Improvement in Endothelial Function in Men Taking Phosphodiesterase Type 5 Inhibitors for Erectile Dysfunction.

BACKGROUND: The purpose of this research was to explore the mechanistic protective cardiovascular effects of phosphodiesterase-5 inhibitors (PDE5-Is) in males with erectile dysfunction. Erectile dysfunction and endothelial dysfunction both precede clinical atherosclerosis. Studies have shown that treatment for erectile dysfunction with PDE5-Is decreased death, heart failure, myocardial infarction, and revascularization in males with erectile dysfunction who had previous myocardial infarction, and cardiovascular events. METHODS: This was a pilot study that recruited 5 men with erectile dysfunction without cardiovascular disease. Endothelial function (flow-mediated percent change of the diameter of the brachial artery), erectile dysfunction grade, high-sensitivity C-reactive protein, and body mass index were measured before and 3 months after starting treatment with tadalafil, 5 mg daily. Pearson's analysis was performed to study a correlation between the change in erectile dysfunction and the change in endothelial function. RESULTS: A significant correlation was found between changes in flow-mediated percent change of the diameter of the brachial artery and changes in erectile dysfunction following the administration of tadalafil (P = .010; Pearson correlation coefficient = 0.959). No change was observed in C-reactive protein or weight. CONCLUSIONS: Erectile dysfunction and endothelial dysfunction are risk factors for cardiovascular disease. Our study showed that PDE5-Is improved endothelial function and erectile dysfunction (with a significant correlation). Improving endothelial function could be the mechanism that leads to a reduction in cardiovascular events and death in men with erectile dysfunction treated with PDE5-Is.

Erectile Dysfunction, Sleep Disorders, and Endothelial Function.

BACKGROUND: Erectile dysfunction (ED) is a syndrome associated with endothelial dysfunction, which may predict cardiovascular events in men presenting with this syndrome. It has been shown to be associated with a higher rate of acute myocardial infarction and cardiovascular mortality, vascular inflammation, and impaired endothelial function. In this review we present the literature findings and describe the mechanistic pathways that are known to be involved in this syndrome and its related clinical consequences.

Retrospective Analysis of Laparoscopic Partial Nephrectomies Using the Zero Ischemia Technique.

PURPOSE: To report a series of 89 off-clamp laparoscopic partial nephrectomies (LPN) performed without using any additional "nephron sparing" manipulations. METHODS: Retrospective analysis of surgical characteristics, complications, postoperative results, and renal function changes. RESULTS: Between March 2008 and May 2014, 89 LPN using zero ischemia technique were performed. Most of the patients (61.8%) were male. The median age was 62 years (23-88). The mean BMI was 27.5 kg/m2 (20.8-54.2). The median tumor size was 3.0 cm (1.0-8.0). Tumor location was upper, middle, and lower part of the kidney in 33 (37.0%), 42 (47.2%), and 14 (15.7%) of patients, respectively. The median operative time was 154 min (58-289). The median hemoglobin change was -1.6 g/dL (0.5-5.5). The transfusion rate was 7.9%. The mean preoperative glomerular filtration rate was 96.6 mL/min (21.5-180.0) with a mean postoperative decline of 6.52 mL/min. The mean creatinine elevation after LPN was 0.09 mg/dL. The median hospital stay was 6 days (2-24). The intraoperative complications rate was 2.3%. Early postoperative complication rate was 33.7%. Late complications occurred in 6.7%. In 7 cases (7.9%), the surgical margins were microscopically involved by tumor cells. Conversion rate was 3.4%. CONCLUSION: Data obtained in the current series show that laparoscopic partial nephrectomy can be successfully performed without hilar clamping. Our results are comparable with contemporary data. Larger prospective studies would be helpful in assessing the evidence-based advantages of the "zero ischemia" technique.

Concomitant laparoscopic renal surgery and cholecystectomy: outcomes and technical considerations.

INTRODUCTION: We report our experience with simultaneous laparoscopic treatment of coexisting kidney and gallbladder pathologies, assess the feasibility of this technique, and highlight some technical considerations. METHODS: Our institutional database was searched for the records of simultaneous laparoscopic kidney surgery and laparoscopic cholecystectomy between 2002 and 2008. We retrieved data on patient demographics, preoperative work-up, surgical information, and postoperative outcome in terms of final pathology, complications, and hospital stay. RESULTS: A total of 19 patients had undergone laparoscopic renal surgery combined with cholecystectomy. Renal surgery consisted of a laparoscopic partial nephrectomy in 5 patients (26.3%), a laparoscopic radical nephrectomy in 12 (63.2%), and a simple nephrectomy in 2 (10.5%). Laparoscopic cholecystectomy was performed as a second surgery in all 19 patients. Two patients simultaneously underwent a third procedure: one was a bilateral salpingo-oophorectomy, and the other was a postoperative ventral hernia repair with mesh. The average renal surgery time was 144 minutes, and the average cholecystectomy time was 28.0 minutes. All procedures were successfully completed laparoscopically with no conversions. The mean hospital stay was 4.2 days (median 4, range 2-8). CONCLUSIONS: Combining laparoscopic renal surgery and laparoscopic cholecystectomy is a feasible, efficacious, and safe strategy that requires close collaboration between urologists and general surgeons. This approach offers the patient the benefits of minimally invasive surgery together with the obvious advantages of simultaneous treatment of coexisting pathologies.