ED与LUTS药物治疗的相关性研究

目的探索、研究勃起功能障碍(ED)和下尿路症状(LUTS)在药物治疗方面是否存在相关性。方法本组研究对象80例病人均患有ED和LUTS,分为3组,每例研究对象在初诊时,必须填写IIEF-5、IPSS评分表,作为研究开始的基线。A组服用两地那非,B组服用多沙唑嗪控释片,C组联合应用西地那非和多沙唑嗪控释片。用药6个月后再次填写IIEF-5和IPSS评分表以作对比。用方差分析检验方法,进行用药前后数据统计学分析。结果3组治疗前后IIEF-5、IPSS评分变化差异均有编者计学意义,C组(联合用药组)变化最大(P<0.001)。结论ED与LUTS相互影响,ED患者LUTS发生率明显升高,而LUTS患者的ED危险性亦显著增加。西地那非可显著改善ED患者合并的LUTS症状,多沙唑嗪可改善LUTS患者的性功能;西地那非联合多沙唑嗪治疗ED、LUTS患者具协同作用。     

万艾可治疗ED时对BPH引起LUTS改善的研究

目的 :探索、研究万艾可在治疗阴茎勃起功能障碍 (ED)时对由良性前列腺增生 (BPH)引起的下尿路症状(LUTS)的影响。　方法 :32例ED同时伴有BPH的研究对象 ,采用IIEF 5问卷表和IPSS评分表 ,在服用万艾可前和服药后 6个月分别各填写一次 ,应用单因素方差分析对所得到的前后评分进行统计学分析。结果 :在服药前32例ED中 ,轻、中、重分别为 14、13、5例 ,BPH中轻、中、重分别为 3、15、14例 ;服药后IIEF 5评分平均上升4 2 .36 % ,IPSS评分平均下降 2 0 .14 % ,两者在统计学上都有显著性差异 ,P <0 .0 1。　结论 :在治疗中老年性ED合并BPH中 ,应用万艾可既能治疗ED ,取得完美的性生活 ,又能达到改善由BPH引起的LUTS。万艾可是一治疗ED有效的药物 ,但对于前列腺基质平滑肌亦有辅助性松弛作用 ,因此也有助于BPH时LUTS的缓解。     

The Relationship between LUTS and sexual function

Lower urinary tract symptoms (LUTS) are common in middle-aged and elderly men and are frequently caused by an enlarged prostate. Increasing severity of LUTS may negatively affect patients' health-related quality of life (QoL) to varying degrees. Sexual function is an important aspect of QoL and studies show that sexual dissatisfaction increases with increased severity of LUTS. The ICS-BPH International Study of 1271 men aged 45 y and over who reported to one of 12 clinics examined the relationship between urodynamic parameters, LUTS, sexual dysfunction and QoL. Results showed that nearly 90% of men found that the effect of LUTS on their sex lives was a problem and 45% reported that their sex lives were spoilt by LUTS. Storage symptoms, in particular incontinence, had a greater association with sexual dysfunction than voiding symptoms. Similar results were reported in the ICS-BPH UK Community Study, which involved 423 men aged 40 y and over. In contrast, a French Community Study of 2011 men aged 50-80 y reported that symptoms of hesitancy, straining, reduced stream and wet underclothes were most strongly associated with sexual dysfunction. Sexuality is clearly of concern to men with LUTS and should be included in discussions on treatment decisions.Prostate Cancer and Prostatic Diseases (2001) 4, S2-S6     

Association between prehypertension and chronic kidney disease in the Japanese general population

The increased prevalence of chronic kidney disease (CKD) is a consequence of the accumulation of risk factors, one of which is hypertension. Here we assessed the prevalence of CKD according to blood pressure among 232,025 patients in a Japanese nationwide database with a focus on the prevalence and risk factors of CKD in prehypertension. Patients were stratified by blood pressure and included 75,474 with optimal blood pressure (less than 120/80 mm Hg); 59,194 with prehypertension and a normal blood pressure (120-129/80-84 mm Hg) or 46,547 patients with high-normal blood pressure (130-139/85-89 mm Hg); and 50,810 with hypertension (over 140/90 mm Hg without anti-hypertensive drugs). CKD was defined as an estimated glomerular filtration rate of stage 3 or lower or having proteinuria greater than 1+ by a dipstick method. The prevalence of CKD among patients with optimal blood pressure, prehypertension having normal or high-normal blood pressure, and hypertension was 13.9, 15.6, 18.1, and 20.7% in men, and 10.9, 11.6, 12.9, and 15.0% in women, with a significant difference between genders at each strata of blood pressure. In men, but not in women, whose blood pressure was high-normal, the CKD risk was significantly greater (odds ratio 1.11) than those with optimal blood pressure. Obesity (body mass index over 25) was significantly associated with an increased risk of CKD in both men and women (odds ratio 1.43 and 1.26, respectively), and there was an additive effect of obesity and pre-hypertension on CKD risk in men compared with men with optimal blood pressure. Thus, the prevalence of CKD increased with the severity of blood pressure. Prehypertension with high-normal blood pressure, particularly in conjunction with obesity, was found to be an independent risk factor of CKD in men.     

The correlation between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED): results from a survey in males from Mexico City (MexiLUTS)

Introduction

ED and LUTS affect a high proportion of male population. Although Hispanics are suspected to have a higher risk of experiencing LUTS, detailed information on its frequency and association with ED in this population is scarce.

Objective

To determine the frequency of LUTS and ED, and its correlation in Mexican males.

Methods

A cross-sectional analytical survey was answered by 1041 men. It included the International Prostate Symptom Score and the quality of life question (IPSS/QoL); International Index of Erectile Function (IIEF-5); the short form of the International Consultation of Incontinence Questionnaire (ICIQ-SF); and demographic data. For the analysis, we divided our population into 2 groups (18–39 and 40 and older), and then an exploratory correlation analysis was performed to search for significant differences among IPSS severity groups, and finally a multivariate regression model was applied.

Results

Mean age was 48.6 ± 14.5 years. One hundred twenty-three individuals (11.8 %) were asymptomatic, and 611 (58.7 %) had mild, 226 (21.7 %) had moderate, and 81 (7.8 %) had severe IPSS score. The most common symptoms were nocturia (72.4 %), increased urinary frequency (58.3 %), and slow urinary stream (42.6 %). Two hundred fifty-eight (24.7 %) complained of incontinence. Of 765 individuals, 484(63.2 %) reported some degree of ED. Severe LUTS, DM, and age were independent risk factors for ED severity.

Conclusion

LUTS and ED may represent one of the largest sources of morbidity in our population, and their association was demonstrated. Awareness on these entities should be raised, and further research is required to determine the higher frequency of LUTS and ED in Hispanics.

     

前列腺增生症相关下尿路症状与各临床影响因素关系的研究

目的 探讨不同的临床因素与前列腺增生症(BPH)相关下尿路症状(LUTS)之间的关系,了解影响BPH有关LUTS的危险因素.方法 对2003年7月至2009年10月收治的548例前列腺增生症患者的资料进行回顾性研究.分析不同年龄、病史、最大尿流率(Qmx)、前列腺总体积、移行区体积、移行区指数、总PSA、游总比(f/tPSA)、组织炎症对IPSS值的影响,并进行多元线性回归分析.结果 年龄、移行带体积、Qmax、PSA及前列腺组织炎症对IPSS评分影响显著.随着年龄增大和移行带体积的增加,IPSS值变大;随着最大尿流率的减少,IPSS值显著增加(P＜0.05).当PSA ≥4 ng/mL时,IPSS值要显著大于＜4 ng/mL组(P＜0.05),但是介于4～10 ng/mL组和≥10 ng/mL组的IPSS评分并无差异(P＞0.05).合并前列腺组织炎症患者的IPSS值要显著高于非炎症组(P＜0.05).进一步通过多元线性回归分析,发现所有可能影响IPSS评分的因素中,Qmax和前列腺组织炎症与IPSS评分密切相关(β=-0.807,5.736;P＜0.001).结论 前列腺组织炎症和Qmax对下尿路症状的影响最显著.其他的临床因素如患者年龄、移行带体积和PSA值对BPH患者的下尿路症状影响有限,经过多因素回归分析发现并无显著性.     

VISER检查鉴别心理性与器质性勃起功能障碍(附320例报告)

目的应用VISER鉴别心理性与器质性ED并利用该方法对心理性ED严重性进行客观分级。方法320例ED患者接受了VISER检查。首先海绵体内注射罂粟硷10mg；未诱发勃起，药物剂量增至30mg。将药物试验阳性者定义为心理性ED，并根据海绵体压力、波幅形态以及药物剂量将心理性ED分为轻、中、重二度。两次检查均失败者，行阴茎彩色多普勒超声和海绵体造影检查。结果本组中，心理性ED占81．9％，其中轻度、中度和重度者分别占19．8％，60．7％和19．5％。在部分病例中，检查结果与Zung氏抑郁量表评分具有一定相关性。33例接受阴茎多普勒超声或海绵体造影检查提示，正常13例，动脉性ED5例，静脉性ED9例，动脉静脉混合性ED6例。结论VISER有助于签别心理性与器质性ED，依据其结果对心理性ED严重程度进行客观分级，便于对患者选择有针对性的治疗。     

Patterns of injury in helmeted and nonhelmeted motorcyclists

In the present study, the incidence of severe brain injury was 600 percent higher for patients riding without a helmet and the incidence of all brain injuries was nearly twice as high in the nonhelmeted riders. All surviving patients with severe brain injury sustained residual long-term disability. The incidence of injury and death was much higher for motorcyclists than for occupants of automobiles involved in accidents. Riding a motorcycle is dangerous and riding without a helmet is fool-hardy. Helmets also protect the face, as facial fractures were twice as common in the nonhelmeted riders. There were no significant differences between nonhelmeted and helmeted motorcyclists in terms of overall injury as measured by an injury severity score of 16 or greater. Orthopedic injuries, in this study, were so common that orthopedic surgeons performed more major operations than all other surgical specialists combined. Depth of orthopedic coverage is essential to treat significant numbers of injured motorcyclists. Neurosurgeons are key members of a trauma care team. Helmet laws would help us utilize our limited neurosurgical capacity more effectively by reducing the incidence of brain injury. Medical professionals must educate the public regarding the societal and personal cost of unhelmeted motorcycle riding. Legislation mandating helmet usage for motorcycle riders must be sought.