Francesco Montorsi

Is erectile dysfunction a reliable proxy of general male health status? The case for the International Index of Erectile Function-Erectile Function domain.

INTRODUCTIONnErectile dysfunction (ED) has emerged progressively as a sentinel marker of cardiovascular disease (CVD). The correlation between ED and the burden arising from multiple comorbid conditions has been incompletely analyzed.nnnAIMnAssess whether erectile function, defined with the International Index of Erectile Function-Erectile Function (IIEF-EF) domain score, is associated with health-significant comorbidities scored with the Charlson comorbidity index (CCI).nnnMETHODSnClinical and hemodynamic variables of the last 140 consecutive patients who underwent penile color Doppler ultrasonography for new-onset ED were considered. Patients were assessed with a thorough medical and sexual history. Health-significant comorbidities were scored with the CCI.nnnMAIN OUTCOME MEASUREnDescriptive statistics and either linear or logistic regression models tested the association among IIEF-EF, hemodynamic parameters, and CCI, which was included in the model both as continuous and categorized variable (0 vs. ≥1).nnnRESULTSnComplete data were available for 138 patients (98.6%) (mean age 46.6 years [standard deviation 13.0]; range 21-75 years). CCI was 0, 1, and ≥2 in 94 (68.1%), 23 (16.7%), and 21 (15.25%) patients, respectively. Of all, 35 patients (79.5%) did not have a CVD comorbidity. Mean IIEF-EF was 13.7 (9.3). ED severity was no ED, mild, mild to moderate, moderate, and severe in 12 (9.1%), 28 (20.2%), 12 (9.1%), 23 (16.2%), and 63 (45.5%) patients, respectively. At multivariable linear regression analysis, CCI significantly worsened with increased age (β=0.33; P=0.001) and decreased IIEF-EF values (β=-0.25; P=0.01). At logistic regression analysis, age (odds ratio [OR]: 1.05; P=0.004) and IIEF-EF (OR: 0.95; P=0.04) emerged as significant predictors of categorized CCI.nnnCONCLUSIONSnSeverity of ED, as objectively interpreted with IIEF-EF, accounts for a higher CCI, which may be considered a reliable proxy of a lower general male health status regardless of the etiology of ED.

One Patient Out of Four with Newly Diagnosed Erectile Dysfunction Is a Young Man—Worrisome Picture from the Everyday Clinical Practice

INTRODUCTIONnErectile dysfunction (ED) is a common complaint in men over 40 years of age, and prevalence rates increase throughout the aging period. Prevalence and risk factors of ED among young men have been scantly analyzed.nnnAIMnAssessing sociodemographic and clinical characteristics of young men (defined as ≤ 40 years) seeking first medical help for new onset ED as their primary sexual disorder.nnnMETHODSnComplete sociodemographic and clinical data from 439 consecutive patients were analyzed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF).nnnMAIN OUTCOME MEASUREnDescriptive statistics tested sociodemographic and clinical differences between ED patients ≤ 40 years and >40 years.nnnRESULTSnNew onset ED as the primary disorder was found in 114 (26%) men ≤ 40 years (mean [standard deviation [SD]] age: 32.4 [6.0]; range: 17-40 years). Patients ≤ 40 years had a lower rate of comorbid conditions (CCI = 0 in 90.4% vs. 58.3%; χ(2) , 39.12; P < 0.001), a lower mean body mass index value (P = 0.005), and a higher mean circulating total testosterone level (P = 0.005) as compared with those >40 years. Younger ED patients more frequently showed habit of cigarette smoking and use of illicit drug, as compared with older men (all P ≤ 0.02). Premature ejaculation was more comorbid in younger men, whereas Peyronies disease was prevalent in the older group (all P = 0.03). At IIEF, severe ED rates were found in 48.8% younger men and 40% older men, respectively (P > 0.05). Similarly, rates of mild, mild-to-moderate, and moderate ED were not significantly different between the two groups.nnnCONCLUSIONSnThis exploratory analysis showed that one in four patients seeking first medical help for new onset ED was younger than 40 years. Almost half of the young men suffered from severe ED, with comparable rates in older patients. Overall, younger men differed from older individuals in terms of both clinical and sociodemographic parameters.

Orgasmic Dysfunction After Robot-assisted Versus Open Radical Prostatectomy.

UNLABELLEDnSeveral alterations of orgasmic function that occur after radical prostatectomy (RP) have never been assessed in robot-assisted RP (RARP) series. We sought to assess the prevalence and predictors of recovery from orgasm-associated incontinence (climacturia) and painful orgasm (PO) after RARP and open RP (ORP). Following surgery, sexually active patients who had undergone either RARP or ORP prospectively completed a 28-item questionnaire including sensitive issues regarding sexual function (eg, climacturia and PO). Rates of postoperative climacturia and PO were compared for RARP and ORP patients. Kaplan-Meier analysis was applied to assess estimated rates of recovery from either climacturia or PO after both procedures. Cox regression models tested predictors of recovery from those conditions. Overall, 221 (29.5%) of 749 patients reported climacturia, without differences between RARP and ORP. Conversely, PO was significantly more frequently reported after ORP than after RARP (46 [11.6%] vs 25 [7.1%] patients, respectively; p=0.04). At Kaplan-Meier analysis, recovery from climacturia over time was faster and greater after RARP than after ORP (8.5% vs 5%, respectively, at 24-mo assessment and 48% vs 15%, respectively, at 84-mo assessment; p<0.01). Conversely, no differences were found between groups in terms of postoperative recovery from PO. At multivariable analysis, only RARP achieved independent predictor status for recovery from climacturia after adjusting for other functional outcomes. Conversely, no variables were significantly associated with recovery from postoperative PO.nnnPATIENT SUMMARYnOrgasmic modifications such as climacturia and painful orgasm (PO) are frequently reported after radical prostatectomy. Robotic surgery was associated with a lower rate of postoperative PO and with greater and faster recovery from climacturia.

Secondary Provoked Vestibulodynia in Sexually Active Women with Uncomplicated Recurrent Urinary Tract Infections

INTRODUCTIONnUncomplicated recurrent urinary tract infections (rUTIs) associated with uropathogenic Escherichia coli (UPEC) are common among healthy, reproductive-aged women. Provoked vestibulodynia (PVD) is a major reason of sexual pain in premenopausal women.nnnAIMnThe aim of this paper is to assess prevalence and predictors of secondary PVD in a cohort of Caucasian-European, heterosexual, sexually active, reproductive-aged women seeking medical help for rUTIs as their primary complaint.nnnMETHODSnClinical and psychometric variables for 60 consecutive patients with rUTIs were considered. Patients were assessed with a thorough medical and sexual history, a number of psychometric instruments, and a specific physical examination. Urinalysis and self-collected urine cultures from the previous 12 months were also examined.nnnMAIN OUTCOME MEASUREnDescriptive statistics and logistic regression models were used to test the associations between secondary PVD and sociodemographic and clinical variables.nnnRESULTSnMean age was 34.2 years (median 33 years; range 21-42). Secondary PVD was found in 36 of 60 patients (60%). Women with PVD had a higher prevalence of urinary tract infections (UTIs) over the previous 12 months (χ(2) : 4.54; Pu2009=u20090.03) and suffered more frequently from UPEC-related rUTIs (χ(2) : 5.92; Pu2009=u20090.01) than those without PVD. Moreover, women with PVD showed significantly lower scores on Female Sexual Function Index domains (all Pu2009≤u20090.01), as compared with PVD-negative women. UPEC-related rUTIs (odds ratio [OR]: 3.1; Pu2009=u20090.01), six or more UTIs over the previous 12 months (OR: 2.8; Pu2009=u20090.01), and treatment with three or more antibiotics throughout the same period (OR: 2.1; Pu2009=u20090.04) emerged as independent predictors of PVD.nnnCONCLUSIONSnThree of five Caucasian-European, heterosexual, sexually active women of reproductive age complaining of rUTIs as their primary disorder also suffer from secondary PVD. Uncomplicated UPEC-related rUTIs are more frequently associated with secondary PVD than are UTIs caused by different uropathogens.

Postprostatectomy Erectile Dysfunction: A Review

In the current era of the early diagnosis of prostate cancer (PCa) and the development of minimally invasive surgical techniques, erectile dysfunction (ED) represents an important issue, with up to 68% of patients who undergo radical prostatectomy (RP) complaining of postoperative erectile function (EF) impairment. In this context, it is crucial to comprehensively consider all factors possibly associated with the prevention of post-RP ED throughout the entire clinical management of PCa patients. A careful assessment of both oncological and functional baseline characteristics should be carried out for each patient preoperatively. Baseline EF, together with age and the overall burden of comorbidities, has been strongly associated with the chance of post-RP EF recovery. With this goal in mind, internationally validated psychometric instruments are preferable for ensuring proper baseline EF evaluations, and questionnaires should be administered at the proper time before surgery. Careful preoperative counselling is also required, both to respect the patients wishes and to avoid false expectations regarding eventual recovery of baseline EF. The advent of robotic surgery has led to improvements in the knowledge of prostate surgical anatomy, as reflected by the formal redefinition of nerve-sparing techniques. Overall, comparative studies have shown significantly better EF outcomes for robotic RP than for open techniques, although data from prospective trials have not always been consistent. Preclinical data and several prospective randomized trials have demonstrated the value of treating patients with oral phosphodiesterase 5 inhibitors (PDE5is) after surgery, with the concomitant potential benefit of early re-oxygenation of the erectile tissue, which appears to be crucial for avoiding the eventual penile structural changes that are associated with postoperative neuropraxia and ultimately result in severe ED. For patients who do not properly respond to PDE5is, proper counselling regarding intracavernous treatment should be considered, along with the further possibility of surgical treatment for ED involving the implantation of a penile prosthesis.

Unsuccessful Investigation of Preoperative Sexual Health Issues in the Prostate Cancer Couple : Results of a Real-Life Psychometric Survey at a Major Tertiary Academic Center

INTRODUCTIONnInvestigating preoperative sexual function of patients with prostate cancer (PCa) and their partners is needed for realistic functional outcome analyses after radical prostatectomy (RP).nnnAIMnTo assess pre-RP sexual health issues of PCa patients and their partners in a stable heterosexual relationship.nnnMETHODSnData were analyzed from 3,282 consecutive patients who underwent RP over a three-period survey. During Period 1, on admission to the hospital the day prior to surgery, 1,360 patients were asked to complete the International Index of Erectile Function (IIEF). During Period 2, 1,171 patients were asked to complete the preoperative IIEF; similarly, patients partners were invited to complete the Female Sexual Function Index (FSFI). Lastly, during Period 3, only candidates for RP were asked to fill in the IIEF.nnnMAIN OUTCOME MEASURESnTo assess the rate of patients who completed the questionnaire during the three-period survey. To detail the proportion of patients partners who filled in the questionnaire, along with the partners reasons for non-adherence to the proposed investigation during Period 2.nnnRESULTSnA small rate of men completed the IIEF during Period 1 (583 in 1,360 [42.9%]), Period 2 (290 in 1,171 [24.8%]), and Period 3 (261 in 751 [34.8%]) (chi(2) trend: 13.06; P = 0.0003). In this context, a significantly lower proportion of patients completed the questionnaire during Period 2, as compared with both Period 1 (chi(2): 95.13; P = 0.0001) and Period 3 (chi(2): 21.87; P < 0.0001). Only 82 in 1,171 (7.0%) partners completed the FSFI over Period 2. Moreover, only 6 in 82 (7.3%) of women provided complete data.nnnCONCLUSIONSnThe investigation of sexual health issues of both partners prior to RP is largely unsuccessful. In this context, the prevalence of incomplete data collection is high, and these results demonstrate that contemporaneously investigating the sexual health issues of both partners significantly increases the prevalence of incomplete data collection.

Peyronie's Disease and Autoimmunity—A Real-Life Clinical Study and Comprehensive Review

INTRODUCTIONnAlthough heavily investigated over the last decades, Peyronies disease (PD) pathogenesis remains unclear.nnnAIMnWe sought to investigate the association between PD and autoimmune diseases (ADs) in men seeking medical help for sexual dysfunction in the real-life setting.nnnMETHODSnComplete sociodemographic and clinical data from a homogenous cohort of 1,140 consecutive Caucasian-European men were analyzed. Health-significant comorbidities were scored with the Charlson Comorbidity Index and ADs were stratified according to International Classification of Diseases, Ninth Revision classification.nnnMAIN OUTCOME MEASURESnDescriptive statistics and multivariate logistic regression models tested the association between ADs and PD.nnnRESULTSnPD was diagnosed in 148 (13%) of the 1,140 men; of PD patients, 14 (9.5%) had a comorbid AD; conversely, the rate of ADs in non-PD patients was significantly lower (χ(2)u2009=u200924.7; Pu2009<u20090.01). Both patient age and AD comorbidity achieved multivariable independent predictor status for PD (odds ratio [OR]: 1.05; Pu2009<u20090.01 and OR: 4.90; Pu2009<u20090.01, respectively).nnnCONCLUSIONSnOur observational findings showed that ADs are highly comorbid with PD in a large cohort of same-race individuals seeking medical help for sexual dysfunction in the real-life setting.

Awareness and knowledge of human papillomavirus‑related diseases are still dramatically insufficient in the era of high‑coverage vaccination programs

AbstractPurposenAssess knowledge and awareness concerning human papillomavirus (HPV) infection, HPV-associated diseases, and the existence of a specific vaccine among non-HPV-screened Caucasian-European adults after the market introduction of HPV vaccines.MethodsA cohort of 934 consecutive patients seeking their first medical help for uroandrologic purposes anonymously completed a 17-item questionnaire related to HPV. Data were compared with those of an age-comparable cohort of nurses (controls; nxa0=xa0172).ResultsKnowledge and awareness of HPV infection were reported in 564 (51xa0%) and 735 (66.5xa0%) participants, respectively. Overall, 51.3xa0% participants were informed that HPV is sexually transmitted, but most reported not being aware that HPV infection can be associated with anogenital warts (61.7xa0%), female genitalia (46.6xa0%), penile (58.5xa0%), and oropharyngeal cancer (79.7xa0%). Only 36.5xa0% of the participants were informed regarding the existence of a specific vaccine. HPV knowledge was retrieved through the media and/or the Internet, at school, doctors, and relatives or friends in 395 (35.7xa0%), 155 (14xa0%), 97 (8.8xa0%), and 88 (8.0xa0%) participants, respectively. Multivariable analyses showed that female gender [odds ratio (OR) 3.08; pxa0<xa00.001; 95xa0% confidence interval 2.18–4.35] and educational status [high school diploma versus primary–secondary (OR 1.61; pxa0=xa00.03; 1.04–2.51); university degree versus primary–secondary (OR 2.89; pxa0<xa00.001; 1.83–4.57)] were significantly associated with awareness of HPV.ConclusionsOnly approximately half of the participants reported knowing what HPV infection is, even after the approval and market introduction of the HPV vaccine. Awareness about the existence and availability of a HPV vaccine was even lower.

Prevalence and predictors of concomitant low sexual desire/interest and new-onset erectile dysfunction – a picture from the everyday clinical practice

Prevalence and risk factors of concomitant primary low sexual desire/interest (LSD/I) and subsequent new‐onset erectile dysfunction (ED) in men have been only partially investigated. We looked at the sociodemographic and clinical predictors of the concomitant condition of primary LSD/I – defined as the reduction in the usual level of SD/I which precedes ED or another sexual dysfunction – and new‐onset ED (LSD/I + ED) in a cohort of consecutive Caucasian‐European patients seeking their first medical help for sexual dysfunction at a single outpatient clinic in the everyday clinical practice setting. Data from 439 sexually active patients were analysed. Health‐significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients LSD/I were evaluated according to the findings of a comprehensive sexual history. Moreover, patients completed the International Index of Erectile Function (IIEF). Descriptive statistics and logistic regression models tested the prevalence and predictors of LSD/I + ED as compared with ED only. Of the 439 men, LSD/I + ED was observed in 33 (4.2%) individuals. One of three men with LSD/I + ED was younger than 40 years. Patients complaining of LSD/I + ED or ED alone did not differ in terms of hormonal milieu. No significant differences emerged between groups in terms of sexual orientation, rates of stable sexual relationships, educational status, recreational habits and comorbid sexual dysfunctions. Patients with LSD/I + ED had significantly lower IIEF‐sexual desire and IIEF‐overall satisfaction scores than ED‐only individuals (all p ≤ 0.003). At multivariable analysis younger age and severe CCI scores emerged as independent predictors of LSD/I + ED (all p ≤ 0.04). These findings showed that primary LSD/I is concomitant with new‐onset ED in less than 5% of men seeking first medical help. Younger age and severe CCI emerged as independent predictors of LSD/I + ED. Patients with both conditions reported an impaired overall sexual satisfaction.

Erectile dysfunction in young patients is a proxy of overall men's health status.

Purpose of review This article summarizes current findings supporting the role of erectile dysfunction as a proxy of general health status, with a focus on the young population. Recent findings Erectile dysfunction has been historically associated to increased cardiovascular risk and mortality. Several studies supported the role of erectile dysfunction as a predictive factor of subsequent cardiovascular events, acquiring significant importance even in young men. Similarly, erectile dysfunction emerged as a potential marker for metabolic alterations including diabetes mellitus and metabolic syndrome, eventually presenting as the initial manifestation of a dysmetabolic condition in young patients. Moreover, current epidemiologic data demonstrated a significant association of erectile dysfunction with several conditions including vascular, respiratory, gastrointestinal disorders, and endocrine with chronic-sustained inflammation representing the common pathophysiological link between erectile dysfunction and comorbidities. Interestingly, longitudinal studies demonstrated a higher risk of overall mortality in patients complaining of erectile dysfunction, even irrespective of cardiovascular risk. Summary Erectile dysfunction does not represent an uncommon condition among young men. Considering the amount of data demonstrating a strong correlation between several life-risky comorbidities and erectile dysfunction, a careful and comprehensive general health assessment of patients complaining of erectile dysfunction should be carried out, regardless of patients age. The identification of erectile dysfunction as an early sign of a major comorbidity would allow the implementation of therapeutic measures aimed at improving the overall health status and life expectancy across the entire aging process.