Francesco Chierigo

Age at First Presentation for Erectile Dysfunction: Analysis of Changes over a 12-yr Period

BACKGROUNDnThe awareness regarding erectile dysfunction (ED) may have increased over the past decade due to the widespread availability of phosphodiesterase type 5 inhibitors and the growing knowledge of a link between ED and mens overall health.nnnOBJECTIVEnWe examined whether the increased awareness of ED has led to observable changes in patient characteristics among first-time assessments for ED.nnnDESIGN, SETTING, AND PARTICIPANTSnData was collected from 1586 men seeking their first medical attention for ED at a single academic center during 2005-2017.nnnINTERVENTIONnPatients completed the International Index of Erectile Function (IIEF) to assess ED.nnnOUTCOME MEASUREMENTS AND STATISTICAL ANALYSISnLocal polynomial regression models explored the relationship between patient characteristics and the year of first-time assessment. Linear and logistic regression models estimated the association between the time at first assessment and the investigated outcomes. Restricted cubic splines tested the nonlinearity for continuous variables.nnnRESULTS AND LIMITATIONSnWe observed a nonlinear correlation between age and year of assessment (p=0.0003); the probability that a patient aged <40 yr presented for ED increased from 13.5% in 2006 to 21.7% in 2017 (p=0.002). Patients assessed over the last period were significantly healthier (Charlson Comorbidity Index≥1; odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92-0.99, p=0.02). We observed an increase in the rate of smokers (OR: 1.19, 95% CI: 1.14-1.23, p<0.0001) and in regularly physically active men (OR: 1.05; 95% CI: 1.01-1.08, p=0.008) over the same period. No changes were observed in terms of baseline IIEF-Erectile function scores over time. The single center design is the main limitation of the study.nnnCONCLUSIONSnAge at first presentation for ED significantly decreased over the past decade. Physicians should carefully assess EF even at younger age groups, suggesting lifestyle modifications and relevant treatments for comorbid conditions as soon as possible.nnnPATIENT SUMMARYnPatients presenting for erectile dysfunction (ED) are younger than they were 10 yr ago. These findings may suggest an increase in ED awareness. Likewise, this age reduction could represent a worrisome increase in terms of ED incidence in young men.

Temporal Trend in Incidental Prostate Cancer Detection at Surgery for Benign Prostatic Hyperplasia

OBJECTIVEnTo assess changes in the rate of incidental prostate cancer (PCa) after benign prostatic hyperplasia (BPH) surgery over the last decade.nnnMATERIALS AND METHODSnWe identified 1177 patients surgically treated for BPH (open prostatectomy, transurethral resection or holmium laser enucleation [HoLEP] of the prostate) in 2007-2016 at a single European academic center. Local polynomial regression was used to explore changes in the rate of incidental PCa detected after BPH surgery and of preoperative biopsy performed over time. Logistic regression analyses tested the association of incidental PCa diagnosis with year of surgery and preoperative biopsy.nnnRESULTSnIncidental PCa was found in 6.4% (74) of cases, 67 (91%) with Grade group 1 disease. We observed an increased incidence of PCa diagnosis after BPH surgery over time (odds ratio [OR]: 1.12; 95%confidence interval [CI]: 1.02-1.24, Pu202f=u202f.02) along with a concomitant decrease in the rate of preoperative prostate biopsies (OR: 0.83; 95%CI: 0.79-0.88, P < .0001). Patients undergoing a preoperative biopsy showed a lower risk of being diagnosed with PCa after surgery (OR: 0.29; 95% CI: 0.12, 0.72 Pu202f=u202f.007). Patients treated with HoLEP had a higher chance of incidental PCa detection (OR: 2.28; 95%CI: 1.30-4.00; Pu202f=u202f.004), although this may be related to the significantly higher number of HoLEP performed over the last years.nnnCONCLUSIONnThe increased rate of low-risk PCa detected after BPH surgery in the last decade reflects the clinical practice changes in PCa screening and diagnosis leading to a reduced number of unnecessary biopsies and indolent cancer diagnosis.

MP60-13 WHEN TO PERFORM SEMEN CULTURE IN ASYMPTOMATIC INFERTILE MEN? HINTS FROM A CROSS SECTIONAL STUDY

staining was higher in the O þ A group (52.4 3.0%) than in the Normo group (31.2 2.5%). There were not relationships beween alteration of CP staining and age or semen volume. However, some semen parameters such as sperm concentration, total sperm count, abnormal morphology and motility were related to alteration of CP staining. Even by confining the observations to morphologically normal spermatozoa, the percentage of abnormal staining was still higher in the O þ A group (39.9 2.9%) versus the Normo group (22.5 2.1%) (P < 0.001). CONCLUSIONS: Human CPb3 is expressed in testis, changes its localization dynamically during spermatogenesis. The altered expression of hCPa3 and hCPb3 may not only be a cause of male infertility but also a prognostic factor for the results of ART. They may be useful biomarkers to determine the fertilization ability of human sperm in ART.

Unrecognized Prediabetes Is Highly Prevalent in Men With Erectile Dysfunction–Results From a Cross-Sectional Study

INTRODUCTIONnThe association between prediabetes (PreDM) and erectile dysfunction (ED) has been analyzed scantly.nnnAIMnTo assess the association between PreDM and erectile function (EF) in a cohort of white European men with ED.nnnMETHODSnDemographic, clinical, and laboratory data from 372 consecutive men were analyzed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients were invited to complete the International Index of Erectile Function (IIEF)-EF domain questionnaire. The EF domain was categorized according to Cappelleris criteria. Men were defined as having PreDM according to the criteria defined by the American Diabetes Association (2015). Descriptive statistics and logistic regression models tested the association between clinical variables and PreDM status and severe ED.nnnMAIN OUTCOME MEASURESnWe assessed the prevalence of PreDM in our cohort of men with ED and the potential association of PreDM and sexual health within the same cohort.nnnRESULTSnOf 372 men,xa0+PreDM was found in 86 (23.1%) patients. Men withxa0+PreDM had lower total testosterone (tT), higher triglycerides, and higher total cholesterol values (all P < .03) than those without PreDM. Likewise,xa0+PreDM patients had a higher rate of CCI ≥1 (Pxa0= .03) and more frequently had severe ED (Pxa0= .013) compared with -PreDM. Age (OR 1.03; Pxa0= .01); lower tT (OR 0.81; Pxa0= .02); and severe ED (OR 3.37; Pxa0= .004) were associated withxa0+PreDM status, after accounting for BMI, CCI, alcohol consumption, and cigarette smoking. Similarly, age (OR 1.02; Pxa0= .02) andxa0+PreDM (OR 2.02; Pxa0= .02) were associated with severe ED, after accounting for other clinical variables.nnnCLINICAL IMPLICATIONSnIdentifyingxa0+PreDM status in ED men is clinically relevant in order to adopt preventive strategies to attempt and reduce risk of developing DM and subsequent cardiovascular diseases.nnnSTRENGTHS & LIMITATIONSnTo our knowledge, this is the first study evaluating the prevalence of unrecognized PreDM and the association of PreDM and ED severity in a real-life setting. Limitations are the retrospective nature of the cross-sectional study and the lack of haemodynamic parameters for every patient.nnnCONCLUSIONSn1 in 5 men seeking medical help for new-onset ED showed glucose values suggestive for unrecognized PreDM andxa0+PreDM status was associated with worse hormonal and metabolic profiles, along with a higher risk of severe ED thanxa0-PreDM. Boeri L, Capogrosso P, Perderzoli F, etxa0al. Unrecognized prediabetes is highly prevalent in men with erectile dysfunction-results from a cross-sectional study. J Sex Med 2018;15:1117-1124.

Multiple PDE5Is use as a marker of decreased overall men’s health: A real-life study

Erectile dysfunction (ED) is considered a sentinel marker for poor general men’s health status. Severe ED has been associated with poor response to phosphodiesterase type 5 inhibitors (PDE5Is) therapy. We sought to assess the association of multiple PDE5Is prescription with the overall patients’ health status. Socio-demographic and clinical variables from 939 consecutive white–European, heterosexual, sexually-active men seeking medical help for ED at same tertiary-referral academic outpatient clinic were analyzed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients have been stratified into naïve and non-naïve according to their history of previous prescriptions of any PDE5I. Every patient completed the International Index of Erectile Function (IIEF) questionnaire. Logistic regression models tested the association between patients’ baseline characteristics (thus including previous PDE5Is prescriptions) and the overall health status. Overall, 328 (35%) patients were non-naïve for PDE5Is. Of them, 172 (52%), 99 (30%), and 57 (17%) had been prescribed with 1, 2 or 3 different PDE5Is, respectively. Naïve and non-naïve patients did not differ in terms of age, BMI, baseline ED severity; conversely, non-naïve patients had a higher CCI score. At logistic MVA, the number of PDE5Is prescriptions emerged as an independent predictor of a higher burden of comorbidities regardless of ED severity; the higher the number of PDE5Is prescriptions, the higher the CCI score (OR 1.69, 2.49, and 2.90 for 1, 2 or 3 previous PDE5Is, respectively), after accounting for age, BMI, baseline ED severity and cigarette smoking. More than a third of patients seeking medical help for ED at a single tertiary-referral center were non-naïve for PDE5Is. The increasing number of previous prescriptions of PDE5Is emerged as a worrisome marker of a poorer overall men’s health status regardless of ED severity.

The role of neutrophil-to-lymphocyte ratio in men with erectile dysfunction-preliminary findings of a real-life cross-sectional study

The aim of this study was to investigate the role of systemic inflammation by means of the neutrophil‐to‐lymphocyte ratio (NLR) in men with erectile dysfunction (ED). Complete demographic, clinical, and laboratory data from 279 consecutive men with newly diagnosed ED were analyzed. Health‐significant comorbidities were scored with the Charlson Comorbidity Index (CCI). A complete blood count was requested for every man, and the NLR was calculated for every individual. Patients were invited to complete the IIEF questionnaire. Logistic regression models tested the odds (OR, 95% CI) of severe ED (defined as IIEF‐EF <11, according to Cappelleris criteria) after adjusting for age, BMI, comorbidities (CCI >0), metabolic syndrome, NLR, cigarette smoking, and color duplex Doppler ultrasound parameters. Likewise, LNR values were also dichotomized according to the most informative cutoff predicting severe ED using the minimum p value approach. Median [IQR] age of included men was 51 [40–64] years. Of all, 87 (31%) men had severe ED. Men with severe ED were older (median [IQR] age: 61 [47–67] vs. 49 [39–58] years) and had a higher rate of CCI>0 [46/87 (53%) vs. 44/192 (23%) patients]. Thereof, NLR was dichotomized according to the most informative cutoff (NLR>3); patients with severe ED more frequently had NLR>3 as compared to all other ED patients [namely, 18/87 (21%) vs. 13/192 (7%)]. At multivariable logistic regression analysis, NLR>3.0 emerged as an independent predictor (OR [CI] 2.43 [1.06; 5.63]) of severe ED, after accounting for other clinical variables. A NLR>3 increased the risk of having severe ED in our cohort, boosting the already existing evidence linking systemic inflammation to ED. Moreover, this easily obtainable index can be clinically useful in better risk‐stratifying patients with ED.

Clinical Profile of Young Patients with Erectile Dysfunction: Preliminary Findings of a Real-life Cross-sectional Study

BACKGROUNDnErectile dysfunction (ED) is an increasingly common complaint among men aged <40 yr.nnnOBJECTIVEnTo assess clinical factors potentially associated with impaired erectile function (EF) in a cohort of young men seeking first medical help for ED as their primary complaint.nnnDESIGN, SETTING, AND PARTICIPANTSnComplete sociodemographic and clinical data for 307 consecutive patients aged <40 yr were analysed. Health-significant comorbidities were scored using the Charlson comorbidity index. Patients completed the International Index of Erectile Function (IIEF) and Becks Inventory for Depression (BDI) and were categorised into two groups: those with impaired EF (IIEF-EF <26) and those with normal IIEF-EF scores.nnnOUTCOME MEASUREMENTS AND STATISTICAL ANALYSISnDescriptive statistics and logistic regression analyses were used to test the association between risk factors and impaired EF.nnnRESULTS AND LIMITATIONSnOverall, 78 patients (25%) had normal and 229 (75%) had impaired IIEF-EF scores. Among ED patients, 90 (29%) had IIEF-EF scores suggestive of severe ED. The two cohorts did not differ in terms of median age, body mass index, prevalence of hypertension, general health status, smoking history, or alcohol use. No differences were reported for serum sex hormones and lipid profiles. Patients with ED reported higher median BDI scores (7, interquartile range [IQR] 3-13) than those with normal EF (5, IQR 1-9). Overall, the higher the BDI score, the lower was the IIEF-EF domain score (odds ratio 1.08, 95% confidence interval 1.02-1.15; p=0.01). The single-centre cohort is the main study limitation.nnnCONCLUSIONSnOverall, young men with impaired EF showed comparable clinical characteristics to those with normal IIEF-EF; conversely, young individuals with worse EF had BDI scores suggestive of significant mood deflection.nnnPATIENT SUMMARYnYoung men complaining of erectile dysfunction show significant mood deflection in comparison to patients with normal erectile function. Conversely, the clinical characteristics are similar between the two groups.

Attitude towards active surveillance: a cross-sectional survey among patients with uroandrological disorders

Objectives We looked at subjective attitude towards active surveillance (AS) as the first option for cancer management in a cohort of patients seeking first medical help for uroandrological disorders prior to a formal discussion with a caregiver. Design Cross-sectional observational study. Setting Uroandrological outpatient clinic of a European academic centre. Participants Data of 1059 patients at their first access for uroandrological purposes from January 2014 to December 2016 were analysed. Intervention Patients were invited to complete a survey with closed questions investigating their attitude towards AS, prior to any clinical evaluation. Likewise, patients were invited to score the importance given to different aspects of personal life in the case of a cancer diagnosis, using a 10-point Likert scale. Primary and secondary outcomes measures The reported opinion towards AS management for cancer was assessed. Logistic regression analyses tested participants’ sociodemographic characteristics associated with a positive opinion on AS. Results Positive, negative and doubtful attitudes towards AS were observed in 347 (33%), 331 (31%) and 381 (36%) patients, respectively. Female patients were more likely to report a negative attitude towards AS (38.7% vs 29.6%, p=0.04) while patients with previous parenthood more frequently reported a positive opinion on AS (37.2% vs 29.9%, p=0.005). Patient age emerged as the only predictor of a positive attitude towards AS (OR 1.03; 95%u2009CI 1.01 to 1.04, p<0.001), with a 46% and 33% probability of being pro-AS for a patient aged 65 and 45 years, respectively. Conclusions One out of three patients would express positive feedbacks on AS in the unfortunate case of tumour diagnosis, only according to his/her baseline personal opinion and prior to any discussion with a cancer caregiver. The older the patient, the higher the probability of being compliant with a conservative management for cancer.

Undiagnosed prediabetes is highly prevalent in primary infertile men - results from a cross-sectional study

To study the prevalence and the risk associated with prediabetes (PreDM) in primary infertile men.