ED Severity Research Articles

Is food addiction a predictor of treatment outcome among patients with eating disorder?

The study aimed to examine whether food addiction (FA) was associated with greater severity in both binge eating disorders (BED) and bulimia nervosa and, therefore, to determine if FA was predictive of treatment outcome. Seventy-one adult patients with bulimia nervosa and BED (42 and 29, respectively) participated in the study. FA was assessed by means of the Yale Food Addiction Scale. The results confirmed a high prevalence of FA in patients with binge disorders (around 87%) and also its association with a greater severity of the disorder (i.e., related to an increased eating psychopathology and greater frequency of binge eating episodes). Although FA did not appear as a predictor of treatment outcome in general terms, when the diagnostic subtypes were considered separately, FA was associated with poor prognosis in the BED group. In this vein, FA appeared as a mediator in the relationship between ED severity and treatment outcome. Our findings suggest that FA may act as an indicator of ED severity, and it would be a predictor of treatment outcome in BED but not in BN.

A characterization of binge planning behavior in individuals with binge-spectrum eating disorders.

Although binge eating is associated with impulsivity, clinical reports suggest that some individuals with bulimia nervosa (BN) and binge eating disorder (BED) plan binge episodes in advance. This study is the first to examine: (1) the frequency of binge planning (BP; defined as both advanced knowledge that a binge episode will occur and taking steps to facilitate the binge episode); (2) associations of BP with ED severity, and (3) whether BP serves a negative reinforcement function. Patients with BN- and BED-spectrum eating disorders (EDs; n = 111) were administered semi-structured interview questions regarding BP. Results indicate that a substantial minority of patients (27.8%) engage in BP. BP was significantly more common in BN versus BED-spectrum EDs (38.3% versus 20.6%, p = 0.04) and in those who did versus did not endorse self-induced vomiting (50.0% versus 21.3%, p < 0.01). Frequency of BP was positively associated with overall ED psychopathology (r = 0.19, p < 0.05). Exploratory analyses indicated that approximately two-thirds (67.7%) reported that BP served to distract from unpleasant experiences. BP is present for a significant subset of patients and may play a critical role in the reinforcement cycles of binge eating. Future research should further elucidate the function of BP to inform treatment development.

Erectile Dysfunction in 45-Year-Old Heterosexual German Men and Associated Lifestyle Risk Factors and Comorbidities: Results From the German Male Sex Study.

BackgroundErectile dysfunction (ED) is a common public health issue with a significant impact on quality of life. The associations between ED and several risk factors have been reported previously. The continuously increasing incidence of these factors is contributing to the increasing prevalence of ED.AimTo assess ED prevalence and severity in a representative sample of 45-year-old German men and to analyze the association with risk factors (lifestyle risk factors/comorbidities).MethodsData were collected within the German Male Sex-Study. Randomly selected 45-year-old men were invited. A total of 10,135 Caucasian, heterosexual, sexually active men were included in this analysis. The self-reported prevalence of ED was assessed using the Erectile Function domain of the International Index of Erectile Function. Risk factors for ED were ascertained using self-report questionnaires. An anamnesis interview and a short physical examination were performed.Main Outcome MeasureED prevalence and severity were evaluated in a cross-sectional design. The associations of ED with comorbidities (eg, depression, diabetes, hypertension, lower urinary tract symptoms) and lifestyle factors (ie, smoking, obesity, central obesity, physical inactivity, and poor self-perceived health-status) were analyzed by logistic regression.ResultsThe overall prevalence of ED was 25.2% (severe, 3.1%; moderate, 9.2%; mild to moderate, 4.2%; mild, 8.7%). Among the men with ED, 48.8% had moderate or severe symptoms. ED prevalence increased with the number of risk factors, to as high as 68.7% in men with 5–8 risk factors. In multiple logistic regression with backward elimination, the strongest associations with ED were found for depression (odds ratio [OR] = 1.87), poor self-perceived health status (OR = 1.72), lower urinary tract symptoms (OR = 1.68), and diabetes (OR = 1.38).ConclusionOne out of 4 men already had symptoms of ED at age 45. Almost one-half of the men with ED had moderate to severe symptoms. ED was strongly associated with each analyzed risk factor, and the prevalence and severity of ED increased with an increasing number of risk factors.Hallanzy J, Kron M, Goethe VE, et al. Erectile Dysfunction in 45-Year-Old Heterosexual German Men and Associated Lifestyle Risk Factors and Comorbidities: Results From the German Male Sex Study. Sex Med 2019;7:26–34.

The relationship between erectile dysfunction severity, mean platelet volume and vitamin D levels

Background: The aim of this study was to evaluate the relationship between mean platelet volume (MPV) and vitamin D levels according to ED severity.Methods: Between October 2015 and September 2017, patients who applied to the andrology outpatient clinic with an ED complaint were retrospectively reviewed. Patients with diabetes, hypertension, hyperlipidemia, malignancy, late-onset hypogonadism and smokers were not included in the study. The International Erectile Function Index-Erectile Function (IIEF-EF) questionnaire was used to assess the levels of erectile function. According to this scoring system, patients were divided into two groups. IIEF score: between 17 and 25 = mild ED (Group 1) and IIEF score between 16 and 0 = moderate–severe ED (Group 2). Blood samples of the patients were taken from antecubital vein and MPV and 25-hydroxyvitamin D [25(OH)D] levels were evaluated.Results: Ninety patients were included in the study (Group 1: n = 41, Group 2: n = 49). The mean age of the patients was 41.07 ± 8.56 and the mean body mass index (BMI) was 27.59 ± 3.91. 25(OH)D levels were found to be statistically lower in Group 2 (18.85 ± 6.09; 13.98 ± 7.10; p = .001). MPV levels were found to be statistically higher in Group 2 (10.05 ± 0.81; 10.78 ± 1.16; p = .001). Correlation between IIEF-EF scores and 25(OH)D levels was positive (p = .03, r = 0.22). There was negative correlation between IIEF-EF scores and MPV and between 25(OH)D levels and MPV levels [p = .003 for IIEF-EF/MPV, p = .04, r = −0.23 for 25(OH)D/MPV].Conclusion: There is a significant positive correlation between ED severity and 25(OH)D levels and there is a significant negative correlation between ED severity and MPV levels.

Erectile dysfunction and quality of life in men receiving methadone or buprenorphine maintenance treatment. A cross-sectional multicentre study.

BackgroundErectile dysfunction (ED) is common among men on opioid replacement therapy (ORT), but most previous studies exploring its prevalence and determinants yielded contrasting findings. Moreover, the impact of ED on patients’ quality of life (QoL) has been seldom explored.ObjectiveTo explore the prevalence and determinants of ED in men on ORT, and the impact on QoL.MethodsIn a multicentre cross-sectional study, we recruited 797 consecutive male patients on methadone and buprenorphine treatment, collected data on demographic, clinical, and psychopathological factors, and explored their role as predictors of ED and QoL through univariate and multivariate analysis. ED severity was assessed with a self-assessment questionnaire.ResultsNearly half of patients in our sample were sexually inactive or reported some degree of ED. Some demographic, clinical and psychopathological variables significantly differed according to the presence or absence of ED. Multivariate regression analysis indicated that age, employment, smoke, psychoactive drugs, opioid maintenance dosage, and severity of psychopathological factors significantly influenced the risk and severity of ED. QoL was worse in patients with ED and significantly correlated with ED severity. Age, education, employment, opioid maintenance dosage, ED score, and severity of psychopathology significantly influenced QoL in the multivariate analysis.ConclusionsED complaints can be explored in male opioid users on ORT through a simple and quick self-assessment tool. ED may have important effects on emotional and social well-being, and may affect outcome.

Eating disorder severity and functional impairment: moderating effects of illness duration in a clinical sample.

The aim was to examine duration of illness and body mass index as possible moderators of the relationship between eating disorder severity and functional impairment, as well as psychological distress as a possible mediator of this relationship. The study included 159 patients diagnosed with bulimia nervosa, binge eating disorder or eating disorder not otherwise specified. Regression analysis was applied to assess the effect of the hypothesized moderators and mediators. Eating disorder severity was measured with the Eating Disorder Examination Questionnaire, functional impairment was measured with the Sheehan Disability Scale, and psychological distress was measured with the Symptom Check List-90-R. Duration of illness and body mass index were assessed clinically. Duration of illness significantly moderated the relationship between eating disorder severity and functional impairment; the relationship was strongest for patients with a shorter duration of illness. Psychological distress partly mediated the relationship between eating disorder severity and functional impairment. Duration of illness significantly moderated the relationship between psychological distress and functional impairment; the strongest relationship was seen for patients with a shorter duration of illness. Body mass index was not a significant moderator of the relationship between ED severity and functional impairment. Overall, this study established a link between ED severity, psychological distress and functional impairment indicating that both eating disorder severity and psychological distress are more strongly related to impaired role functioning for patients with more recent onset of an eating disorder. More research in the complex relationship between ED severity and functional impairment is needed.

Erectile dysfunction and cardiovascular risk factors in a Mediterranean diet cohort.

Erectile dysfunction affects more than 100 million men worldwide, with a wide variability in prevalence. An overall association of cardiovascular risk factors, lifestyle and diet in the context of ED in a Mediterranean population is lacking. To assess ED prevalence and associated factors in a Mediterranean cohort of non-diabetic patients with cardiovascular risk factors. Observational, cross-sectional study of patients aged over 40 treated at cardiovascular risk units in Catalonia. Anthropometric data, risk factors, lifestyle and diet habits were recorded. ED was assessed using the International Index of Erectile Function. Four hundred and forty patients included, 186 (42.3%) with ED (24.8% mild, 6.8% moderate and 10.7% severe). ED presence and severity were associated with age, obesity, waist circumference, hypertension, antihypertensive treatment and ischaemic disease. Patients with ED were more frequently smokers, sedentary and consumed more alcohol. In multivariate analysis, consumption of nuts (> twice a week) (OR 0.41 (95% CI 0.25 to 0.67) and vegetables (≥ once a day) (OR 0.47 (95% CI 0.28-0,77)), were inversely related to ED. Obesity (as BMI ≥ 30 kg/m(2) ) (OR 2.49 (95% CI 1.48-4.17)), ischaemic disease (OR 2.30 (95% CI 1.22 to 4.33), alcohol consumption (alcohol-units a day) (OR 1.14 (95% CI 1.04 to 1.26), and age (year) (OR = 1.07 (95% CI 1.04-1.10) were directly related to ED. Erectile dysfunction is a common disorder in patients treated in lipid units in Catalonia for cardiovascular risk factors. This condition is associated with age, obesity, ischaemic disease and unhealthy lifestyle habits.

PD45-11 SEVERE OBSTRUCTIVE SLEEP APNOEA SYNDROME AND ERECTILE DYSFUNCTION: A PROSPECTIVE RANDOMISED STUDY TO COMPARE SILDENAFIL VS. NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE

yGroup D-Subjects from the placebo group of the RCT study, who did not demonstrated significant improvement in their IIEF-EF domain score, received an additional treatment course with an active shockwave applicator. The treatment protocol those subjects received was identical to the original study protocol.yyRCT-Subjects that were poor responders to PDE5i prior to Li-ESWT, were allowed PDE5i use at baseline and following last treatment until FU1 assessment (all pt. achieved erection hardness score 2 at baseline, and EHS 3 in 62% at FU1 . Population pilot study included).zMCID (Rosen)-Success define as: an increase in the IIEF-EF Domain score 2 points from baseline for mild ED, 5 points for moderate ED, and 7 points for severe ED. ED Severity define as : Mild ED: IIEF-EF score 17-22 ,Moderate ED: IIEF-EF score 11-16, Severe ED: IIEFEF score 0-10.

PD45-10 THE SAFETY AND EFFICACY OF LI-ESWT IN 604 PATIENTS FOR ERECTILE DYSFUNCTION: SUMMARY OF CURRENT AND EVOLVING EVIDENCE

PD45-10 THE SAFETY AND EFFICACY OF LI-ESWT IN 604 PATIENTS FOR ERECTILE DYSFUNCTION: SUMMARY OF CURRENT AND EVOLVING EVIDENCE

Does puberty moderate the relationship between personality and eating disorders?

Result A range of pubertal risk factors significantly moderated the relationship between temperaments and ED severity. In particular, the relationship between TCI-Novelty Seeking and ED severity was found to be positively moderated by a negative attitude toward menstruation (p<0.01) and negatively moderated by earlier breast development (p<0.05). Similarly, the relationships between TCI-Harm Avoidance, TCI-Reward Dependency and TCI-Persistence and ED severity were found to be positively moderated by an earlier age of menarche and negatively moderated by a negative attitude towards breast development (p<0.05). Regarding ED subtypes, the only significant findings were obtained for AN-R patients. Conclusion These findings suggest that puberty moderates temperaments and consequent ED severity. The assessment of personality provides important insights into which girls struggle more with pubertal development and are at increased risk of EDs.

Prevalence of Risk Factors of Erectile Dysfunction among Men with Diabetes

Result: Four hundred fifteen questionnaires were analyzed. The mean age of the patients was 54.6 years. The prevalence of ED was 81.9%. Based on IIEF5 scoring, it was found that 136 (32.8%) patients had mild, 159 (38.3%) had moderate and 45 (10.8%) had severe ED. There was a statistically significant association between ED severity and age (P=0.000), diabetes duration (P=0.002), the presence of CVD (P=0.002), poor metabolic control (P=0.038), and retinopathy (P=0.040). Previous ED diagnosis was present in 51 (12.3%) patients. Conclusion: ED is very common among our patients. However, the majority were undiagnosed. Regular screening and increasing awareness of the treating physicians of ED is needed.

MP48-16 EMPIRICAL VS. RISK-BASED APPROACH TO INTRACAVERNOSAL INJECTION THERAPY: A PROSPECTIVE STUDY

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Non-surgical1 Apr 2014MP48-16 EMPIRICAL VS. RISK-BASED APPROACH TO INTRACAVERNOSAL INJECTION THERAPY: A PROSPECTIVE STUDY Robert Segal, Brian Le, Kristen Burns, Arthur L. Burnett, and Trinity Bivalacqua Robert SegalRobert Segal More articles by this author , Brian LeBrian Le More articles by this author , Kristen BurnsKristen Burns More articles by this author , Arthur L. BurnettArthur L. Burnett More articles by this author , and Trinity BivalacquaTrinity Bivalacqua More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1490AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Intracavernosal injection (ICI) therapy is widely used for ED. Employing it in practice is largely empirical and has not been validated with evidence-based approaches. This study compares two strategies for ICI to determine whether a risk-based approach is more efficacious, increases satisfaction and/or results in fewer treatment complications. Methods After obtaining IRB approval, a prospective database of patients enrolled in the ICI program at the Johns Hopkins Hospital from May 2012-present was amassed. Demographic information, treatment outcomes and subjective patient evaluations of sexual function (IIEF, QEQ, SQoL and EDITS questionnaires) were obtained at baseline, 3 and 6 months. Two approaches were compared. Group 1 consisted of empiric ICI treatment. Patients were treated with Prostaglandin E1 10mcg, irrespective of ED etiology or severity, and only if poor response noted at test injection, then initiated on bimix or trimix. Group 2 was a risk-based approach, where using an algorithm that factored in: organic vs. neurogenic ED, number of ED risk factors, prostatectomy, nerve-sparing status, time from surgery and radiation status, patients were treated with either bimix, low- or high-dose trimix. Dose titration was permitted in both groups. Statistical analysis was carried out using t-test and chi-squared analysis. Results 156 patients were enrolled (55 in Group 1, 101 in Group 2) with 3 and 6 month f/u at 57% and 35% respectively, and similar between groups. Baseline patient characteristics and sexual function questionnaire responses were similar between groups 1 and 2, (mean age 62 vs. 61.3 p=0.73, IIEF-EF 8.25 vs. 7.30 p=0.20, and SQoL 37.8 vs. 39.8 p=0.27), though Group 1 reported higher quality erections at baseline (QEQ 14.59 vs. 7.36 p=0.02) and had a lower proportion of post-prostatectomy patients 56% vs. 72% (p=0.02). In both groups, quality of erections (QEQ) improved with treatment (mean 10.98 vs. 60.24, p<0.05), SQoL improved (38.77 vs. 50.60, p<0.05), and IIEF-EF improved (7.78 vs. 18.85, p<0.05). However, between groups at 3 and 6 months, there were no statistically significant differences in responses for IIEF, QEQ, SQoL or EDITS, and no difference in failure or medication switch rates. There were no significant differences in complication rates, though at 3 months group 2 reported a higher incidence of priapism and pain (23% vs. 7.4% p=0.08). Conclusions Both approaches resulted in significant improvements across multiple domains of sexual function. Complications rates, satisfaction and efficacy overall were similar between both approaches. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e533 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Robert Segal More articles by this author Brian Le More articles by this author Kristen Burns More articles by this author Arthur L. Burnett More articles by this author Trinity Bivalacqua More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Assessment of quality of life in people with severe and enduring anorexia nervosa: a comparison of generic and specific instruments

BackgroundCriticisms that generic measures of health-related quality of life (HRQoL) are not sensitive to impairment in anorexia nervosa (AN) has spurred the development of disease-specific measures. This study aimed to compare the psychometric properties of a generic to a disease-specific measure of HRQoL.Methods63 participants with AN completed measures of a generic HRQoL (SF-12), disease-specific HRQoL (Eating Disorders Quality of Life Questionnaire; EDQOL), functional impairment (days out of role; DOR; Work and Social Adjustment Scale; WSAS), and eating disorder severity (Eating Disorder Examination; EDE) at baseline, post-treatment, and 6- and 12-months follow-up. Cronbach’s α was computed for the SF-12 and EDQOL (internal consistency). Correlations were assessed between SF-12/EDQOL scores and DOR, WSAS, and EDE scores (convergence validity). Three sets of three multiple linear regressions were performed using SF-12 and EDQOL scores as predictors and change in DOR, WSAS, and EDE global scores from baseline to (i) post-treatment, (ii) 6-month follow-up, (iii) and 12-month follow-up as dependent variables (predictive validity and sensitivity).ResultsThe EDQOL displayed stronger internal consistency (α = 0.92) than the SF-12 (α = 0.80). The SF-12 converged more strongly with DOR and the WSAS (rp = −0.31 to −0.63 vs. 0.06 to 0.70), while the EDQOL converged more strongly with the EDE (rp = −0.01 to 0.48 vs. -0.01 to −0.37). The SF-12 demonstrated stronger predictive validity (β = −0.55 to 0.29) and sensitivity to changes in ED severity (β = −0.47 to 0.32).ConclusionsThe SF-12 is a valid and sensitive measure of HRQoL impairment in patients with AN. While the SF-12 may be preferred in research comparing EDs to other populations, and in research and practice as an indicator of functional impairment; the EDQOL may be preferred by clinicians and researchers interested in HRQoL impairment specifically associated with an ED and as an additional indicator of ED severity.

Assessment of quality of life in people with severe and enduring anorexia nervosa: a comparison of generic and specific instruments

Background: Criticisms that generic measures of health-related quality of life (HRQoL) are not sensitive to impairment in anorexia nervosa (AN) has spurred the development of disease-specific measures. This study aimed to compare the psychometric properties of a generic to a disease-specific measure of HRQoL. Methods: 63 participants with AN completed measures of a generic HRQoL (SF-12), disease-specific HRQoL (Eating Disorders Quality of Life Questionnaire; EDQOL), functional impairment (days out of role; DOR; Work and Social Adjustment Scale; WSAS), and eating disorder severity (Eating Disorder Examination; EDE) at baseline, post-treatment, and 6- and 12-months follow-up. Cronbach’s α was computed for the SF-12 and EDQOL (internal consistency). Correlations were assessed between SF-12/EDQOL scores and DOR, WSAS, and EDE scores (convergence validity). Three sets of three multiple linear regressions were performed using SF-12 and EDQOL scores as predictors and change in DOR, WSAS, and EDE global scores from baseline to (i) post-treatment, (ii) 6-month follow-up, (iii) and 12-month follow-up as dependent variables (predictive validity and sensitivity). Results: The EDQOL displayed stronger internal consistency (α = 0.92) than the SF-12 (α = 0.80). The SF-12 converged more strongly with DOR and the WSAS (rp = �0.31 to �0.63 vs. 0.06 to 0.70), while the EDQOL converged more strongly with the EDE (rp = �0.01 to 0.48 vs. -0.01 to �0.37). The SF-12 demonstrated stronger predictive validity (β = �0.55 to 0.29) and sensitivity to changes in ED severity (β = �0.47 to 0.32). Conclusions: The SF-12 is a valid and sensitive measure of HRQoL impairment in patients with AN. While the SF-12 may be preferred in research comparing EDs to other populations, and in research and practice as an indicator of functional impairment; the EDQOL may be preferred by clinicians and researchers interested in HRQoL impairment specifically associated with an ED and as an additional indicator of ED severity.

1511 MID-TERM FOLLOW-UP ON THE EFFECT OF LOW INTENSITY SHOCK WAVES FOR THE TREATMENT OF ERECTILE DYSFUNCTION

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Nonsurgical Therapy1 Apr 20131511 MID-TERM FOLLOW-UP ON THE EFFECT OF LOW INTENSITY SHOCK WAVES FOR THE TREATMENT OF ERECTILE DYSFUNCTION Ilan Gruenwald, Boaz Appel, Omar Massarwi, and Yoram Vardi Ilan GruenwaldIlan Gruenwald Haifa, Israel More articles by this author , Boaz AppelBoaz Appel Haifa, Israel More articles by this author , Omar MassarwiOmar Massarwi Haifa, Israel More articles by this author , and Yoram VardiYoram Vardi Haifa, Israel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2989AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Our aim was to evaluate the overall mid-term efficacy (6 months) of penile Low Intensity Shock Wave therapy (LI-ESWT) in patients who participated in different studies regardless of ED severity, response to PDE5i, and etiology of ED. METHODS During the past 30 months we have followed up and evaluated the efficacy of LI-ESWT on 191 ED patients (155 treated and 36 Sham). These subjects represent various degrees of ED severity and response to PDE5i therapy. All received the same treatment protocol but participated in different trials. Follow- up data were collected at the 6 month period after end of treatment and were compared to the patients' baseline scores before treatment. RESULTS Mean age was 59± 10.3 and Mean ED Duration was 65.1 months. 86.4% were cardiovascular patients, 61 (40%) were diabetic of which 50.81% had a significant clinical improvement. The mean baseline IIEF-EF domain scores were 11.0 (and mean baseline total IIEF scor was 34.48. Based on changes in IIEF-EF Domain scores, 57.4% of all males had a significant clinical mprovement 6 months after therapy. Categorizing them to severe, moderate and mild ED groups showed that 52%, 65% and 79% improved respectively according to the newly defined minimal clinical improvement criteria. Thirty two percent of the mild group reached normalization, while 24% and 15% of the moderate and severe group reached normalization respectively. CONCLUSIONS In this study we have demonstrated that applying LI-ESWT directly to the penis has a significant clinical effect for all ED severities, for cardiovascular and diabetic patients as well as for either responders or non- responders to PDE5i therapy. This study also showed that the clinical effect is maintained at least for a 6 month period. Further follow up on a larger scale of ED populations is necessary in order to fully evaluate the long term or permanent effect of this treatment modality. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e619 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ilan Gruenwald Haifa, Israel More articles by this author Boaz Appel Haifa, Israel More articles by this author Omar Massarwi Haifa, Israel More articles by this author Yoram Vardi Haifa, Israel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1976 EVALUATION OF REGION OF INTEREST (ROI) STRATEGIES FOR CHARACTERIZATION OF UPPER URINARY TRACT STONES DETECTED ON COMPUTERIZED TOMOGRAPHY

metric data from 135 patients submitted to HoLEP were analysed. All patients completed a remembered ( targeting sexual function regarding a period preceding HoLEP) International Index of Erectile Functionerectile function (IIEF-EF) domain; likewise, a real-time ( targeting the 4 weeks prior to surgery) IIEF (all domains) was filled. EF was stratified according to Cappelleri criteria. Both a remembered and a real-time International Prostate Symptom Score (IPSS) were also completed. Descriptive statistics and logistic regression models tested the association among potential clinical and surgical predictors and the eventual improvement of total IIEF-EF [also considering Minimal Clinically Important Differences (MCIDs) criteria]. RESULTS: Mean (median) age at surgery was 63 (63.6) years (range: 49-82). Post-HoLEP FU was 152.1 (163.9) months (range: 12-324). At long-term FU, mean (SD) IPSS score significantly improved [15.9 (8.7) vs 5.4 (5.6); p 0.0001]. At long-term FU, IIEF domain scores were as follows: IIEF-EF: 19.2 (23); IIEF-SD: 6.3 (7); IIEF-OF: 4 (5); IIEF-IS: 8.0 (9); IIEF-OS: 6.6 (8). IIEF-EF significantly changed [mean delta -3.9 (-1)] as compared with the preoperative assessment with 23 (17%) patients reporting an improved IIEF-EF. Preoperative EF was normal EF, mild ED, mild-to-moderate ED, moderate ED, and severe ED in 83 (61.5%), 12 (9.0%), 16 (12%), 8 (6%), and 16 (12%) patients, respectively. Conversely, postoperative ED severity was normal EF, mild ED, mild-to-moderate ED, moderate ED, and severe ED in 42.2%, 15.6%, 10.4%, 5.2%, and 26.7% patients, respectively. Of all, 37% patients worsened of at least one IIEF-EF category; conversely, 55.6% and 7.4% patients maintained and eventually improved their IIEF-EF domain category, respectively. Nine (6.7%) patients showed a significant improvement according to MCIDs criteria. At MVA, both preoperative IPSS (OR: 1.12; p 0.002) and IIEF-EF (OR: 0.92; p 0.005) scores were significantly associated with postoperative improvement of IIEF-EF. CONCLUSIONS: Long-term FU data showed that HoLEP significantly improved urinary symptoms in patients with symptomatic obstructive BPH, with a concomitant clinically significant EF improvement in roughly 7% of the individuals.

1975 LONG-TERM ERECTILE FUNCTION OUTCOMES AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP)

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (I)1 Apr 20131975 LONG-TERM ERECTILE FUNCTION OUTCOMES AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) Andrea Salonia, Matteo Ferrari, Umberto Capitanio, Maria Chiara Clementi, Giulia Castagna, Paolo Capogrosso, Michele Colicchia, Eugenio Ventimiglia, Cesare Regina, Fabio Castiglione, Alberto Briganti, Rocco Damiano, Patrizio Rigatti, and Francesco Montorsi Andrea SaloniaAndrea Salonia Milan, Italy More articles by this author , Matteo FerrariMatteo Ferrari Milan, Italy More articles by this author , Umberto CapitanioUmberto Capitanio Milan, Italy More articles by this author , Maria Chiara ClementiMaria Chiara Clementi Milan, Italy More articles by this author , Giulia CastagnaGiulia Castagna Milan, Italy More articles by this author , Paolo CapogrossoPaolo Capogrosso Milan, Italy More articles by this author , Michele ColicchiaMichele Colicchia Milan, Italy More articles by this author , Eugenio VentimigliaEugenio Ventimiglia Milan, Italy More articles by this author , Cesare ReginaCesare Regina Milan, Italy More articles by this author , Fabio CastiglioneFabio Castiglione Milan, Italy More articles by this author , Alberto BrigantiAlberto Briganti Milan, Italy More articles by this author , Rocco DamianoRocco Damiano Catanzaro, Italy More articles by this author , Patrizio RigattiPatrizio Rigatti Milan, Italy More articles by this author , and Francesco MontorsiFrancesco Montorsi Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2394AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess the rate of erectile function (EF) improvement at long-term follow-up (FU) in patients who underwent HoLEP for symptomatic obstructive benign prostatic hyperplasia (BPH). METHODS Complete sociodemographic, clinical and psychometric data from 135 patients submitted to HoLEP were analysed. All patients completed a remembered (=targeting sexual function regarding a period preceding HoLEP) International Index of Erectile Function-erectile function (IIEF-EF) domain; likewise, a real-time (=targeting the 4 weeks prior to surgery) IIEF (all domains) was filled. EF was stratified according to Cappelleri criteria. Both a remembered and a real-time International Prostate Symptom Score (IPSS) were also completed. Descriptive statistics and logistic regression models tested the association among potential clinical and surgical predictors and the eventual improvement of total IIEF-EF [also considering Minimal Clinically Important Differences (MCIDs) criteria]. RESULTS Mean (median) age at surgery was 63 (63.6) years (range: 49-82). Post-HoLEP FU was 152.1 (163.9) months (range: 12-324). At long-term FU, mean (SD) IPSS score significantly improved [15.9 (8.7) vs 5.4 (5.6); p<0.0001]. At long-term FU, IIEF domain scores were as follows: IIEF-EF: 19.2 (23); IIEF-SD: 6.3 (7); IIEF-OF: 4 (5); IIEF-IS: 8.0 (9); IIEF-OS: 6.6 (8). IIEF-EF significantly changed [mean delta -3.9 (-1)] as compared with the preoperative assessment with 23 (17%) patients reporting an improved IIEF-EF. Preoperative EF was normal EF, mild ED, mild-to-moderate ED, moderate ED, and severe ED in 83 (61.5%), 12 (9.0%), 16 (12%), 8 (6%), and 16 (12%) patients, respectively. Conversely, postoperative ED severity was normal EF, mild ED, mild-to-moderate ED, moderate ED, and severe ED in 42.2%, 15.6%, 10.4%, 5.2%, and 26.7% patients, respectively. Of all, 37% patients worsened of at least one IIEF-EF category; conversely, 55.6% and 7.4% patients maintained and eventually improved their IIEF-EF domain category, respectively. Nine (6.7%) patients showed a significant improvement according to MCIDs criteria. At MVA, both preoperative IPSS (OR: 1.12; p=0.002) and IIEF-EF (OR: 0.92; p=0.005) scores were significantly associated with postoperative improvement of IIEF-EF. CONCLUSIONS Long-term FU data showed that HoLEP significantly improved urinary symptoms in patients with symptomatic obstructive BPH, with a concomitant clinically significant EF improvement in roughly 7% of the individuals. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e810-e811 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrea Salonia Milan, Italy More articles by this author Matteo Ferrari Milan, Italy More articles by this author Umberto Capitanio Milan, Italy More articles by this author Maria Chiara Clementi Milan, Italy More articles by this author Giulia Castagna Milan, Italy More articles by this author Paolo Capogrosso Milan, Italy More articles by this author Michele Colicchia Milan, Italy More articles by this author Eugenio Ventimiglia Milan, Italy More articles by this author Cesare Regina Milan, Italy More articles by this author Fabio Castiglione Milan, Italy More articles by this author Alberto Briganti Milan, Italy More articles by this author Rocco Damiano Catanzaro, Italy More articles by this author Patrizio Rigatti Milan, Italy More articles by this author Francesco Montorsi Milan, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Retrospective analysis of the efficacy and safety of once-daily tadalafil in patient subgroups: men with mild vs moderate ED and aged &lt;50 vs ⩾50 years

The aim of this post-hoc pooled-data analysis was to evaluate the effects of once-daily tadalafil in men with mild or moderate ED and aged <50 or 50 years. Data from three randomized controlled trials were analyzed. Analysis of covariance models included a term for ED severity and age group. The three coprimary outcome measures in the base studies were changes from baseline to end point in the mean International Index of Erectile Function Erectile Function (IIEF-EF) domain score and the mean per-patient percentage successful vaginal penetration and intercourse attempts. Irrespective of baseline severity, once-daily tadalafil 5 mg for 12 weeks compared with placebo significantly increased the mean: (1) IIEF-EF by 6.8; (2) percent successful penetration attempts from 70.1 to 91.3%; and (3) percent successful intercourse attempts from 33.4 to 76.8% (each P<0.001). Treatment-by-age-group interaction P-values for all three coprimary efficacy end points exceeded 0.10, indicating that tadalafil treatment effects did not differ by age <50 vs 50 years. Tadalafil was generally well tolerated.

Endovascular embolisation therapy in men with erectile impotence due to veno-occlusive dysfunction

ObjectivesTo evaluate the impact of endovascular embolisation therapy in men with erectile impotence due to veno-occlusive dysfunction. MethodsWe retrospectively evaluated 29 patients with a history of erectile impotence due to veno-oclusive dysfunction confirmed by pharmacocavernosometry and cavernosography. All underwent endovascular embolisation therapy over transfemoral approach. After positioning the catheter system at the target level heights, embolisation with N-butyl-2-cyanoacrylate (Histoacryl®) was performed. Technical and clinical success as well as major and minor complications were evaluated. ResultsAll procedures were performed without any major or minor events. Complication rate was 0%. Technical success was achieved in 27/29 (93.1%). Two patients failed for anatomical reasons. Overall clinical success was achieved in 24/27 (88.8%) patients with recovering from E1 (poor tumescense/no rigidity) to E4 (good tumescence/intermediate rigidity) in 11/27 (40.7%), E1 to E5 in 8/27 (tumescence/normal rigidity) (29.6%) and E1 to E3 (good tumescence/poor rigidity) in 5/27 (18.5%) respectively. 3/27 (11.1%) received no change in ED severity score. ConclusionEndovascular embolisation therapy for veno-occlusive dysfunction in erectile impotence is a safe and effective therapeutic option with low complication rate and highly technical and clinical success rates.

Multidetector computed tomography predictors of late ventricular remodeling and function after acute myocardial infarction

BackgroundDespite advent of rapid arterial revascularization as 1st line treatment for acute myocardial infarction (AMI), incomplete restoral of flow at the microvascular level remains a problem and is associated with adverse prognosis, including pathological ventricular remodeling. We aimed to study the association between multidetector row computed tomography (MDCT) perfusion defects and ventricular remodeling post-AMI. MethodsIn a prospective study, 20 patients with ST-elevation AMI, treated by primary angioplasty, underwent arterial and late phase MDCT as well as radionuclide scans to study presence, size and severity of myocardial perfusion defects. Contrast echocardiography was performed at baseline and at 4 months follow-up to evaluate changes in myocardial function and remodeling. ResultsEarly defects (ED), late defects (LD) and late enhancement (LE) were detected in 15, 7 and 16 patients, respectively and radionuclide defects in 15 patients. The ED area (r=0.74), and LD area (r=0.72), and to a lesser extent LE area (r=0.62) correlated moderately well with SPECT summed rest score. By univariate analysis, follow-up end-systolic volume index and ejection fraction were both significantly related to ED and LD size and severity, but not to LE size or severity. By multivariate analysis, end-systolic volume index was best predicted by LD area (p<0.05) and ejection fraction by LD enhancement ratio. ConclusionsLD size and severity on MDCT are most closely associated with pathological ventricular remodeling after AMI and may thus play a role in early identification and treatment of this condition.