Initial experience with aspirin use during robotic radical prostatectomy.

BACKGROUND: New cardiology guidelines recommend antiplatelet therapy for some patients with cardiac stents. Aspirin use is relatively contraindicated during urologic surgery because of increased bleeding risk. We sought to review the outcomes of patients who continued aspirin during robot-assisted radical prostatectomy. PATIENTS AND METHODS: Between October 2007 and February 2010, 249 patients underwent robot-assisted radical prostatectomy by a single surgeon. After consultation with the patients' cardiologists, 6 patients had coronary artery stents and continued aspirin perioperatively (Group 1), and 7 patients had coronary artery stents but did not continue aspirin perioperatively (Group 2). The remaining 236 patients had no coronary artery stents and did not require continued aspirin (Group 3). We analyzed our patients' preoperative characteristics, including age, prostate-specific antigen volume, and D'Amico risk, as well as operative time, blood loss, hematocrit changes, transfusion requirements, length of hospital stay, and complications. RESULTS: We found no differences in operative time, estimated blood loss, changes in hematocrit, or length of hospital stay. No patients with any type of cardiac stent required a postoperative blood transfusion or had complications requiring more than simple anti-emetics, analgesics, or electrolyte correction. Nine patients in Group 3 required interventions for significant complications. CONCLUSION: Larger studies need to be performed to validate these observations.

The relationship of obesity and gender prevalence changes in United States inpatient nephrolithiasis.

OBJECTIVE: To review the Nationwide Inpatient Sample database to examine the relationships between obesity, gender, and nephrolithiasis. Recent reports indicate that the prevalence of nephrolithiasis has been increasing, especially among women. METHODS: The Nationwide Inpatient Sample contains data on approximately 20% of hospital stays in the United States. Included in this analysis were discharges with primary diagnosis ICD-9 codes 592.0 (renal calculus) or 592.1 (ureteral calculus), from 1998 through 2003. All raw data were weighted to produce national estimates. Descriptive and inferential statistics were performed to determine changes in nephrolithiasis prevalence and associations of obesity and other comorbidities with nephrolithiasis. RESULTS: We reviewed 181,092,957 hospital stays (weighted data). The prevalence of nephrolithiasis was relatively stable: 0.52% (149,302) in 1998 and 0.47% (147,541) in 2003. The prevalence of obesity increased from 3.06% (878,155) to 4.99% (1,575,247). The male:female ratio of patients with stones decreased from 1.6:1 to 1.2:1. Multivariate analysis revealed a statistically significant relationship (OR = 1.22, 95% CI 1.20-1.23, P <.001) between obesity and urinary stones. Obese females were more likely to develop stones than nonobese females (OR = 1.35, 95% CI 1.33-1.37, P <.001). The association between obesity and stones was weaker in males (OR = 1.04, 95% CI 1.02-1.06, P <.001). CONCLUSION: In this sample of inpatients, obesity was associated with a significantly increased prevalence of urinary stones. This relationship was stronger in females than in males. Further studies are needed to determine whether weight reduction in obese patients affects urinary stone disease.

The relationship between the type of penile abnormality and penile vascular status in patients with peyronie's disease.

PURPOSE: We evaluated penile vascular status using penile duplex Doppler ultrasound (PDDU) according to the type of abnormality in men with Peyronie's disease (PD). MATERIALS AND METHODS: A total of 523 patients with PD were evaluated retrospectively. Each patient underwent PDDU following injections of 10 to 15 mug prostaglandin E1 intracavernously with accompanying visual sexual stimulation to evaluate penile blood flow. Abnormalities were divided into 7 groups. Objective evaluation of penile curvature was done with a protractor during maximum erection. Specific criteria were used to categorize patients into varying definitions of vascular status. The results were compared statistically among groups. RESULTS: Mean patient age +/- SEM was 54.2 +/- 1.5 years. The most frequently noted type of curvature was dorsal (43.5% of cases), followed by lateral (24.8%). Mean peak systolic velocity in the ventrolateral group was the highest, while the lowest peak systolic velocity was noted in the hourglass abnormality group. The hourglass group had the highest rate of pure arterial insufficiency, while veno-occlusive dysfunction was seen most commonly in the ventral curvature group. The ventrolateral group showed the most normal vascular status parameters. CONCLUSIONS: This study demonstrates there is a relationship between the type of curvature and penile hemodynamics. Although patients with PD in the hourglass abnormality group were the youngest, this abnormality was associated with the poorest penile vascular status. Patients with ventrolateral curvature had the best penile hemodynamics in our series. PDDU findings may direct the treating physician to different treatment options.

The impact of vascular risk factors on erectile function.

The main cause of erectile dysfunction is organic in nature, with vascular etiologies being the most common risk factors. The incidence of erectile dysfunction increases with the number of vascular comorbidities such as hypertension, diabetes, hyperlipidemia, smoking and atherosclerosis. The earliest signal of endothelial damage in men with vascular risk factors is the manifestation of erectile dysfunction. The penis is a barometer of the body's endothelial function, so it is reasonable then to correlate vascular pathologies as direct causes of erectile dysfunction. Moreover, erectile dysfunction may be the first clinical presentation of any of these comorbidities, with the vascular endothelium playing a pivotal role in regulating vascular homeostasis of the corpora cavernosa. This article addresses the impact of vascular risk factors on erectile function based on current evidence.

The impact of vascular risk factors on erectile function.

The main cause of erectile dysfunction is organic in nature, with vascular etiologies being the most common risk factors. The incidence of erectile dysfunction increases with the number of vascular comorbidities such as hypertension, diabetes, hyperlipidemia, smoking and atherosclerosis. The earliest signal of endothelial damage in men with vascular risk factors is the manifestation of erectile dysfunction. The penis is a barometer of the body's endothelial function, so it is reasonable then to correlate vascular pathologies as direct causes of erectile dysfunction. Moreover, erectile dysfunction may be the first clinical presentation of any of these comorbidities, with the vascular endothelium playing a pivotal role in regulating vascular homeostasis of the corpora cavernosa. This article addresses the impact of vascular risk factors on erectile function based on current evidence.

The impact of intralesional interferon alpha-2b injection therapy on penile hemodynamics in men with Peyronie's disease.

INTRODUCTION: Penile duplex Doppler ultrasound (PDDU) is currently the preferred method for the functional evaluation of penile hemodynamics. PDDU may be used to monitor objectively changes in penile vascular parameters in men who undergo treatment for Peyronie's disease (PD), including intralesional interferon alpha-2b (IFN alpha-2b). AIM: To investigate the impact of intralesional IFN alpha-2b therapy for PD on penile hemodynamics by using PDDU and to assess the objective role of PDDU in monitoring treatment outcomes. MATERIALS AND METHODS: Thirty-nine patients (20 in the placebo and 19 in the IFN alpha-2b treatment arm) were enrolled in this prospective, placebo-controlled, parallel study. Patients received either 10 mL saline or 5 x 10(6) units of IFN alpha-2b intralesional injections every other week for a total of six injections. Patients in each group were evaluated at baseline and after completion of treatment regarding changes in penile hemodynamic parameters, penile curvature, plaque size and density, pain on erection, and erectile function. Specific published criteria were used for PDDU measurements. Outcomes were statistically compared between each group by using Mann-Whitney U and chi-square tests. RESULTS: The mean age of the patients and the duration of PD were similar in both groups. The improvement in penile blood flow was significantly greater in IFN alpha-2b-treated patients than those in the placebo group. The number with the nonvascular classification increased significantly in the IFN alpha-2b arm from 31.5% to 57.8%. Additionally, improvements in penile curvature, plaque size and density, and pain on erection were better in the IFN alpha-2b group compared with the control. No significant improvement was observed in the erectile function domain in either group. CONCLUSION: This study reveals that intralesional IFN alpha-2b injections have a significant benefit on penile hemodynamic parameters. Moreover, intralesional IFN alpha-2b is an effective, minimally invasive treatment for PD, and PDDU is a useful adjunct to monitor objectively changes in penile vascular parameters. interferon alpha-2b injection therapy on penile hemodynamics in men with Peyronie's disease.

Factors affecting patient-physician communication via the Internet.

Patients with chronic diseases would potentially benefit greatly from more rapid communication with their health provider of their medical status, healthcare concerns, and personal medical information such as vital signs, blood sugar, and medication use. This study surveyed patients in a multidisciplinary transplant and liver disease clinic to determine whether they would consider using an Internet-based system for medical management of their illness, what specific factors would impact their use of such a system, and what limitations might be encountered with respect to patient education, socioeconomic status, and Internet access.

Internet use by a multidisciplinary transplant clinic population.

BACKGROUND: This study was designed to determine patterns of patient Internet use and to define socioeconomic and other barriers that affect such use. METHODS: A 44-item questionnaire was distributed to patients seen in the transplant clinic during April 2001. RESULTS: A total of 170 patients completed the questionnaire. Fifty-six percent had access to the web. Seventy-two (42%) were African American, and 85 (50%) were Caucasian. Internet use was higher among Caucasian patients, but education level had the strongest correlation. Seventy-three percent of patients with a college education had Internet access compared with 38% of patients with a high school diploma. Twenty-two percent of patients used the Internet to find information about their doctor, and 35% searched for transplant survival results. CONCLUSIONS: Patients use the Internet to find information about their doctors and results of transplantation and other treatments. Physicians should consider establishing guidelines for use of Internet services by patients for education and communication.