Penile duplex pharmaco-ultrasonography of cavernous arteries in men with erectile dysfunction and generalized atherosclerosis

Assessment of cavernosal perfusion in men with erectile dysfunction (ED) relies on Doppler spectrum analysis of pharmachologically stimulated peak systolic velocity (sPSV) in cavernous arteries but its accuracy in identifying men affected by a cavernosal perfusion disorder correlated with atherosclerosis remains undefined. We estimated by B-mode ultrasound, the accuracy of sPSV of cavernous arteries to identify ED with an expected cavernosal perfusion disorder. This was predicted by an elevated intima-media thickness (IMT) of common carotid arteries, a reference methodology to estimate the degree of generalized atherosclerosis, in men exposed to vascular risk factors (VRFs). sPSV and IMT were evaluated in 269 men with ED, 49 had no VRFs, 100 were overweight with/or without hyperlipidaemia, 120 were affected by type 2 diabetes and/or essential hypertension. sPSV was significantly lower (p<0.05) in patients with VRFs associated with atherosclerosis (IMT>or=1 mm) (n=39) than in men with no VRFs and no atherosclerosis (n=49). sPSV correlated negatively with age (p<0.0001), with serum% of glycated haemoglobin (p=0.010) and with carotid artery IMT (p=0.013). An sPSVor=1 mm combined to the exposure to VRFs. The ultrasonographic evaluation of sPSV had a very limited accuracy in discriminating ED with an expected cavernosal perfusion disorder, based on the presence of a generalized atherosclerosis in men with VRFs.     

Endothelial cell activation in men with erectile dysfunction without cardiovascular risk factors and overt vascular damage

PURPOSE: Endothelial cell activation (ECA) is an initiating event in atherosclerosis. Biochemical measures of ECA were evaluated in patients with erectile dysfunction (ED) associated or not associated with cardiovascular risk factors (VRFs) to assess whether ED is a sentinel of atherosclerosis. MATERIALS AND METHODS: Circulating soluble P-selectin, intercellular adhesion molecule-1, vascular cell adhesion molecule-1 and endothelin-1 concentrations were assessed in 45 men with ED but no VRFs, 45 men with ED associated with VRFs and 25 healthy men. Ultrasound intima-media thickness of carotid arteries and pharmacologically stimulated peak systolic velocity of cavernous arteries were used to assess vascular damage. RESULTS: Measures of ECA were higher in men with ED but no VRFs than in controls (p <0.01) and all were comparable among groups of men with ED. Levels of endothelin-1 in men with ED and no VRFs versus healthy men of the same age resulted in the best independent predictor for ED after adjusting for the confounding effect of increased body mass index and smoking (OR 5.37, 95% CI 2.12 to 19.70). Intima-media thickness of carotid arteries was comparable in controls and in men with ED but no VRFs, and ruled out the bias of overt damage of large arteries in the latter. Peak systolic velocity of cavernous arteries excluded vasculogenic ED in the majority of patients with no VRFs. CONCLUSIONS: Increased biochemical measures of ECA were associated with ED independent of coexisting VRFs and overt vascular damage, suggesting that ED is a sentinel of early atherosclerosis.     

Serum from patients with erectile dysfunction inhibits circulating angiogenic cells from healthy men: relationship with cardiovascular risk, endothelial damage and circulating angiogenic modulators

Erectile dysfunction (ED) is an early manifestation of arteriosclerosis associated with endothelial damage/dysfunction and to a blunted ability of cultured mononuclear circulating cells (MNCs) to differentiate circulating angiogenic cells (CACs), putatively involved in endothelial damage repair. Here we explored effects of human serum (HS) from patients with ED and cardiovascular risk factors (VRFs) but no clinical atherosclerosis, on cultured MNCs of healthy men to differentiate CACs and to form colonies. Effect of HS on number of CACS and of colony forming units (CFUs) was correlated with circulating markers of endothelial damage and with angiogenic modulators. MNCs from healthy men were cultured in standard conditions or with 20% HS from 35 patients with ED and from 10 healthy men. CACs were identified after 7?days of culture by uptake of acetylated low-density lipoprotein with concomitant binding of Ulex europaeus agglutinin I. CFUs were counted after 5?days of culture. Enzyme-linked immunosorbent assays assessed plasmatic soluble (s) form of E-selectin, Endothelin (ET)-1, tissue type plasminogen activator (tPA), vascular endothelial growth factor (VEGF)(165) and sVEGF receptor (R)-1. The number of CACs and of CFUs from healthy men was reduced after culturing MNCs with HS compared to standard medium. The inhibitory effect was significantly higher with HS from ED patients with higher or lower VRF exposure compared to healthy men. Inhibition was positively correlated with VRFs exposure, with ED severity, with common carotid artery intima media thickness measured using B-mode ultrasound, and to a lesser extent with plasmatic sE-Selectin, sET-1 and sVEGFR-1. Dysfunction of cells involved in vascular homoeostasis is induced by soluble factors still unknown and already present in a very initial systemic vascular disease in men with ED and VRFs.     

Psychological features in men with erectile dysfunction with or without preclinical atherosclerosis

Psychological distress was assessed with a multidimensional self-report questionnaire (Symptom Check-List-90R) in 247 men complaining of erectile dysfunction (ED), with or without preclinical atherosclerosis. This was estimated by ultrasound determination of intima-media thickness (IMT) in common carotid arteries (CC). Psychological distress was reported in 31% of men and was more prevalent in those with a vascular damage. A higher level of obsessive-compulsive (OC) features was observed in men with high CC-IMT (P=0.0069; OR 3.18, CL 1.31-7.80). Among a large number of vascular risk factors, elevated CC-IMT and a severe ED resulted independently associated with an elevated level of OC features (OR 3.36, CL 1.38-8.15; OR 2.60, CL 1.01-6.70, respectively). Mental stress driven by OC features may link ED and vascular disease by activating reciprocal exacerbating mechanisms. Psychological distress identifies men at risk for cardiovascular disease that deserve a vigorous treatment of ED to reduce risk of vascular events.     

Analysis of cardiovascular risks for erectile dysfunction in Chinese patients with type 2 diabetes mellitus lacking clinical symptoms of cardiovascular diseases

BackgroundErectile dysfunction (ED) is common but usually underdiagnosed in diabetics. The correlation between different vascular lesions and ED in diabetics without clinical cardiovascular symptoms is unknown. The aim was to explore the association between cardiovascular risks and ED in Chinese type 2 diabetic men lacking clinical performance.MethodsErectile function of patients with type 2 diabetes was assessed by the 5-item International Index of Erectile Function (IIEF-5) questionnaire. The data of clinical characteristics and vascular lesions at carotid and lower limb sites assessed by the Doppler ultrasound were collected to evaluate diabetes- metabolic indices. Univariate and multivariate analyses were conducted to find statistical correlation between cardiovascular risks and diabetic ED.ResultsA total of 71.21% reported suffering from ED. Lower limb plaques were more common (45.38%) than carotid district (35.62%) in diabetes. Men with ED had higher carotid intima-media thickness (IMT) (P<0.001) and the presence of lower limb plaques (P<0.001) compared with men without ED. After adjusting for age, diabetic duration, blood pressure (BP) and antidiabetic medication, carotid IMT greater than 0.75 mm (P<0.001) and the presence of lower limb plaques (P=0.051) remained associated with the presence of ED and its severity. Compared with isolated atherosclerosis at carotid or lower limb district, vascular lesions at any site and both sites were more correlative with ED presence (all P<0.001).ConclusionsThe prevalence of ED is high among Chinese diabetic men. A higher carotid IMT and the presence of lower limb plaques indicate a tight correlation between peripheral atherosclerosis and diabetic ED. ED may be the only clinical association of symptomatic cardiovascular diseases (CVDs) in diabetes. It is significant to screen ED to prevent the further development of severe symptomatic CVDs.     

【原创论文】他达拉非治疗有血管风险的ED男性对改善内皮细胞损伤和修复效果不明显

循环成血管细胞数（CACs）与来源于循环单核细胞的集落形成单位数（CFUs）在实验室检测中代表内皮细胞的修复能力。具有血管危险因素（VRF）的ED男性血清中内皮细胞损伤／功能障碍的标志物水平增加以及来源于健康男性的循环成血管细胞数和集落形成单位数减少。我们研究了选择性磷酸二酯酶5抑制剂他达拉非能否改善有VRF的ED男性内皮细胞的修复能力以及减少血清内皮细胞损伤／功能障碍标志物的水平。36例ED患者的20％血清培养健康男性的单核细胞以检测循环成血管细胞和集落形成单位。检测JED患者服用他达拉非（隔日20毫克）及安慰剂前及用药4周后的血清标志物。他达拉非治疗能改善勃起功能（P=0．0028）,但不能减轻ED患者的血清对健康男性的CACs和CFUs的抑制。与基线及安慰剂比较,治疗后内皮素．1的水平（P=0．011）和组织型纤溶酶原激活物（P=0．005）均减少,而E-选择素水平无变化。有血管危险因素的ED患者经他达拉非治疗后实验室检测内皮细胞损伤与修复能力显示只有轻微影响。PDE5抑制剂对血管稳态的可能益处尚需进一步研究。     

Carotid intima-media thickness in patients with abdominal aortic aneurysms.

OBJECTIVE: The contribution of atherosclerosis to the development of Abdominal Aortic Aneurysms (AAA) is still controversial. Ultrasound scans can detect intima-media thickening of the carotid arteries as an early sign of atherosclerosis. The aim of this study was to investigate whether patients with Abdominal Aortic Aneurysms (AAAs) have thickened carotid IMT as patients with atherosclerotic peripheral arterial disease (PAD). METHODS: With high-resolution B-mode ultrasonography, the intima-media thickness (IMT) in the carotid arteries (right and left common carotid artery) was measured in AAA patients and compared with that of age and sex-matched patients with atherosclerotic peripheral arterial disease (PAD). A third group of healthy age and sex- matched control subjects were included for comparison. The corresponding carotid artery lumen was also determined in all groups. Comparison of the three groups was made by ANOVA. RESULTS: Fifty-eight AAA patients and 69% were men (mean age of 72.3 years) were studied. Aged and sex-matched groups comprised of 111 PAD patients and 71 healthy. The mean carotid IMT was highest in PAD patients (1.036+/-0.18mm). The values of controls and AAA patients were similar and significantly lower than that of atherosclerotic patients (0.875+/-0.11mm and 0.812+/-0.53mm respectively, both p<0.005 vs. PAD). Narrowing of the corresponding lumen was found in PAD patients compared with that of AAA patients, but no difference can be seen between healthy subjects and AAA patients. The mean carotid IMT was greater in men (P<0.05) in all studied groups, but no similar gender specificity was found in the lumen diameter. CONCLUSIONS: This study shows that the carotid artery IMT of AAA patients is similar to healthy subjects, but not as thick as patients with atherosclerotic disease. As carotid (IMT) is a surrogate marker of atherosclerosis, the findings support the notion that the formation of AAA may not be fully atherosclerosis-dependent. Gender may be a confounding factor for carotid intima-media thickening.     

DOES SILDENAFIL COMBINED WITH TESTOSTERONE GEL IMPROVE ERECTILE DYSFUNCTION IN HYPOGONADAL MEN IN WHOM TESTOSTERONE SUPPLEMENT THERAPY ALONE FAILED?

PURPOSE: We evaluated the efficacy of testosterone gel (T-gel) alone and in combination with sildenafil in hypogonadal patients with erectile dysfunction (ED). MATERIALS AND METHODS: A total of 49 hypogonadal men (mean age 60.7 years) with ED participated for a mean of 20.2 months. Blood was tested for total and bioavailable testosterone, and prostate specific antigen. Sexual function was assessed using the International Index of Erectile Function questionnaire and a global assessment question (GAQ). Men received 1% 5 gm T-gel for 6 months, and 100 mg sildenafil was added to those with a "no" response to the GAQ after 3 months on testosterone supplement. RESULTS: A total of 31 patients reported significant improvement in the sexual desire domain (from a mean +/- SD of 4.2 +/- 0.8 to 8.6 +/- 0.4) and erectile function (EF) domain (from 13.6 +/- 1.9 to 27 +/- 0.8) following treatment with testosterone supplement alone. One patient was excluded from study after urinary retention developed and 9 reported irritation at the gel application site. In spite of normalization of total and bioavailable testosterone values, and significant improvement of sexual desire domain scores, the EF of 17 men remained less than 26 or they responded "no" to the GAQ. These men received combined T-gel and sildenafil, after which all graded EF greater than 26 and responded positively to the GAQ. CONCLUSIONS: Combined treatment with sildenafil and T-gel has a beneficial effect on ED in hypogonadal patients in whom treatment with testosterone supplement alone failed.     

Treatment of erectile dysfunction reduces psychological distress

Mental stress is a risk factor for cardiovascular events in men with vascular risk factors (VRFs) and is also associated with erectile dysfunction (ED), a frequent complaint of men with VRFs. The aim of this study was to investigate the effect of inhibition of phosphodiesterase-5 or of placebo in men with ED and VRFs on self-evaluated psychological distress, erectile function and quality of sexual life. Thirty-six men with ED and VRFs were randomized to 4 weeks of tadalafil (20 mg/every other day) or placebo treatment. Sexual Health Inventory for Men (SHIM), questions 1–3 of Life Satisfaction (LiSat) questionnaire, Symptom Check-List-90R, a multidimensional inventory exploring psychological dimensions were applied before and after treatment. The SHIM score improved after treatment with tadalafil compared with baseline and with placebo ( F  = 10.38; p  =   0.0030). Sexual life satisfaction (LiSat-2) was significantly improved after tadalafil and after placebo, but a strong positive correlation was observed between LiSat-2 and SHIM score after tadalafil treatment ( r  = 0.59, p  = 0.0003) and not after placebo ( r  = 0.22, p  = 0.189). Psychological features were significantly changed after treatment, although a specific effect of tadalafil vs. placebo was observed only for interpersonal sensitivity ( F  = 4.48; p  =   0.042). Obsessive–compulsive dimension, depression, anxiety, psychoticism were significantly improved in the tadalafil group and in the placebo group, although the improvement was always more relevant after treatment with tadalafil. These preliminary data suggest that a short treatment of ED reduced psychological distress and improved quality of sexual life in men with VRFs.     

Effect of lower urinary tract symptoms on the incidence of erectile dysfunction

PURPOSE: We determined the effect of lower urinary tract symptoms (LUTS) on the incidence of erectile dysfunction (ED). MATERIALS AND METHODS: The target population consisted of all men 50, 60 or 70 years old residing in Tampere area, Finland in 1994. Questionnaires were mailed to 3,143 men in 1994 and to 2,864 men 5 years later. The followup sample consisted of the 1,683 men who responded to baseline and followup questionnaires. We estimated the effect of LUTS and bother on the incidence of ED during the 5-year followup among the 1,126 men free from ED at baseline. ED was assessed by 2 questions on subject ability to achieve and maintain erection sufficient for intercourse and LUTS assessed by the Danish Prostatic Symptom Score. Logistic regression model was used in the multivariate analysis. RESULTS: The incidence of ED increased with the presence and with the intensity of urinary symptoms and bother at baseline. Compared with men with LUTS score 0, the incidence of ED was 2.7 (95% CI 1.3-5.5) times higher among men with score 7 to 11, and 3.1 times with score 12 or more. The incidence of ED increased by 5% for each 1-point increment in LUTS score, while it increased by 12% and 11% for 1-point increment in cumulative symptom or bother score, respectively. Men with cumulative symptoms or bother score 4 or more were significantly 2.0 to 2.7 times at higher incidence of ED relative to those who were free from symptoms or bother at baseline. Only overflow incontinence (OR = 2.2) and incomplete emptying (OR = 1.8) independently increased the incidence of ED. CONCLUSIONS: Lower urinary tract symptoms and bother independently increase the incidence of erectile dysfunction.     

Viscoelastic properties of normal and atherosclerotic carotid arteries.

BACKGROUND: remodelling of the arterial wall occurs with ageing, even in the absence of atherosclerotic risk factors. With increasing age, arteries dilate, thicken, and get stiffer. The aim of this study was to correlate carotid artery stiffness with wall thickness and plaque presence between healthy individuals and patients with early and advanced atherosclerosis. METHODS: twenty healthy volunteers, 40 carotid segments and 90 patients, 174 carotid segments, with vascular disease were included in the study. The carotid artery was imaged longitudinally and measurements of the intimal-medial thickness (IMT) and plaque were obtained. Systolic and diastolic blood pressures were taken from each arm. The carotid artery stiffness (pressure-strain elastic modulus, Ep) was calculated in all sites from the changes in pressure and diameter. M-mode was used to detect the diameter change (systolic to diastolic) over five cardiac cycles. RESULTS: in the healthy volunteers there was no evidence of plaque or increased IMT. The mean IMT was significantly higher in the patients compared to control (0.83+/-0.27 mm vs. 0.54+/-0.08 mm, p <0.0001). The IMT had a poor correlation with Ep at lower thickness (r=0.24, p=0.08) but this association became stronger with increasing thickness (r=0.62, p<0.001). Arterial segments with an IMT 5 0.88 mm became significantly stiffer compared to the controls (p<0.001) and to patients with an IMT<0.88 mm (p <0.01). Carotid Ep was markedly greater in arterial segments with plaques than in those with increased IMT (p <0.001) and the controls (p<0.0001). CONCLUSIONS: carotid wall areas with small increase in IMT have a poor correlation with carotid artery stiffness. The carotid stiffness increases in areas with marked wall thickening and particularly in segments with plaque. The simultaneous study of vessel-wall elastic behaviour with IMT and plaque changes may increase our understanding of atherosclerotic progression and wall remodelling.     

Erectile dysfunction and andropause symptoms in infertile men

PURPOSE: We evaluated the prevalence of andropause symptoms and erectile dysfunction in our infertile population. MATERIALS AND METHODS: A total of 302 consecutive men presenting for infertility evaluation and 60 consecutive men with proven fertility seeking vasectomy (controls) were administered the Androgen Deficiency in the Aging Male and Sexual Health Inventory for Men (SHIM) questionnaires. Information regarding other clinical parameters, including seminal parameters, was collected by review of patient charts. RESULTS: Of the 302 infertile men screened, 38% reported significant andropause symptoms and 28% had abnormal SHIM scores. Of the subgroup of infertile men with nonobstructive azoospermia, 25% reported andropause symptoms and 27% had an abnormal SHIM score. In the fertile group 21% reported andropause symptoms and only 11% had an abnormal SHIM score. The prevalence of erectile dysfunction in infertile men was significantly higher than in the fertile controls (p = 0.007). CONCLUSIONS: Andropause symptoms and erectile dysfunction are common among infertile men, affecting approximately 38% of this population. This finding suggests that the population of infertile men should be carefully screened to identify and treat those with erectile dysfunction.     

The application of digital pulse amplitude tonometry to the diagnostic investigation of endothelial dysfunction in men with erectile dysfunction

The application of digital pulse amplitude by fingertip peripheral arterial tonometry (PAT) device in patients with erectile dysfunction (ED) has never been performed. We investigated the diagnostic value of reactive hyperaemia (RH) and augmentation index (AI) as evaluated using PAT in men with ED of any origin. A total of 40 patients underwent diagnostic investigation for ED, including dynamic penile duplex ultrasound (PDU) and PAT device. Moreover, 30 patients without ED served as controls. According to PDU cutoff at 35 cm/sec, patients were divided into vascular (n = 30) and nonvascular (n = 10) ED aetiology. Moreover, controls with (n = 10) or without (n = 20) vascular risk factors (VRFs) were studied in a separate analysis. Average RH-PAT was not different in men with or without ED (P = 0.56) independently of VRFs. The AI was higher in men with ED compared with the controls (P < 0.0001) as well as when controlled for the presence or absence of VRFs (P < 0.0001). An inverse relationship between AI and PSV was also found (r2 = -0.72, P < 0.0001). In conclusion, an increased AI but not an impaired RH-PAT is present in men with vascular ED independently of VRFs and may represent an early detection of vascular impairment that may precede endothelial dysfunction in populations at low risk for developing vascular ED.     

Atherosclerosis in patients with end-stage renal failure prior to initiation of hemodialysis

BACKGROUND: In dialysis patients cardiovascular mortality is 10 to 20 times higher than in general population. It remains uncertain whether atherosclerosis of dialysis patients is effectively accelerated because many of dialysis patients have more or less marked vascular lesions already at the start of dialysis treatment. SUBJECTS AND METHODS. Using B-mode ultrasonography (ATL HDI 3000), we compared intima-media thickness (IMT) and plaque occurrence (indicators of atherosclerosis) in the common carotid arteries (CC), in the area of bifurcation (CB) and in the proximal part of internal carotid arteries (CI) in 28 hemodialysis patients (14 men and 14 women; mean age 49.4 years; mean duration of HD treatment 66.6 months) with that in 28 age-sex matched patients prior to initiation of hemodialysis. We also investigated possible differences in atherosclerotic risk factors in both groups. RESULTS: The IMT values of CC (0.71 vs. 0.70 mm; p = 0.937), CB (0.81 vs. 0.77 mm; p = 0,423) and CI (0.72 vs. 0.71 mm; p = 0.935) were not significantly different in dialysis patients and patients starting dialysis treatment. We also found no difference in plaque occurrence (61% vs. 54%; p = 0.787) and in atherosclerotic risk factors (hypertension, smoking, lipids) between both groups. CONCLUSIONS: In our study we found no difference in atherosclerotic lesions in carotid arteries between dialysis patients and patients with end-stage renal failure starting dialysis treatment. Patients with chronic renal failure are at high risk for cardiovascular diseases so we should intervene earlier and more actively long before dialysis treatment in order to reduce the atherosclerotic risk factors.     

The impact of visceral fat on multiple risk factors and carotid atherosclerosis in chronic haemodialysis patients.

BACKGROUND: There has been recent interest in the importance of visceral fat (VF) for the development of atherosclerosis. The purpose of this study was to examine associations between VF and multiple risk factors as well as the prevalence of carotid atherosclerosis in chronic haemodialysis patients. METHODS: We classified 77 non-diabetic haemodialysis patients into 'low VF', 'middle VF' and 'high VF' groups after determining VF area using computed tomography. Systemic atherosclerosis was assessed from intima-media thickness (IMT), plaque score (PS) and stiffness parameter beta (stiffness-beta) measured by high-resolution B-mode ultrasonography. RESULTS: Compared with the low VF group, the high VF group exhibited (i) significantly higher fasting plasma insulin (11.0 +/- 6.8 vs 7.1 +/- 2.9 micro U/ml, P = 0.0061); (ii) significantly higher plasma triglycerides (141.8 +/- 94.0 vs 86.5 +/- 32.5 mg/dl, P = 0.0032); and (iii) significantly lower plasma high-density lipoprotein cholesterol (42.1 +/- 14.5 vs 53.0 +/- 15.7mg/dl, P = 0.0134). Moreover, the high VF group had a higher prevalence and extent of carotid atherosclerosis: IMT was 0.69 +/- 0.13 vs 0.61 +/- 0.12 mm (P = 0.0239), PS was 4.8 +/- 3.2 vs 2.4 +/- 3.6 (P = 0.0236) and stiffness-beta was 11.4 +/- 3.1 vs 8.5 +/- 3.0 (P = 0.0082) in the high and low VF groups, respectively. CONCLUSION: We show that VF is associated with the prevalence of carotid atherosclerosis as well as with hyperinsulinaemia and lipid abnormalities in chronic haemodialysis patients.     

Carotid intima-media thickness and plaques in hemodialysis patients

Atherosclerosis is accelerated in hemodialysis patients. Using B-mode ultrasonography, we compared intima-media thickness (IMT) and the prevalence of plaques in the common carotid and internal carotid arteries in 28 randomly selected hemodialysis patients with that in 28 age- and sex-matched normal controls. The IMT values of the common carotid and internal carotid arteries were higher in hemodialysis patients than in controls with more hemodialysis patients having plaques. In hemodialysis patients, there was a relationship between age and IMT in the common carotid arteries, in the area of bifurcation, and in the internal carotid arteries. We found no relationship between IMT and atherosclerotic risk factors or duration of hemodialysis treatment. IMT at all sites correlated with the number of plaques. Age was the only significant determinant for number of plaques. The results indicate that hemodialysis patients showed advanced atherosclerosis in the carotid arteries compared with age- and sex-matched normal subjects.     

Crural ligation for primary erectile dysfunction: a case series

PURPOSE: Some men with primary erectile dysfunction (ED) have maldevelopment of the crura of the penis. We report our experience with crural ligation for primary venous leakage ED in the last 5 years. MATERIALS AND METHODS: Between December 1998 and March 2004, 11 patients with primary ED underwent crural ligation surgery for congenital venous leakage. All patients were evaluated with pertinent history and physical examinations, color duplex ultrasound, nocturnal penile tumescence study with RigiScan, cavernosometry and cavernosography. Localized crural leakage was the pathognomonic feature in these patients. Surgery involved reflection of the dorsal and cavernous arteries and nerves off of the crura, followed by ligation of the 2 crura proximal to the entrance of the cavernous artery with umbilical tapes. Followup was performed by telephone interview or personal interview at the clinic. A retrospective preoperative and postoperative questionnaire, that is the abridged 5-item version of the 15-item International Index of Erectile Function, was given at the time of the interview. Statistical analysis was performed with the paired t test. RESULTS: Median patient age at surgery was 28 years (range 22 to 39) and mean followup after surgery was 34 months (range 6 to 58). Mean International Index of Erectile Function +/- SD preoperatively and postoperatively was 8.9 +/- 4.5 and 17.5 +/- 5.0, respectively. For questions 2, 3 and 5 mean postoperative scores were significantly better than postoperative scores (p <0.05). Marked improvement in erectile function was noted in 9 of our 11 patients. CONCLUSIONS: Penile venous surgery may not have a lasting result in men in whom venous leakage is due to systemic diseases or penile smooth muscle atrophy. However, in patients with a congenital venous leak abnormality of the crura ligation of the proximal crura with umbilical tapes seems to have a satisfactory, durable result.     

Are men with erectile dysfunction more likely to have hypertension than men without erectile dysfunction? A naturalistic national cohort study

PURPOSE:: We examined whether men with erectile dysfunction (ED) are more likely to have hypertension than men without ED in a managed care setting. MATERIALS AND METHODS:: We used a naturalistic cohort design to compare hypertension prevalence rates in 285,436 men with ED to that in 1,584,230 men without ED from 1995 through 2001. We also used a logistic regression model to isolate the effect of ED on the likelihood of hypertension after controlling for subject age, census regions and 9 concurrent diseases. The ED and the nonED cohort came from a nationally representative, managed care claims database that covers 51 health plans and 28 million members in the United States. Finally, the prevalence rate difference between members with and without ED, and the OR of having hypertension were calculated. RESULTS:: The hypertension prevalence rate was 41.2% in men with ED and 19.2% in men without ED. After controlling for subject age, census region and 9 concurrent diseases the OR was 1.383 (p <0.0001), which implies that the odds for men with ED to have hypertension were 38.3% higher than the odds for men without ED. CONCLUSIONS:: Men with ED were more likely to have hypertension than men without ED. This evidence supports the hypothesis that ED shares common risk factors with hypertension. It also suggests that men with ED and clinicians could use ED as an alerting signal to detect and treat undiagnosed hypertension earlier.     

Inflammation as a risk factor for carotid intimal-medial thickening, a measure of subclinical atherosclerosis in haemodialysis patients: the role of chlamydia and cytomegalovirus infection

OBJECTIVES: Atherosclerotic vascular disease is the most frequent complication seen in haemodialysis (HD) patients. Evidence suggests that inflammation may play a role in the pathogenesis and progression of atherosclerosis. Our aim was to evaluate the causative role of inflammation in atherosclerosis among HD patients. METHODS: Intima-media thickness (IMT) in carotid arteries was determined in 54 HD patients and 52 controls. Plasma levels of lipids, glucose, albumin and several acute phase proteins, and immunoglobulin G titres against chlamydia and cytomegalovirus were measured in all subjects. RESULTS: Mean carotid IMT was significantly greater in HD patients than in controls (0.75 mm vs 0.56 mm, P < 0.005). While plasma levels of C-reactive protein (CRP), serum amyloid A (SAA), lipoprotein (a) Lp(a), fibrinogen and ferritin were higher in HD patients, albumin levels were lower. In HD patients, carotid IMT was correlated positively with CRP (R = 0.29, P = 0.019), SAA (R = 0.69, P < 0.001), Lp(a) (R = 0.42, P = 0.001), fibrinogen (R = 0.57, P < 0.001) and chlamydia pneumonia immunoglobulin G titres (R = 0.50, P < 0.001), and negatively with albumin levels (R = -0.33, P = 0.02); there was no relationship between carotid IMT and hypertension, plasma lipid levels and cytomegalovirus. In multivariate regression analysis, these variables still showed a significant relationship with IMT (R(2) = 0.694 and P < 0.001). CONCLUSION: We conclude that atherosclerotic changes are more common in HD patients than in controls, and that inflammatory processes may play a role in the pathogenesis of atherosclerosis.     

The association between vascular risk factors and lower urinary tract symptoms in both sexes

OBJECTIVES: To test the potential role of atherosclerosis in the development of lower urinary tract symptoms (LUTS), we investigated the association between vascular risk factors and LUTS in both sexes. METHODS: Men and women participating in a health screening project completed the International Prostate Symptom Score (IPSS). In parallel all individuals underwent a detailed health investigation with assessment of diabetes mellitus, hypertension, hyperlipidemia, and nicotine use. RESULTS: A total of 1724 men (52.3+/-9.1yr, mean+/-standard deviation; IPSS: 6.3+/-4.3) and 812 women (56.0+/-9.9 yr; IPSS: 5.2+/-4.9) entered the study. A total of 62.5% (n=1077) of men had no vascular risk factor, 32.1% (n=554) one, and 5.4% (n=93) two or more; the corresponding figures for women were 64.7% (n=525), 30.7% (n=249), and 4.7% (n=38). In men, the IPSS was identical in those with no (6.2+/-4.1) and one (6.2+/-4.4) vascular risk factor yet increased to 7.7+/-5.5 (+24.2%) in those with two or more risk factors (p=0.01). In women, the IPSS increased from 4.8+/-4.6 in those with no vascular risk factor to 5.7+/-5.3 (+18.7%) with one and 7.0+/-5.7 (+45.8%) with two or more factors (p=0.05). CONCLUSIONS: Our data suggest that vascular risk factors play a role in the development of LUTS in both sexes. This observation opens new aspects in our understanding of the pathogenesis of LUTS and warrants future studies.