RESUMEN

Testosterone deficit syndrome is a clinical and biochemical syndrome associated with advanced age and characterized by some symptomsassociated with serum testosterone levels deficiency, which may result in a decrease of quality of life and negatively affect the function of multiple organs or systems. Clinical guidelines recommend testosterone replacement therapy (TRT) in patients with testosterone decrease that associate muscle mass and strength loss, lumbar spinal column bone density decrease, or libido and erection decrease. Contraindications for treatment would include active prostate cancer or without treatment, PSA >4 ng/ml waiting for diagnostic workup, breast cancer, severe sleep apnea, infertility, hematocrit over 50% or severe lower urinary tract symptoms secondary to benign prostatic hypertrophy. In certain situations there is still great controversy, without enough evidence to establish an action. References in case of patientstreated with brachytherapy or radiotherapy are unspecific: they only recommend caution in the treatment with TRT in these patients and strict monitoring of the possible recurrence. In our opinion, low-intermediate risk prostate cancer patients treated with radiotherapy only, without evidence of residual or recurrent disease, are candidates for TRT if symptoms justify it, leaving a free period of never less than one year after nadir (or 24 months after the end of therapy) which guarantees, on the possible means, the absence of biochemical or clinical recurrence,with strict follow up of clinical and biochemical usual parameters (hematocrit, hemoglobin, DRE, PSA).

Asunto(s)

Terapia de Reemplazo de Hormonas/métodos , Radioterapia/efectos adversos , Testosterona/uso terapéutico , Anciano , Colecistectomía , Humanos , Masculino , Neoplasias de la Próstata/complicaciones , Neoplasias de la Próstata/radioterapia , Procedimientos Quirúrgicos Urológicos Masculinos

RESUMEN

El síndrome de déficit de testosterona es un síndrome clínico y bioquímico asociado a la edad avanzada y caracterizado por unos síntomas asociados con una deficiencia en los niveles de testosterona sérica, lo que puede resultar en una disminución de la calidad de vida y afectar de modo negativo a la función de múltiples órganos o sistemas. Las guías clínicas recomiendan el tratamiento sustitutivo con testosterona (TST) en pacientes con disminución de la misma y que asocien pérdida de masa muscular y fuerza, descenso de la densidad ósea en columna lumbar o disminución de la libido y erección. Las contraindicaciones para el tratamiento incluirían el cáncer de próstata activo o no tratado, el PSA > 4 ng/ml pendiente de valoración, el cáncer de mama, la apnea de sueño severa, la infertilidad, el hematocrito por encima de 50% o los síntomas severos del tracto urinario inferior debidos a hipertrofia prostática benigna. En determinadas situaciones existe todavía gran controversia, sin que dispongamos de niveles de evidencia suficientes para establecer una actuación. Las referencias en el caso de los pacientes tratados con braquiterapia o radioterapia son poco concretas: se aconseja únicamente la cautela en el tratamiento con TST de estos pacientes con monitorización estricta de la posible recidiva. En nuestra opinión, los pacientes tratados con radioterapia sola por cáncer de próstata de bajo o medio riesgo, sin evidencia de enfermedad residual o recidiva, son susceptibles de TST si la sintomatología lo justifica, dejando un período libre nunca inferior a un año tras su nadir (o 24 meses tras el final del tratamiento) que garantice, en la medida de lo posible, la ausencia de recidiva bioquímica o clínica, con seguimiento estricto de los parámetros clínicos y bioquímicos habituales (hematocrito, hemoglobina, TR, PSA) (AU)

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Testosterone deficit syndrome is a clinical and biochemical syndrome associated with advanced age and characterized by some symptoms associated with serum testosterone levels deficiency, which may result in a decrease of quality of life and negatively affect the function of multiple organs or systems. Clinical guidelines recommend testosterone replacement therapy (TRT) in patients with testosterone decrease that associate muscle mass and strength loss, lumbar spinal column bone density decrease, or libido and erection decrease. Contraindications for treatment would include active prostate cancer or without treatment, PSA > 4 ng/ml waiting for diagnostic workup, breast cancer, severe sleep apnea, infertility, hematocrit over 50% or severe lower urinary tract symptoms secondary to benign prostatic hypertrophy. In certain situations there is still great controversy, without enough evidence to establish an action. References in case of patients treated with brachytherapy or radiotherapy are unspecific: they only recommend caution in the treatment with TRT in these patients and strict monitoring of the possible recurrence. In our opinion, low-intermediate risk prostate cancer patients treated with radiotherapy only, without evidence of residual or recurrent disease, are candidates for TRT if symptoms justify it, leaving a free period of never less than one year after nadir (or 24 months after the end of therapy) which guarantees, on the possible means, the absence of biochemical or clinical recurrence, with strict follow up of clinical and biochemical usual parameters (hematocrit, hemoglobin, DRE, PSA) (AU)

Asunto(s)

Humanos , Masculino , Radioterapia/efectos adversos , Testosterona/deficiencia , Neoplasias de la Próstata/radioterapia , Factores de Riesgo

RESUMEN

INTRODUCTION: Erectile dysfunction (ED) has been associated with several comorbidities and can cause significant loss of quality of life and self-esteem. AIM: In men with ED, to use the validated Self-Esteem and Relationship (SEAR) questionnaire to evaluate changes in self-esteem associated with sildenafil treatment of ED and to assess changes dependent on concomitant comorbid conditions. METHODS: This was a 14-week, international, randomized, parallel-group, double-blind, flexible-dose (25, 50, or 100 mg), placebo-controlled study of sildenafil in men aged >or=18 years with a clinical diagnosis of ED (score

Asunto(s)

Disfunción Eréctil/tratamiento farmacológico , Emoción Expresada , Inhibidores de Fosfodiesterasa/uso terapéutico , Piperazinas/uso terapéutico , Sulfonas/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Método Doble Ciego , Disfunción Eréctil/epidemiología , Humanos , Hiperlipidemias/epidemiología , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Inhibidores de Fosfodiesterasa 5 , Hiperplasia Prostática/epidemiología , Purinas/uso terapéutico , Calidad de Vida/psicología , Autoimagen , Citrato de Sildenafil , Encuestas y Cuestionarios , Adulto Joven

RESUMEN

OBJECTIVE: Erectile dysfunction and depression are highly associated. Previous studies have shown benefits of phosphodiesterase-5 inhibitor treatment for erectile dysfunction associated with antidepressant therapy or subsyndromal depression. The present study assessed the safety and efficacy of vardenafil in men with erectile dysfunction and untreated mild depression. METHOD: In this 12-week, multicenter, randomized, flexible-dose, parallel-group, double-blind study, 280 men with erectile dysfunction for at least 6 months and untreated mild major depression received placebo or vardenafil, 10 mg/day, for 4 weeks, with the option to titrate to 5 mg/day or 20 mg/day after each of two consecutive 4-week intervals. Endpoints included International Index of Erectile Function erectile function domain and 17-item Hamilton Depression Rating Scale (HAM-D) scores. RESULTS: Vardenafil produced statistically significant and clinically meaningful improvement in all erectile function parameters. The International Index of Erectile Function erectile function domain score was 22.9 with vardenafil compared to 14.9 with placebo. The HAM-D score was lower in the vardenafil group (7.9) than in the placebo group (10.1). Treatment with vardenafil was the most important predictor for return to normal erectile function. Improvement in International Index of Erectile Function erectile function domain score was the most important predictor of remission in depressive symptoms. CONCLUSIONS: Vardenafil was well tolerated and highly efficacious in men with erectile dysfunction and untreated mild major depression. Significant improvements in erectile function and depression were observed in patients treated with vardenafil versus placebo. Erectile dysfunction treatment should be considered a component of therapy for men with depression and erectile dysfunction.

Asunto(s)

Trastorno Depresivo Mayor/psicología , Disfunción Eréctil/tratamiento farmacológico , Imidazoles/uso terapéutico , Hidrolasas Diéster Fosfóricas/uso terapéutico , Piperazinas/uso terapéutico , Comorbilidad , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Método Doble Ciego , Esquema de Medicación , Disfunción Eréctil/epidemiología , Humanos , Imidazoles/efectos adversos , Análisis de los Mínimos Cuadrados , Masculino , Persona de Mediana Edad , Hidrolasas Diéster Fosfóricas/efectos adversos , Piperazinas/efectos adversos , Placebos , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Sulfonas/efectos adversos , Sulfonas/uso terapéutico , Encuestas y Cuestionarios , Resultado del Tratamiento , Triazinas/efectos adversos , Triazinas/uso terapéutico , Diclorhidrato de Vardenafil

RESUMEN

We performed an extensive bibliographic search, and review the alternatives for surgical treatment of varicocele, especially microsurgical techniques. The surgical techniques for varicocele have not suffered much variation over the last years, being their use generalized among urologists. The lower incidence of relapse and secondary hydrocele to lymphatic lesion make retroperitoneal techniques be used less frequently in favour of inguinal or subinguinal techniques, microsurgical or not. For better understanding of the surgical indications and development of techniques we offer some short anatomical and physiopathological comments about varicocele.

Asunto(s)

Microcirugia , Varicocele/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Humanos , Masculino

Asunto(s)

Disfunción Eréctil/etiología , Hipertensión/complicaciones , Adulto , Anciano , Envejecimiento/fisiología , Antihipertensivos/efectos adversos , Disfunción Eréctil/epidemiología , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia

RESUMEN

No disponible

Asunto(s)

Persona de Mediana Edad , Adulto , Anciano , Masculino , Femenino , Humanos , Trasplante de Riñón , Trasplante de Páncreas , Prevalencia , Enfermedades del Sistema Nervioso Autónomo , Antihipertensivos , Neuropatías Diabéticas , Envejecimiento , Hipertensión , Insuficiencia Renal Crónica , Disfunción Eréctil , Cardiopatías