Relationship between lower urinary tract symptoms and serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia

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

OBJECTIVES

To investigate a possible association between the severity of lower urinary tract symptoms (LUTS) and the serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia (BPH) that underwent surgery for severe benign prostatic obstruction.

PATIENTS AND METHODS

In all, 127 selected men with symptomatic BPH attending our urology clinic were recruited. The clinical conditions of BPH were assessed by digital rectal examination, serum prostate‐specific antigen (PSA) determination, International Prostate Symptom Score (IPSS), transrectal ultrasonography and maximum urinary flow rate (Q_max) value at uroflussimetry. Before surgery, we measured the serum concentrations of total testosterone (TT) and free testosterone (FT), oestradiol, prolactin, luteinizing hormone and follicle‐stimulating hormone. We excluded men with endocrine diseases, those with prostate disease who were receiving antiandrogen therapy and those with psychological diseases. The relationships between the IPSS score and serum sex hormone levels were determined.

RESULTS

The final study population consisted of 122 men (mean age of 70.66 years), as five were excluded (three due to incomplete evaluation and two who were diagnosed with prostate cancer). On statistical analysis, the total IPSS was significantly associated with age (r= 0.405, P < 0.001) and TT (r= 0.298, P= 0.020) but not with FT or the serum levels of the other sex hormones. The serum levels of testosterone and IPSS did not correlate with prostate volume and Q_max. PSA level and age correlated with prostate volume (r= 0.394, P < 0.001; r = 0.374, P < 0.001, respectively). We distinguished two subgroups of patients: the first group of 40 men with an IPSS of <19 and the second group of 82 with an IPSS of >19, and we evaluated the median levels of TT in each group. There was an increased risk of LUTS in men with a greater serum concentration of TT (P= 0.042), although the mean TT level was in the normal range.

CONCLUSIONS

In the present study, the severity of LUTS was associated with age and serum levels of TT but only age correlated with the measures of BPH, especially prostate volume. The potential effects of testosterone on LUTS may well be indirect. Additional large studies are needed to confirm these preliminary results.     

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.     

Uroflowmetric assessment of acute effects of sildenafil on the voiding of men with erectile dysfunction and symptomatic benign prostatic hyperplasia

Purpose  To evaluate the acute effects of sildenafil (50 mg) on the micturation of men with erectile dysfunction (ED) and concomitant benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) using uroflowmetric parameters. Materials and methods  A total of 68 male patients randomized into two groups (36 treatment, 32 control groups) with International Prostate Symptom Score (IPSS) greater than 7 and International Index of Erectile Dysfunction-erectile function domain score lower than 26 were enrolled in the study. Patients in the treatment group received a single dose of 50 mg of oral sildenafil. Patients in the control group received no treatment. Prevoiding urine volumes determined ultrasonographically and voided urine volumes were also recorded. Statistical comparisons were made with the use of analysis of variance (ANOVA). Results  Mean ages were similar between treatment and control groups (60.4 ± 9.8 and 58.6 ± 8.3 years, respectively, P = 0.430). In the treatment group the maximum and average flow rates increased significantly (Q _max from 15.6 ± 6.8 cc/s to 19.3 ± 7.2 cc/s, P < 0.0001; Q _avg from 7.3 ± 3.0 cc/s to 9.1 ± 3.0 cc/s, P < 0.0001) with sildenafil administration, while other parameters studied remained unchanged. Conclusion  Despite the limitations of variations of uroflowmetry, this study showed that sildenafil improves Q _max and Q _avg in patients suffering from ED with concomitant BPH-LUTS. Long-term studies are needed to evaluate the effects on IPSS, side effects, and drug interactions.     

Therapeutic Strategies for Managing BPH Progression

The aim of therapy for benign prostatic hyperplasia (BPH) is to improve quality of life by providing symptom relief and an increased maximum flow rate (Q_max), as well as to reduce disease progression and the development of new morbidities. Watchful waiting can be recommended when the International Prostate Symptom Score is ≤7, that is, mild symptoms that do not interfere with daily life activities. The α₁-blockers are an established therapy for BPH and onset of action is rapid, generally within 2 wk of commencing treatment. Intermediate-term benefits can be seen in an improvement in Q_max of 10–15% and in symptom scores of 15–20%. The other main medical therapies for BPH are the 5α-reductase inhibitors (5ARIs), which not only reduce symptoms and improve Q_max, but also importantly reduce prostate volume. Dutasteride, a dual 5ARI, can provide benefits in symptom score and Q_max within 1 mo. The improvements in symptom score and Q_max continue up to 4 yr, with stabilisation of prostate volume. In the long-term, unlike α₁-blockers, 5ARIs reduce the risk of BPH progression. The risk of acute urinary retention for men taking dutasteride was reduced by 48% compared with placebo at 2 yr (p < 0.001) and the risk of BPH-related surgery by 55% (p < 0.001). The combination of an α₁-blocker and a 5ARI could be considered to provide added benefits over either therapy alone.     

LVAD Pump Flow Does Not Adequately Increase With Exercise

Left ventricular assist devices (LVADs) restore cardiovascular circulatory demand at rest with a spontaneous increase in pump flow to exercise. The relevant contribution of cardiac output provided by the LVAD and ejected through the aortic valve for exercises of different intensities has been barely investigated in patients. The hypothesis of this study was that different responses in continuous recorded pump parameters occur for maximal and submaximal intensity exercises and that the pump flow change has an impact on the oxygen uptake at peak exercise (pVO₂). Cardiac and pump parameters such as LVAD flow rate (Q_LVAD), heart rate (HR), and aortic valve (AV) opening were analyzed from continuously recorded LVAD data during physical exercises of maximal (bicycle ergometer test) and submaximal intensities (6‐min walk test and regular trainings). During all exercise sessions, the LVAD speed was kept constant. Cardiac and pump parameter responses of 16 patients for maximal and submaximal intensity exercises were similar for Q_LVAD: +0.89 ± 0.52 versus +0.59 ± 0.38 L/min (P = 0.07) and different for HR: +20.4 ± 15.4 versus +7.7 ± 5.8 bpm (P < 0.0001) and AV‐opening with 71% versus 23% of patients (P < 0.0001). Multi‐regression analysis with pVO₂ (R² = 0.77) showed relation to workload normalized by bodyweight (P = 0.0002), HR response (P = 0.001), AV‐opening (P = 0.02), and age (P = 0.06) whereas the change in Q_LVAD was irrelevant. Constant speed LVADs provide inadequate support for maximum intensity exercises. AV‐opening and improvements in HR show an important role for higher exercise capacities and reflect exercise intensities. Changes in pump flow do not impact pVO₂ and are independent of AV‐opening and response in HR. An LVAD speed control may lead to adequate left ventricular support during strenuous physical activities.     

Associations between erectile dysfunction and psychological disorders (depression and anxiety): A cross‐sectional study in a Chinese population

The present cross‐sectional survey was performed to evaluate the prevalences and correlations of depression and anxiety among Chinese erectile dysfunction (ED) men. Between February 2017 and January 2019, male patients with or without ED treated in andrology clinic and urology clinic were enrolled in the investigation. All enrolled patients were required to fill in the International Index of Erectile Function Questionnaire (IIEF‐5), Patient Health Questionnaire (PHQ‐9) and Generalized Anxiety Disorder 7‐item scale (GAD‐7) which intended to evaluate the diagnosis and severity of ED, depression and anxiety respectively. Of the 958 included participants, 79.82% (613/768) and 79.56% (611/768) ED patients appeared to have anxiety and depression; 13.68% (26/190) of men without ED had anxiety and depression. In addition, young ED patients (age ≤35 years) and long ED duration patients (duration >12 months) had higher incidences and severities of anxiety and depression (p < .05). After adjusting the age, IIEF‐5 was negatively correlated with PHQ‐9 (adjusted r = ?.653, p < .001) and GAD‐7 scores (adjusted r = ?.607, p < .001). The prevalences of anxiety and depression were 79.82% and 79.56% in Chinese ED patients. The prevalences and severities of anxiety and depression increased as the ED severity increased. Based on the high incidences of anxiety and depression among Chinese ED patients, clinicians are supposed to pay more attention to early diagnosis and therapy of psychiatric symptoms for ED patients, especially among young patients and patients with long ED duration.     

Impact of physician assistance on the reliability of the International Index of Erectile Function

The aim of this study was to analyse the impact of assistance on the comprehensibility and reliability of the Turkish version of International Index of Erectile Function (IIEF). In this study, 458 patients were asked to complete the IIEF questionnaire by themselves during their first visit and then once again during their second visit with the assistance of a physician. The impact of physician assistance was evaluated by comparing the first and second questionnaires. The data were analysed using statistical package software (spss ). A t test, Cronbach's alpha analysis, test–retest correlation (Pearson) and comparison of two rates between two independent groups test were used to analyse the impact of physician assistance. A P value <0.05 was considered to be significant. The proportions of the patients who completed the questionnaires were 70.9% and 100% at the first and second visit respectively. Physician assistance significantly increased the number of patients who completed the questionnaire among patients ≥60 years old (P = 0.0009) and in patients with low levels of education (P = 0.0001). The Cronbach's alpha coefficients were 0.782 and 0.917 for the first and second questionnaires respectively. A high degree of internal consistency was observed for the ‘physician‐assisted’ questionnaire (P < 0.001), and relatively less internal consistency was found for the ‘self‐administered’ questionnaire (P < 0.05) A relatively weaker correlation was found between the first and second questionnaires in primary school graduates (r = 0.391, P < 0.05) and in patients ≥60 years old (r = 0.433, P < 0.05). There was a significant difference between the ‘self‐administered’ and ‘physician‐assisted’ IIEF scores in patients ≥60 years old (P < 0.0001) and primary school graduates (P < 0.0001). Physician assistance increased the comprehensibility and reliability of the IIEF questionnaire, especially in elderly patients and in patients with low education levels.     

Natural history of lower urinary tract symptoms in Japanese men from a 15-year longitudinal community-based study

Study Type – Symptom prevalence (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? There have been few longitudinal community‐based studies on LUTS suggestive of BPH. It is important to determine the natural history of LUTS suggestive of BPH among men in various countries because it is known that there are differences according to race. Although we previously reported a cross‐sectional community‐based survey on LUTS suggestive of BPH in Japanese men, no longitudinal data were available. The present study provides 15‐year longitudinal data on LUTS suggestive of BPH and related variables in Japanese men.

OBJECTIVE

• ? To report the natural history of benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) in Japanese men.

PATIENTS AND METHODS

• ? From 1992 to 1993, we conducted a cross‐sectional community‐based study on LUTS suggestive of BPH in Japanese men aged 40–79 years.
• ? After 15 fifteen years, a follow‐up study was conducted to determine their longitudinal changes of LUTS.
• ? Of the 319 participants taking part in the initial study, 135 participated again in the follow‐up study.
• ? We investigated International Prostate Symptom Score (IPSS), quality of life index and bother score using a questionnaire, and measured prostate volume (PV), prostate‐specific antigen (PSA) level and peak urinary flow rate (Q_max) using a method that we have employed previously.

RESULTS

• ? The change in the total IPSS during 15 years was significant (P= 0.001) and its mean (sd ) annual change was 0.11 (0.40).
• ? Although there was little change in the bother score, a significant correlation was observed between changes in the IPSS and bother score (r= 0.528, P < 0.001).
• ? For the individual IPSS and bother scores, only changes in urgency, weak stream and nocturia were significant.
• ? The changes in PV, PSA level and Q_max were significant.
• ? The change in the total IPSS did not correlate with the changes in these variables.

CONCLUSION

• ? In a 15‐year‐longitudinal community‐based study for Japanese men, we have shown that the IPSS and quality of life index deteriorated, PV and PSA level increased, and Q_max decreased.

     

Silodosin is effective for treatment of LUTS in men with BPH: a systematic review

The aim of this study was to systematically review the evidence on the efficacy and safety of silodosin treatments on lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) from randomized controlled trials. We searched PubMed (1966–December 2011), Embase (1974–December 2011) and the Cochrane Library Database (2011, Issue 12). The assessed outcome measures were the change from baseline for the International Prostate Symptom Score (IPSS), quality of life (QoL) score, peak urine maximum flow rate (Q_max), QoL related to urinary symptoms and adverse effects. Two authors independently assessed the study quality and extracted data. All data were analysed using RevMan 5.1. The meta-analysis included four randomized controlled trials with a total of 2504 patients. The study durations were each 12 weeks. At the follow-up end points, the pooled results showed that the change from baseline for the silodosin group was significantly higher than the placebo group for the IPSS, QoL score and Q_max(mean difference (MD)=−2.78, P<0.00001; MD=−0.42, P=0.004; MD=1.17, P<0.00001,respectively) and patients felt more satisfied with QoL related to urinary symptoms in the silodosin group than the placebo group. Ejaculation disorder was the most commonly reported adverse effect. The pooled results also showed that the silodosin group was superior to the 0.2 mg tamsulosin group with respect to the IPSS and QoL score (IPSS: MD=−1.14, P=0.02; QoL score: MD=−0.26, P=0.02) and inferior to the 0.2 mg tamsulosin group with respect to Q_max (MD=−0.85, P=0.01). In contrast, there was no significant difference in the incidence of ejaculation disorder and dizziness between the silodosin and 0.2 mg tamsulosin groups. The current meta-analysis suggested that silodosin is an effective therapy for LUTS in men with BPH and is not inferior to 0.2 mg tamsulosin.     

The effect of α-blocker therapy on erectile functions in patients with lower urinary tract symptoms due to benign prostate hyperplasia

In this study we aimed to evaluate the impact of doxazosin treatment on erectile functions in patients with lower urinary tract symptoms （LUTS） and having erectile dysfunction （ED） at baseline. Fifty-three patients with LUTS （IPSS score 〉 7） whose maximum flow rate （Qmax） 〈 15 mL s-1 and PSA 〈 4 ng dL^-1 were enrolled in the study. Patients received doxazosin 4 nag once daily for 6 weeks. Subjective efficacy was assessed by IPSS, IPSS- Quality of Life （IPSS-QoL） for LUTS and efficacy was assessed by International Index of Erectile Function （IIEF） for erectile functions at baseline and sixth weeks. The objective efficacy was assessed by Q The patients were classified according to their self reported erectile status： group I had ED and group II did not have ED. At the endpoint, doxazosin significantly improved the total IPSS score （-7.7 ±6.1, P = 0.006）, IPSS-QoL score （-1.5 ± 1.5, P = 0.024） and Qmax （3.2 ± 4.6 mL s^-1, P = 0.002） over baseline. Mean decrease in IPSS and IPSS-QoL scores after the treatment period were 6.9 ＋ 6.4 （P 〈 0.001） and 0.95 4- 1.80 （P 〈 0.05） in group I, whereas 8.2 4- 5.8 （P 〈 0.001） and 1.9 4- 1.1 in group IX （P 〈 0.001）, respectively. Mean changes of Qmax values were 2.3 4- 3.3 mL s^-1 in group I （P 〈 0.05） and 3.7 4- 5.3 mL s-1 in group II （P 〈 0.001）. The improvement of IIEF-EF scores after the treatment period was only significant for group I. The efficacy of a-blocker therapy for LUTS was better by means of symptomatic relief for patients who did not have ED when compared with patients who had ED at baseline. However, slight improvement in erectile functions with a-blocker therapy was only seen in LUTS patients with ED.     

Exploration of the association between chronic periodontal disease and erectile dysfunction from a population‐based view point

Several cross‐sectional studies have indicated an association between chronic periodontal disease (CPD) and cardiovascular disease and metabolic syndrome. Erectile dysfunction (ED) also shares pathological mechanisms with these diseases. Using a nationwide population‐based data set, we examined the association between ED and CPD and assessed the effect of dental extraction (DE) on ED prevalence in different aged CPD populations in Taiwan. We identified 5105 patients with ED and randomly selected 10 210 patients as controls. Of these patients, 2617 (17.09%) were diagnosed with CPD according to the index data: 1196 (23.43%) in the ED group and 1421 (13.92%) in the control group. After adjusting for comorbid factors, patients with ED were more likely to have been diagnosed with prior CPD than controls (OR = 1.79, 95% CI = 1.64–1.96, P < 0.001). Moreover, the association was much stronger in the populations aged less than 30 years (OR = 2.13, 95% CI = 1.23–3.70, P < 0.001) and more than 59 years (OR = 2.27, 95% CI = 1.99–2.59, P < 0.001). Dental extraction seems to attenuate damage to the penile endothelial beds caused by CPD‐related inflammation and overcame the process of ED in the middle‐aged and older populations.     

Oxidised low‐density lipoprotein,a possible distinguishing lipid profile biomolecule between prostate cancer and benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) share common conditions such as lower urinary tract symptoms (LUTS) and dyslipidaemia. Whether an extensive lipid profile analysis could discriminate between BPH and PCa was the objective. Thirty‐six (36) BPH and twenty (20) PCa outpatients of a urology clinic plus forty (40) controls without LUTS, but normal PSA, were recruited. Body mass index (BMI), lipid profile (total cholesterol [CHOL], triglycerides [TG], high‐density lipoprotein [HDL], very‐low‐density lipoprotein [VLDL], low‐density lipoprotein [LDL] and Castelli's risk index I [CR I] [TC/HDL]), oxidised LDL, apolipoprotein E, ceramide and PSA were determined. Mean ages for BPH, PCa and control were 69 ± 13, 67 ± 10 and 53 ± 7 years respectively. Most parameters apart from BMI and HDL were significantly different compared to the control group. oxLDL for BPH versus control, PCa versus control and BPH versus PCa was significant (p < 0.001, p = 0.02 and p < 0.001 respectively). Ceramide showed significant group differences. Between BPH and PCa, total cholesterol, LDL and Apo E were significantly different (p = 0.00, p = 0.01 and p = 0.03 respectively). Apo E could potentially be a discriminating biomarker. Receiver operating characteristic curves for TPSA, Apo E and oxLDL demonstrated sensitivity of 69.44 and specificity of 88.24 for oxLDL, hence more discriminatory.     

Increased Plasma Matrix Metalloproteinase-2 (MMP-2), Tissue Inhibitor of Proteinase-1 (TIMP-1), TIMP-2, and Urine MMP-2 Concentrations Correlate With Proteinuria in Renal Transplant Recipients

Background

The most frequent cause of kidney allograft loss is chronic allograft injury, often with proteinuria as the clinical feature. Occurrence of proteinuria late after kidney transplantation is associated with worse graft function and patient survival.

Aim

The aim of the study was to assess plasma and urine matrix metalloproteinases (MMP-2 and MMP-9) and tissue inhibitors of metalloproteinases (TIMP-1 and TIMP-2) in proteinuric renal transplant recipients (RTRs). The factors were determined by enzyme-linked immunosorbent assay in 150 RTRs (51 women and 99 men), aged 49.2 ± 11.5 years, at mean 73.4 ± 41.2 months after kidney transplantation (range: 12 to 240 months).

Results

Proteinuric RTRs compared with non-proteinuric RTRs had higher median plasma MMP-2 (P = .012), TIMP-1 (P = .0003), and TIMP-2 (P = .0021) concentrations, as well as higher urine MMP-2 (P < .0001) excretion. The presence of proteinuria had no impact on plasma MMP-9 and urine MMP-9, TIMP-1, and TIMP-2. Proteinuria and estimated daily proteinuria (uPr:uCr) correlated positively with plasma MMP-2 (r_s = 0.226, P = .0054 and r_s = 0.241, P = .003), TIMP-1 (r_s = 0.305, P = .00015 and r_s = 0.323, P = .000055), TIMP-2 (r_s = 0.273, P = .0007 and r_s = 0.269, P = .001) and urine MMP-2 (r_s = 0.464, P < .0001 and r_s = 0.487, P < .0001), respectively. Proteinuric RTRs had impaired graft function with higher median serum creatinine concentrations (1.91 [1.60–2.43] mg/dL versus 1.41 [1.20–1.65] mg/dL, P < .00001) and lower estimated glomerular filtration rate (36 [28–45] mL/min/1.73 m² versus 53 [43–61] mL/min/1.73 m², P < .00001) than RTRs without proteinuria.

Conclusions

Our research revealed that in RTRs, proteinuria was significantly associated with increased concentrations of enzymes involved in extracellular matrix (ECM) degradation: plasma MMP-2, TIMP-1, TIMP-2, and urine MMP-2. Findings strongly emphasize increased plasma TIMPs in proteinuric RTRs that inhibit degradation of ECM by MMPs and favor excessive deposition of ECM proteins.     

Is there a relationship among age,international index of erectile function,international prostate symptom score,and aging males’ symptoms score?

Purpose To investigate the relationship among the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), and Aging Males’ Symptoms (AMS) scale scores in various age groups of males. Patients and methods A total of 307 male patients enrolled in the study. Mean age was 52.3 (range 21–77) years. Group 1 consisted of 51 (≤39 years), Group 2 consisted of 160 (40–59 years), and Group 3 consisted of 96 (≥60 years) patients. First five and 15th questions of the IIEF, IPSS, and AMS scale were replied by all the patients. The patients were assessed based on the IIEF for erectile dysfunction (ED), IPSS for lower urinary tract symptoms (LUTS), and AMS scale for Symptomatic Late-Onset Hypogonadism (SLOH). Results ED, LUTS, and SLOH symptoms were detected in 236 (76.8%), 162 (52.8%), and 184 (59.9%) patients. Except for total AMS scores, IIEF and IPSS scores were significantly different among the groups (p _AMS = 0.320, p _IIEF = 0.000, p _IPSS = 0.000). In the comparisons of the IIEF scores between the each group, significant differences were observed (p _{Group1–Group2} = 0.000, p _{Group1–Group3} = 0.000, p _{Group2–Group3} = 0.000). Nevertheless, IPSS score was significantly lower in the patients with age ≤39 years than the other age groups (p = 0.000). Conclusions In the present study, ED ratio and LUTS severity significantly increased in older men. We did not find significant relationship between aging and SLOH symptoms. In the light of our results, LUTS seems to be an important risk factor on erectile function.     

Erectile dysfunction may predict coronary artery disease: relationship between coronary artery calcium scoring and erectile dysfunction severity

Objectives The aim of this prospective study is to evaluate patients with erectile dysfunction (ED) in terms of coronary artery calcium (CAC) levels assessed by multidetector computed tomography (MDCT) and to find out if ED severity may predict coronary heart disease risk. Patients and method Sixty men with a mean age of 55.7 (41–77) years with ED and 23 men with a mean age of 53.2 (39–76) years without ED, who admitted to our clinic between January 2005 and December 2005, were included in the study. All patients answered the standard International Index of Erectile Function (IIEF) forms, and were classified into four groups as mild, moderate, severe ED and no ED. CAC levels were assessed by MDCT protocol. CAC levels and IIEF scores were analyzed within each group. Results Pearson correlation test demonstrated significant negative correlation between IIEF score and CAC score (r = −497; P < 0.0001). CAC scores increased significantly with regard to IIEF scores decrease: IIEF 1–10 (n = 18), mean CAC: 557.7; IIEF 11–16 (n = 13), mean CAC: 541.3; IIEF 17–25 (n = 29), mean CAC: 84.6; and IIEF ≥ 26 [n = 23 (Control group)], mean CAC: 10.1. The difference between the mean CAC scores of these four groups was statistically significant (P < 0.0001). When we took the cut-off value for IIEF score 26 we observed significantly higher CAC scores at the group of IIEF < 26 (mean 325.5 vs 10.1; P < 0.0001). Conclusion We observed positive correlation with ED severity and CAC levels. Therefore, we think that detection and quantification of preclinical coronary artery disease by CAC scoring with a non-invasive method might have a great potential for early cardiac preventive measures.     

Association between bone mineral density,lean mass,and fat mass among healthy middle-aged premenopausal women: a cross-sectional study in southern Sri Lanka

Associations between lean mass, fat mass, and bone mass have been reported earlier; however, most of those studies have been done in Caucasian populations, and data from Asian countries, especially those in South Asia, are limited. We examined the associations between lean mass, fat mass, bone mineral density (BMD), and bone mineral content (BMC), determined by dual-energy X-ray absorptiometry technology, in a group of healthy, middle-aged, premenopausal female volunteers. The mean (SD) age of the women (n = 106) was 42.1 (6.1) years and the mean (SD) body mass index was 24.3 (3.6) kg/m². Total body BMD, total body BMC, and BMD in total spine, total hip, and femoral neck showed statistically significant partial correlations (adjusted for age) with total fat mass (r = 0.19–0.43, P < 0.05) and lean body mass (r = 0.28–0.54, P < 0.05). Truncal fat mass correlated positively with total body BMC and BMD at total hip and femoral neck (r = 0.33–0.40, P < 0.001). When a stepwise regression model was fitted, lean mass remained the strongest predictor of total body BMD, total body BMC, and total spine BMD (regression coefficients = 0.004–0.008 g/cm² per 1-kg change in lean mass, P < 0.001). Similarly, crude BMD and BMC increased across the tertiles of lean mass (P trend < 0.05). We show that lean mass is the strongest predictor of total body BMC and BMD at different sites, although positive correlations with fat mass also exist.     

The effect of using tadalafil 5 mg/day on neutrophil–lymphocyte and platelet–lymphocyte ratios in mild‐medium and severe erectile dysfunction patients; and comparison of clinical response

To examine the relation between NLR (neutrophil–lymphocyte ratio) and PLR (platelet–lymphocyte ratio) rates and the severity of ED (erectile dysfunction) and the effect of tadalafil 5 mg/day on these, a total of 143 patients were retrospectively evaluated. Sixty‐three patients with ED who came for follow‐up examinations in the 1st month of the treatment were included as the study group, and 80 men who were not diagnosed with ED were as the control group. The age and Charlson Comorbidity Indexes (CCI) of the study and control groups were compared with the IIEF 5, NLR and PLR values before and after the treatment. The mean age and median CCI were higher in the severe ED group (p < 0.05). The mean NLR and PLR values were lower in the control group (p < 0.001). In the study group, the NLR and PLR values decreased with the increase in the IIEF 5 scores (p < 0.001). The ROC curve was significant for the NLR and PLR scores (AUC = 0.779, [95% CI: 0.698–0.860]; AUC = 0.754, [95% CI: 0.670–0.838] p < 0.001). Although more prospective and randomized studies are needed, the systemic inflammation decreases and the clinical symptoms improve in patients who use tadalafil 5 mg/day.     

Male Sexual Function in Patients Receiving Different Types of Renal Replacement Therapy

BackgroundPatients with end-stage renal disease (ESRD) experience erectile dysfunction (ED). Although it is a benign disorder, ED is related to physical and psychosocial health, and it has a significant impact on the quality of life (QOL). The objective of the present study was to investigate the effects of different renal replacement therapies on ED.MethodsA total of 100 ESRD patients and 50 healthy men were recruited to the present cross-sectional study. The study was consisted of 53 renal transplantation (RT; group I; mean age, 39.01 ± 7.68 years; mean duration of follow-up, 97.72 ± 10.35 months) and 47 hemodialysis (HD) patients (group II; mean age, 38.72 ± 9.12 years; mean duration of follow-up, 89.13 ± 8.65 months). The control group consisted of 50 healthy men (group III; mean age 39.77 ± 8.51 years). Demographic data and laboratory values were obtained. All groups were evaluated with the following scales: International Index of Erectile Function (IIEF)-5 and Short Form (SF)-36 questionnaires, and Beck Depression Inventory (BDI). The patients whose IIEF score were ≤21 were accepted as having ED.ResultsThe mean age of these groups were similar (P > .05). Total IIEF-5 scores of men in groups I, II, and III were 19.5 ± 4.5, 16.4 ± 5.9, and 22.5 ± 3.4, respectively. The mean total IIEF-5 score of control group was higher than those of groups I and II (P < .001). Posttransplant group mean total IIEF-5 score was also higher than the HD group (P < .05). Groups I and II significantly differed from control group in terms of presence of ED (IIEF score ≤21: Group I, n = 28 [52.8%]; group II, n = 29 [61.7%]; and group III, n = 12 [%24], respectively [P < .001]), whereas there was no difference between groups I and II. In the logistic regression analysis (variables included age, BDI, and renal replacement therapy [HD and transplantation]), ED was independently associated with age (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.05–1.2), BDI (OR, 1.1; 95% CI, 1.01–1.13). Additionally, ED was not associated with renal replacement therapy (OR, 1.46; 95% CI, 0.60–3.57). Physiologic health domain of SF-36 was significantly better in healthy controls (P < .001). Patient groups were similar in terms of BDI score (P > .05). ED score was negatively correlated with BDI (r = ?0.368; P < .001), and positively correlated with SF-36 (r = 0.495; P < .001) in all patient groups.ConclusionPatients with ESRD had significantly lower sexual function and lower QOL scores than the healthy control men. Notably, the mode of renal replacement therapy had no impact on male sexual function.     

Serum cystatin C for estimation of residual renal function in children on peritoneal dialysis

Residual renal function (RRF) is an important parameter in the management of patients on chronic dialysis. The aim of this cross-sectional study was to determine the efficacy of serum cystatin C (CysC) for RRF estimation in 20 children (16 boys, 4 girls; median age 13.4 years) undergoing peritoneal dialysis (PD). For studies of correlation with serum CysC, the average of creatinine clearance rate (C_cr) and urea clearance rate (C_urea), Kt/V_urea, and weekly C_cr were evaluated as parameters reflecting RRF. The serum CysC level was found to be negatively correlated with urine volume (r = −0.717, P < 0.001), average of C_cr and C_urea(r = −0.851, P < 0.001), total and renal weekly C_cr (r = −0.795, P < 0.001; r = −0.845, P < 0.001, respectively), and renal Kt/V_urea (r = −0.793, P < 0.001) and positively correlated with peritoneal weekly C_cr (r = 0.738, P < 0.001) and peritoneal Kt/V_urea (r = 0.785, P < 0.001). There was no significant association with total Kt/V_urea (r = −0.335, P = 0.148). In non-anuric group of patients, serum CysC had no link to peritoneal Kt/V_urea (r = 0.573, P = 0.066), but was negatively correlated with renal Kt/V_urea (r = −0.609, P = 0.047). In the multiple regression analysis, renal Kt/V_urea significantly contributed to log CysC concentration rather than peritoneal Kt/V_urea. The results of this study suggest that serum CysC could be an appropriate marker for RRF, independent of total and peritoneal Kt/V_urea.