Charles Edison Riedner

Glycosylated haemoglobin levels and the severity of erectile function in diabetic men

To evaluate the association between the levels of glycosylated haemoglobin (HbA1c) and the severity of erectile dysfunction (ED) in men with diabetes mellitus (DM).

The Ratio of Serum Testosterone-to-Prostate Specific Antigen Predicts Prostate Cancer in Hypogonadal Men

PURPOSE We determined whether the ratio of serum testosterone to prostate specific antigen might provide diagnostic value regarding the risk of prostate cancer in a population of hypogonadal men undergoing prostate biopsy. MATERIALS AND METHODS The study population consisted of 184 consecutive men with symptomatic hypogonadism and prostate specific antigen 4.0 ng/ml or less who underwent prostate biopsy before the anticipated initiation of testosterone therapy. All men had testosterone 300 ng/dl or less. Testosterone concentrations were converted to ng/ml, eg 270 ng/dl equals 2.7 ng/ml, to calculate the testosterone-to-prostate specific antigen ratio. RESULTS Mean patient age was 58.5 years. There were 154 men with benign biopsies and 30 with cancer. Testosterone concentrations were similar in the prostate cancer and noncancer groups, although mean prostate specific antigen was higher in the prostate cancer group. The testosterone-to-prostate specific antigen ratio was inversely related to prostate cancer risk (OR 0.49, 95% CI 0.33-0.74). On multivariate analysis performed by logistic regression neither age nor prostate specific antigen was be predictive of prostate cancer. However, the testosterone-to-prostate specific antigen ratio remained strongly associated with prostate cancer risk. An ROC for the testosterone-to-prostate specific antigen ratio suggested that a ratio of below 1.8 was diagnostic for prostate cancer, while values below this threshold were associated with an OR of 3.17 (95% CI 1.17-8.59) for prostate cancer. CONCLUSIONS A low ratio of testosterone to prostate specific antigen is an independent predictor of prostate cancer in hypogonadal men with prostate specific antigen 4.0 ng/ml or less. Ratios less than 1.8 were associated with a greater than 3-fold increase in prostate cancer risk.

A cross-sectional study for the analysis of clinical, sexual and laboratory conditions associated to Peyronie's disease.

INTRODUCTION Although Peyronies Disease (PD) was first described over 250 years ago, its precise etiology remains obscure. AIM Analyze a variety of potential associated factors with PD, including erectile dysfunction. MATERIALS AND METHODS This cross-sectional study included 83 consecutive men with PD and 252 age-matched controls. All men completed the International Index of Erectile Function (IIEF) and were evaluated regarding their clinical and demographic characteristics, comorbidities, and used medications. Anthropometric measures included body mass index and waist circumference (WC). Fasting blood glucose, lipid profile, total testosterone, and dehydroepiandrosterone-sulfate were determined. MAIN OUTCOME MEASURES Clinical and laboratory characteristics associated to PD. RESULTS The mean age was 59.2 + or - 10 years in the cases and 59.7 + or - 12 years in the controls. Marital status, current smoking, and excessive consumption of alcoholic beverages were similar between groups (P > 0.05). PD was more common among white skin color males (P = 0.001). The mean score for each IIEF domain and the androgen levels were similar in the two groups. Thiazides were the only medication associated to PD (P = 0.03). Dupuytrens disease was more frequent among individuals with PD (P = 0.001). The distribution of all other comorbidities investigated was similar between groups (P > 0.05). The characteristics WC > 102 cm and levels of low-density lipoprotein (LDL) > 130 mg/dL were more prevalent in the controls (P < 0.05). After multivariate analysis, white skin color (OR: 8.47, 95%CI: 1.98-36.24) and thiazide use (OR: 2.29, 95%CI: 1.07-4.90) were associated to PD, and LDL > 130 mg/dL (OR: 0.55, 95%CI: 0.32-0.92) and WC > 102 cm (OR: 0.53, 95%CI: 0.29-0.96) were inversely associated to PD. CONCLUSIONS In this study, PD was more common among white skin colored males. An inverse relationship with the presence of elevated serum levels of LDL and WC was observed. We found no association with medications other than thiazides and comorbidities other than Dupuytrens disease. Androgen serum levels and sexual dysfunction had also no association to PD.

Erectile Dysfunction and Coronary Artery Disease: An Association of Higher Risk in Younger Men

INTRODUCTION The association between erectile dysfunction (ED) and coronary artery disease (CAD) has been described in various settings, but it is unclear if there is an independent interaction with age. AIM To investigate the interaction of age in the association between ED and CAD. METHODS This case-control study was conducted among 242 patients referred for elective coronary angiography. One hundred fourteen patients with significant CAD were identified as cases and 128 controls without significant CAD. ED was evaluated by the erectile function domain of the International Index of Erectile Function (IIEF) questionnaire, determined by a score ≤ 25 points. MAIN OUTCOME MEASURES Significant CAD was based on stenosis of 50% or greater in the diameter in at least one of the major epicardial vessels or their branches. The analysis was conducted in the whole sample and according to the age strata, controlling for the effects of cardiovascular risk factors, testosterone, and C-reactive protein. Results.  Patients had on average 58.3 ± 8.9 years. CAD and ED were associated exclusively in patients younger than 60 years (ED in 68.8% of patients with CAD vs. 46.7% of patients without CAD, P = 0.009). The association was independent of cardiovascular risk factors, testosterone and C-reactive protein (risk ratio 2.3, 95% confidence interval from 1.04 to 5.19). Severity of CAD was higher in patients younger than 60 years with ED. CONCLUSIONS Men with less than 60 years of age who report ED presented a higher risk of having chronic CAD and more severe disease diagnosed by coronary angiography.

Evaluation of the Association between Lower Urinary Tract Symptoms and Erectile Dysfunction, Considering its Multiple Risk Factors

AIM To investigate the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), while considering multiple risk factors for ED, including an anthropometric evaluation of central obesity. METHODS A cross-sectional study was carried out with 192 consecutive male subjects (>or=40 years old). Conditions clearly associated with ED, other than obesity and age, were considered exclusion criteria. Men were evaluated routinely for clinical history, received a physical examination, and were subjected to blood analysis for fasting serum glucose, lipid profile, and serum testosterone. Patients with previous known history of diabetes mellitus or hypertension were excluded. Anthropometric measures taken included body mass index (general obesity) and waist circumference, waist-hip index, and sagittal abdominal diameter (visceral obesity). Analyses were performed using bivariate and multivariate models (multiple logistic regression). Age, education, alcohol consumption, smoking, sedentary lifestyle, fasting blood glucose level, dyslipidemia, hypogonadism, general obesity, and visceral obesity were taken into account as potential confounding factors. MAIN OUTCOME MEASURES All men completed the International Index of Erectile Function and International Prostate Symptom Score (IPSS). RESULTS IPSS scores were low, intermediate, and high in 89 (46.4%), 76 (39.6%), and 27 (14.1%) men, respectively. Overall IPSS scores were significantly associated with ED (P = 0.002). In addition, an association between the severity of ED and LUTS was observed (P = 0.008). The mean quality of life assessment in the IPSS revealed a statistically significant difference between individuals with varying degrees of ED (P = 0.008). The logistic regression analyses showed that IPSS scores and ED remained independently associated even after the control for confounding factors (odds ratio = 1.07, 95% CI = 1.02-1.13, P = 0.01). CONCLUSION This study suggests that LUTS are independently associated with ED, taking into account various risk factors for ED, including visceral obesity.