção Erétil , Ejaculação Precoce , Adulto , Idoso , Atitude , Ejaculação , Disfunção Erétil/diagnóstico , Disfunção Erétil/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Ejaculação Precoce/diagnóstico , Ejaculação Precoce/epidemiologia , Espanha/epidemiologia , Inquéritos e Questionários
7.
Cochrane Database Syst Rev ; 6: CD006590, 2020 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-32495338

RESUMO

BACKGROUND: Prostate cancer is a common cancer but is oftentimes slow growing. When confined to the prostate, radical prostatectomy (RP), which involves removal of the prostate, offers potential cure that may come at the price of adverse events. Deferred treatment, involving observation and palliative treatment only (watchful waiting (WW)) or close monitoring and delayed local treatment with curative intent as needed in the setting of disease progression (active monitoring (AM)/surveillance (AS)) might be an alternative. This is an update of a Cochrane Review previously published in 2010. OBJECTIVES: To assess effects of RP compared with deferred treatment for clinically localised prostate cancer. SEARCH METHODS: We searched the Cochrane Library (including CDSR, CENTRAL, DARE, and HTA), MEDLINE, Embase, AMED, Web of Science, LILACS, Scopus, and OpenGrey. Additionally, we searched two trial registries and conference abstracts of three conferences (EAU, AUA, and ASCO) until 3 March 2020. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) that compared RP versus deferred treatment in patients with localised prostate cancer, defined as T1-2, N0, M0 prostate cancer. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the eligibility of references and extracted data from included studies. The primary outcome was time to death from any cause; secondary outcomes were: time to death from prostate cancer; time to disease progression; time to metastatic disease; quality of life, including urinary and sexual function; and adverse events. We assessed the certainty of evidence per outcome using the GRADE approach.  MAIN RESULTS: We included four studies with 2635 participants (average age between 60 to 70 years). Three multicentre RCTs, from Europe and USA, compared RP with WW (n = 1537), and one compared RP with AM (n = 1098). Radical prostatectomy versus watchful waiting RP probably reduces the risk of death from any cause (hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.70-0.90; 3 studies with 1537 participants; moderate-certainty evidence). Based on overall mortality at 29 years, this corresponds to 764 deaths per 1000 men in the RP group compared to 839 deaths per 1000 men in the WW group. RP probably also lowers the risk of death from prostate cancer (HR 0.57, 95% CI 0.44-0.73; 2 studies with 1426 participants; moderate-certainty evidence). Based on prostate cancer-specific mortality at 29 years, this corresponds to 195 deaths from prostate cancer per 1000 men in the RP group compared with 316 deaths from prostate cancer per 1000 men in the WW group. RP may reduce the risk of progression (HR 0.43, 95% CI 0.35-0.54; 2 studies with 1426 participants; I² = 54%; low-certainty evidence); at 19.5 years, this corresponds to 391 progressions per 1000 men for the RP group compared with 684 progressions per 1000 men for the WW group) and probably reduces the risk of developing metastatic disease (HR 0.56, 95% CI 0.46-0.70; 2 studies with 1426 participants; I² = 0%; moderate-certainty evidence); at 29 years, this corresponds to 271 metastatic diseases per 1000 men for RP compared with 431 metastatic diseases per 1000 men for WW. General quality of life at 12 years' follow-up is probably similar for both groups (risk ratio (RR) 1.0, 95% CI 0.85-1.16; low-certainty evidence), corresponding to 344  patients with high quality of life per 1000 men for the RP group compared with 344 patients with high quality of life per 1000 men for the WW group. Rates of urinary incontinence may be considerably higher (RR 3.97, 95% CI 2.34-6.74; low-certainty evidence), corresponding to 173 incontinent men per 1000 in the RP group compared with 44 incontinent men per 1000 in the WW group, as are rates of erectile dysfunction (RR 2.67, 95% CI 1.63-4.38; low-certainty evidence), corresponding to 389 erectile dysfunction events per 1000 for the RP group compared with 146 erectile dysfunction events per 1000 for the WW group, both at 10 years' follow-up. Radical prostatectomy versus active monitoring Based on one study including 1098 participants with 10 years' follow-up, there are probably no differences between RP and AM in time to death from any cause (HR 0.93, 95% CI 0.65-1.33; moderate-certainty evidence). Based on overall mortality at 10 years, this corresponds to 101 deaths per 1000 men in the RP group compared with 108 deaths per 1000 men in the AM group. Similarly, risk of death from prostate cancer probably is not different between the two groups (HR 0.63, 95% CI 0.21-1.89; moderate-certainty evidence). Based on prostate cancer-specific mortality at 10 years, this corresponds to nine prostate cancer deaths per 1000 men in the RP group compared with 15 prostate cancer deaths per 1000 men in the AM group. RP probably reduces the risk of progression (HR 0.39, 95% CI 0.27-0.56; moderate-certainty evidence; at 10 years, this corresponds to 86 progressions per 1000 men for RP compared with 206 progressions per 1000 men for AM) and the risk of developing metastatic disease (RR 0.39, 95% CI 0.21-0.73; moderate-certainty evidence; at 10 years, this corresponds to 24 metastatic diseases per 1000 men for the RP group compared with 61 metastatic diseases per 1000 men for the AM group).The general quality of life during follow-up was not different between the treatment groups. However, urinary function (mean difference (MD) 8.60 points lower, 95% CI 11.2-6.0 lower) and sexual function (MD 14.9 points lower, 95% CI 18.5-11.3 lower) on the Expanded Prostate Cancer Index Composite-26 (EPIC-26) instrument, were worse in the RP group. AUTHORS' CONCLUSIONS: Based on long-term follow-up, RP compared with WW probably results in substantially improved oncological outcomes in men with localised prostate cancer but also markedly increases rates of urinary incontinence and erectile dysfunction. These findings are largely based on men diagnosed before widespread PSA screening, thereby limiting generalisability. Compared to AM, based on follow-up to 10 years, RP probably has similar outcomes with regard to overall and disease-specific survival yet probably reduces the risks of disease progression and metastatic disease. Urinary function and sexual function are probably decreased for the patients treated with RP.


Assuntos
Prostatectomia/métodos , Neoplasias da Próstata/terapia , Conduta Expectante , Idoso , Causas de Morte , Progressão da Doença , Disfunção Erétil/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Complicações Pós-Operatórias/epidemiologia , Prostatectomia/efeitos adversos , Prostatectomia/mortalidade , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Incontinência Urinária/epidemiologia
8.
Med. clín (Ed. impr.) ; 154(11): 440-443, jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-195536

RESUMO

ANTECEDENTES Y OBJETIVO: El objetivo fue determinar la prevalencia de disfunción eréctil en los varones mayores de 40 años, y su relación con enfermedades frecuentes en atención primaria. PACIENTES Y MÉTODOS: Se incluyeron 302 varones (40-79 años). Se determinaron antecedentes médicos, hábitos y parámetros antropométricos. Se les administró el cuestionario internacional de sintomatología prostática (IPSS), el cuestionario de salud sexual del varón (SHIM) y el test de Goldberg para ansiedad y depresión. Se determinó la prevalencia de disfunción eréctil y se estudió la relación de las diferentes variables obtenidas mediante análisis univariante y multivariante. RESULTADOS: La prevalencia de disfunción eréctil fue del 36%. Los pacientes de mayor edad, fumadores, con obesidad abdominal, hipertensos, diabéticos, con riesgo de depresión o con síntomas miccionales tenían puntuaciones más bajas del cuestionario de salud sexual. Según el análisis multivariante, el riesgo de padecer disfunción eréctil aumentaba con la edad, si se era diabético o si existía sintomatología miccional. CONCLUSIÓN: La edad, la diabetes mellitus y la presencia de sintomatología miccional son factores asociados a la disfunción eréctil en el ámbito de la atención primaria


BACKGROUND AND OBJECTIVE: The objective was to determine the prevalence of erectile dysfunction in men over 40 years of age and their relationship with frequent pathologies in Primary Care. PATIENTS AND METHODS: Three hundred two men (40-79 years) were included. Anthropometric medical history, habits and parameters were determined. They were given the international prostate symptomatology questionnaire (IPSS), the male sexual health questionnaire (SHIM) and the Goldberg test for anxiety and depression. The prevalence of erectile dysfunction was determined and the relationship of the different variables obtained by univariate and multivariate analysis was studied. RESULTS: The prevalence of erectile dysfunction was 36%. Older patients, smokers, with abdominal obesity, hypertensive, diabetic, at risk of depression or with voiding symptoms had lower scores on the sexual health questionnaire. According to the multivariate analysis, the risk of suffering from erectile dysfunction increased with age, if the person was diabetic, or if there was voiding symptomatology. CONCLUSION: Age, diabetes mellitus and the presence of voiding symptoms are factors associated with erectile dysfunction in the field of Primary Care


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Disfunção Erétil/diagnóstico , Disfunção Erétil/epidemiologia , Sintomas do Trato Urinário Inferior/complicações , Atenção Primária à Saúde , Disfunção Erétil/fisiopatologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Antropometria , Inquéritos e Questionários , Análise Multivariada , Estudos Transversais , Fatores de Risco
9.
Diabetes Metab Syndr ; 14(4): 649-653, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32438327

RESUMO

BACKGROUND AND AIMS: Erectile Dysfunction (ED) is more common in diabetic men and, unfortunately, occurs at an earlier age in diabetic patients when compared with the general population. The study aims to evaluate the independent predictors of ED in adult men with type 2 diabetes mellitus (DM) at a tertiary care center of South India. METHODS: A total of 720 men aged 30-70 years who had been diagnosed with type 2 DM were enrolled for the study from January 2017 to January 2020 from the outpatient diabetes clinic of the Hospital. All patients completed the abridged version of the International Index of Erectile Function (IIEF-5) questionnaire. RESULTS: The mean age of the patients was (58.4 ± 7.8 years). 68.6% of subjects had varying degrees of erectile dysfunction, of which 54.6% had moderate to severe ED. 55.8% had poor glycemic control (HbA1c ≥ 7%). Subjects with ED had a longer duration of DM than those without ED (mean DM duration was 8.1 ± 4.9 years versus 4.4 ± 3.5 years; p < 0.001). Longer duration of DM, poor glycemic control, hypertension, peripheral arterial disease, testosterone deficiency were all independent predictors ED (p < 0.05). CONCLUSIONS: A high incidence of erectile dysfunction was observed in type 2 DM patients attending the diabetic clinic, and over half of the people affected were of moderate-to-severe in intensity. Poor glycemic control, testosterone deficiency, peripheral arterial disease were the modifiable risk factors for ED in diabetic subjects. At the same time, a longer duration of type 2 DM was noticed as a glaring non-modifiable risk factor, according to our study.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Disfunção Erétil/epidemiologia , Adulto , Idoso , Estudos Transversais , Disfunção Erétil/etiologia , Humanos , Incidência , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Centros de Atenção Terciária/estatística & dados numéricos
10.
Einstein (Sao Paulo) ; 18: eAO5070, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32321079

RESUMO

OBJECTIVE: To evaluate epidemiological aspects of priapism in patients with sickle cell disease, and these aspects impact on adult sexual function. METHODS: This was a cross-sectional study including individuals with sickle cell disease who were evaluated at a reference center for sickle cell. Participants completed a structured questionnaire about their sociodemographic characteristics and priapism events. Sexual function was assessed using validated two instruments, the Erection Hardness Score and one about the sex life satisfaction. RESULTS: Sixty-four individuals with median aged of 12 (7 to 28) years were interviewed. The prevalence of priapism was 35.9% (23/64). The earliest priapism episode occurred at 2 years of age and the latest at 42 years. The statistical projection was that 71.1% of individuals of the study would have at least one episode of priapism throughout life. Patients with episodes of priapism (10/23) had significantly worse erectile function Erection Hardness Score of 2 [1-3]; p=0.01 and were less satisfied with sexual life 3 [3-5]; p=0.02. CONCLUSION: Priapism is usually present in childhood, and severe episodes are associated with cavernous damage, impairment in the quality of the erection, and lower sexual satisfaction.


Assuntos
Anemia Falciforme/epidemiologia , Anemia Falciforme/fisiopatologia , Disfunção Erétil/epidemiologia , Disfunção Erétil/fisiopatologia , Priapismo/epidemiologia , Priapismo/fisiopatologia , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Criança , Estudos Transversais , Intervalo Livre de Doença , Humanos , Masculino , Ereção Peniana/fisiologia , Prevalência , Priapismo/etiologia , Qualidade de Vida , Estudos Retrospectivos , Estatísticas não Paramétricas , Inquéritos e Questionários , Adulto Jovem
11.
J Sex Med ; 17(8): 1489-1494, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32340919

RESUMO

BACKGROUND: Erectile dysfunction (ED) is widely considered as an early manifestation of cardiovascular diseases (CVDs), sharing similar risk factors. AIM: Assess rates and predictors of developing CVD and/or hypertension (HTN) over a long-term follow-up period using user-friendly and clinically reliable tools in men presenting with ED but without CVD/HTN or known vascular risk factors at baseline. METHODS: Data from 108 patients presenting between 2005 and 2011 with ED were analyzed. All patients were free from CVD and/or HTN (CVD/HTN) at baseline. Patients completed the International Index of Erectile Function (IIEF) at baseline and were followed up every 6 months with clinical assessment or phone interview. Kaplan-Meier analyses estimated the probability of developing CVD/HTN over time. Cox-regression models tested the association between patient baseline characteristics (for example, age, Charlson Comorbidity Index, baseline IIEF-EF, ED severity, alcohol intake, smoking), response to phosphodiesterase type-5 inhibitors (PDE5is), and the risk of developing CVD/HTN. RESULTS: Of all, 43 (40%) patients showed IIEF-EF scores suggestive of severe ED; 37 (39%) and 59 (61%) were nonresponders and responders to PDE5i, respectively. Median (interquartile range) age was 51 (41, 61) years. Median (interquartile range) follow-up was 95 (86-106) months. Overall, the estimated risk of developing CVD/HTN was 15% (95% confidence interval [CI]: 9-27) at 10-year assessment. Men with baseline severe ED had a higher risk of developing CVD/HTN (34%; 95% CI: 17-59, P = .03) at 10 years than patients with mild to moderate ED (5% [95% CI: 2-14]). At the Cox regression analysis, severe ED (Hazard ratio [HR], 4.62; 95% CI: 1.43, 8.89; P = .01) and baseline IIEF-EF score (HR, 0.92; 95% CI: 0.86, 0.99; P = .02) were associated to the risk of CVD/HTN overtime. Conversely, age and nonresponders to PDE5is (HR, 0.92; 95% CI: 0.32, 2.68; P = .9) were not associated to a risk of CVD/HTN over time. CLINICAL IMPLICATIONS: The use of an easy and user-friendly tool, as the IIEF-EF domain score, would allow to reliably assess which men with ED at first presentation may deserve a different, more specific and detailed cardiologic investigation to prevent inauspicious CV events. STRENGTHS & LIMITATIONS: A single-center-based, observational longitudinal study, raising the possibility of selection biases are the main limits. CONCLUSIONS: Patients with severe ED and lower baseline IIEF-EF but no vascular risk factors at first presentation have more than 30% risk of developing CVD/HTN in 10-year time. Those patients may benefit from medical preventive strategies to lowering the risk of CV events and HTN. Pozzi E, Capogrosso P, Boeri L, et al. Longitudinal Risk of Developing Cardiovascular Diseases in Patients With Erectile Dysfunction-Which Patients Deserve More Attention?. J Sex Med 2020;17:1489-1494.


Assuntos
Doenças Cardiovasculares , Disfunção Erétil , Doenças Cardiovasculares/epidemiologia , Disfunção Erétil/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Ereção Peniana , Inibidores da Fosfodiesterase 5/uso terapêutico
14.
J Sex Med ; 17(6): 1086-1093, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32192923

RESUMO

BACKGROUND: The angiographically documented association between severity of coronary artery disease (CAD) and aorto-ilio-pudendal (A-I-P) artery disease and vascular erectile dysfunction (ED) was not yet settled. AIM: To assess the relation between angiographically proved CAD and A-I-P artery disease in patients with ischemic heart disease (IHD)-associated vascular ED. METHODS: 60 men were assigned to 3 study groups: Group 1 (n = 25), patients who had IHD and ED; group 2 (n = 25), patients who had IHD and had no ED; group 3 (n = 10), patients who had ED and had no suspected IHD. All patients were subjected to detailed medical, cardiac, and sexual history. International Index of Erectile Function and penile color Doppler ultrasound were used to assess ED. Quantitative coronary angiography and invasive angiography were used to assess the vascular tree for the right and left (A-I-P) arteries. Endothelial markers, that is, endothelial microparticles and endothelial progenitor cells were also assessed. OUTCOMES: The main outcome measures are assessment of ED and angiographically proved CAD and A-I-P artery disease. RESULTS: The mean age ± SD of the 3 study groups were 50.4 ± 6.6, 51.4 ± 3.9, and 49.9 ± 6.1 years, respectively, with no statistically significant difference among groups (P = .380). There were significant higher rates of left main (LM) lesions (≥50%), CAD (≥70%), right and left internal pudendal artery lesions, and right and left internal iliac artery lesions in G1 in comparison with G2 and G3. Patients with ED alone had a higher rate of peripheral lesions compared with patients with CAD alone. 10 percent of patients with ED alone had CAD. Patients in G1 had notably higher rates of peripheral lesions than the other groups combined Patients with left internal pudendal artery lesions had a chance by 1.25 and 2.11 times to have LM lesions and significant CAD, respectively. There was a significant increase of endothelial microparticles in G1 in comparison with other groups (P < .05). CLINICAL IMPLICATIONS: The clinical implications are uses of peripheral angiograghy as a diagnostic tool in patients with CAD-associated vascular ED may have a clinical merit. STRENGTHS & LIMITATIONS: The strengths in the present study are the use of angiography, color Doppler ultrasound, and standardized instruments. The main limitations are the small sample size and lack of intervention and longitudinal data. CONCLUSION: ED correlates more with A-I-P vascular lesions compared with CAD alone. There was a statistically significant association between severity of CAD including LM significant lesions and A-I-P arteries disease in patients with CAD-associated vascular ED. Sanad AM, Younis SE, Oraby, MA, et al. Relation Between Severity of Coronary Artery Disease and Aorto-Ilio-Pudendal Artery Disease in Patients With Ischemic Heart Disease-Associated Vascular Erectile Dysfunction. J Sex Med 2020;17:1086-1093.


Assuntos
Doença da Artéria Coronariana , Disfunção Erétil , Isquemia Miocárdica , Adulto , Artérias , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/epidemiologia
15.
J Sex Med ; 17(6): 1101-1108, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32222434

RESUMO

BACKGROUND: Erectile dysfunction (ED) has been proposed as an early indicator for future coronary and peripheral vascular disease. AIM: We aimed to investigate the longitudinal change in proportion and predictors for ED with changes in erectile function domain (EFD) of the International Index of Erectile Function-15 (IIEF-15) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). METHODS: Between December 2018 and June 2019, 286 male patients aged between 40 and 70 years who were treated with PPCI for STEMI were included. The patients were asked to complete the IIEF-EFD form 3 days after the procedure for the evaluation of baseline erectile functions. During follow-up 3 months after the index procedure, the patients were asked to refill the IIEF-EFD form. Both baseline and third-month IIEF-EFD scores were calculated, and the patients were classified into ED severity groups as per the IIEF-EFD scores. A linear mixed model was used to identify predictors of ED at 3 months. OUTCOMES: This study identifies the prevalence and predictors of ED with STEMI who underwent PPCI. RESULTS: The median age was 54 (range 48-61) years. The median IIEF-EFD scores at 3 days and 3 months were 25.5 (range 20.0-27.0) and 22.00 (range 18.25-25.00), respectively. Half of the patients were found to have ED with varying severity as per baseline IIEF-EFD scores. This rate increased to 79% at the 3-month follow-up visit. The IIEF-EFD scores of the patients decreased over time (P < .001). Advanced age (ß = -0.603, se = 0.192, P = .002), presence of three-vessel coronary artery disease (ß = -3.828, se = 0.783, P < .001), and diabetes (ß = -2.934, se = 0.685, P < .001) were found to be inversely associated with the IIEF-EFD scores. CLINICAL IMPLICATIONS: Advanced age, presence of three-vessel disease, and diabetes mellitus are the indicators of sexual rehabilitation needs in patients after STEMI. STRENGTHS & LIMITATIONS: This is the first study investigating the predictor variables for the development of ED after coronary artery disease treatment. The limitations include the lack of evaluation of anxiety and depression and the measurements of testosterone levels. CONCLUSION: The prevalence of ED was high among patients with coronary artery disease, and the frequency of ED increased during 3-month follow-up. Advanced age, three-vessel disease, and diabetes were significant predictors of ED with changes in IIEF-EFD score in patients with STEMI who underwent PPCI. Karabay E, Karsiyakali N, Cinier G, et al. Change in Frequency and Predictors of Erectile Dysfunction With Changes in the International Index of Erectile Function-Erectile Function Domain Score in Patients With ST-Elevation Myocardial Infarction: A Prospective, Longitudinal Study. J Sex Med 2020;17:1101-1108.


Assuntos
Disfunção Erétil , Infarto do Miocárdio com Supradesnível do Segmento ST , Adulto , Idoso , Disfunção Erétil/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Estudos Prospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia
16.
J Sex Med ; 17(5): 919-929, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32156585

RESUMO

BACKGROUND: Bicycle riding's impact on erectile function remains a topic of great interest given cycling's popularity as a mode of transportation and exercise. AIM: We evaluated risk factors for sexual dysfunction in male cyclists with the primary intention of determining if genital/pelvic pain and numbness are associated with erectile dysfunction (ED). METHODS: We surveyed male cyclists using an online anonymous questionnaire. Cyclists were queried on their demographics, cycling experience, and sexual function using the Sexual Health Inventory for Men (SHIM). ED was diagnosed when a completed SHIM score was <22. Regression analysis was used to evaluate the risk of ED in men with genital/pelvic pain or numbness after riding. The survey was designed in the United States. OUTCOMES: Quantitative characterization of cycling habits, onset and timing of genital pain and numbness, and SHIM score. RESULTS: A total of 1635 participants completed the survey. A majority of men were over the age of 50 (58%, 934/1,607), Caucasian (88%, 1,437/1,635), had been active cyclists for over 10 years (63%, 1,025/1,635) and used road bikes (97%, 1,578/1,635). Overall, 22%, 30%, and 57% of men reported ED, genital pain, and genital numbness, respectively. While controlling for cohort demographics, body mass index, cycling intensity and equipment, and medical comorbidities, no saddle characteristics were associated with the risk of developing genital numbness. However, men reporting penile numbness were at higher risk of reporting ED (odds ratio [OR] = 1.453, P = .048). In addition, quicker onset of numbness and resolution of numbness within a day was associated with impaired erectile function. For example, numbness occurring less than 1 hour after cycling had greater odds of leading to ED than numbness after 5 hours (OR = 2.002, P = .032). Similarly, genital pain occurring less than 1 hour (OR = 2.466, P = .031) after cycling was associated with higher ED risk. STRENGTHS & LIMITATIONS: Strengths include a large sample size of high-intensity cyclists and validated questionnaire use. Limitations include reliance on anonymous self-reported survey data and minimal inquiry into the riding preferences and terrain traversed by cyclists. CONCLUSIONS: Pelvic pain and numbness are common complaints among male riders in the United States. Men with such complaints are more likely to also report ED especially if it occurs earlier in the ride. Although direction of causality and temporality are uncertain, alleviation of factors resulting in pelvic discomfort may reduce cycling's impact on sexual function. Such interventions are critical given that cycling for both active travel and aerobic exercise confers numerous health benefits. Balasubramanian A, Yu J, Breyer BN, et al. The Association Between Pelvic Discomfort and Erectile Dysfunction in Adult Male Bicyclists. J Sex Med 2020;17:919-929.


Assuntos
Disfunção Erétil , Disfunções Sexuais Fisiológicas , Adulto , Ciclismo , Estudos Transversais , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Humanos , Masculino , Autorrelato
17.
Biomed Res Int ; 2020: 2302348, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32104681

RESUMO

It is an interesting clinical phenomenon that when evaluating the erectile function of men with erectile dysfunction by couples, respectively, using the erectile hardness model, there will exist the evaluation difference between men and their female partners. This phenomenon reflects the problem of communication and cognition between husband and wife in ED patients. To explore the influencing factors associated with this clinical phenomenon, we conducted this interesting, observational, and cross-sectional field survey. We enrolled 385 couples from the andrology clinics of the first affiliated hospital of Anhui Medical University from December 2017 to December 2018. The demographic data of couples, the medical history, sexuality and the characteristics of ED, and anxiety and depression of the couples were collected through face-to-face interview and questionnaires. The couples were divided into two groups containing 238 couples and 147 couples, respectively. We divided couples into difference group including couples which have inconsistent evaluation results from touching the erectile hardness model and no difference group including couples which have consistent evaluation results from touching the erectile hardness model, respectively. The difference group where the couples share different evaluation results reported higher erectile hardness grade from men than from their female partners (male > female: 73.11% vs. male < female: 26.89%). The scores of IIEF-5 in difference group and no difference group are 13.43 ± 5.75 and 16.82 ± 8.23, respectively. The average grades evaluated from men and women in difference group are 2.79 ± 0.85 and 2.45 ± 0.63, respectively. The average grades evaluated from couples in no difference group are 3.02 ± 0.45. Through statistical comparison and logistic regression analysis, duration of ED > 16 months, seeking treatment from female, negative communication state, and depression from men are the relevant factors accounting for the different evaluation results. This phenomenon reflects the problem of communication and cognition between husband and wife in ED patients. As for couples with these risk factors, we cannot focus only on the oral medication which only restores the penile erectile function. More importantly, we must combine the sexual counseling and sexual knowledge education with the drug treatment. When the two treatments are tightly integrated, not only the penile erection but also the gap of couples can be restored which is the best result of the ED treatment.


Assuntos
Disfunção Erétil/terapia , Relações Interpessoais , Ereção Peniana/fisiologia , Comportamento Sexual/fisiologia , Adulto , Idoso , Ansiedade/fisiopatologia , Ansiedade/psicologia , Estudos Transversais , Depressão/fisiopatologia , Depressão/psicologia , Disfunção Erétil/epidemiologia , Disfunção Erétil/fisiopatologia , Feminino , Dureza/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana/psicologia , Satisfação Pessoal , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Sexualidade/fisiologia , Sexualidade/psicologia , Citrato de Sildenafila/uso terapêutico , Inquéritos e Questionários
18.
Eur J Cancer ; 128: 7-16, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32109852

RESUMO

BACKGROUND: Concurrent chemoradiotherapy is the standard treatment for anal cancer. Following national UK implementation of intensity-modulated radiotherapy (IMRT), this prospective, national cohort evaluates the one-year oncological outcomes and patient-reported toxicity outcomes (PRO) after treatment. MATERIALS AND METHODS: A national cohort of UK cancer centers implementing IMRT was carried out between February to July 2015. Cancer centers provided data on oncological outcomes, including survival, and disease and colostomy status at one-year. EORTC-QLQ core (C30) and colorectal (CR29) questionnaires were completed at baseline and one-year followup. The PRO scores at baseline and one year were compared. RESULTS: 40 UK Cancer Centers returned data with a total of 187 patients included in the analysis. 92% received mitomycin with 5-fluorouracil or capecitabine. One-year overall survival was 94%; 84% were disease-free and 86% colostomy-free at one-year followup. At one year, PRO results found significant improvements in buttock pain, blood and mucus in stools, pain, constipation, appetite loss, and health anxiety compared to baseline. No significant deteriorations were reported in diarrhea, bowel frequency, and flatulence. Urinary symptom scores were low at one year. Moderate impotence symptoms at baseline remained at one year, and a moderate deterioration in dyspareunia reported. CONCLUSIONS: With national anal cancer IMRT implementation, at this early pre-defined time point, one-year oncological outcomes were reassuring and resulted in good disease-related symptom control. one-year symptomatic complications following CRT for anal cancer using IMRT techniques appear to be relatively mild. These PRO results provide a basis to benchmark future studies.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias do Ânus/terapia , Medidas de Resultados Relatados pelo Paciente , Lesões por Radiação/epidemiologia , Radioterapia de Intensidade Modulada/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Ânus/mortalidade , Diarreia/diagnóstico , Diarreia/epidemiologia , Diarreia/etiologia , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Relação Dose-Resposta à Radiação , Dispareunia/diagnóstico , Dispareunia/epidemiologia , Dispareunia/etiologia , Disfunção Erétil/diagnóstico , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Feminino , Flatulência/diagnóstico , Flatulência/epidemiologia , Flatulência/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Estudos Prospectivos , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Índice de Gravidade de Doença , Reino Unido/epidemiologia
19.
Arch Ital Urol Androl ; 91(4): 245-250, 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31937085

RESUMO

OBJECTIVE: Overweight and low physical activity (PA) increase the risk of prostatic enlargement and erectile dysfunction (ED). Less clear is the role of these factors at young age on the lifelong risk. MATERIALS AND METHODS: During June 2018 the Italian Society of Urologists organized the month of Male Urologic Prevention "#Controllati". Men aged 18 years or more were invited to attend urologic centers for a visit and counselling about urologic/ andrologic conditions. Each participating man underwent a physical examination and was asked about urologic symptoms, sexual activity and possible related problems. RESULTS: We analyzed data from 2786 men, aged 55.1 years (SD 10.9, range 19-97). A total of 710 (25.5%) subjects had a diagnosis of prostatic enlargement and 632 (22.7%) of DE. Overweight/obese men were at increased risk of prostatic enlargement and ED with corresponding odds ratio (0R) in comparison with normal or underweight men, being respectively 1.18 (95% Confidence Interval (CI) 1.00-1.44) and 1.69 (95% CI 1.39-2.05). The OR of prostatic enlargement in comparison with men reporting at age 25 a BMI < 25.0 was 1.22 (95% CI 1.01-1.51) for men with a BMI at 25 years of age ≥ 25; the corresponding OR value for ED was 1.17 (0.92- 1.48). Considering total PA at diagnosis, the OR of prostatic enlargement in comparison with no or low PA, was 0.69 (95%CI 0.55-0.86) for men reporting moderate PA and 0.75 (95%CI 0.58-0.98) for those reporting intense PA. When we considered PA at 25 years of age, the OR of subsequent diagnosis of prostatic enlargement, in comparison with men reporting no/low PA at 25 years of age was 0.81 (95%CI 0.63-1.04) for men reporting moderate PA and 0.70 (95%CI 0.52-0.99) for those reporting intense PA. CONCLUSIONS: These findings underline the utility of encouraging healthy lifestyle habits among young men in order to reduce the subsequent risk of prostatic enlargement and ED.


Assuntos
Disfunção Erétil/epidemiologia , Obesidade/complicações , Sobrepeso/complicações , Hiperplasia Prostática/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Disfunção Erétil/etiologia , Exercício Físico/fisiologia , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Hiperplasia Prostática/etiologia , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
20.
Arch Ital Urol Androl ; 91(4): 241-244, 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31937090

RESUMO

OBJECTIVES: To determine the prevalence of sexual dysfunction in male partners of infertile couples and evaluate the effect of childlessness on erectile dysfunction (ED) and sexual relationship stress. MATERIALS AND METHODS: We collected datas of couples who attended our clinics for infertility between 2009 and 2016. Erectile dysfunction was investigated with the Questionnaires of International Index of Erectile Function-15 (IIEF-15) whereas premature ejaculation (PE) status with the Premature Ejaculation Diagnostic Tool (PEDT). The stress status of the childlessness in terms of sexual intercourse was scored by the Visual analogue scale (VAS) questionnaire. These scores were measured before and after a successful assisted reproductive treatment with the birth of the child. RESULTS: The median age of the 193 male patients was 31 years (range 23-48). Erectile dysfunction was found in 68 (35.2%) and PE in 42 (21.7%) subjects. One hundred and forty-one couples were treated with assisted reproductive treatments. Forty eight couples had successful pregnancy. The IIEF-15 test was repeated after the birth of the child to the male partners of these couples. We observed that the IIEF-15 scores increased from 16 to 21 (p = 0.014). However there were no significant improvement on their ejaculation status (p > 0.05). The mean VAS scores of male partners was 5.2 (3-10) in the treatment period while it decreased to 4.1 (0-8) after the birth of the chils (p = 0.02). Statistically analysis showed a correlation between VAS and infertility as did IIEF-15. CONCLUSIONS: We observed that having children has a reducing effect on sexual relationship stress. Infertility is absolutely blamed on the women and men. This condition may have negative effects on male sexual performance and it is closely related with some emerging female sexual disorders. It should be taken into consideration that infertile couples may have sexual dysfunction.


Assuntos
Disfunção Erétil/epidemiologia , Infertilidade Masculina/complicações , Ejaculação Precoce/epidemiologia , Estresse Psicológico/epidemiologia , Adulto , Azoospermia/psicologia , Disfunção Erétil/psicologia , Humanos , Infertilidade Masculina/psicologia , Masculino , Pessoa de Meia-Idade , Ejaculação Precoce/psicologia , Prevalência , Técnicas de Reprodução Assistida , Comportamento Sexual/fisiologia , Comportamento Sexual/psicologia , Inquéritos e Questionários , Adulto Jovem
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