Association between International Index of Erectile Function and axial penile rigidity in patients with erectile dysfunction

We investigated the association between the International Index of Erectile Function (IIEF) and axial penile rigidity parameters in patients with erectile dysfunction (ED). A total of 516 male patients (491 patients with ED and 25 patients without ED) were assessed using IIEF. Patients were assessed for axial penile rigidity (APR) using a digital inflection rigidometer. Mean age+/-s.d. was 52.4+/-9.9 y. ED was mild in 11.4% of the patients, moderate in 40.1%, and severe in 48.5%. Regarding APR, the following was found: (1) no significant difference between patients who had a mild degree of ED and patients who had no ED (P>0.05); (2) a significant difference between patients with different degrees of ED (P<0.05 for each); (3) a significant association between overall presence of ED and low APR (P<0.05). IIEF score is associated with APR and can differentiate between patients with and without ED.     

Erectile dysfunction in chronic renal failure patients undergoing hemodialysis in Egypt

In clinical practice, the attention given to sexual problems in patients with end-stage renal disease is low. In order to evaluate the erectile function in chronic renal failure patients undergoing hemodialysis (HD) as a renal replacement therapy in upper Egypt, we used the abridged version of the International Index of Erectile Function (IIEF-5). In all, 75 HD patients were subjected to clinical and laboratory investigations. The controls were 948 healthy males representing the general Egyptian population. The prevalence of erectile dysfunction (ED) among the HD patients was 82.5% compared to 30% among controls. The prevalence of ED in HD group was significantly higher than in controls. The prevalence of ED in HD patients <50 y was 80% and it was 88% in those > or =50 y, while the prevalence of ED among controls was 28 and 69.8%, respectively. The prevalence of severe degree of ED was significantly higher in both groups compared to controls, while moderate degree of ED showed a statistical significance compared to controls in age groups <50 y and mild degree of ED showed a statistical significance compared to controls in age groups > or =50 y. [corrected] Age (r=-0.3368, P<0.01), serum urea (r=-0.5974, P<0.001), and creatinine level (r=-0.5804, P<0.001) have a significant negative correlation with the presence of ED among HD patients, while serum hemoglobin (r=0.3396, P<0.001) and years of HD age (r=0.3147, P<0.01) have a significant positive correlation with the presence of ED among the HD patients. In view of the observed high prevalence of ED among the HD patients, we believe that a complete health evaluation of male HD patients should include a discussion about erectile function in the standard clinical care program of patients with renal disease.     

Coronary artery risk factors in patients with erectile dysfunction

PURPOSE: We evaluated the risk factors of coronary artery disease in patients with erectile dysfunction (ED). MATERIALS AND METHODS: A total of 417 male patients with ED were enrolled in this study. Patients were interviewed for ED using the International Index of Erectile Function. All patients were also screened for sociodemographic data and risk factors for ischemic heart disease (IHD), including age, smoking, diabetes, hypertension, dyslipidemia and psychological disorders. Patients underwent routine laboratory investigation plus testosterone and prolactin assessment. All patients were referred to a cardiologist for IHD evaluation. RESULTS: Mean age +/- SD was 59.1 +/- 10.3 years. Of the patients 27.3% were younger than 50 years, 37.2% were current or former smokers, and 27.6% had mild, 30% had moderate and 42.4% had severe ED. Of the patients 26.9% had different degrees of IHD, of whom 84.8% were older than 50 years. There was a significant association between age and IHD (p <0.05). There were significant associations between IHD, and the increased severity and progressive course of ED (each p <0.05). Furthermore, higher degrees of IHD were significantly associated with severe ED. Diabetes, hypertension, dyslipidemia and psychological disorders were present in 75.1%, 39.3%, 45.6% and 8.2% of the patients, respectively. Overall 92.1% of the patients with ED had 1 or more coronary artery risk factors. The presence of at least 1 risk factor is significantly associated with ED in patients with IHD (p <0.05). CONCLUSIONS: Coronary artery risk factors are significantly associated with erectile dysfunction. A significant association between higher degrees of IHD and the increased severity of ED was detected.     

Lower Urinary Tract Symptoms in Patients with Erectile Dysfunction: Is There a Vascular Association?

Objective:To assess if there is an underlying vascular association between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED).Materials and methods:A total of 374 male patients with ED were enrolled in this study. Patients were interviewed for ED using the International Index of Erectile Function. Assessments for penile vasculature using color Doppler ultrasonography and rigidometer were performed. All patients were also screened for LUTS using the International Prostate Symptoms Score. All patients underwent routine laboratory investigation, plus total testosterone and prolactin assessment.Results:Mean age ± SD was 54.4 ± 8.9 years with an age range of 28–84 years. Eighty-five percent of the patients had organic causes of ED. Of the patients, 80.7% had different degrees of LUTS. There was a significant association between presence of LUTS and: arteriogenic and neurogenic causes of ED, poor response to intracorporeal injection, poor rigidity in the rigidometer, and low peak systolic velocity of the cavernosal arteries (p < 0.05 for each). No significant association was found between presence of LUTS and increasing values of end diastolic velocity or decreasing values of resistive index of the cavernosal arteries (p > 0.05 for each). There was a significant association between the higher degrees of LUTS and the decreasing values of peak systolic velocity (p < 0.05).Conclusions:This study demonstrated that reduced peak systolic velocity of the cavernous artery does associate with LUTS in patients with erectile dysfunction. Further studies are warranted to address the underlying vascular mechanisms of ED in patients with LUTS.     

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

OBJECTIVE

To determine the prevalence of erectile dysfunction (ED) in a large cohort of Brazilian men who were screened for prostate cancer, and to determine risk factors in this population, as there are large cultural differences among countries in reporting the frequency of ED, and it is likely that the prevalence of ED among men screened for prostate cancer cannot be generally applied across countries.

SUBJECTS AND METHODS

The analysis focused on the baseline characteristics of 1008 consecutive South American men from Brazil with no known prostate disease who had routine screening for prostate cancer by urologists. The variables analysed were patient age, urinary symptoms, patient health‐related quality of life (HRQL), prostate‐specific antigen (PSA) levels, prostate volume and erectile function. To assess lower urinary tract symptoms (LUTS) and HRQL, we used the American Urological Association symptom score and its appended eighth question, respectively. Benign prostatic hyperplasia was defined as a prostate volume of >30 g. Sexual function was assessed using the five‐item version of the International Index of Erectile Function questionnaire. Thus, ED was considered to absent for scores of 22–25, mild for 17–21, mild to moderate for 12–16, moderate for 8–11, or severe for 5–7. Obesity was defined by calculating the body mass index (BMI), and categorized as underweight (<18.5 kg/m²), normal weight (18.5–24.9 kg/m²), overweight (25–29.9 kg/m²) or obese (= 30 kg/m²). The mean (sd ) PSA level was 4.3 (6.7) ng/mL and the mean prostate volume 37.8 (21.8) mL. The correlation of ED with these variables was estimated using unconditional logistic regression models.

RESULTS

Information about erectile function was available for 908 patients. ED was considered to be absent, mild, mild to moderate, moderate and severe in 169 (18.6%), 210 (23.1%), 169 (18.6%), 138 (15.2%) and 222 (24.5%) patients, respectively. The ED was severe in 18.4%, 25.7% and 43.4% of patients with mild, moderate and severe LUTS, respectively (P < 0.001). The answer to the HRQL question was also significantly associated with ED; ED was severe in 16.5% of patients feeling delighted/pleased and in 35.8% of patients feeling unhappy/terrible (P < 0.001). The prostate volume was significantly related to ED. The BMI category showed that normal weight, overweight and obese patients had similar rates of ED (P = 0.415); ED was severe in about a quarter of the patients in each of these categories, and 50% and 24% of patients in the underweight and greater BMI groups had severe ED, respectively.

CONCLUSIONS

Of men screened for prostate cancer in Brazil, ≈40% have moderate or severe ED. Severe LUTS, higher HRQL scores, a large prostate volume, a low BMI and higher PSA levels might be associated with higher rates of ED. These variables should be considered when analysing the erectile function of patients screened for prostate cancer.     

Erectile dysfunction risk factors in noninsulin dependent diabetic Saudi patients

PURPOSE: We assessed the prevalence of and analyzed risk factors for erectile dysfunction in patients with noninsulin dependent diabetes in Makkah, Saudi Arabia. MATERIALS AND METHODS: A total of 562 male diabetic Saudi patients were enrolled in this study. Patients were screened for erectile dysfunction using the International Index of Erectile Function. At the time of screening patients were also interviewed for sociodemographic data, including age, education, occupation, marital status and smoking. Medical history included diabetes, diabetes related complications, risk factors for diabetes and erectile dysfunction, and current medication. RESULTS: Mean age of the study sample was 53.7 years (range 27 to 84). Of the patients 86.1% had various degrees of erectile dysfunction, including mild in 7.7%, moderate in 29.4% and severe in 49.1%. The prevalence of erectile dysfunction was 25% in patients younger than 50 years, which increased to 75% in those older than 50 years. Of those without erectile dysfunction 70% were younger and 30% were older than 50 years (p = 0.0001). Patients with a history of diabetes of greater than 10 years were 3 times as likely to report erectile dysfunction as those with a history of less than 5 years. Men with poor metabolic control were 12.2 times as likely to report erectile dysfunction as those with good metabolic control. Of diabetic patients with erectile dysfunction 53% had 1 or more diabetic related complications compared with 20.5% with no erectile dysfunction (p = 0.0001). CONCLUSIONS: Erectile dysfunction is common in diabetic Saudi men. This study provides a quantitative estimate of the prevalence of erectile dysfunction and its main risk factors in diabetic Saudi patients.     

The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction

The purpose of this research was to determine the prevalence of erectile dysfunction (ED) in a non-selected population using the abridged 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool. In a non-institutionalized population and during a free screening program for prostate cancer (Prostate Cancer Awareness Week of Santa Casa Hospital, Porto Alegre, Brazil), from 26 to 30 July 1998, all men who were attending were invited to complete a sexual activity questionnaire (the abridged 5-item version of the International Index of Erectile Function-IIEF-5) as a diagnostic tool for ED. The possible scores for the IIEF-5 range from 5 to 25, and ED was classified into five categories based on the scores: severe (5-7), moderate (8-11), mild to moderate (12-16), mild (17-21), and no ED (22-25). Of the 1071 men who participated in the program, 965 (90.1%) were included in this study. Of the responding men 850 were Caucasian (88%) and 115 were black (12%). The mean age of the men was 60.7 y, ranging from 40 to 90 y old. In this sample the prevalence of all degrees of ED was estimated as 53.9%. In this group of men, the degree of ED was mild in 21.5%, mild to moderate in 14.1%, moderate in 6.3%, and severe in 11.9%. According to age the rates of ED were: 40-49 (36.4%); 50-59 (42.5%); 60-69 (58.1%); 70-79 (79.4%), and over 80 y (100%) showed ED (P<0.05). The Pearson coefficients between the variables age and IIEF-5 showed a statistically significant inverse (negative) relation (r=-0.3449; P<0.05). ED is highly prevalent in men over 40 and this condition showed a clear relationship to aging, as demonstrated in other studies published. The simplified IIEF-5, as a diagnostic tool, showed to be an easy method, which can be used to evaluate this condition in studies with a great number of men.     

Correlation between lower urinary tract symptoms and erectile dysfunction in men presenting for prostate cancer screening

Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are age-related conditions that may have a profound impact on the quality of life. The relationship between LUTS and ED is not completely understood. In this study, we assessed this relationship in men over 45 years of age during a prostate cancer screening program. LUTS and ED were evaluated in 1267 men aged 45-75 years (mean 58.2+/-8.2 years). Patients completed the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function-5 (IIEF-5). The association between LUTS and ED was analyzed and the influence of age in the results was tested. We also evaluated the influence of the intensity of LUTS in the ED severity. A total of 514 (40.6%) patients were considered symptomatic of LUTS (24.8% with mild, 11.8% with moderate and 4% with severe LUTS). ED was present in 758 (59.9%) men and was considered mild in 25.0%, moderate in 18.3% and severe in 16.7%. The IIEF-5 score had a negative correlation with both the IPSS score (r=-0.33, P<0.001) and age (r=-0.31 and P<0.001). Age was positively associated with the IPSS score (r=0.14 and P<0.001). A significant correlation was observed between LUTS and ED, with 57.6% of the men with LUTS presenting ED as opposed to 29.7% of the asymptomatic population (odds ratio=3.32; 95% CI =2.57-4.29, P<0.001). Age-adjusted univariate analysis revealed a significant and independent influence of LUTS on the incidence of ED (odds ratio=2.72; 95% CI=2.08-3.57, P<0.001). IIEF scores varied significantly according to the severity of the urinary symptoms. Our findings in a prostate cancer screening population confirm that LUTS is an age-independent predictor of ED. Furthermore, they demonstrate that not only the presence of LUTS increases the likelihood of developing ED, but the severity of LUTS is associated with the intensity of ED.     

Association between ED and LUTS in Japanese motorcyclists

Recently, the association between motorcycling and erectile dysfunction (ED) has been reported. Also, lower urinary tract symptoms (LUTS) were reported to be associated with ED. The aim of this study is to evaluate the association of ED with LUTS in motorcyclists. We investigated the prevalence and the status of ED using a 5-item version of the International Index of Erectile Function (IIEF-5) in 150 motorcyclists. ED was diagnosed when the IIEF-5 score was less than 17. The International Prostate Symptom Score (IPSS) was also applied, and the relationship between IIEF-5 and IPSS was evaluated. Of the 150 motorcyclists, 37 (25%) had ED, and 31 (21%) had moderate or severe symptoms of LUTS (IPSS >or=8). The IIEF-5 was significantly associated with the severity of IPSS (P=0.002) and age (P<0.0001). The IIEF-5 was also significantly associated with the scores of both voiding (P<0.0001) and storage symptoms (P=0.001). On stepwise logistic regression analysis, age and storage symptoms are independent risk factors for ED in motorcyclists. LUTS seemed to be associated with ED in motorcyclists.     

Sexual dysfunction in male patients on hemodialysis: assessment with the International Index of Erectile Function (IIEF)

In this study we determine the sexual problems and the prevalence of erectile dysfunction (ED) in male hemodialysis patients by means of the International Index of Erectile Function (IIEF). A total of 187 male patients were included in the study. All of the patients who underwent hemodialysis were asked to complete the IIEF questionnaire. The IIEF domain scores were calculated and erectile dysfunction grading was determined on erectile function domain. Patients were also asked to report whether they had disclosed their sexual problems to physicians or not.The mean age was 49.3+/-13.2 y and the duration of hemodialysis was 38.1+/-8.4 months. By means of the IIEF, the prevalence of erectile dysfunction of any degree was 80.7%. The prevalence of any ED for the patients <50 y and >or=50 y was 74.5% and 86.6%, respectively. The prevalence and the severity of ED was significantly higher in patients >or=50 y. The frequency of intercourse attempts during the last four weeks was 1-2 in 130 (69.5%) of patients. Only 1% of patients disclosed their erectile problems and sought medical assistance prior to our study.Erectile dysfunction is highly prevalent in hemodialysis patients. The prevalence and the severity of ED increased with age. Evaluations for ED should be included in routine assessment of hemodialysis patients.     

The relationship between lower urinary tract symptoms (LUTS), diagnostic indicators of benign prostatic hyperplasia (BPH), and erectile dysfunction in patients with moderate to severely symptomatic BPH

Purpose  To evaluate the relationship between lower urinary tract symptoms (LUTS), different diagnostic indicators of benign prostatic hyperplasia (BPH), and erectile dysfunction (ED) in a selected group of BPH patients with moderate-or-severe symptoms, for whom either transurethral or open prostatectomy was planned. Materials and methods  Between 2003 and 2006, 453 patients were included in this study. LUTS and ED were assessed by validated symptom scales. Maximum and average urine flow rates and post-void residual urine volumes (PVRU) of all patients were measured. Additionally, prostate volumes for all patients were detected with transrectal ultrasound (TRUS). Results  The incidence of LUTS and ED increased significantly with aging (P < 0.001). ED was reported to be 36% in men with moderate LUTS and 94% in men with severe LUTS (P < 0.001). The odds ratio for ED was 28.7 for severe LUTS. When age, IPSS, and IIEF scores were analyzed we observed that the occurrence of LUTS is an age-independent risk factor for the development of ED (P < 0.001). There was a positive correlation between IIEF score, Q _max (r = 0.441, P < 0.001), and Q _ave (r = 0.326, P < 0.001), and a negative correlation was found between IIEF score, prostate volume (r = -0.299, P < 0.001), and PVRU (r = -0.486, P < 0.001). Conclusions  The presence of LUTS, particularly severe LUTS, is an independent risk factor for ED. It is crucial to assess ED of the patient before BPH surgery, otherwise ED may be regarded as an outcome of the surgery rather than a preoperative, already existing condition.     

Efficacy and treatment satisfaction with on-demand tadalafil (Cialis) in men with erectile dysfunction

OBJECTIVE: Tadalafil (Cialis) is an inhibitor of phosphodiesterase type 5, which mediates relaxation of vascular smooth muscle in the corpus cavernosum thus facilitating erection. The purpose of this multicentre, randomized, double-blind, parallel group, placebo-controlled study was to evaluate efficacy and treatment satisfaction of on-demand Cialis in men with mild-to-severe erectile dysfunction (ED). METHODS: Following a 4-week treatment-free run in period, patients stratified into three severity groups by the International Index of Erectile Function (IIEF) Erectile Function (EF) domain score were randomized to receive either placebo or Cialis 20 mg taken on demand over a 12-week period. Efficacy endpoints were change from baseline in IIEF EF domain scores, responses to Sexual Encounter Profile diary (SEP) questions, and responses to the Global Assessment Questions (GAQ). Treatment satisfaction was evaluated using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire in two of seven participating countries where validated translations were available. RESULTS: Of the 443 men who entered the trial, 409 (mean age, 52 years) formed the intent-to-treat population. Mean baseline demographics and ED severity measures were balanced between treatment groups except for a higher percentage of patients na?ve to sildenafil in the tadalafil group compared to placebo (50% versus 36%). The percentage of patients in each IIEF EF severity class (mild, moderate and severe) was 47%, 30% and 23% for placebo patients and 48%, 29% and 23% for tadalafil patients, respectively. Tadalafil was significantly superior to placebo on all primary efficacy measures (IIEF EF domain scores, SEP15, GAQ1; p < 0.001); notably 64% of tadalafil patients achieved a normal IIEF EF domain score at endpoint compared to 16% of placebo patients (p < 0.001). Of the 185 patients completing the EDITS questionnaire (137 receiving Cialis and 48 receiving placebo), tadalafil-treated patients had a median EDITS score of 84 (95%CI 80, 86), which was significantly higher than the median score for placebo-treated patients of 41 (95%CI 32, 59; p < 0.001; Wilcoxon test). The proportion of patients satisfied with treatment (defined as final EDITS score greater than 50) was 87% for the tadalafil-treated group and 46% for the placebo-treated group (p < 0.001; exact test). Adverse events were significantly more common with tadalafil than placebo (p < 0.01) and included primarily headache (7.2% versus 1.9%) and flushing (4.6% versus 0%). One patient discontinued tadalafil treatment due to back pain. CONCLUSION: In men with mild-to-severe ED, tadalafil 20 mg significantly improves erectile function, demonstrates superior treatment satisfaction relative to placebo, and is well tolerated. This is the first study to yield efficacy data on tadalafil in an Eastern European population of men with erectile dysfunction, and the first to measure satisfaction with the EDITS questionnaire in any study population of men with this condition using tadalafil.     

Epidemiology of erectile dysfunction and its risk factors: a practice-based study in Denmark

The objective of this study was to estimate the prevalence of erectile dysfunction (ED) and its health-related correlates among Danish men, to evaluate the influence of age, tobacco smoking, educational level and medication and the needs for treatment and willingness to be treated. A validated questionnaire was sent to 4310 noninstitutionalized Danish men, aged 40-80 y. The men selected constituted all male patients aged 40-80 y in 12 general practitioner practices in a county of Zealand, representing both the urban and rural population. Besides age, education, marital status and International Index of Erectile Function, the questionnaire included the duration of sexual problems (ED, premature ejaculation, penile curvature), comorbidity, medication, risk factors and the effect of prior treatment and willingness to seek treatment for sexual problems. A total of 2210 men responded, giving a response rate of 51.3%. No difference in the response rate by age groups was noted. The prevalence of complete ED increased with increasing age: 40-45 y, ED: 4.5%; 50-55 y, ED: 11.1%; and 75-80 y ED: 52%. The frequency of ED increased three-fold from men without comedication to men having some kind of medical treatment. Risk factors included tobacco smoking and low educational level. Only 9% suffering from ED had received some kind of treatment. Of the treated men, 75% were satisfied with the treatment. Willingness to discuss sexual matters depended both upon the age of the man and his actual erectile function. Taboos were seen more frequently among elderly people. ED increases with age, but only 10% of the men with sexual problems seek advice. Medication predisposes to ED.     

The epidemiology of erectile dysfunction and its correlates in men with chronic renal failure on hemodialysis in Londrina,southern Brazil

Erectile dysfunction (ED) is a common condition in aging men, but little is known about the prevalence of ED in some specific groups of patients such as those with end-stage renal disease (ESRD). A cross-sectional study was conducted to determine the prevalence of ED in ESRD patients undergoing hemodialysis in two clinics of Londrina, Brazil. The prevalence and severity of ED were assessed using the International Index of Erectile Function and a single global question. The dependence of ED on independent variables was evaluated by logistic regression. Some degree of ED was found in 86.4% of our sample (n=118). Complete ED was reported by 25.4% of subjects, moderate ED by 35.4%, and minimal ED by 24.6%. Subjects < 50 y old had a prevalence of moderate/complete ED of 52.6%, whereas in men > or = 50 y old, it was 70.5%. Age, diabetes, and low income were significantly associated with ED. Although highly prevalent, only a low percentage of uremic ESRD patients on hemodialysis were being treated for ED. Our data suggest that ED is related to uremia and other comorbid conditions that often accompany ESRD.     

Prevalence of erectile dysfunction in male stroke patients, and associated co-morbidities and risk factors

BACKGROUND: Sexual problems have been a common finding in chronically ill and physically disabled patients such as those with cerebrovascular accidents. Previous studies have supported the association between stroke and erectile dysfunction (ED). OBJECTIVES: The aim of this study was to investigate the prevalence of ED and its severity in male stroke patients in Qatar and to assess the co-morbidities and risk factors associated with ED. DESIGN: This was a cross-sectional study. SETTING: The study was conducted from January to December 2006 at the Hamad General Hospital, Hamad Medical Corporation (HMC). SUBJECTS: Eight hundred Qatari and non-Qatari patients 35-75 years of age were invited to participate in this study; 605 patients gave their consent, which was a response rate of 75.6%. METHODS: Face-to-face interviews were based on a questionnaire that included socio-demographic factors. The classification of the type of stroke was made according to the criteria of stroke by the World Health Organization (WHO). All patients completed a second questionnaire addressing their general medical history, type of treatment and co-morbidity with other diseases or risk factors. Sexual function was evaluated with the International Index of Erectile Function (IIEF). RESULTS: The mean age of subjects was 56.1 +/- 9.8 years. Approximately 48.3% of the studied population reported some degree of erectile dysfunction. Of the stroke patients with ED, 36% had severe ED, 32.9% had moderate ED and 31.2% had mild ED. More than half of the stroke patients (59.6%) with ED were in the age group 60-75 years. The prevalence of ED increased with increasing age. The co-morbidities and risk factors were significantly more prominent in ED patients than in those without ED for hypercholesterolemia (P < 0.001), diabetes (P = 0.002), and hypertension (P = 0.031). Medication taken for these diseases also had a significant association with ED. CONCLUSIONS: Our study findings revealed a greater prevalence of ED in stroke patients in the population of Qatar. The most important co-morbid factors for ED in stroke patients were diabetes, hypertension and hypercholesterolemia, and the risk factors were smoking and obesity.     

Ambulatory surgery and sleep disorders

The aim of this study was to assess the impact of ambulatory surgery on sleep quality in patients undergoing ambulatory surgery and to identify those patients who are at an increased risk of preoperative anxiety and sleep disorders. A total of 220 patients were admitted for ambulatory surgery between October 1996 and April 1997. They were asked to assess their usual sleep patterns on a questionnaire. Patients were divided into three groups: good, intermediate and bad sleep quality. Of the 220 patients, 150 (68.1%) had severe disturbances in the quality of sleep the night before surgery. Of the patients with usually bad sleep quality, 100% had disturbances the night before surgery. In conclusion, these data show that many patients undergoing ambulatory surgery, experience disturbances in the quality of sleep the night before surgery. Premedication could help the group of patients with previous abnormal sleep patterns.     

Type 2 diabetes but not metabolic syndrome is associated with an increased risk of lower urinary tract symptoms and erectile dysfunction in men aged <45 years

Study Type – Prognosis (case series)
Level of Evidence 4

OBJECTIVE

To investigate the association of type 2 diabetes mellitus (T2DM) and metabolic syndrome with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in Taiwanese men aged <45 years.

PATIENTS, SUBJECTS AND METHODS

Voiding and erectile function in 226 men with T2DM, at one diabetes clinic, and 183 healthy men with normal fasting blood glucose levels, were compared. Participants were evaluated using the International Prostate Symptom Score (IPSS), the five‐item version of the International Index of Erectile Function questionnaire (IIEF‐5), and measurements of flow rate and postvoid residual urine volume. The association of metabolic syndrome with LUTS and ED was also evaluated.

RESULTS

The mean (sd , range) age of the patients was 38.9 (6.1, 20–45) years and the mean duration of diabetes was 2.8 (3.1, 0.5–20) years. Compared with controls, men with T2DM had a significantly mean (sd ) higher IPSS, of 6.1 (5.8) vs 4.1 (4.6) (P < 0.001), an increased of odds ratio (95% confidence interval) of having moderate to severe LUTS of 1.78 (1.12–2.84) (P = 0.01), greater voiding volume of 376 (177) vs 326 (102) mL (P = 0.04), a worse IIEF‐5 score of 17.3 (6.4) vs 20.0 (3.8) (P < 0.001), an increased of odds ratio of having moderate to severe ED of 3.5 (2.1–5.8) (P < 0.001) but a similar maximum flow rate and postvoid residual. The IIEF‐5 score was negatively correlated with the IPSS (P < 0.0001, coefficient = ?0.23, 0.35–0.11) and glycosylated haemoglobin (P = 0.02, coefficient = ?0.14, 0.26–0.01). In all, 156 (69%) patients met the criteria for metabolic syndrome. The mean age, duration of diabetes, glycosylated haemoglobin, IPSS, voided volume, maximum urinary flow rate and IIEF‐5 score were similar between patients with and without metabolic syndrome.

CONCLUSIONS

Men with T2DM and aged <45 years had more LUTS but a similar bladder emptying function than the controls. ED was highly prevalent and was associated with the severity of LUTS. Metabolic syndrome did not aggravate the severity of LUTS, emptying function or ED in the early stage of DM.     

The effect on erectile function of 103palladium implantation for localized prostate cancer

OBJECTIVE: To determine in a prospective study the effect on erectile function of (103)Pd brachytherapy for localized prostate cancer, using a validated questionnaire. PATIENTS AND METHODS: Between July 1999 and April 2003, 113 men with localized prostate cancer were treated by permanent implantation of (103)Pd seeds, of whom 78 with a follow-up of 30 months were included in this study. No patient received supplemental external beam radiation therapy. At baseline and 3-month intervals, erectile function (EF) was assessed by the EF domain score of the International Index of Erectile Function-15 (IIEF-15); 77% received (neo)adjuvant antiandrogen therapy for up to 3 months. RESULTS: At baseline, 27 (35%) patients had no erectile dysfunction (ED; EF domain score 26-30), 24 (31%) had mild/moderate ED (score 11-25) and 27 (35%) severe ED (score 6-10). The mean EF domain score decreased from 17 to 12 (P < 0.001) after 30 months. Overall, 52 men (67%, including those with severe ED at baseline) remained in the same ED category at 30 months after therapy as before, 12 (15%) deteriorated by one category, 14 (18%) by two or more, and no patient improved. Of the 27 patients fully potent (score 26-30) at baseline, 37% remained so after 30 months, 19% developed mild and the remaining 44% moderate/severe ED. In a multivariate analysis, neither age nor preoperative prostate-specific antigen level, prostate volume, D90, hormonal treatment, diabetes, smoking or hypertension were predictive of preserving potency (P > 0.05). CONCLUSIONS: There was a high prevalence of pre-existing ED in these men; 57% of men fully potent or with mild ED at baseline remained so 30 months after brachytherapy.     

不同年龄段勃起功能障碍患者的心理状况与人格特征分析

目的探讨不同年龄段勃起功能障碍(ED)患者心理状况的差异。方法回顾性分析郑州大学第三附属医院2018年7月至2019年7月收治的401例ED患者的临床资料。年龄20~60岁。将所有患者按年龄段分为4组:A组158例,年龄20~29岁;B组182例,年龄30~39岁;C组38例,年龄40~49岁;D组23例,年龄50~60岁。基于国际勃起功能评分表(IIEF-5)评估患者的勃起功能情况。采用症状自评量表(SCL-90)评估患者的敌对、焦虑、精神病性、恐怖、偏执、强迫、躯体化、人际关系、抑郁等9项心理状况。采用状态-特质焦虑量表(STAI)区分患者是否存在状态性或特质性的焦虑情绪。采用艾森克人格问卷(EPQ)分析患者的人格类型。分析患者组与文献报道的全国常模组SCL-90、STAI和EPQ量表的差异。分析不同年龄组患者各项指标的差异。结果患者组SCL-90量表的敌对(1.64±0.67,t=4.81,P<0.001)、焦虑(1.58±0.66,t=6.83,P<0.001)、精神病性(1.62±0.68,t=11.87,P<0.001)、偏执(1.55±0.66,t=3.58,P<0.001)、强迫(1.95±0.70,t=9.56,P<0.001)、躯体化(1.43±0.58,t=2.10,P=0.036)、人际关系/敏感(1.74±0.74,t=2.79,P=0.005)、抑郁(1.66±0.74,t=4.50,P<0.001)等因子分,以及总分(1.53±0.63,t=3.07,P=0.002)均显著高于全国常模组。A、B、C、D组的人际关系/敏感得分差异有统计学意义(1.72±0.78、1.65±0.69、1.58±0.92、1.43±0.59,F=2.84,P=0.038)。患者组STAI量表的状态焦虑(t=7.35,P<0.001)、特质焦虑(t=6.31,P<0.001)等因子分和总分(t=8.41,P<0.001)均显著高于全国常模组,不同年龄组的状态焦虑(F=5.29,P=0.001)、特质焦虑(F=5.54,P<0.001)因子分和总分(F=5.66,P<0.001)差异有统计学意义。患者组的精神质(t=30.56,P<0.001)、情绪(t=45.94,P<0.001)、外倾-内倾(t=11.72,P<0.001)、掩饰性(t=29.16,P<0.001)等因子分和总分(t=30.56,P<0.001)均显著高于全国常模组。401例的人格类型分别为抑郁质183例(45.64%),胆汁质94例(23.44%),黏液质66例(16.46%),多血质58例(14.46%)。不同年龄组的抑郁质、胆汁质、黏液质、多血质人格类型分布分别为A组76、35、26、21例,B组87、40、32、23例,C组14、10、6、8例,D组6、9、2、6例,组间比较差异无统计学意义(χ^2=10.65,P=0.30)。结论ED患者存在一系列异常的情绪、躯体化的不适感,敏感的人际关系以及内向、情绪不稳定的人格特征;年龄越小的患者其焦虑情绪越严重,人际关系越敏感,可能与其内向的个性特征及情绪的不稳定性相关。     

High incidence of post-transplant diabetes mellitus in a single-centre study.

Twelve of 29 Saudi patients (41.4%) developed diabetes mellitus following renal transplantation. Post-transplant diabetes mellitus occurred within the first 2 months in eight patients; two others presented with diabetic ketoacidosis associated with severe infections. The diabetic and non-diabetic patients had received similar doses of prednisolone and cyclosporin (CsA) during the initial 2 months post-transplantation, and their mean CsA blood values at 3 months were not significantly different. Increasing patient age (over 40 years), but not sex, donor source, or body mass index, was associated with an increased risk for developing diabetes mellitus. Post-transplant diabetes mellitus was controlled with oral hypoglycaemic agents in most patients, but one-third required insulin. Patients who developed diabetes had significantly decreased mean creatinine clearance/1.73 m2 at a mean graft age of 3.4 years (P less than 0.001). Diabetes mellitus after transplantation may be more common among Saudi patients than elsewhere, especially those aged over 40 years. It develops rapidly, may present with ketosis, and is associated with graft dysfunction.