ORIGINAL RESEARCH—PEYRONIE'S DISEASE: Peyronie's Disease Following Radical Prostatectomy: Incidence and Predictors

IntroductionBoth prostate cancer and Peyronie's disease (PD) are prevalent in men after their fifth decade of life. The evidence to support or refute a link between radical prostatectomy (RP) and PD is limited.AimsTo define the incidence of PD in men who had RP and determine possible predictors of PD development after RP.MethodsA review of a prospectively built sexual medicine database, years 2002–2008, looking at subjects who had RP as a monotherapy for localized prostate cancer. We identified and characterized subjects who developed PD within 3 years after RP and compared them with subjects who did not.Main Outcome MeasuresThe incidence of PD among men who attended a sexual medicine clinic after they had RP, predictors of PD development after RP.ResultsThe study population included 1,011 subjects, and PD incidence in this population was 15.9%. Mean time to develop PD after RP was 13.9 ± 0.7 months. Mean curvature magnitude was 31 + 17 degrees. On univariate analysis, younger age (mean age of 59 + 7 in men with PD vs. 60 + 7 years in men without PD, P = 0.006) and white race (vs non-white, 18% vs. 7%, P < 0.001) were predictive of PD development after RP, but post-op erectile function was not a predictor of PD development. On multivariate analysis, younger age (odds ratio (OR) = 1.3, for 5-year decrease in age) and white race (OR = 4.1, vs. non-white) remained independent significant predictors.ConclusionsMen presenting with sexual dysfunction after RP have higher PD incidence then the general population. Therefore, they should be routinely evaluated for PD. Younger men and men of white race are at increased risk for PD. Prospective controlled studies are needed to elucidate the incidence of PD following RP and to conclude if RP has a causative role in the pathogenesis of PD. Tal R, Heck M, Teloken P, Siegrist T, Nelson CJ, and Mulhall JP. Peyronie's disease following radical prostatectomy: Incidence and predictors.     

Three‐Year Outcomes of Recovery of Erectile Function after Open Radical Prostatectomy with Sural Nerve Grafting

IntroductionOptimal oncologic control of higher stage prostate cancers often requires sacrificing the neurovascular bundles (NVB) with subsequent postoperative erectile dysfunction (ED), which can be treated with interposition graft using sural nerve.AimsTo examine the long term outcome of sural nerve grafting (SNG) during radical retropubic prostatectomy (RRP) performed by a single surgeon.MethodsSixty‐six patients with clinically localized prostate cancer and preoperative International Index of Erectile Function (IIEF) score >20 who underwent RRP were included. NVB excision was performed if the risk of side‐specific extra‐capsular extension (ECE) was >25% on Ohori’ nomogram. SNG was harvested by a plastic surgeon, contemporaneously as the urologic surgeon was performing RRP. IIEF questionnaire was used pre‐ and postoperatively and at follow‐up.Main Outcome MeasuresPostoperative IIEF score at three years of men undergoing RRP with SNG. Recovery of potency was defined as postoperative IIEF‐EF domain score >22.ResultsThere were 43 (65%) unilateral SNG and 23 (35%) bilateral SNG. Mean surgical time was 164 minutes (71 to 221 minutes).The mean preoperative IIEF score was 23.4 + 1.6. With a mean follow‐up of 35 months, 19 (28.8%) patients had IIEF score >22. The IIEF‐EF scores for those who had unilateral SNG and bilateral SNG were 12.9 + 4.9 and 14.8 + 5.3 respectively. History of diabetes (P = 0.001) and age (P = 0.007) negatively correlated with recovery of EF. 60% patients used PDE5i and showed a significantly higher EF recovery (43% vs. 17%, P = 0.009).ConclusionsSNG can potentially improve EF recovery for potent men with higher stage prostate cancer undergoing RP. The contemporaneous, multidisciplinary approach provides a good quality graft and expedited the procedure without interrupting the work‐flow. Siddiqui KM, Billia M, Mazzola CR, Alzahrani A, Brock GB, Scilley C, and Chin JL. Three‐year outcomes of recovery of erectile function after open radical prostatectomy with sural nerve grafting. J Sex Med 2014;11:2119–2124.     

Efficacy and Safety of Dapoxetine in Men with Premature Ejaculation and Concomitant Erectile Dysfunction Treated with a Phosphodiesterase Type 5 Inhibitor: Randomized,Placebo-Controlled,Phase III Study

IntroductionMen with comorbid erectile dysfunction (ED) and premature ejaculation (PE) may be concomitantly prescribed a phosphodiesterase type 5 (PDE5) inhibitor and dapoxetine.AimEvaluate efficacy and safety of dapoxetine 30 mg and 60 mg on demand (prn) in men with PE and ED who were being treated with PDE5 inhibitors.MethodsThis randomized, double-blind, placebo-controlled, flexible-dose, multicenter study enrolled men ≥18 years who met diagnostic criteria for PE including intravaginal ejaculatory latency time (IELT) of ≤2 minutes in ≥75% of sexual intercourse episodes; were on stable regimen of a PDE5 inhibitor; and had International Index of Erectile Function-erectile function domain score ≥21. Subjects received placebo, dapoxetine 30 mg, or dapoxetine 60 mg prn (1–3 hours before intercourse) for 12 weeks.Main Outcome MeasureStopwatch-measured average IELT, Clinical Global Impression of Change (CGIC) in PE, Premature Ejaculation Profile (PEP), and treatment-emergent adverse events (TEAEs).ResultsOf 495 subjects randomized, 429 completed the study. Arithmetic mean average IELT significantly increased with dapoxetine vs. placebo at end point (5.2 vs. 3.4 minutes) and weeks 4, 8, and 12 (P ≤ 0.002 for all). Men who described their PE at least “better” using the CGIC were significantly greater with dapoxetine vs. placebo at end point (56.5% vs. 35.4%) and weeks 4, 8, and 12 (P ≤ 0.001 for all). Significantly better outcomes were also reported with dapoxetine vs. placebo on PEP measures. Incidence of TEAEs was 20.0% and 29.6% in placebo- and dapoxetine-treated subjects, respectively (P = 0.0135). TEAEs led to discontinuation in 1.6% of subjects in both groups. Most frequent TEAEs were known adverse drug reactions of dapoxetine treatment including nausea (9.2%), headache (4.4%), diarrhea (3.6%), dizziness (2.4%), and dizziness postural (2.4%).ConclusionsIn men with PE and comorbid ED on a stable regimen of PDE5 inhibitor, dapoxetine provided meaningful treatment benefit and was generally well tolerated. McMahon CG, Giuliano F, Dean J, Hellstrom WJG, Bull S, Tesfaye F, Sharma O, Rivas DA, and Aquilina JW. Efficacy and safety of dapoxetine in men with premature ejaculation and concomitant erectile dysfunction treated with a phosphodiesterase type 5 inhibitor: Randomized, placebo-controlled, phase III study. J Sex Med 2013;10:2312–2325.     

Physical Activity and PDE5 Inhibitors in the Treatment of Erectile Dysfunction: Results of a Randomized Controlled Study

IntroductionPhysical activity (PhA) has proven to be a protective factor for normal erectile function in numerous epidemiological studies.AimThe aim of this study was to establish if PhA could have a therapeutic role in the treatment of erectile dysfunction (ED).MethodsThis was a randomized, open-label study. A total of 60 patients complaining of ED were studied. Patients were assessed at baseline and after 3 months of study treatment. At baseline, patients were randomized to receive phosphodiesterase type 5 inhibitor (PDE5i) alone (group A) or PDE5i plus regular (≥3 hours/week), aerobic, non-agonistic PhA (group B).Main Outcome MeasuresAll subjects completed the International Index of Erectile Function (IIEF-15) questionnaire and performed total testosterone (TT).ResultsMean PhA was 3.4 hours/week in group B vs. 0.43 in group A; mean energy expenditure in group B was 1,868 kcal/ week or 22.8 metabolic equivalent (MET)/week. IIEF restoration of ED occurred in 77.8% (intervention group) vs. 39.3% (control) (P < 0.004). The IIEF-15 score resulted in statistical improvement in intervention group in all the domains but one (orgasm): erectile function 24.7 vs. 26.8 (P = 0.003); confidence (Q15) 3.53 vs. 4.07 (P = 0.006); sexual desire 6.46 vs. 7.18 (P = 0.028); intercourse satisfaction 9.85 vs. 11.25 (P = 0.001); total satisfaction 7.17 vs. 8.07 (P = 0.009); total score 56.2 vs. 61.07 (P = 0.007). TT was statistically similar in the two groups; separate analysis in each group showed statistical increase in group B 4.24 vs. 4.55 (P = 0.012). At multivariate logistic regression analysis, PhA was the only independent variable for normal erection (P = 0.010) (95% confidence interval [CI] 0.036–0.643), higher sexual satisfaction (P = 0.022) (95% CI 0.084–0.821) and normal total IIEF-15 score (P = 0.023) (95% CI 0.85–0.837).ConclusionIn this randomized controlled pilot study, PDE5i plus PhA was more effective than PDE5i alone in the treatment of ED. Maio G, Saraeb S, and Marchiori A. Physical activity and PDE5 inhibitors in the treatment of erectile dysfunction: Results of a randomized controlled study.     

The Female Factor: Predicting Compliance with a Post-Prostatectomy Erectile Preservation Program

IntroductionEarly post-radical prostatectomy (RP) erectile preservation (EP) therapy may be critical to preserve erections after surgery.AimTo assess if pre-RP female sexual function predicts of partner compliance with an EP protocol.Main Outcome MeasuresCompliance, defined as use of localized penile EP therapy (intracavernosal injections [ICIs], vacuum erection device [VED], or alprostadil) at 3 and 6 months after RP.MethodsRecords of patients enrolled in our EP program from April 2007 to June 2008 were reviewed. Before surgery, patients completed the Sexual Health Inventory for Men (SHIM) and their female partners completed the Female Sexual Function Index (FSFI) questionnaire. Prior to surgery, patients were advised to take sildenafil 25 mg every nightly and use a 250-µg alprostadil suppository three times/week. At 1 month, additional daily use of a VED was encouraged. All patients unable to achieve erections sufficient for penetration were encouraged to initiate ICI of Trimix (phentolamine, papaverine, and PGE1) twice weekly after 3 months following surgery. Data were analyzed using binary logistic regression analysis holding all input variables constant.ResultsTwenty-nine patients had preoperative SHIM > 7 and pre-RP partner FSFI data available. After a 4-week follow-up, compliance with alprostadil suppository declined and both ICI and VED usage increased. At 6 months, six (25.0%) patients had return of natural erectile function and 22 (91.7%) were achieving assisted erections. Higher preoperative partner FSFI scores were associated with greater compliance to the localized penile therapy component of our EP protocol (risk ratio 3.8, P = 0.05).ConclusionsPreoperative female sexual function correlated with greater partner compliance with the localized component of our EP protocol. Consideration of a female partner's preoperative sexual function in predicting patient erectile function recovery after RP is warranted. Future studies are necessary to determine the clinical significance of this factor. Moskovic DJ, Mohamed O, Sathyamoorthy K, Miles BJ, Link RE, Lipshultz LI, and Khera M. The female factor: Predicting compliance with a post-prostatectomy erectile preservation program.     

Pelvic insufficiency fractures in patients with cervical and endometrial cancer treated with postoperative pelvic radiation

ObjectiveThere is an increased awareness of pelvic insufficiency fractures (PIF) as a potential morbidity of pelvic radiotherapy (RT). The purpose of this study was to determine the incidence of PIF and assess prognostic factors, including intensity-modulated RT (IMRT), in gynecologic oncology patients treated with postoperative pelvic RT.MethodsWe performed a retrospective review of all patients with endometrial or cervical carcinoma who received postoperative pelvic RT at our institution during 2000–2008. Patients who received definitive or palliative RT were excluded.ResultsA total of 222 patients were identified, of whom 11 (5%) developed PIF at a median time of 11.5 months (range, 5.5–87.3 months) from RT completion. The 5-year actuarial rate was 5.1% (95% CI 3.3–6.9). In patients with osteoporosis, the 5-year rate was 15.6% compared with 2.9% for those without (P = 0.01). Similarly, patients who were on prior hormone-replacement therapy (HRT) had a higher rate (14.8% vs 4.1%, P = 0.009). The median body-mass index (BMI) for patients who developed PIF was significantly lower than those who didn't (25.9 vs 27.2, P = 0.016). The rate of PIF was 4.9% whether patients received IMRT or conventional RT.ConclusionsThe 5-year risk of PIF for postoperative pelvic RT in cervical and endometrial cancer is 5.1%. Women with history of osteoporosis, prior HRT, or low BMI need to be counseled about the risk of PIF. The use of IMRT did not decrease PIF, but further studies are needed to determine if a dose/volume relationship exists between RT and PIF.     

Efficacy and Safety of Oral Mirodenafil in the Treatment of Erectile Dysfunction in Diabetic Men in Korea: A Multicenter,Randomized, Double-Blind,Placebo-Controlled Clinical Trial

IntroductionMirodenafil is a newly developed selective phosphodiesterase type 5 (PDE5) inhibitor for the treatment of erectile dysfunction (ED).AimTo evaluate the efficacy, safety and tolerability of mirodenafil in the treatment of ED in Korean men with diabetes.MethodsA multicenter, randomized, double-blind, placebo-controlled, parallel-group, fixed-dose study was conducted with 112 subjects who were randomized to either placebo or mirodenafil 100 mg on demand for 12 weeks.Main Outcome MeasuresPrimary efficacy variable was the erectile function (EF) domain scores of the International Index of Erectile Dysfunction (IIEF) questionnaire. Secondary efficacy variables included change in the scores of IIEF question 3 and 4 (IIEF Q3 and Q4) from baseline, change in all domain scores in the IIEF from baseline, Sexual Encounter Profile questions 2 and 3 (SEP2 and SEP3), the Global Assessment Question (GAQ) and the Life Satisfaction Checklist (LSC).ResultsAfter 12 weeks of treatment, mirodenafil group showed significantly greater change in the IIEF-EF domain score from baseline compared with the placebo group (9.3 vs. 1.4, P < 0.0001). The changes from baseline in the mirodenafil group in IIEF Q3 (1.7 vs. 0.4, P < 0.0001) and Q4 (1.7 vs. 0.3, P < 0.0001) were higher compared with the placebo group. Differences between the mirodenafil and placebo groups were significant in the SEP2 (82.0% vs. 55.2%, P = 0.0003), SEP3 (68.9% vs. 22.3%, P < 0.0001). Difference in GAQ “YES” responses was also significant (76.9% vs. 19.1%, P < 0.0001). Normal EF domain scores (≥26) at study end were achieved by 32.7% and 9.4% in the mirodeniafl and placebo groups, respectively (P = 0.0031). As for the LSC scores, the mirodenafil group showed significantly greater improvements in sexual life and partner relationship than the placebo group. Most treatment-associated AEs were mild that resolved spontaneously.ConclusionsMirodenafil is an effective and well-tolerated agent for the treatment of diabetic patients with ED in Korea. Park HJ, Choi HK, Ahn TY, Park JK, Chung WS, Lee SW, Kim SW, Hyun JS, and Park NC. Efficacy and safety of oral mirodenafil in the treatment of erectile dysfunction in diabetic men in Korea: A multicenter, randomized, double-blind, placebo-controlled clinical trial.     

Première enquête nationale française sur les modes de vie et les facteurs toxiques chez les couples infertiles

ObjectivesThe purpose of our study is to assess, prior to any treatment for infertility, the environment and quality of life of candidate couples for medically assisted procreation (MAP) and the toxic factors which may be related to their difficulty in conceiving.Patients and methodsA screening questionnaire aimed at 796 patients (348 couples) has been collected by 43 assisted reproductive techniques (ART) centers in France. Stress factors, anxiety, toxic and environmental factors have been recorded and analysed.ResultsWomen were on average younger than men (34.9 y ± 5.3 vs. 37.5 y ± 7.5), with a normal BMI, and 78% of them had no children. Sexual relations are regular: 2.14 per week. However, 1 in 8 women reports having sexual problems as opposed to 2 in 100 men (P < 0.0001), the most common problems being painful intercourse, insensitivity and bleeding. Fifty percent of the surveyed women say they have painful periods. Smoking and cannabis use were significantly higher in the men (32% vs. 20% and 6,4% vs. 1,2%). Alcohol consumption is more common in men (32 vs. 23%, P < 0.01). Stress related to infertility was significantly higher in the women (54% vs. 23%; P < 0.001).Discussion and conclusionThis first prospective French survey has revealed an increased incidence of smoking and an escalation of sexual problems (decrease in sexual relations, dyspareunia) and dysmenorrhea in women. It has also revealed stress at work in couples, and increased stress levels due to infertility in the female partners participating in this study. Our study suggests that there are numerous toxic and environmental factors which are potentially harmful for a couple's fertility and which should be corrected before any MAP treatment is attempted in order to optimise the results in ART and to increase natural fertility.     

A Randomized Trial of Oral Misoprostol in Premenopausal Women Before Hysteroscopy

ObjectiveTo determine if the use of oral misoprostol in premenopausal women undergoing diagnostic hysteroscopy produces a clinically important difference in pre-procedural cervical dilatation.MethodsAt a tertiary care hospital, premenopausal women undergoing diagnostic hysteroscopy were randomized to receive either 400 μg of misoprostol or a vitamin B6 placebo orally 12 hours before the procedure. Patients were stratified on the basis of parity. The primary outcome was the pre-procedural dilatation of the cervix. Secondary outcomes included the need to further dilate the cervix, the time required to further dilate the cervix, and side effects.ResultsSixty-four women (11 nulliparous and 53 parous) undergoing diagnostic hysteroscopy consented to participate in the study. Thirty-three women received misoprostol and 31 received placebo. Baseline demographics showed no difference in age and parity between the two groups. There were no significant differences in pre-procedural dilatation (5.0 mm vs. 4.7 mm, P = 0.52), need to further dilate the cervix (56.7% vs. 63.0%, P = 0.63), and time required to further dilate the cervix (12.7 seconds vs. 25.7 seconds, P = 0.27). Significantly more women in the misoprostol group experienced menstrual-like cramping (24.2% vs. 3.3%, P = 0.03) and vaginal spotting (21.2% vs. 3.3%, P = 0.05).ConclusionIn premenopausal women, there is no improvement in pre-procedural cervical dilatation with administration of oral misoprostol 12 hours before diagnostic hysteroscopy. Further research is required in both nulliparous and parous premenopausal women to determine whether oral misoprostol improves cervical dilatation and, if so, the ideal dose, route and timing.     

Évaluation d’une crème œstrogénique vaginale dans le traitement de la vestibulodynie provoquée : essai randomisé à double insu

ObjectiveOur objective was to assess the short-term effect of an estrogen cream on symptoms associated with provoked vestibulodynia.MethodsWe undertook a double-blind randomized trial in women who had experienced dyspareunia satisfying the Friedrich criteria for at least three months. We compared the daily application of 3 g of vaginal cream containing 1.875 g of conjugated estrogens for six weeks (estrogen group) with the application of a comparable cream without estrogens (placebo group). The main outcome was modification of dyspareunia, determined by a visual analogue scale of pain from the pretreatment period to the post-treatment period. Secondary outcomes were colposcopic evaluation of the vulva and pain reported during the swab test.ResultsOf 69 women randomized, 61 participated for the full duration of the trial. Dyspareunia was significantly lessened in both groups (estrogen group: 7.4 ± 1. 9 pre-treatment vs. 4.8 ± 3.0 post-treatment, P < 0.01; placebo group: 7.1 ± 1. 9 vs. 4.9 ± 2.7, P < 0.01), but the difference observed in terms of decrease between the two groups was not found to be significant (P = 0.5). Alternatively, the group treated with estrogen cream showed (1) a more substantial decrease of the pain reported at the orifices of the Bartholin’s glands when palpated with a swab (P < 0.01), and (2) a decrease of the inflammation observed at the orifices of the Bartholin’s glands orifices and the posterior fourchette (P < 0.01).ConclusionApplying a vaginal cream, whether it contains estrogens or not, for six weeks lessens dyspareunia. Adding estrogens to such a cream could facilitate a decrease of the inflammation observed at the orifices of the Bartholin’s glands and the vestibule.     

Tadalafil Once Daily Improves Ejaculatory Function,Erectile Function,and Sexual Satisfaction in Men with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia and Erectile Dysfunction: Results from a Randomized,Placebo‐ and Tamsulosin-Controlled, 12-Week Double-Blind Study

IntroductionTadalafil, a long‐acting phosphodiesterase type 5 inhibitor, is approved for treating signs and symptoms of benign prostatic hyperplasia (BPH) and erectile dysfunction (ED); tamsulosin, an alpha‐blocker, is approved for treating signs and symptoms of BPH.AimTo determine the effects of tadalafil or tamsulosin on sexual function, including ejaculation and orgasm, satisfaction, and erectile function, in sexually active men with ED and lower urinary tract symptoms suggestive of BPH (LUTS/BPH).MethodsA randomized, double‐blind, placebo‐controlled study of tadalafil 5 mg once daily for 12 weeks in men with LUTS/BPH; tamsulosin 0.4 mg once daily was an active control.Main Outcome MeasuresThe International Index of Erectile Function (IIEF) questionnaire was administered at baseline and 4, 8, and 12 weeks. Analysis of orgasm and ejaculation was post hoc based on the IIEF‐Orgasmic Function (OF) domain (IIEF‐Q9 [ejaculatory frequency] and Q10 [orgasmic frequency]). Other measures included IIEF‐Intercourse Satisfaction (IS), Overall Satisfaction (OS), and Erectile Function (EF) domains. Changes from baseline to 12 weeks (or last observation) vs. placebo were analyzed using analysis of covariance. Higher IIEF scores indicate better functioning.ResultsOf 511 study participants, 310 (60.7%) had ED and were sexually active. The IIEF‐OF increased significantly through 12 weeks with tadalafil vs. placebo (P = 0.048), as did IIEF‐Q9 (P = 0.045) but not IIEF‐Q10 (P = 0.100). Compared with placebo, IIEF‐OF, Q9, and Q10 decreased significantly with tamsulosin (all P < 0.05). The IIEF‐IS and OS increased significantly at end point with tadalafil (both P < 0.001); for tamsulosin, change was not significant for IS, while OS decreased significantly (P = 0.009). The IIEF‐EF domain increased significantly vs. placebo with tadalafil (P < 0.001) but not tamsulosin (P = 0.699).ConclusionsTadalafil 5 mg once daily significantly improved ejaculation and orgasm, intercourse and overall satisfaction, and erectile function. Men receiving tamsulosin 0.4 mg once daily experienced a decrease in both ejaculatory/orgasmic frequency and overall satisfaction vs. placebo, with no significant effect on erectile function.     

Prognostic value of responsiveness of neoadjuvant chemotherapy before surgery for patients with stage IB2/IIA2 cervical cancer

ObjectiveTo evaluate the factors that might affect the putative survival benefit from pre-operative neoadjuvant chemotherapy (NAC) in patients with early stage bulky cervical cancer.MethodsA retrospective review for 304 patients with stage IB₂/IIA₂ cervical cancer was performed. Two groups were made according to pre-operative NAC or not: NAC group (n = 154) and primary surgery group (PST, n = 150). Recurrence risks and survival were analyzed.ResultsThe total response rate was 72.1%. For those NAC-responders, NAC decreased the ratio of lymphovascular space invasion (0 vs. 4.7%, p = 0.022; 0 vs. 3.3%, p = 0.052), deep stromal invasion (19.8% vs. 53.5%, p = 0.000; 19.8% vs. 29.3%, p = 0.08), lymph node metastasis (8.1% vs. 25.6%, p = 0.004; 8.1% vs. 17.3%, p = 0.031), and the need of adjuvant radiotherapy (5.5% vs. 30.2%, p = 0.000; 5.4% vs. 15.3%, p = 0.012), whereas improve 5-year PFS rate (94% vs. 86%, p = 0.041; 94% vs. 80%, p = 0.089) and 5-year OS rate (96% vs. 86%, p = 0.015; 96% vs. 82%, p = 0.05), as compared with non-responders and PST. Multivariate analysis suggested that the response to NAC is an independent prognostic factor of PFS (HR 0.221, 95% CI 0.048–1.022, p = 0.053) and OS (HR 0.126, 95% CI 0.016–1.000, p = 0.05); as compared, stage IIA disease demonstrates negative impact upon PFS (HR 4.778, 95% CI 1.490–15.317, p = 0.009) and OS (HR 4.142, 95% CI 1.258–13.639, p = 0.019).ConclusionResponsiveness of NAC before surgery might be an independent prognostic factor for the patients with early stage bulky cervical cancer.     

Zinc sulfate treatment of secondary male infertility associated with positive serum and seminal plasma anti-sperm antibody test

ObjectiveThe traditional use of corticosteroids in the treatment of infertile patients who developed anti-sperm antibodies may be associated with many systemic side effects of such administered drugs. So the use of alternatives for corticosteroids becomes mandatory in order to minimize these systemic side effects. Like the use of immune modulator zinc sulfate.DesignProspective study.SettingInstitute of the Embryo Research and Infertility Treatment, College of Medicine, AL – Nahrain University.Patients and methodsForty-eight infertile men with poor semen parameters and elevated serum and seminal plasma level of ASA were classified into three groups. The first group (n = 18 patients) received oral zinc sulfate, the second group (n = 20 patients) received oral prednisolone and the third group (n = 10 patients) received oral placebo. Drugs were administered for 45 days.Main outcome measure(1) Standard semen analysis was performed, including semen volume, sperm concentration, percent motility, sperm vitality and sperm morphology. (2) Serum and seminal plasma Anti-Sperm Antibody ELISA test.ResultsStatistical analysis of serum and seminal plasma level of ASA reveals that the level is decreased significantly (P < 0.001, P < 0.002) in zinc sulfate treatment group as compared to the control group (67.5 ± 2.64 vs. 71.6 ± 2.5, 66.94 ± 3.24 vs. 71 ± 2.54), respectively, but the decrease in prednisolone treatment group is significantly higher (P < 0.001) as compared to the zinc sulfate treatment group (57.3 ± 6.30 vs. 67.5 ± 2.64, 56.5 ± 6.83 vs. 66.94 ± 3.24), respectively. This improvement in serum and seminal plasma level of ASA, result in a significant enhancement of the seminal fluid parameters including sperm concentration, sperm motility, vitality and normal sperm morphology in both zinc sulfate and prednisolone treatment groups.ConclusionIn conclusion, infertile men with elevated level of ASA and poor basic parameters of seminal fluid characters can be treated with zinc sulfate protocol with great chance for decreasing the level of serum and seminal plasma ASA, and alleviating the serious side effects associated with corticosteroids.     

Is the Flexible GnRH Antagonist Protocol Better Suited for Fresh eSET Cycles?

ObjectiveThis study was performed to evaluate the efficacy of the flexible GnRH antagonist protocol in comparison with the long GnRH agonist protocol in elective single embryo transfer (eSET) practice. It was conducted in a publicly funded in vitro fertilization program.MethodsWe performed a prospective cohort analysis of data from a private infertility clinic from August 2010 to August 2011. Three hundred fourteen women with normal ovarian reserve and undergoing fresh eSET cycles were included. Sixty-four women underwent follicular stimulation using a flexible GnRH antagonist protocol, and 250 underwent stimulation with a standard long mid-luteal GnRH agonist protocol.ResultsImplantation rates (35.9% in the GnRH antagonist group and 29.6% in the GnRH agonist group, P = 0.5) and ongoing pregnancy rates (32.8% in the GnRH antagonist group and 28.8% in the GnRH agonist group, P = 0.5) were equivalent in both groups. The duration of stimulation (9.8 ± 2 days vs. 10.7 ± 1.8 days, P < 0.001) and total FSH dose required (2044 vs. 2775 IU, P < 0.001) were lower in the GnRH antagonist group than in the GnRH agonist group. The number of mature oocytes (6.0 vs. 10.0, P < 0. 001) and number of embryos (5.0 vs. 7.0, P < 0.001) were also lower in GnRH antagonist group. However, the number of embryos cryopreserved was similar in both groups (median 2.0, P = 0.3).ConclusionIn women undergoing in vitro fertilization, the flexible GnRH antagonist protocol yields implantation and ongoing pregnancy rates that are similar to the long GnRH agonist protocol, and requires lower doses of gonadotropins and a shorter duration of treatment. The flexible GnRH antagonist protocol appears to be the protocol of choice for an eSET IVF program.     

Seroprevalencia de Mycoplasma ssp. en mujeres con esterilidad

ObjectivesTo investigate the serological prevalence of Mycoplasmas genitalium, M. fermentans and M. penetrans in infertile women compared with fertile women.Material and methodsWe studied 55 women with infertility due to peritoneal-tubal factors and 55 fertile women. The serological prevalence in each group was evaluated and the results were compared.ResultsThe prevalence of IgM in the infertile and fertile groups was, respectively: M. genitalium (27.27% vs 30.91%; p = 0.152), M. fermentans (83.64% vs 61.82%; p = 0.006), M. penetrans (38.18% vs 49.09%; p = 0.079). IgA: M. genitalium (5.45% vs 1.82%; p = 0.250), M. fermentans (0.00% vs 12.73%; p = 0.006), M. penetrans (36.36% vs 3.64%; p < 0.001). IgG: M. genitalium (92.73% vs 92.73%; p = 0.284), M. fermentans (65.45% vs 40.00%; p = 0.004), M. penetrans (96.36% vs 9.09%; p < 0.001).ConclusionsNo statistically significant differences were found in the prevalence of M. genitalium between the infertile and the fertile groups. IgG for M. fermentans and M. penetrans were significantly higher in the infertile group than in the fertile group, suggesting that these microorganisms could be the cause of, or risk factors for, pelvic inflammatory disease and female infertility.     

The Impact of Erectile Dysfunction on the Quality of Life of Men Undergoing Hemodialysis and Its Association with Depression

IntroductionErectile dysfunction (ED) is highly prevalent among men undergoing hemodialysis.AimThis study was performed to identify the influence of ED on the patient's quality of life (QoL) and to evaluate the influence of depression on erectile function of these patients.Main Outcome MeasuresFor this multicenter cross-sectional study, 275 patients were interviewed through questionnaires: the five-item version of the International Index of Erectile Function was used for diagnosing and classifying ED; the Medical Outcomes Study Questionnaire 36-Item Short Form Health Survey (SF-36) for scoring QoL; and the Hospital Anxiety and Depression Scale (HADS) to evaluate depressive symptoms. Linear regression was used to examine the associations between some of the variables and ED. Predialytic biochemical and hematological parameters were determined during the longer interdialytic period.ResultsPatients had a mean age of 48.6 ± 12.8 years, and the ED prevalence was 72.3%. Advanced age, diabetes and depression score were independent risk factors for the development of ED as confirmed by linear regression (P < 0.001, P = 0.002, and P < 0.001, respectively). QoL was worse among patients with any degree of ED, and the scores were statistically significant for overall health rating (P = 0.016), physical composite score (P = 0.003), bodily pain (P = 0.042), physical functioning (P < 0.001), and vitality (P = 0.005). Furthermore, more severe forms of ED were associated with a lower QoL. After adjustment for some variables, such as age, time under dialysis, hemoglobin, albumin, parathyroid hormone, Kt/V, and depression, linear regression showed that domains related to poorer physical functioning (P = 0.047) and decreased vitality (P = 0.009) were significantly related to ED.ConclusionDepression is an important trigger for the development of ED in hemodialysis patients, and this sexual condition is an independent risk factor for their poor QoL. Fernandes GV, dos Santos RR, de Lima LG, de Macêdo BS, da Fonte JE, de Carvalho BSP, Coelho SN, and Calado AA. The impact of erectile dysfunction on the quality of life of men undergoing hemodialysis and its association with depression.