Epidemiology of erectile dysfunction: a community-based study in rural New York State.

PURPOSE: Few published population-based studies that deal with the prevalence of erectile dysfunction (ED) involve rural populations. This study determined the prevalence and determinants of ED among a rural population. It also evaluated the relevance of some major predictors of help-seeking decisions. METHODS: A self-administered survey was conducted by mail among 5198 randomly selected men 50-76 years old, living in four rural counties in Central New York State. RESULTS: The response rate was 44.7% and the participation rate among respondents was 71.0%. Mean ages of men reporting and those not reporting ED were 64.5 7.2 and 59.8 7.2 years respectively. The mean duration of self-reported ED was 4.9 4.6 years. The overall prevalence of ED was 46.3% while the minimum prevalence was estimated as 21.3%. Age-specific prevalence was 26.0%, 34.9%, 46.9%, 57.8% and 69.4% among men 50-54, 55-59, 60-64, 65-69, and 70-76 years old respectively. There was a statistically significant relationship between age, socio-economic status, perceived state of health and erectile function status (p < 0.001). However, socio-economic status, marital status, perceived state of health and age were not significant predictors of help-seeking decisions. CONCLUSIONS: The prevalence of ED among men 50-76 years old in rural Central New York State is at least 21.3% and may be as high as 46.3%. Age, perceived state of health and socio-economic status were found to be important determinants of erectile dysfunction among this population. For purposes of comparative analyses, future epidemiological studies should report both the overall and minimum rates among men with clinically relevant erectile dysfunction.

Reconstruction of umbilicus in bladder exstrophy.

A surgical method for reconstruction of the umbilicus in patients with bladder exstrophy is described. The technique is based on the surgical principle of eventual tubularization of a skin strip buried in the subcutaneous space.

Physical characteristics of percutaneous nephroscopes.

Flexible and rigid endoscopes are being used in the kidney with increasing frequency for endourologic procedures such as stone removal. The available instruments have different physical characteristics, a knowledge of which is important in proper instrument selection. We compared irrigant flow rates and the angles and areas of vision of the Olympus, ACMI, and Pentax flexible endoscopes and the Storz, Wolf, and Thackray rigid instruments. These findings and their implications for instrument use are described.

Prophylactic use of ureteral stent in iatrogenic injuries to ureter.

Injury to the ureter during pelvic and abdominal surgical procedures is not uncommon. We herein present the results of the prophylactic use of ureteral stents in iatrogenically traumatized dog ureters.

Help-seeking decisions among men with impotence.

OBJECTIVES: There is a paucity of valid contemporary data concerning the proportion of impotent men who seek treatment. The aim of this study was to determine the proportion of impotent men who sought treatment, from whom they sought treatment, and their reasons for seeking or not seeking treatment. METHODS: A self-administered survey of 5198 randomly selected men between 50 and 76 years old, living in four rural counties in central New York State, was used. RESULTS: The sample included 649 men who reported having experienced impotence in the 6 months preceding the study period (November 1996 to June 1997). The mean age of these men and mean duration of impotence were 64.5+/-7.2 and 4.9+/-4.6 years, respectively. Two hundred five men (31.6%) had sought treatment, 432 (66.6%) had not, and 12 (1.8%) neglected to answer the question. Most first consulted with either their primary care provider (44.7%) or a urologist (40.7%). Among those who had sought treatment, 36.3% were satisfied, 48.4% were dissatisfied, and 15.2% were neither satisfied nor dissatisfied with the results. The primary reasons for seeking treatment were to improve their self-esteem (44.8%), awareness of a new treatment (33.4%), partner insistence ( 11.3%), and coverage by their health insurance (10.4%). The reasons for not seeking treatment were embarrassment (29.8%), ignorance or misinformation (45.2%), and lack of affordability (25.0%). CONCLUSIONS: Despite increased availability of effective treatment, most men with impotence do not seek treatment, and among those who do, only 36.3% are satisfied with the results.

Technique and trial of continent ileocystostomy.

To overcome the problem of incontinence which failed to respond to standard measures, an animal model was designed for continent diversion without cystectomy. A tapered terminal ileal segment was implanted in a submucosal tunnel on the anterior aspect of the bladder, and the proximal end of the segment was brought out to the abdominal wall as a stoma that is catheterized intermittently. Ileocystostomy provided continent diversion in 10 dogs at intravesical pressures as high as 45 cm H2O, and there were no changes in serum electrolytes, creatinine, or urea nitrogen concentration.

An assessment of the clinical relevance of serum testosterone level determination in the evaluation of men with low sexual drive.

PURPOSE: We evaluated the relationship between sexual drive and serum testosterone level among men with erectile dysfunction. MATERIALS AND METHODS: A retrospective medical record review of 180 men who attended a hospital based erectile dysfunction clinic between April 1997 and January 1998 was performed. Sexual drive was assessed using the Brief Sexual Function Inventory questionnaire, and serum total and free testosterone levels were measured. RESULTS: A total of 108 complete records were included in this report. Mean patient age plus or minus standard deviation was 59.5+/-10.2 years (range 33 to 79). Of the men 55 (50.9%) had low, 38 (35.2%) moderate and 15 (13.9%) high sexual drive. Mean sexual drive, bothersomeness and total sexual function scores among the groups were significantly different (p<0.001). Mean serum total testosterone levels among men with low, moderate and high sexual drive were 2.8, 3.2 and 3.4 mg./ml. (normal 2.8 to 8.8), respectively, and mean free testosterone levels were 9.1, 9.5 and 11.4 pg./ml. (normal 8.7 to 54.7), respectively. Differences among means were not statistically significant. As a screening test for low sexual drive, low total testosterone had a positive predictive value, negative predictive value and yield of 59.2, 55.9 and 26.9%, respectively.

Complications of ureteroscopy in relation to experience: report of survey and author experience.

During the last 4 years we performed ureteroscopy for diagnostic evaluation in 20 patients and for removal of mid or distal ureteral stones in 127. All of the diagnostic studies were successful. In the stone removal cases the success rate increased from 71 per cent for the 24 procedures done during the first 2 years to 92 per cent for the 60 procedures done in the first 9 months of 1985. The rate of ureteral injury in the entire series was 2 per cent and in only 9 of the 23 failures was an open operation necessary. The benefit of experience also was evident in the results reported by 28 medical centers, with a 78 per cent success rate at the 11 centers that had performed less than 20 procedures each and an 84 per cent success rate at the 9 centers that had done more than 50. Despite early frustration with ureteroscopy, the value of mastering the technique allows the urologist to proceed endourologically with minimum morbidity and without precluding further interventional procedures.

The case for immediate pyeloplasty in the neonate with ureteropelvic junction obstruction.

The 99mtechnetium-diethylenetriaminepentaacetic acid renal scan allows differentiation of ureteropelvic junction obstruction from multicystic kidney in most instances. Although renal function usually will improve at least a little after relief of obstruction, the young infant is privileged and more improvement can be expected than occurs usually in older children. Since an operation is as safe and results of pyeloplasty are as good in the neonate as in older infants or children early correction of ureteropelvic junction obstruction is advocated in otherwise healthy infants as soon as the diagnosis is established.