Diagnostic value of four-dimensional CT angiography in arterial erectile dysfunction using 320-detector row dynamic volume CT.

The present study aims to evaluate the diagnostic value of four-dimensional CT angiography (4D-CTA) in the diagnosis of arterial erectile dysfunction (ED) using 320-detector row dynamic volume CT. Arterial ED patients attributed to arterial insufficiency were enrolled. To induce penile erection, an intracavernous injection (ICI) of corpus cavernosum with a vasoactive drug was administered. Patients were assigned into the erection hardness score (EHS) 1/2 group or EHS 3/4 group. Color duplex Doppler ultrasound (CDDU) was used to analyze blood flow spectrum. Each patient was examined using 4D-CTA. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of 4D-CTA in arterial ED. According to Irwin Goldstein, the EHS 3/4 group (n=38) had a shorter course of ED and low proportion with history of hypertension, hyperlipidemia, and diabetes than the EHS 1/2 group (n=35). The peak systolic velocity (PSV), end diastolic velocity (EDV), and resistant index (RI) in the EHS 3/4 group were lower than those of the EHS 1/2 group. 4D-CTA showed there were a total of 35 cases in the EHS 1/2 group (two cases missed) and 38 cases in the EHS 3/4 group (seven cases misdiagnosed). Using 4D-CTA to diagnose arterial ED, the area under the ROC curve yielded a value of 0.879, with a specificity of 93.9% and a sensitivity of 82.5%. These findings indicated that 4D-CTA using 320-detector row dynamic volume CT is a promising and reliable utility in diagnosing arterial ED.

Is there a relationship between penile vasculogenic erectile dysfunction, platelet functions and eosinophil count? / Existe una relación entre la disfunción eréctil vasculogénica del pene, las funciones de plaquetas y el conteo de eosinófilos?

Purpose. Blood count parameters of patients referring with penile vasculogenic erectile dysfunction (ED) were examined in this study. It was investigated whether eosinophil count (EC), platelet count (PC) and mean platelet volume (MPV), values among the suspected predictive parameters which may affect vascular functions, have a contribution on ED pathology or not. Materials and methods. Patients referring erectile dysfunction complaint were evaluated. Depending on the medical story, ED degree was determined by measuring International Index of Erectile Function (IIEF). Values such as hormones, complete blood count and other laboratory markers were examined. Penile doppler ultrasonography (PDU) was performed in patients suspected to have vasculogenic ED. According to PDU result, patients with vascular deficiency were included in the penile vasculogenic ED group and patients with normal results were included in the control group. 49 patients participated in the study from the penile vasculogenic ED group and 30 patients from the control group. Intergroup comparisons were performed using the Mann-Whitney U test and the chi-square (χ2) test was used to assess the relationship between categorical variables within the patient groups. Results. Low IIEF score in vasculogenic ED group compared to the control group and high EC, MPV and PC values were detected to be statistically significant (p<0.001, p=0.026, p=0.009, p=0.029, respectively). No statistically significant difference was observed among the two groups when age, white blood cells, red blood cells or hemoglobin values are considered (p=0.332, p=0.235, p=0.127, p=0.696, respectively). Conclusion. High MPV value and platelet count showing the platelet functions and high eosinophil count are important factors which may play a role in penile vasculogenic ED etiopathogenesis (AU)

Propósito. Los parámetros de conteo de sangre de los pacientes referidos con disfunción eréctil (DE) vasculogénica del pene fueron examinados en este estudio. Se investigó si los valores de conteo de eosinófilos (CE), el conteo de plaquetas (CP) y el volumen plaquetario medio (VPM), entre los parámetros predictivos sospechados de afectar las funciones vasculares, contribuyen a la patología de DE o no. Materiales y métodos. Se evaluó a los pacientes referidos con quejas de DE. Dependiendo de su historial médico, el grado de DE fue determinado midiendo el índice internacional de función eréctil (IIFE). Se examinaron los valores de hormonas, el conteo total de sangre y otros valores de laboratorio. Se utilizó la ultrasonografía Doppler peneana (UDP) en pacientes en los que se sospechaba DE vasculogénica. Según el resultado de la UDP, los pacientes con deficiencia vascular fueron incluidos en el grupo de DE vasculogénica del pene y los pacientes con resultados normales fueron incluidos en el grupo de control. En el estudio participaron 49 pacientes en el grupo de DE vasculogénica del pene y 30 pacientes en el grupo de control. Las comparaciones intergrupales fueron realizadas utilizando el test U de Mann-Whitney y el test de la chi cuadrado (χ2) para analizar la relación entre los variable categóricos en los grupos de pacientes. Resultados. Resultados bajos de IIFE en el grupo de DE vasculogénica comparados con el grupo de control y resultados altos de CE, VPM y PC fueron detectados como estadísticamente significativos (p<0,001, p=0,026, p=0,009 y p=0,029, respectivamente). No se observó ninguna diferencia significativa estadísticamente entre los 2 grupos cuando se consideraron los valores de edad, glóbulos blancos, glóbulos rojos y hemoglobina (p=0,332, p=0,235, p=0,127 y p=0,696, respectivamente). Conclusión. Unos valores altos de VPM, un conteo de plaquetas que muestra las funciones de plaquetas y un conteo alto de eosinófilos son factores importantes que pueden desempeñar un papel en la etiopatogenia de la DE vasculogénica del pene (AU)

Comprehensive assessment of cavernosography with 320-row dynamic volume CT versus conventional cavernosography in erectile dysfunction patients caused by venous leakage.

The present study aims to investigate and compare the diagnostic and prognostic value of cavernosography with 320-row dynamic volume computed tomography (DVCT) versus conventional cavernosography in men with erectile dysfunction (ED) caused by venous leakage. A total of 174 patients diagnosed with ED were enrolled and received cavernosography with 320-row DVCT (DVCT group) and conventional cavernosography scans (control group) respectively. The diagnosis, complications, and prognosis of patients were evaluated. The DVCT group provided high-resolution images with less processing and testing time, as well as lowered radiological agent and contrast agent compared with the control group. In the DVCT group, 89 patients who were diagnosed with venous ED had six various venous leakage, namely superficial venous leakage, profundus venous leakage, the mixed type, cavernosal venous leakage, crural venous leakage, and also venous leakage between the penis and urethra cavernosum (9, 21, 32, 6, 18, and 3 cases respectively). Similarly, 74 patients out of the 81 who suffered from venous ED were classified to have superficial venous leakage (11), profundus venous leakage (14), the mixed type venous leakage (26), and middle venous leakage (23). Six out of 25 patients in the DVCT group, had improvements in ED while the remaining 19 achieved full erectile function recovery with no penile fibrosis and erectile pain. Cavernosography with 320-row DVCT is a reliable system that can be used to diagnose ED caused by venous leakage. This is especially useful in accurately determining the type of venous and allows for a better prognosis and direction of treatment.

Initial evidence demonstrating the association between the vascular status in surgically resected renal parenchymal pathology and sexual function.

Our goal is to evaluate the association between histopathology of glomerulosclerosis (GS) and atherosclerosis (AS) in the nephrectomized normal parenchyma together with patients' background, and erectile dysfunction (ED) of patients treated with radical nephrectomy (RN) for renal cell carcinoma (RCC). ED was assessed with the International Index of Erectile Function in 65 patients who were less than age 70 years at the time of questionnaire. Glomeruli status was assessed by the extent of global GS. AS was graded based on lumen occlusion and frequency of involvement. Patients' backgrounds included any comorbidities, post-RN renal insufficiency, tumor pathology, demographics and social status. The presence of diabetes mellitus and lack of a spouse were independent predictors for severe ED, whereas G0/1 AS was an independent predictor for mild/no ED. The extent of global GS was significantly lower in patients with mild/no ED than in other patients. Our study represents the first report identifying healthy arterial status in the renal parenchyma as a significant indicator of favorable erectile function and that the evaluation of AS severity is not a superior indicator of severe ED in the presence of comorbidities or social status among patients treated with RN.

The direction and severity of penile curvature does not have an impact on concomitant vasculogenic erectile dysfunction in patients with Peyronie's disease.

Although the association between Peyronie's disease (PD) and erectile dysfunction (ED) is well established, limited data are available correlating penile curvature and penile hemodynamic parameters. We sought to examine this association in a cohort of PD men undergoing penile duplex Doppler ultrasound (PDDU). PD patients were retrospectively evaluated to correlate the extent and direction of penile curvature with measured vascular parameters. Demographic variables, disease characteristics and PDDU parameters were tabulated and statistically compared based on extent (≤ 45° and >45°) and direction (dorsal, ventral, lateral, ventrolateral, dorsolateral) of curvature. A total of 220 PD patients (mean age of 55.0 ± 9.2 years) underwent PDDU at one institution from January 2008 to December 2010. Overall, 69.5% of patients were found to have vasculogenic ED (arterial insufficiency (AI): 10%; veno-occlusive dysfunction (VOD): 43.2%; AI + VOD: 16.4%). Mean curvature was similar among all PDDU groups (AI: 41.7 ± 5.2°; VOD: 41.3 ± 2.5°; AI+VOD: 37 ± 4.1°; no-ED: 37.3 ± 3°; P > 0.85). No significant differences were noted in the presence or type of ED among various directions of curvature (P = 0.34) or when curvatures were stratified by ≤ 45° and >45°. The direction and extent of penile curvature are not associated with altered rates of vasculogenic ED on PDDU in PD patients.

[Sildenafil citrate in the treatment of men with erectile dysfunction].

Based on literature data and the results of own authors' research, the review article considers the efficacy and safety of sildenafil, including its long-term use. Application of this drug leads to an improvement of erectile function in patients of all ages, regardless of etiology, severity and duration of erectile dysfunction (ED). Drug has long-term efficacy. Sildenafil affects both arterial and venous blood flow to the penis, which makes it indicated in vasculogenic erectile dysfunction first. Treatment with sildenafil is accompanied by improvement of the cavernous electrical activity, which justifies its use in neurogenic form of the disease. According to results of IIEF questionnaire, sildenafil provides quick and lasting therapeutic effect. Efficacy and safety of sildenafil is rated as good. As for short-term and long-term use, sildenafil does not cause dependence and addiction.

Penile alterations with severe sperm abnormalities in antiphospholipid syndrome associated with systemic lupus erythematosus.

This study aims to perform global gonadal and sexual function assessments in systemic lupus erythematosus-related antiphospholipid syndrome (SLE-APS) patients. A cross-sectional study was conducted in ten SLE-APS male patients and 20 healthy controls. They were assessed by demographic data, clinical features, urological examination, sexual function, testicular ultrasound, seminal parameters, sperm antibodies, and hormone profile. The median of current age was similar in SLE-APS patients and controls with a higher frequency of erectile dysfunction in the former group (30 vs. 0 %, p = 0.029). The median penis circumference was significantly reduced in SLE-APS patients with erectile dysfunction compared to patients without this complication (8.17 vs. 9.14 cm, p = 0.0397). SLE-APS patients with previous arterial thrombosis had a significantly reduced median penis circumference compared to those without this complication (7.5 vs. 9.18 cm, p = 0.039). Comparing SLE-APS patients and controls, the former had a significant lower median of sperm concentration (41.1 vs. 120.06 × 10(6)/mL, p = 0.003), percentages of sperm motility (47.25 vs. 65.42 %, p = 0.047), normal sperm forms by WHO guidelines (11 vs. 23.95 %, p = 0.002), and Kruger criteria (2.65 vs. 7.65 %, p = 0.02). Regarding seminal analysis, the medians of sperm concentration and total sperm count were significantly lower in SLE-APS patients treated with intravenous cyclophosphamide vs. those untreated with this drug (p < 0.05). Therefore, we have observed a novel association of reduced penile size with erectile dysfunction and previous arterial thrombosis in SLE-APS patients. Penis assessment should be routinely done in SLE-APS patients with fertility problems. We also identified that intravenous cyclophosphamide underlies severe sperm alterations in these patients.

The implications of increasing age on erectile dysfunction.

Erectile dysfunction (ED) has long been correlated with psychological well-being. More recently, an understanding has developed of ED being, in some cases, a vascular condition of the penile artery. Given the narrowness of the penile artery, a small amount of atherosclerosis may result in ED before any other manifestations are evident, making ED a useful marker for other vascular conditions with potentially greater clinical implications. In light of this, possible underreporting of ED takes on added significance. A questionnaire regarding ED prevalence and management was distributed for self-administration to men in the waiting room of primary care clinics; the data were analyzed with a focus on the relationship between ED and age. The study had a remarkable response rate of >95%. The prevalence of ED in the ≥70-year age-group was 77%, compared with 61% in the 40- to 69-year age-group (p = .0001). ED correlated linearly with age (R(2) = .80, p < .0001). Among those who had ED, more than half had not discussed it with any provider; the likelihood of discussing ED did increase with the reported severity of symptoms (p < .0001). Older men had more severe ED than younger men (p < .0001). Furthermore, 72% of men with a history of ED were never treated. Younger men were more likely to be treated than older men (p = .004). Given the potential implications of underreporting ED, and the willingness of the men in this study to complete the questionnaire, further work may be merited on new models for ED assessment and follow-up.

Endothelial antioxidant compound prolonged the endothelial antiapoptotic effects registered after tadalafil treatment in patients with arterial erectile dysfunction.

This study evaluated the effects of a chronic treatment with tadalafil, a specific phosphodiesterase V inhibitor, on endothelial apoptosis through changes in the serum concentration of endothelial microparticles (EMP). EMPs were arbitrarily chosen as a marker of endothelial apoptosis, and the changes in their concentration were monitored before and after treatment. Additionally, administration of endothelial antioxidant compound (EAC) during the follow-up, after discontinuation of tadalafil, was evaluated to determine whether this treatment improved the potential effects of tadalafil on the endothelium. Seventy-five patients with arterial erectile dysfunction were evaluated at baseline and after administration of tadalafil (5 mg once daily for 90 days). The International Index of Erectile Function questionnaire was administered, and penile dynamic Doppler and flow-cytometric (serum concentrations of EMPs) analyses were performed before (T0) and after treatment. Time points after tadalafil discontinuation: T1, after 1 week; T2, after 3 months; and T3, after 6 months. Three different schemes of follow-up were evaluated: group A, follow-up with EAC administration, after tadalafil discontinuation, for 6 months; group B, follow-up without other treatment; and group C, follow-up with placebo during the follow-up, after tadalafil cessation. The events CD45(neg)/CD144(pos)/annexinV(pos) were defined EMPs. Patients treated with tadalafil showed a significant decrease in serum EMPs 1 week after discontinuing tadalafil (16.4% ± 3.6% vs 7.1% ± 3.3%). This effect was maintained for up to 3 months in the group without other treatment during follow-up and was maintained for up to 6 months in the group treated with EAC during follow-up. Chronic treatment with tadalafil reduces endothelial apoptosis in patients with arterial erectile dysfunction. Further, EAC treatment prolongs and stabilizes the duration of antiapoptotic effects on the endothelium that are initially promoted by tadalafil treatment.

Is there a concordance between carotid and penile cavernosal artery intima-media thickness in patients with erectile dysfunction?

This study aimed to investigate the predictive accuracy of carotid and cavernosal Doppler ultrasound findings for discriminating patients with vasculogenic erectile dysfunction (ED). Fifty patients with complaints of ED were included. B-mode ultrasound of bilateral carotid arteries were performed and peak systolic velocity (PSV), end-diastolic velocity (EDV) and intima-media thickness (IMT) values were measured. Afterwards, corresponding values of cavernosal arteries were obtained by penile color duplex ultrasonography (P-CDU). Of total 50 patients, 29 (58%) were included in vasculogenic ED group and 21 (42%) in non-vasculogenic ED group according to P-CDU findings. There was a significant difference between groups for cavernosal IMT (P=0.012) but not for carotid IMT (P=0.601). When patients were reclassified according to carotid IMT values (IMT of the first group <0.9 mm and the second ≥0.9 mm), carotid PSV and EDV values were different (P=0.033 and 0.018, respectively). Cavernosal PSV and EDV displayed no difference (P=0.816 and 0.123) while cavernosal IMT and percent change of cavernosal caliper were significantly different (P=0.014 and 0.018). Carotid PSV and EDV successfully mirrored respective measurements in cavernosal artery. However, carotid IMT failed to demonstrate such a correlation. Cavernosal IMT seems promising as an additional tool in the evaluation of cavernosal function.

Circulating endothelial progenitor cells and endothelial microparticles in patients with arterial erectile dysfunction and metabolic syndrome.

Blood endothelial progenitor cells (EPC) and microparticles (EMP) have been proposed as markers of endothelial dysfunction. The aim of this study was to evaluate both EPCs and EMPs in patients with arterial erectile dysfunction (ED) and metabolic syndrome (MetS). To accomplish this, 100 patients (ages 45-60 years) with ED and MetS (Adult Treatment Panel III [ATP III] 1999 criteria) and 17 healthy men (ages 44-57 years) were selected. EPC (CD45(neg)/CD34(pos)/CD144(pos)) and EMP (CD45(neg)/CD144(pos)/Annexin V(pos)) blood concentrations were evaluated by flow cytometry, before and after administration of tadalafil (20 mg) on demand for 3 months. Before treatment, EPCs and EMPs were significantly higher in patients compared with healthy men. EPCs increased significantly after tadalafil administration, whereas EMPs did not differ significantly. EPCs correlated positively or negatively with body mass index and with some cavernous artery indices, both before and after tadalafil administration. EMPs showed only positive correlations with body mass index and some cavernous artery indices, both before and after tadalafil administration. Patients with arterial ED and MetS have higher EPCs and EMPs compared with healthy men; hence, these cells may be regarded as markers of cavernous artery dysfunction. Tadalafil administration increased EPCs but not EMPs, suggesting that this compound may play a role in the endothelial repair response.

Phosphodiesterase type 5 (PDE5) inhibitors in erectile dysfunction: the proper drug for the proper patient.

INTRODUCTION: Erectile dysfunction (ED) is a very common multidimensional disorder affecting men worldwide. Physical illness, reaction to life stresses, or an unhappy couple relationship influence clinical outcome. Phosphodiesterase type 5 (PDE5) inhibitors are recognized as efficacious and well tolerated, and are the first-line treatment for ED. Sildenafil, tadalafil, and vardenafil are the most widely used and studied PDE5 inhibitors. Data acquired during a routine diagnostic workup for ED should be taken into account when choosing the best PDE5 inhibitor for the individual patient, creating an individualized treatment plan, and going beyond "experience-based" subjective opinion and unfounded ideas and prejudice regarding currently available drugs. AIM: As the process of matching a given patient's profile to any selected PDE5 inhibitor often relies more on physician's personal convictions than on solid evidence, the aim of this review is to identify the main clinical, demographic, and relational factors influencing the choice of the PDE5 inhibitor to be used for the treatment of ED. METHODS: A systematic literature search and current treatment guidelines were evaluated in a systematic manner. MAIN OUTCOME MEASURES: The main clinical, cultural, and demographical factors to be considered for the treatment of ED have been identified. RESULTS: Main factors influencing the choice of the treatment for ED have been described. A short list of items that may help in choosing the right PDE5 inhibitor for the treatment of different patients in daily clinical practice has been prepared. CONCLUSIONS: The simple algorithms prepared should be a useful tool to be used in daily practice, which may help in choosing the right treatment for each subject affected by ED.

Cavernous smooth muscle hyperplasia in a rat model of hyperlipidaemia-associated erectile dysfunction.

UNLABELLED: What's known on the subject? and what does the study add? Increased cavernous smooth muscle content has been repeatedly observed in rat models of hyperlipidaemia - associated erectile dysfunction. This study shows that the increased smooth muscle content is due to hyperplasia. OBJECTIVE: • To investigate the structural changes, including possible smooth muscle hyperplasia, in the penis of a hyperlipidaemia-associated erectile dysfunction (ED) animal model. MATERIALS AND METHODS: • Hyperlipidaemia was induced in rats through a high-fat diet. • Penile tissues of normal and hyperlipidaemic rats were stained with Alexa-488-conjugated phalloidin and/or with antibodies against rat endothelial cell antigen, neuronal nitric oxide synthase (nNOS), and collagen type IV (Col-IV) before image and statistical analyses were carried out. • The main outcome measures were the smooth muscle, endothelial, Col-IV and nNOS content of the corpus cavernosum. RESULTS: • Phalloidin intensely stained all smooth muscle in the penis, revealing the circular and longitudinal components of cavernous smooth muscle (CSM). • The CSM content was significantly higher in the hyperlipidaemic than in the normal rats (P < 0.05). • Cell numbers in both circular and longitudinal CSM were significantly higher in the hyperlipidaemic than in the normal rats (P < 0.05). • Cavernous endothelial content was significantly lower in hyperlipidaemic than in normal rats (P < 0.05). • nNOS-positive nerves within the dorsal nerves, around the dorsal arteries, and in the corpora cavernosa were all significantly lower in the hyperlipidaemic than in the normal rats (P < 0.05). CONCLUSIONS: • Hyperlipidaemia is associated with reduced nNOS-positive nerves, reduced endothelium, and increased CSM in the penis. • The increased CSM is attributable to hyperplasia. • These structural changes may explain why hyperlipidaemic men are more likely to develop ED.

New therapeutic targets for the treatment of erectile dysfunction.

INTRODUCTION: Despite the high efficacy and safety rates of the currently available treatments for erectile dysfunction, basic research reveals numerous new targets that are explored for therapeutic use. AIM: To overview potential new targets and to review available animal and human studies focusing on the potential of these targets for effective therapy for treating erectile dysfunction. METHODS: A comprehensive literature search was conducted using the PubMed and Medline database, and citations were selected based on relevance. MAIN OUTCOME MEASURES: Data are presented based on the analysis of the selected scientific information and published clinical trials. RESULTS: Fundamental research has, in the past decade, increased the understanding in both the physiological and the pathophysiological pathways that play a role in erectile function. As this information increases each day, new targets to treat erectile dysfunction are frequently presented. Currently a number of new therapeutic targets have been published. Some of them target the nitric oxide/cyclic guanosine monophosphate relaxation pathway as the phosphodiesterase type 5 inhibitors do, others primarily target pathways involved in contraction. Also, targets within the central nervous system currently receive much attention. Some of these targets have already been used in clinical trials to test their efficacy and safety, with either disappointing or promising results. CONCLUSIONS: This review overviews potential therapeutic targets and summarizes animal as well as human studies evaluating their perspectives for the treatment of erectile dysfunction.

Increased expression of endothelial-platelet dysfunctional pathway in patients with arterial erectile dysfunction.

AIM: Pathophysiological externalization of specific substances belonging to the vessel wall (after endothelial injury), usually not in contact with the blood (subintimal area) is the signal which is captured by surface receptor platelet's results in their adhesion. There are no studies that have so far examined the expression of these receptors in patients with arterial erectile dysfunction (ED). The aim of this study was to assess by flow cytometry, serum concentration of apoptotic endothelial microparticles (EMPa) and vitronectin receptor (VR) in a selected series of patients with arterial ED and without apparent other sistemic arterial involvement. METHODS: Evaluated consecutively 50 selected patients with arterial ED-based (mean IIEF-5 score of 6.3±0.3 and mean peak systolic velocity of 24.5±0.6 cm/s). Evaluation of EMPa and VR was conducted using a flow cytometer. The events CD45neg-CD144pos-annexinVpos were defined EMPa, while events CD51pos-CD61pos-CD41neg were defined VR. RESULTS: Patients with arterial ED had a serum baseline concentrations of circulating EMPa (12.2±2.2% vs. 1.8±0.4%) and VR (7.4±1.2% vs. 1.2±0.2%) significantly higher than control group. CONCLUSION: The present study shows that patients with arterial ED had an increased expression of endothelial apoptosis and initial platelet adhesion.

New immunophenotype of circulating endothelial progenitor cells and endothelial microparticles in patients with erectile dysfunction and metabolic syndrome: effects of tadalafil administration.

AIM: Circulating endothelial progenitor cells (EPCs) and endothelial microparticles (EMPs) increase, respectively, in the attempt to repair the damaged endothelium and in response to endothelial dysfunction. Erectile dysfunction (ED) of arterial origin recognizes endothelial dysfunction as one of its main determinants and shares risk factors and physiopathological evolution with the metabolic syndrome (MetS). Tadalafil, selective inhibitor of phosphodiesterase V, long half-life, is used to treat erectile dysfunction, and several studies have already documented the beneficial effects on endothelial dysfunction. The aim of this paper was to evaluate the concentrations of EPCs and EMPs in patients with arterial ED and MetS, before and after tadalafil administration, and in healthy men. METHODS: Thirty patients (47-54 years) with ED and MetS (ATP III 1999 criteria) and 17 healthy men (44-57 years) were selected. EPCs (CD45neg/CD34pos/CD144pos) and EMPs (CD45neg/CD34neg/CD144pos) blood concentrations were evaluated by flow cytometry before and after administration of tadalafil (20 mg) on demand for 3 months. After treatment, the patients were divided into responders and poor responders, according to their IIEF-5 score. MAIN OUTCOME MEASURES: Blood EPCs and EMPs. RESULTS: Before treatment, the percentage of EPCs and EMPs was significantly higher in patients with ED and MetS compared to healthy men. Treatment with tadalafil increased significantly EPCs in both responders and poor responders. The latter had significantly higher EPCs compared to responders, both before and after tadalafil. Before tadalafil, EMPs were higher, but not significantly, in poor responders vs. responders. No significant change occurred after tadalafil administration in both responders and poor responders. A significant positive correlation was found between EPCs and age, Body Mass Index (BMI), acceleration time, IMT and EDV; whereas a negative correlation was found with IIEF-5 score, PSV and resistance index. EMPs correlated positively with BMI, acceleration time and IMT and negatively with the IIEF-5 score. CONCLUSION: Tadalafil increased the percentage of EPCs in both responders and poor responders, suggesting the persistence of an adequate bone marrow response. The unchanged EMP concentrations after tadalafil suggest a reduction of the dysfunctional mechanism.

Outcomes of crural ligation surgery for isolated crural venous leak.

INTRODUCTION: Venous ligation surgery results for diffuse venous leak have been disappointing, although in isolated crural venous leak (ICVL) cases, efficacy for crural ligation surgery (CLS) has been demonstrated. AIM: The purpose of this study was to present our experience with treatment of ICVL with CLS. METHODS: All patients underwent preoperative cavernosometry. Cavernosography (CG) or perineal compression (PC) was used to define the diagnosis of ICVL. If CG demonstrated ICVL or flow-to-maintain values normalized with PC, the patient was counseled regarding CLS. Baseline and postoperative erectile function (EF) was assessed by the International Index of Erectile Function (IIEF) questionnaire. MAIN OUTCOME MEASURES: EF, using the EF domain (EFD) score of the IIEF, a domain with six questions with a maximum score of 30 and a minimum score of 6 in the sexually active male. All patients completed the questionnaire preoperatively and in a serial fashion after surgery at a time point after 12 months postoperatively. RESULTS: 14 patients underwent CLS. Mean age was 29 ± 7 years. Also, 64% had primary erectile dysfunction. Mean baseline IIEF-EF score was 18 ± 6. Furthermore, 71% of patients had failed phosphodiesterase type 5 (PDE5) inhibitors and 6/10 (60%) failed intracavernosal injections (ICI). Mean postoperative EFD score was 24 ± 3 representing a mean change of 6.5 points per patient. No patient needed ICI after CLS; however, 4/14 patients needed PDE5 inhibitors, all of whom had been using ICI preoperatively. In addition, 71% experienced unassisted sexual intercourse after CLS. CONCLUSIONS: In a highly selected population of young men with ICVL, CLS cures 70% and improves EF in more than 90% of men. Surgical treatment of ICVL by CLS can be performed safely and with sufficient efficacy that larger and longer term studies should be undertaken.

PARP inhibition restores erectile function by suppressing corporal smooth muscle apoptosis in diabetic rats.

INTRODUCTION: An important mechanism suggested to be responsible for diabetes-associated erectile dysfunction (ED) involves increased apoptosis, increased collagen deposition, and reduced smooth muscle content in the corpus cavernosum. AIM: To determine whether the activation of the pro-apoptotic poly(adenosine diphosphate ribose) polymerase (PARP) pathway is involved in the induction of corporal apoptosis, and whether the administration of 3-aminobenzamide (3-AB), a specific PARP inhibitor, could ameliorate ED in diabetic rats. METHODS: Male Sprague-Dawley rats (8-weeks-old) were randomly divided into three groups: age-matched controls (C), diabetic controls (DM), and 3-AB-treated diabetic group (DM + 3-AB). Diabetes was induced by intraperitoneal (ip) injection of streptozotocin (50 mg/kg). Eight weeks after the induction of diabetes, DM + 3-AB group treated with 3-AB (30 mg/kg/day, ip) for 4 weeks. MAIN OUTCOME MEASURES: At 12 weeks after diabetes induction, erectile function was assessed by cavernous nerve stimulation. Penile tissue was assessed for apoptosis, Masson's trichrome stain and immunohistochemical analysis for smooth muscle alpha actin. Expression of poly(ADP-ribose), phospho-protein kinase B (Akt), phospho-Bcl-2-associated death promoter (Bad), B-cell leukemia/lymphoma 2 (Bcl-2), Bcl-2-associated X Protein (Bax), and apoptosis-inducing factor (AIF) were evaluated by Western blot. Caspase-3 activity and malondialdehyde (MDA), adenosine triphosphate (ATP), and nicotinamide adenine dinucleotide (NAD+) concentrations were also determined. RESULTS: DM group showed impaired erectile function, increased PARP activity and corporal apoptosis, and decreased smooth muscle contents. Expression of phospho-Akt, phospho-Bad, Bcl-2, and concentrations of ATP and NAD+ were decreased in the DM group, whereas concentrations of MDA, expression of Bax, nuclear translocation of AIF, and caspase-3 activity were increased. Treatment with 3-AB restored erectile function and significantly reversed all molecular and histological alterations except for the increased MDA. CONCLUSION: Over-activation of penile PARP pathway in diabetic rats enhances corporal apoptosis via energy depletion, suppression of Akt phosphorylation, and activation of the mitochondrial apoptotic pathway, which results in ED; these event could be prevented by treatment with 3-AB.

[Nebido in the treatment of hypogonadism syndrome and its complications in men].

The article presents original experience with use of undecanoate (nebido, BayerHealthcare Pharmaceuticals, Germany) in androgenic testosteron replacement therapy in males with hypogonadism. Prospective studies of nebido efficacy were made in males with vein-occlusive erectile dysfunction (n = 20), chronic pelvic pain syndrome (n = 77), metabolic syndrome (n = 170). Retrospective studies assessed efficacy of nebido monotherapy in patients with erectile dysfunction and hypogonadism (n = 34), hematological and urological safety of the drug (n = 40). Laboratory monitoring was performed in all the studies according to ISSAM recommendations. The patients were not included in contraindications to androgenic therapy. Nebido treatment significantly improved libido and erectile function, efficacy of phosphodiesterase of type 5 inhibiors used in moderate and severe erectile dysfunction. Depressive, asthenic, pain symptoms declined in males with chronic pelvic pain. Body fat reduced in metabolic syndrome with alleviation of its other components. Insignificant rise of hemoglobin level and packed cell volume was observed in some patients while a PSA level increase was clinically significant in 10% patients who had initial PSA > 2.5 ng/ml and acromegalia. Also, nebido depressed production of gonadotropins and spermatogenesis. Thus, nebido is highly effective in sexual dysfunction and other somatic disorders caused by hypogonadism. Nebido does not induce severe side effects, but clinically significant rise of PSA level requires treatment discontinuation and more careful urological examination. In view of nebido ability to suppress spermatogenesis, the drug should not be used in reproductively active men.