Ernani Luis Rhoden

TAMOXIFEN VERSUS PLACEBO IN THE TREATMENT OF PEYRONIE'S DISEASE

PURPOSEnWe evaluated the effects of oral tamoxifen and placebo in patients with Peyronies disease.nnnMATERIALS AND METHODSnWe selected 25 patients with Peyronies disease who did not have calcified plaque for treatment in the andrology outpatient clinic. A medical history was obtained, and physical examination, penile x-ray, penile ultrasound and pharmacologically induced erection with prostaglandin E1 were performed. Patients were randomly divided into group 1--those who received 20 mg. tamoxifen twice daily for 3 months and group 2--those who received placebo for the same period. The same evaluations were done 4 months later and results were compared. Qualitative (chi-square test) and quantitative (Students t test) results were analyzed using the Yates correction factor with p <0.05 considered significant.nnnRESULTSnPain subsided in 66.6 and 75% of the patients treated with tamoxifen and placebo, respectively (p >0.05). In groups 1 and 2 a reduction in the penile deformity was noticed by 46.1 and 41.7% of the patients (p >0.05), and a decrease in plaque size was noticed by 30.7 and 25%, respectively. On the other hand, objective measurements did not reveal any difference in plaque area or curvature angle.nnnCONCLUSIONSnThis study did not show significant improvement in pain, curvature or plaque size in patients with Peyronies disease who were treated with tamoxifen compared with those treated with placebo.

THE RELATIONSHIP OF SERUM TESTOSTERONE TO ERECTILE FUNCTION IN NORMAL AGING MEN

PURPOSEnWe evaluated the variation in serum testosterone in normal aging men and its relationship with erectile function.nnnMATERIALS AND METHODSnIn a study that was not community based and during a free screening program for prostate cancer 1,071 men were invited to complete a sexual activity questionnaire, that is the abridged 5-item version of the International Index of Erectile Function (IIEF-5), as a diagnostic tool for erectile dysfunction. Possible scores on the IIEF-5 are 1 to 25 and erectile dysfunction was classified into 5 categories based on the scores, namely severe-1 to 7, moderate-8 to 11, mild to moderate-12 to 16, mild-17 to 21 and none-22 to 25. Serum total testosterone was measured between 8:00 and 10:00 a.m. in all men.nnnRESULTSnOf the 1,071 men 965 (90.1%) were included in this study, of whom 88% were white and 12% were black. Mean age was 60.7 years. In this sample the prevalence of all degrees of erectile dysfunction was estimated to be 53.9%. The degree of erectile dysfunction was mild in 21.5% of cases, mild to moderate in 14.1%, moderate in 6.3% and severe in 11.9%. According to age the erectile dysfunction rate was 36.4% in the 40 to 49, 42.5% in the 50 to 59, 58.1% in the 60 to 69, 79.4% in the 70 to 79 and 100% in the 80 years and older groups (p <0.05). The variation in mean serum total testosterone in the age groups was not statistically significantly different (p >0.05). Pearson coefficients of age and total testosterone did not reveal any significant correlation (r = 0.00376, p = 0.907), similar to IIEF-5 score and total testosterone (r = 0.0163, p = 0.612). However, analysis of the variables IIEF-5 and age showed a statistically significant inverse or negative relationship (r = -0.3449, p <0.05).nnnCONCLUSIONSnErectile dysfunction showed a clear association with aging but no consistent correlation of total testosterone with erectile condition was identified.

Prevalence of Peyronie's disease in men over 50-y-old from southern Brazil

The pathogenesis of Peyronies disease still remains an enigma and few epidemiological studies are available. The purpose of this study was to determine the prevalence of Peyronies disease in males older than 50u2005y. From 26 to 30 July 1998, 1071 men attended the ‘Prostate Cancer Awareness Week of Santa Casa Hospital, Porto Alegre, Brazil’. In the prostate exam they also consented to be screened for Peyronies disease. They underwent the 5-item International Index of Erectile Function (IIEF-5) questionnaire for evaluation of the erectile condition. The presence of a well-defined plaque in the penis was the diagnostic criterion for Peyronies disease. The men were examined by five senior residents, under supervision by the staff Urologist. Men younger than 50u2005y as well as patients under intracavernous injection therapy for erectile dysfunction were excluded from the study. χ2 test was used for statistical analysis. Nine hundred and fifty-four (89.1%) out of the 1071 men with a mean age of 62u2005y (ranging from 52 to 77) were included in the study. Peyronies disease plaques were found in 35 men (3.67%). Eight hundred and forty-five (88.6%) were Caucasians. There was no significant statistical difference regarding age (P>0.05). The presence of erectile dysfunction in the men with Peyronies disease and without this condition, was 68.6% and 53.5%, respectively (P>0.05). From this data we can conclude that the prevalence of Peyronies disease is higher than in formerly reported studies. Further observations should be carried out in different communities and in other groups of patients in order to confirm our results.

THERAPEUTIC EFFECTS OF HIGH DOSE YOHIMBINE HYDROCHLORIDE ON ORGANIC ERECTILE DYSFUNCTION

PURPOSEnWe evaluated men with organic erectile dysfunction treated with placebo and high dose oral yohimbine hydrochloride.nnnMATERIALS AND METHODSnWe selected 22 patients with organic erectile dysfunction (mean age 58 years) for treatment in the andrology outpatient clinic. These patients had been previously undergone neurological, vascular, hormonal and psychological testing, and were treated during an equal period of 30 days with placebo and daily single dose oral 100 mg. yohimbine. The response to treatment was evaluated via a questionnaire that comprised the outcome items of complete--normal penile rigidity enabling vaginal penetration, partial--erection improved but not sufficiently for appropriate vaginal penetration, none--no improvement and worse--erection deteriorated. The patients consented to treatment after being told of the severe adverse effects that might occur.nnnRESULTSnThe most common side effects were anxiety, increase in cardiac frequency, increased urinary output and headache but in no case was treatment discontinued. Of the patients 3 (13.6%) and 12 (54.5%) reported complete or partial response to treatment, respectively. However, statistical analysis disclosed no significant difference when yohimbine was compared to placebo (p < 0.05).nnnCONCLUSIONSnOral 100 mg. single dose daily yohimbine promotes no improvement in patients with organic erectile dysfunction.

PENILE STRAIGHTENING WITH CRURAL GRAFT OF THE CORPUS CAVERNOSUM

PURPOSEnWe present a surgical alternative to penile straightening in Peyronies disease that avoids penile shortening by using tissue from the crural segment of the corpora cavernosa as a graft.nnnMATERIALS AND METHODSnWe treated 7 patients with stable Peyronies disease and satisfactory penile rigidity but significant curvature that precluded intercourse with this technique. An incision is made in the fibrous area and after stretching the gap is covered with a graft removed from the crural segment of the corpora cavernosa.nnnRESULTSnIn 6 of the 7 men straightening was satisfactory but in 1 it was not complete. No patient reported worse penile rigidity postoperatively. Donor site healing was uneventful.nnnCONCLUSIONSnUse of tissue from the corpus cavernosum to correct penile curvature is effective. However, our results are preliminary, and long-term effectiveness and safety must be confirmed in a larger number of cases.