José María Martínez-Jabaloyas

Prognostic Factors for Response to Sildenafil in Patients with Erectile Dysfunction

Objective: To assess the clinical efficacy of sildenafil as treatment for erectile dysfunction (ED) the factors associated with treatment failure were investigated. Methods: Open, prospective study including 244 patients suffering from ED who were evaluated by anamnesis, physical exploration, blood test, dynamic penile color duplex ultrasonography and Sexual Health Inventory for Male (SHIM). The efficacy of sildenafil was assessed by repeating the SHIM 2 months after therapy, independent of the final dose used. Side effects were also recorded. Factors influencing treatment outcome were evaluated by univariate and multivariate statistical analysis. Results: Overall, sildenafil was effective in 56.8% of 213 eligible patients. When the etiologic diagnosis was not included in the multivariate analysis, antecedents of diabetes mellitus, non–nerve–sparing radical prostatectomy and SHIM basal score were selected as predictors of a poor response. In a second analysis including etiologic diagnosis, only SHIM basal score and etiological diagnosis proved to be of prognostic value. Side effects were noticed by 24.4% of patients, none of them being severe. Conclusions: Sildenafil is a rather effective and well–tolerated treatment for ED. The basal severity of ED and etiological diagnosis are the prognostic factors most significantly associated with treatment outcome.

Prognostic value of DNA ploidy and nuclear morphometry in prostate cancer treated with androgen deprivation.

OBJECTIVESnTo assess the prognostic value of flow cytometry and nuclear morphometry in prostate cancer after androgen deprivation treatment.nnnMETHODSnA total of 127 patients with a prostate cancer diagnosis who had undergone androgen suppression were retrospectively studied. The DNA content by flow cytometry and nuclear morphometry was studied from biopsy specimens. In the patients with Stage M0, two multivariate analyses by the Cox proportional regression model were performed to determine whether the experimental variables (DNA content and nuclear area) added independent information to the classic prognostic factors (Gleason score and stage). Using the statistical analysis results, risk groups were created.nnnRESULTSnT and M categories, Gleason score, DNA ploidy, and mean nuclear area proved to have prognostic value in the univariate analysis. For the group of patients free of metastasis (M0), it was possible to create low, intermediate, and high-risk groups using stage and Gleason score with statistically significant differences in survival. Multivariate analysis, combining the classic and experimental variables, selected Gleason score and DNA content as prognostic independent factors. Also, risk groups with statistically significant differences in survival were created. However, the net result of combining both kinds of factors was at least as valuable as the combination of stage and Gleason score in predicting survival.nnnCONCLUSIONSnThe determination of DNA ploidy and mean nuclear area do not add enough independent information to improve the predictive value to justify their use in this group of patients treated with hormonal therapy.

Effect of Tadalafil Once Daily on Penile Length Loss and Morning Erections in Patients After Bilateral Nerve-sparing Radical Prostatectomy: Results From a Randomized Controlled Trial

OBJECTIVEnTo report penile integrity measures, including stretched penile length (SPL), from a randomized, double-blind, double-dummy, placebo-controlled trial evaluating treatment with tadalafil initiated after nerve-sparing radical prostatectomy (nsRP).nnnMETHODSnPatients aged ≤ 68 years were randomized after nsRP 1:1:1 to 9-month double-blind treatment (DBT) with tadalafil 5 mg once daily (OaD), 20-mg tadalafil on-demand (pro-re-nata; PRN), or placebo, followed by 6-week drug-free washout and 3-month open-label OaD treatment. Secondary outcome measures included the change in SPL from pre-nsRP to the end of DBT (analysis of covariance adjusting for treatment, country, baseline, age, and nerve-sparing score), responses to Sexual Encounter Profile (SEP) questions 1-3 (mixed models for repeated measures adjusting for treatment, country, visit, visit-treatment-interaction, age), and Standardized Morning Erection Question (Cochran-Mantel-Haenszel test adjusted for age and country).nnnRESULTSnFour hundred twenty-three patients were randomized to tadalafil OaD (N = 139), tadalafil PRN (N = 143), and placebo (N = 141). Greater retainment of SPL was observed with tadalafil OaD vs placebo at the end of DBT (least-square mean [95% confidence interval] difference OaD vs placebo, 4.1 mm [0.4 to 7.8 mm]; P = .032). No significant effects on SPL were found for tadalafil PRN vs placebo, or for the nerve-sparing score. Penile tumescence (SEP1) and ability for vaginal insertion (SEP2) significantly improved vs placebo at the end of double-blind and open-label treatment for patients randomized to tadalafil OaD only. The ability for successful sexual intercourse (SEP3) significantly improved with tadalafil OaD vs placebo only during DBT. The distribution of Standardized Morning Erection Question responses was different at the end of DBT (P = .045); 34.2% of patients on tadalafil OaD, 50.0% on tadalafil PRN, and 56.5% on placebo reported absence of morning erections.nnnCONCLUSIONnThese data suggest the early initiation of tadalafil OaD protects from penile length loss and may contribute to protection from structural cavernosal changes after nsRP.

Aneuploidies in embryos and spermatozoa from patients with Y chromosome microdeletions

In patients with Y chromosome microdeletions and high percentage of numeric chromosome abnormalities detected by fluorescence in situ hybridization on sperm, a high percentage of abnormal embryos was observed compared with oligozoospermic patients without Y chromosome microdeletions, with a significant increase in the percentage of embryos with monosomy X. Differences in fertilization rates between the different patient groups were not observed; however, blastocyst rates were significantly impaired in patients with Y chromosome microdeletions.

The influence of comorbidities on the aging males’ symptoms scale in patients with erectile dysfunction

Abstract Objectives: To investigate if certain common age-related comorbidities are related with a positive aging males’ symptoms (AMS) test outcome. Methods: This was a multicentric, transversal, observational study carried out in a male population with erectile dysfunction. Comorbidities and testosterone levels were registered. The relationship between comorbidities, testosterone levels, and the AMS test outcomes was studied using the global score and the sub-scale score components. Results: The study included 1112 patients. In the multivariate analysis the global score strongly correlated with TTu2009<u200912u2009nmol/L (odds ratio [OR]u2009=u20093.17; pu2009<u20090.05), psychiatric disorders (ORu2009=u20092.73), dyslipidemia (ORu2009=u20092.07) and diabetes mellitus (ORu2009=u20091.64); the somatic sub-component was related to obesity (ORu2009=u20098.62), dyslipidemia (ORu2009=u20092.2) and TTu2009<u200912u2009nmol/L (ORu2009=u20092.09); the psychogenic sub-component correlated with psychiatric disorders (ORu2009=u20093.73), stress (ORu2009=u20092.42), dyslipidemia (ORu2009=u20091.78) and TTu2009<u200912u2009nmol/L (ORu2009=u20091.77); and the sexual sub-component was associated with high blood pressure (ORu2009=u20092.94). Conclusion: Although the AMS test is related to low levels of testosterone, it is also of some limited use for diagnosing hypogonadism because it has low specificity and is influenced by pathologies that are frequent during ageing.

First report of the absence of viral load in testicular sperm samples obtained from men with hepatitis C and HIV after washing and their subsequent use.

Human immunodeficiency virus and hepatitis C infections are sexually transmitted diseases that require sperm samples to be pretreated to eliminate the viral presence before their safe use in assisted reproduction treatments. In this report we describe our experience with sperm washing protocols applied to sperm cells from testicular biopsies as well as the results obtained in subsequent assisted reproduction treatments on seropositive males that are also azoospermic.

Germ cell transplantation into mouse testes procedure

OBJECTIVEnTo illustrate the step-by-step protocol followed to assay germ cell transplantation into the seminiferous epithelium of mouse testes.nnnDESIGNnVideo presentation of an animal model for research in reproductive and regenerative medicine.nnnSETTINGnResearch laboratory.nnnANIMAL(S)nMale nude mice (NU-Foxn1(nu)).nnnINTERVENTION(S)nMice were chemically sterilized with alkylant compounds (busulfan) followed by gonadal microsurgery to inject donor germ cells.nnnMAIN OUTCOME MEASURE(S)nDonor cells should be labeled with reporter genes, such as green fluorescent protein (GFP), lactose operon (LacZ), or alternatively design an effective strategy with specific antibodies to track them within the recipient testes. Sperm detection in the ejaculate can also be used as a read out. However, in this case detection of the donor genotype in the sperm is mandatory to elucidate their origin.nnnRESULT(S)nIn the present study we describe the complete protocol for germ cell transplant by efferent duct injection, including the preparation of recipient mice, surgery for the germ cell transplant, and analysis of recipient testes. The main strength of this technique is that it constitutes the gold standard for a functional test of the germ cell potential as only spermatogonial stem cells are able to properly colonize the seminal lumen. Both fresh and frozen/thawed testicular cells are suitable for this technique as donor germ cells. Also, enrichment of living spermatogonial stem cells, previous to the transplant, seems to improve the efficiency of colonization. For proper colonization of germ cells, the niche should be available and thus mouse strains that lack endogenous spermatogenesis such as W/W(v) mutant mice are usually used. In the case of nonmatched donor cells, seminiferous epithelium of immune-suppressed recipient mice should be germ cell depleted before the transplant. One limitation of this technique is that the procedure can take up to 3xa0months. Also, in contrast to the full recovery of spermatogenesis in mouse-to-mouse transplants, xenotransplantation of germ cells from phylogenetically distant species, such as humans into mouse recipients, results in colonization of donor cells and spermatogonial expansion, but fail in their spermatogenic progression due to evolutive incompatibilities with the recipient niche. Xenografting of pieces of donor testis tissue under the skin of mouse hosts is an alternative approach that is currently being investigated to try to solve this limitation.nnnCONCLUSION(S)nTransplantation of spermatogonial stem cells into the seminal lumen of mouse testes is a functional assay that defines this cellular subpopulation by its ability to colonize it. This technique can be used as a model to elucidate the insights of spermatogonial stem cells, to produce transgenic animals by genetically manipulating donor cells before transplantation, but also it has potential applications in fertility preservation in cattle and humans as it is feasible in large animals, as recent reports have demonstrated with rhesus monkeys, that recovered spermatogenesis after allogenic transplantation, and even from human cadaver testes. Therefore spermatogonial stem cells isolated from prepuberal boys, who are treated with alkylant chemotherapy, could be returned to their testis to regenerate spermatogenesis in the future.

Is a retention time after the instillation of anesthetic lubricant necessary when performing male flexible cystoscopy

OBJECTIVEnFlexible cystoscopy is a common practice in urology. We wanted to determine whether a retention time of 5 minutes between the administration of a local anesthetic lubricant and flexible cystoscope insertion decreased the degree of discomfort or pain in the patient.nnnMATERIALS AND METHODSnMales who underwent flexible cystoscopy during 5 months were randomized in a prospective study. They were divided into two groups. In the first one, the Cathejell lubricant with lidocaine 12.5u2009g was administered and cystoscopy was performed immediately. In the second one, the same lubricant was maintained in the urethra for 5 minutes before the performance of cystoscopy. After scanning, all the patients were requested to indicate the degree of perceived pain on a visual pain scale from 0 to 10, with 0 being no discomfort and 10 being the maximum degree of pain bearable. As a secondary objective, the relationship of pain to age and to the type of cystoscopist (urologist/resident doctor) was studied. For statistical analysis, a Students t-test for independent samples and correlation analysis were used.nnnRESULTSnA total of 242 patients were studied, 110 in the immediate group and 132 in the 5-minute delay group, with samples being homogeneous for the age and type of cystoscopist. The mean in the pain scale in the immediate group was 2.41, and in the 5-minute delay group was 2.04, with no significant differences between them (p=0.175). There was no relationship with age (r=-0.061, p=0.348) or with the type of cystoscopist (2.06 of average pain in the associate group, 2.35 in the resident, p=0.28).nnnCONCLUSIONSnThere is no benefit in waiting a short time after the administration of intraurethral lubrication with a local anesthetic in flexible cystoscopy in men. There is also no relationship between the patient age or the type of cystoscopist (urologist/resident doctor) and perceived pain.

Holmium Laser Endoureterotomy With the Lovaco Technique for the Treatment of Ureterointestinal Stenosis: Tips and Tricks

OBJECTIVEnTo describe holmium laser endoureterotomy with the Lovaco technique for the treatment of ureterointestinal stenosis. This common problem after cystectomy represents a surgical challenge, with endourological techniques being useful in this context. We present a technique that has been described before, but which we consider useful and decisive. The key points and difficult aspects of the technique are shown, along with our experience with it.nnnMETHODSnWe collected data on cases of ureterointestinal stenosis treated using holmium laser endoureterotomy with the Lovaco technique, in a prospective manner, between January 2017 and January 2018. Intraoperative data, postoperative complications, and success rate were recorded. Cases, where there was an improvement of renal function, and the cause that led to surgery was resolved, were considered to be successful.nnnRESULTSnNine endoureterotomies were performed in 7 male patients (2 bilateral), all of them had an ileal conduit. The average age was 68 years, and the average surgery time was 75 minutes. There were no intraoperative complications in any surgery. One patient was readmitted to the hospital 48 hours after discharge, due to febrile urinary tract infection. Of the 7 patients, 1 died shortly after surgery due to a tumor, and another has a short follow-up time. Of the remaining 5 patients, we have considered surgery to have an 80% success rate. The minimum follow-up was 4 months, the maximum was 13 months.nnnCONCLUSIONnWe consider endoureterotomy with the Lovaco technique a useful and decisive surgery for the treatment of ureterointestinal stenosis, being a reproducible technique. In comparison to other similar techniques, it has advantages such as being safer and not requiring the use of flexible material. The use of holmium laser allows a precise incision and good visibility. Larger series and a longer follow-up are needed to obtain weighty conclusions.

Comparison of three different antibiotic protocols in transurethral resection of bladder tumour and the possible infectious risk factors: A non-randomized, prospective study

INTRODUCTIONnWe sought to investigate three different antibiotic protocols in transurethral resection of a bladder tumour (TURBT), and the possible infectious risk factors of this surgery.nnnMETHODSnWe conducted a non-randomized, prospective study, gathering cases of patients in whom TURBT had been performed. The sample was divided into three groups based on those who received antibiotics as: a single preoperative dose (Group A); a preoperative dose, plus a long protocol during the hospitalization (Group B); a preoperative dose, plus a long protocol during the hospitalization, plus five days at home (Group C). Intra- and postoperative data that could be relevant to infections was gathered.nnnRESULTSnA total of 219 patients were included. In the multivariate analysis, it was observed that the patients in Group A were more prone to re-hospitalization due to fever than were those from Group C (odds ratio [OR] 11.13; p=0.03). Furthermore, the cases with tumour necrosis and those who entered surgery with a urinary catheter were more prone to have a temperature above 37.5°C (OR6.74; p=0.02 and OR6.4; p=0.04, respectively), as well as have an increased risk per every additional tumour in the cystoscopy (OR 1.32; p=0.01). Those who received mitomycin had a lower chance of a positive urine culture (OR 0.29; p=0.01), contrary to those patients with over two days of hospitalization (OR 4.11; p<0.01) and those who entered surgery with a urinary catheter (OR 12.35; p=0.02).nnnCONCLUSIONSnThose patients that only received a single dose of antibiotic before TURBT may have an increased risk of re-hospitalization due to fever in comparison to those who received prolonged antibiotic protocols. In addition, there are perioperative factors in this surgery that predict the risk of infectious complications.