Valter Javaroni

Erectile dysfunction and hypertension: impact on cardiovascular risk and treatment.

Erectile dysfunction (ED) is a common complaint in hypertensive men and can represent a systemic vascular disease, an adverse effect of antihypertensive medication or a frequent concern that may impair drug compliance. ED has been considered an early marker of cardiovascular disease. The connection between both conditions seems to be located in the endothelium, which may become unable to generate the necessary dilatation in penile vascular bed in response to sexual excitement, producing persistent impairment in erection. On the other hand, the real influence of antihypertensive drugs in erectile function still deserves discussion. Therefore, regardless of ED mechanism in hypertension, early diagnosis and correct approach of sexual life represent an important step of cardiovascular evaluation which certainly contributes for a better choice of hypertension treatment, preventing some complications and restoring the quality of life.

PROXIMAL INSERTION OF GUBERNACULUM TESTIS IN NORMAL HUMAN FETUSES AND IN BOYS WITH CRYPTORCHIDISM

PURPOSE We determine how the proximal gubernaculum testis is attached to the testis and epididymis in human fetuses, and compare these data with findings in boys who had undergone surgery for cryptorchidism. MATERIALS AND METHODS We analyzed 280 testes and epididymides with the gubernacula of 140 well preserved, fresh human fetuses ranging from 10 to 35 weeks after conception with no detectable congenital malformations and 36 undescended testes of 28 boys 2 to 15 years old (mean age 6.8) who had undergone surgery for cryptorchidism. In both groups the different conformations of the relationship among the proximal gubernaculum, testis and epididymis were classified according to a system used for patients with cryptorchidism. In group A the gubernaculum is attached to the testis and epididymis, in group B the gubernaculum is attached only to the testis with a tail disjunction epididymal anomaly, in group C the gubernaculum is attached only to the testis with total disjunction of the epididymis, in group D the gubernaculum is attached only to the epididymal tail and in group E there are no attachments among gubernaculum, testis and epididymis. RESULTS Of the 280 fetal testes studied 194 (69.2%) were in the abdomen, 38 (13. 57%) in the inguinal canal and 48 (17.14%) in the scrotum. There were 277 cases (98.9%) in group A and 3 (1.1%) in group B. Of the 36 undescended testes analyzed 2 (5.6%) were abdominal and 34 (94.4%) were inguinal. There were 26 cases (72.2%) in group A, 8 (22.2%) in group B and 2 in group D. CONCLUSIONS In fetuses without congenital malformations or epididymal alterations, such as tail disjunction or elongated epididymis, the proximal portion of the gubernaculum was attached to the testis and epididymis in all cases. In undescended testes there was an increased incidence of paratesticular structure malformations accompanied by gubernacular attachment anomalies compared to the testes in normal fetuses.

Brachial Flow-mediated Dilation Correlates With Vardenafil Response in Hypertensive Men With Vasculogenic Erectile Dysfunction

OBJECTIVES To investigate whether vasculogenic erectile dysfunction (ED) severity and the clinical response to vardenafil were associated with structural and functional vascular changes in patients with uncomplicated hypertension. METHODS Sexually active hypertensive men (n = 100), aged 50-70 years, completed the International Index of Erectile Function, Erection Function Domain (IIEF-EF) and were divided into 2 groups: 74 men with mild to moderate, moderate, or severe ED (IIEF-EF score ≤18) and without major cardiovascular disease and 26 controls (IIEF-EF score ≥25). Clinical and laboratory evaluations were performed, followed by measurement of the carotid intima-media thickness (IMT) and brachial flow-mediated dilation (FMD) before 4 attempts with 20 mg of vardenafil. The responders had ≥50% positive answers on sexual encounter profile question 3. RESULTS The carotid IMT was significantly greater and the FMD was significantly lower in patients with ED than in the control patients. The baseline IIEF-EF score correlated negatively with the carotid IMT (r = -0.48, P < .001) and with the Framingham score (r = -0.41, P < .001) among those with ED. After multivariate logistic regression analysis, the baseline IIEF score was independently and only associated with the carotid IMT (β = 6.105, P = .019). Responders were younger, had a lower cardiovascular risk profile and carotid IMT, and greater baseline IIEF-EF score and FMD than did the nonresponders. On logistic regression analysis, the response to vardenafil was independently associated with the brachial FMD (β = 1.085, P = .002). CONCLUSIONS In hypertensive men with vasculogenic ED and no other clinical evidence of arteriosclerosis, the ED severity correlated with the carotid IMT, and phosphodiesterase-5 effectiveness correlated with brachial FMD.