RESUMEN
Premature ejaculation (PE) is thought to be the most common male sexual dysfunction; however, the prevalence of lifelong (LL)-PE is relatively low. The aim of this study was to investigate the effects of on-demand vardenafil (10 mg) to modify the intravaginal ejaculatory latency time (IELT) in men with LL-PE without erectile dysfunction. Forty-two men (18-35 years) were enrolled in a 16-week, double-blind, placebo-controlled, cross-over study. Primary end point was the modification from baseline of IELT assessed by stopwatch technique; secondary end points were post-ejaculatory refractory time (PERT) and variations of scores at the Index of Premature Ejaculation questionnaire. The changes in geometric mean IELT were superior after taking vardenafil (0.6+/-0.3 vs 4.5+/-1.1 min, P<0.01), compared with placebo (0.7+/-0.3 vs 0.9+/-1.0 min, ns). PERT dropped significantly after vardenafil (16.7+/-2.0 vs 4.3+/-0.9 min, P<0.001), compared with placebo (15.3+/-2.2 vs 15.8+/-2.3 min). Patients who took vardenafil (vs placebo) reported significantly (P<0.01) increased ejaculatory control (6+/-2 vs 16+/-2), improved overall sexual satisfaction (7+/-2 vs 15+/-1) and distress (4+/-1 vs 8+/-1) scores, respectively. Multiple regression analysis (r(2)=0.86) for IELT by the number of attempts at sexual intercourse showed significant differences between the slopes of lines for placebo and vardenafil (P<0.0001). The most common adverse events for vardenafil (vs placebo) were headache (10 vs 3%), flushing (12 vs 0%) and dyspepsia (10 vs 0%), which tended to disappear over the time. In conclusion, in our study, vardenafil increased IELT and reduced PERT in men with LL-PE. Besides, improvements in confidence, perception of ejaculatory control and overall sexual satisfaction were reported.
Asunto(s)
Eyaculación/efectos de los fármacos , Imidazoles/uso terapéutico , Inhibidores de Fosfodiesterasa/uso terapéutico , Piperazinas/uso terapéutico , Disfunciones Sexuales Fisiológicas/tratamiento farmacológico , Adolescente , Adulto , Coito/fisiología , Coito/psicología , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Imidazoles/administración & dosificación , Imidazoles/efectos adversos , Masculino , Inhibidores de Fosfodiesterasa/efectos adversos , Piperazinas/administración & dosificación , Piperazinas/efectos adversos , Estudios Prospectivos , Disfunciones Sexuales Fisiológicas/psicología , Sulfonas/administración & dosificación , Sulfonas/efectos adversos , Sulfonas/uso terapéutico , Encuestas y Cuestionarios , Triazinas/administración & dosificación , Triazinas/efectos adversos , Triazinas/uso terapéutico , Diclorhidrato de Vardenafil , Adulto JovenRESUMEN
OBJECTIVES: We present a multicenter, population-based epidemiological survey aimed at assessing the prevalence of Peyronie's disease (PD) and its potential risk factors in the general population. METHODS: In each of the ten centers throughout Italy, a uroandrologist contacted all the men in the age range 50-69 years registered with a general practitioner (GP). The subjects recruited were evaluated on the basis of their medical history, including alcohol consumption and cigarette smoking. The following questionnaires were administered: IIEF, IIPSS symptom score, premature ejaculation and PD. RESULTS: All the subjects registered with a GP were invited to participate in the study. Of the 1,180 subjects, 647 (53%) entered over survey. In this population, 46 cases of PD were identified, accounting for a prevalence of 7.1%. The prevalence rate increased with age even if the trend is not statistically significant. The multivariate analysis showed a significant correlation between cigarette smoking and PD, with an odds ratio (OR) of 4.6 (CL 95%) confidence limit 1.506- 14.287). Smoking as single variable had an OR of 7.2 (95% CL 2.34-24.93). No significant association was observed between PD and the other variables such as cardiovascular diseases, diabetes, hypertension and alcohol consumption. CONCLUSIONS: PD is a much more frequent condition in the general population than previously reported. According to our results, cigarette smoking may be considered a risk factor for developing PD. If further and more targeted studies confirm that giving up smoking may reduce the risk of developing PD, then there will be new prospects for primary and secondary prevention and for curbing the progression of the disease.
Asunto(s)
Induración Peniana/epidemiología , Fumar/efectos adversos , Factores de Edad , Anciano , Consumo de Bebidas Alcohólicas/efectos adversos , Enfermedades Cardiovasculares/complicaciones , Disfunción Eréctil/epidemiología , Disfunción Eréctil/etiología , Humanos , Italia/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Induración Peniana/etiología , Prevalencia , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Prostate cancer is an increasingly common disease for which there are few well-established risk factors. Family history data suggest a genetic component; however, the majority of prostate cancer cases cannot be explained by a single-gene model. Prostate cell division is influenced by two steroid hormones, testosterone and vitamin D, the action of each being mediated by its respective receptor. The genes for the two receptors are candidates in a multigenic model for prostate cancer susceptibility. PURPOSE: We examined genetic polymorphisms in two steroid receptors, the androgen receptor (AR) and the vitamin D receptor (VDR), in a case-control pilot study of prostate cancer. METHODS: Fifty-seven non-Hispanic white case patients with prostate cancer and 169 non-Hispanic white control subjects were genotyped for a previously described microsatellite (CAG repeats) in the AR gene and for a newly discovered poly-A microsatellite in the 3'-untranslated region (3'UTR) of the VDR gene. To compare genotypes with respect to prostate cancer risk, we estimated odds ratios (ORs) by using logistic regression. ORs were also estimated separately for advanced and localized cases of disease. All P values resulted from two-sided tests. RESULTS: Both the AR and the VDR polymorphisms were associated, individually and after mutual adjustment, with prostate cancer. Adjusted ORs (95% confidence intervals [CIs]) for prostate cancer were 2.10 (95% CI = 1.11-3.99) for individuals carrying an AR CAG allele with fewer than 20 repeats versus an allele with 20 or more repeats and 4.61 (95% CI = 1.34-15.82) for individuals carrying at least one long (A18 to A22) VDR poly-A allele versus two short (A14 to A17) poly-A alleles. For both the AR and VDR genes, the at-risk genotypes were more strongly associated with advanced disease than with localized disease. CONCLUSIONS: In this pilot study, genetic variation in both the VDR and the AR genes was associated with prostate cancer, and both genes appear to preferentially confer risk for advanced disease. These two genetic risk factors, if confirmed, are among the strongest risk factors yet identified for prostate cancer. IMPLICATIONS: These results are consistent with a multigenic model of prostate cancer susceptibility. On the basis of the joint effect of several genetic loci, one might ultimately be able to construct a risk profile to predict advanced disease, so that men whose disease is unlikely to progress to an advanced stage can possibly be spared aggressive treatment.
Asunto(s)
Predisposición Genética a la Enfermedad , Polimorfismo Genético , Neoplasias de la Próstata/genética , Receptores Androgénicos/genética , Receptores de Calcitriol/genética , Alelos , Estudios de Casos y Controles , Susceptibilidad a Enfermedades/metabolismo , Genotipo , Humanos , Modelos Logísticos , Masculino , Estadificación de Neoplasias , Oportunidad Relativa , Proyectos Piloto , Neoplasias de la Próstata/metabolismo , Neoplasias de la Próstata/patología , Riesgo , Factores de Riesgo , Repeticiones de Trinucleótidos/genéticaRESUMEN
The tunica albuginea and corpus cavernosum from patients with Peyronie's disease (PD), patients with veno-occlusive dysfunction (VOD), and those from normal control subjects were studied by transmission electron microscopy and immunohistochemical staining for type I, III, and V collagens, platelet-derived growth factor (PDGF) AA and BB homodimers, and PDGF alpha and beta receptors. Ultrastructural modifications resembling a fibrotic reaction were detected in the two pathological tunica albuginea, but not in those from control subjects. Ultrastructural data demonstrated a general increase in fibrous and amorphous extracellular matrix material in the pathological tunica albuginea. The amorphous material probably represents glycoproteins and proteoglycans. The fibrous material, representing collagen, appears disorganized in the tissue and does not display the typical and homogeneous diameter, size, and spatial arrangement. Large areas of extracellular and intracytoplasmic, partially degraded, fibers are visible. An increased type I/III collagen ratio was detected by immunohistochemistry in the two pathological tunica albuginea. Moreover, a strong expression of type V collagen, correlated to fibroblasts, was revealed. Fibroblasts from control tissues, on the other hand, were totally negative. Finally, PDGF AA and BB were positive in fibroblasts from pathological tunica albuginea but were negative in control tissues. PDGF beta receptor was positive in pathological and normal tissue fibroblasts. Tunica albuginea from PD and VOD show similar ultrastructural and immunohistochemical alterations, whereas the corpus cavemosum shows no visible modifications.
Asunto(s)
Matriz Extracelular/ultraestructura , Impotencia Vasculogénica/patología , Induración Peniana/patología , Pene/patología , Colágeno/análisis , Colágeno/ultraestructura , Fibroblastos/química , Fibroblastos/ultraestructura , Humanos , Inmunohistoquímica , Masculino , Microscopía Electrónica , Pene/química , Factor de Crecimiento Derivado de Plaquetas/análisis , Factor de Crecimiento Derivado de Plaquetas/biosíntesis , Receptores del Factor de Crecimiento Derivado de Plaquetas/análisisRESUMEN
This study evaluated pelvic floor rehabilitation as a possible treatment for premature ejaculation. In this treatment it is assumed that the pelvic muscles are involved in the control of the ejaculatory reflex. The treatment avails itself of a method already used for fecal and urinary incontinence. Eighteen patients with premature ejaculation were recruited. Fifteen (83%) of them had suffered from this disturbance for at least five years. Most of them had experienced other therapies without success. After 15-20 sessions of pelvic floor rehabilitation, 11 (61%) patients were cured and are able to control the ejaculatory reflex; seven (39%) patients had no improvement. All patients were followed for a minimum of 6 months to a maximum of 14 months. This therapy is easy to perform, has no side effects, and can be included among the therapuetic options for patients with premature ejaculation.
Asunto(s)
Eyaculación , Terapia por Estimulación Eléctrica , Diafragma Pélvico/fisiología , Disfunciones Sexuales Psicológicas/terapia , Adulto , Estimulación Eléctrica , Disfunción Eréctil , Humanos , Masculino , Persona de Mediana Edad , Contracción Muscular , Músculos/fisiología , Reflejo/fisiologíaRESUMEN
Bilateral palmar and plantar sympathetic skin responses (SSRs) to pudendal and median nerves stimulation have been recorded in a population of 10 healthy adult subjects. A group of 11 patients affected by sphincter disorders and/or impotence of neurological origin (diabetic neuropathy, ischaemic myelopathy, myelitis, cauda aequina syndrome) was investigated and results were compared with normal values obtained from the control group. The technique is focused on the vegetative component of innervation and is shown to give complementary information on sympathetic dysfunction, in addition to traditional techniques relating to somatic innervation (electroneurography, electromyography, somatosensory evoked potentials.
Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Disfunción Eréctil/fisiopatología , Piel/inervación , Sistema Nervioso Simpático/fisiopatología , Adulto , Anciano , Humanos , Masculino , Nervio Mediano/fisiopatología , Persona de Mediana Edad , Vías Nerviosas/fisiopatología , Examen Neurológico , Pene/inervación , Umbral Sensorial/fisiologíaRESUMEN
During the past 10 years we have studied 216 patients with renal cell carcinoma (RCC). After nephrectomy the patients were divided into two groups: one group received adjuvant acetate medroxyprogesterone therapy and the other formed our control group. The mean follow-up was 4.9 years. Survival was studied through univariate and multivariate analysis, according to Cox's multiple regression. To evaluate survival the following variables were taken into consideration: stage, grade, ploidy, sex, age, MAP therapy, Er, AR, PR receptors. The survival curves according to Kaplan and Meier were statistically significant for stage, grade, MAP therapy and DNA cellular content. The other variables were not statistically significant prognostic factors. Multivariate analysis demonstrated that only stage and MAP therapy are capable of influencing survival. A low stage has a better survival rate and in equivalent stages those who have received MAP live longer.
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Neoplasias Renales/tratamiento farmacológico , Medroxiprogesterona/análogos & derivados , Adenocarcinoma/mortalidad , Adenocarcinoma/cirugía , Terapia Combinada , ADN de Neoplasias/análisis , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Renales/mortalidad , Neoplasias Renales/cirugía , Masculino , Medroxiprogesterona/uso terapéutico , Acetato de Medroxiprogesterona , Análisis Multivariante , Nefrectomía , Receptores de Superficie Celular/análisis , Tasa de SupervivenciaAsunto(s)
Ácidos Hidroxámicos/uso terapéutico , Cálculos Renales/tratamiento farmacológico , Infecciones Urinarias/tratamiento farmacológico , Amoníaco/orina , Humanos , Concentración de Iones de Hidrógeno , Cálculos Renales/complicaciones , Cálculos Renales/orina , Infecciones Urinarias/complicaciones , Infecciones Urinarias/orinaRESUMEN
Thirty-two cases of advanced bladder cancer (pT3b-pT4) undergoing radical cystectomy are compared with other similar series of patients of the same stages submitted to different treatments (radiotherapy, chemotherapy and combined treatments) reported in the literature. Survival rates at 3 and 5 years are analyzed in relation to the anatomopathological stage, cellular grading, lymph node infiltration, surgical risk and relative mortality. The results confirm that radical cystectomy is presently the most effective treatment.
Asunto(s)
Neoplasias de la Vejiga Urinaria/cirugía , Vejiga Urinaria/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Factores de Tiempo , Neoplasias de la Vejiga Urinaria/mortalidadRESUMEN
The age-adjusted mortality rate for prostatic carcinoma in Italy between 1969 and 1978 was calculated, as was the regional distribution for this disease. An overall increase in mortality was found, but the increase of the age-adjusted data was not statistically significant. The regional distribution of age-adjusted mortality rate showed a difference between northern and southern Italy, even when errors that can affect these findings were taken into consideration. At present, however, the size of these errors is not known. Such factors should not, however, prevent development of useful information and indications, but they should not be overlooked in an analytical interpretation of the data.