A.A.B. Lycklama à Nijeholt

Erectile dysfunction in primary care: prevalence and patient characteristics. The ENIGMA study

The availability of adequate treatment for erectile dysfunction (ED) triggers studies into the prevalence of ED in the general population. Yet, previous studies showed different prevalence estimates partly due to differences in patient selection, in (unclear) definitions of ED and in assessment. ENIGMA has been designed to study the prevalence of ED in the general population of The Netherlands, using the WHO definition with a description of the way of assessment. In all, 5721 mail surveys were sent to all men, aged 18 y and older in 12 general practices in The Netherlands. A total of 5601 were included in the study and 2117 (38%) were completed. A total of 38% of the men reported to have ever had some kind of erectile problem. The prevalence of ED was 17% (6% mild, 4% moderate and 7% complete). Age, diabetes, cardiovascular diseases, penile disorders, irradiation in the pelvic region, relational problems, fear for failure, surmenage, medication use and regular consumption of alcohol were independently related to ED. Men with ED were less content with their (sexual) life and had less confidence in sexual performance. Presence of ED was negatively related to affected happiness in life. ED is commonly found in men and is related to age, medication, comorbidity and lifestyle factors. Men with ED perceive a lower quality of (sex)life. Doctors should be aware of the presence of ED and its consequences in patients.

Skin Necrosis Caused by Use of Negative Pressure Device for Erectile Impotence

We report a case of skin necrosis as a result of the use of a negative pressure device for erectile dysfunction. To our knowledge this is the first report of such a complication. The patient was paraplegic with hypesthesia and analgesia of the genital area.

Mast Cell Infiltration in Intestine Used for Bladder Augmentation in Interstitial Cystitis

Two patients with histologically confirmed interstitial cystitis underwent bladder augmentation procedures (clam cystoplasty and Mainz pouch cystoplasty) because of therapy resistant low abdominal pain and decreased functional bladder capacity. However, symptoms of low abdominal pain and urinary retention (1 patient) persisted, and cystectomy was performed in both patients after 14 and 20 months, respectively. Histological examination of the specimens showed changes in the intestinal areas of the augmented bladder, resembling interstitial cystitis. The etiology of this phenomenon and the possible role of intestinal interstitial cystitis in augmentation failures are discussed.

The negative pressure device for erectile disorders : when does it fail ?

Of 74 men with erectile dysfunction who used a vacuum device at home only 20 were satisfied with the erections achieved. The device was offered only to men who had not been helped by sexual counseling, self-injection therapy or venous surgery, and to 8 patients who had had problems with a penile implant. Fibrosis reduces the chances of success with the vacuum device, and only 2 of 14 such patients used it successfully. In all 9 patients with psychogenic impotence the device failed. Although 9 men did achieve erections with the device, they disliked it so much that they did not begin regular use. Our disappointing overall result was probably due to negative patient selection.

Impact of various questionnaires on the prevalence of erectile dysfunction. The ENIGMA-study

The prevalence estimates of erectile dysfunction (ED) vary considerably across studies. These differences may be attributed to used definitions of ED. Quantitative data on the effect of different definitions of ED on the prevalence are lacking, because precise information on the used definition and questionnaire is often absent. Aim of this study was to quantify the effect of using different questionnaires for ED on the prevalence estimates. In all, 5721 mail surveys on sexual problems and ED were sent to all men (aged>18 y) in 12 general practices in the middle of the Netherlands of which 2117 were completed. The questionnaire contained Enigma (WHO), International Index of Erectile Function (IIEF), Cologne Erectile Inventory (KEED) and one question (Boxmeer, Krimpen). The prevalence of ED based on the various questionnaires and the effect of these questionnaires on risk factor relationships was compared. IIEF gave the highest age specific and overall ED prevalence, KEED the lowest. The difference in prevalence was 16.8%. The agreement (kappa coefficient) between the various ED definitions varied from 0.52 (IIEF & KEED) to 0.95 (Enigma & Boxmeer). The number of risk factor relations were similar for the Dutch studies, reduced for the IIEF and KEED. This study provides evidence that differences in questionnaires to assess ED have a considerable effect on the (age specific) prevalence estimates and little on the risk factor relations. The number of questions of the survey appears not to be responsible for differences in the prevalence of ED and risk factor relations, however they affect the response rate. Uniform use is strongly recommended, since a ‘golden standard’ for ED assessment (by questionnaire) is lacking. A short questionnaire with one or two questions is recommended for example the one from the Boxmeer-study. These data may be used to adjust (age-specific) prevalence rates comparing ED prevalence in the open population across studies.

Urethral instability: current pathophysiological concept.

The role of urethral pressure variations during filling cystometry is seldom assessed as a potential cause of voiding dysfunction and/or storage disorders. In this article, we review current research in the field of urethral pressure variations and discuss the way of determining urethral pressure variations, its value for the clinical practice and hypothesize the origin of urethral pressure variations. The observation and recognition of urethral pressure variations (urethral instability) could be valuable in the diagnosis and evaluation of therapy in functional lower urinary tract disorders.

Female Sexual Abuse Evaluation in the Urological Practice: Results of a Dutch Survey

INTRODUCTION There is a strong association between urological complaints and a history of sexual abuse, especially in females. It is not known whether urologists integrate these facts in their daily practice. AIM To evaluate whether Dutch urologists address the issues of sexual abuse in their female patients and to evaluate their perception of sexual abuse prevalences. METHODS A five-item anonymous questionnaire was mailed to all 405 registered members of the Dutch Urology Association (urologists and residents). MAIN OUTCOME MEASURES The results of the survey. RESULTS One hundred eighty-six surveys of eligible respondents were returned (45.9% response rate). A total of 68.8% stated that they always ask their female patients about sexual abuse before doing the physical examination. Overall, 79.3% said to do so when a patient has certain urological complaints: 77.6% in case of lower abdominal pain, 62.1% in urgency or frequency, 41.4% in incontinence, 29.3% in urinary tract infections, and 3.4% in hematuria. The majority of the respondents (74.3%) estimated the frequency of sexual abuse in their urological clinic to be equal or less than 10%. CONCLUSION Nearly 70% of the responding Dutch urologists and residents ask their female patients about possible sexual abuse. They estimate the frequency of sexual abuse in their female patients to be equal or less than 10%.

The value of fine-needle aspiration biopsy in prostatic carcinoma, in comparison with core biopsy histology

SummaryPatients in whom an abnormal rectal examination leads to the suspicion of prostatic carcinoma underwent both fine-needle aspiration biopsy for cytological evaluation and core biopsy for histological evaluation. The data from 826 paired observations, collected over a 7-year period are compared. The material available was inadequate for cytology in 94 cases (11.4%) and for histology in 18 cases (2.2%). Cytology results were classified as positive (Papanicolaou 4–5) or negative (1–3) for carcinoma, and histology results as indicative of malignancy or no proven malignancy. Initially the cytology results correlated with the histology results in 84.4%, with a sensitivity of 89.7% and a specificity of 81.5%. After revision of all discrepant slides these figures increased to 88.6%, 92.8% and 86.4%, respectively. Clinical or histological follow up of patients with discrepant results was conclusive in 36 patients, giving evidence of malignancy in 24 patients and of benign pathology in 12. In this “discrepancy” group, comparison of both cytological and histological results with these clinical data gave a sensitivity for cytology of 63% as against 37% for histology, and a specificity for cytology of 17%, as against 83% for histology. It is concluded that fine-needle aspiration biopsy cytology is a reliable, simple and sensitive technique that can be used to confirm a suspicion of prostatic carcinoma.

Results of repeated cavernography in ten patients without good clinical late results after partial resection of the deep dorsal penile vein

SummaryTen patients with impotence due to venous leakage who had undergone resection of the deep dorsal penile vein (DDPV) without showing a good clinical late response underwent a second pharmacocavernometry/ graphy. In two patients we could no longer demonstrate leakage, and in three others we found a decrease in leakage. Eight times we observed persistent leakage through the remaining proximal part of the DDPV. In two patients we succeeded in restoring erectile potency by occluding the remaining proximal part of the DDPV with detachable balloons. Our findings suggest that better results can probably be obtained when the proximal part of the DDPV is occluded as well.

Renal Oncocytoma: A Report of Two Cases With Immunohistochemical Evaluation

Two cases of renal oncocytoma are characterized by histologic electron microscopic, and immunohistochemical evaluation. In one case there was a coexistent renal cell carcinoma. The immunophenotype of the oncocytes provide evidence for an origin from the distal nephron. The results indicate that immunohistochemical methods can be helpful in discriminating renal oncocytoma from (granular type) renal cell carcinoma.