Yi Kuang Chen

Population‐Based Estimates of Medical Comorbidities in Erectile Dysfunction in a Taiwanese Population

INTRODUCTION Erectile dysfunction (ED) is usually associated with systemic disorders. This population-based study supports and expands on previous research. It also presents data in a Taiwanese male population where existing data on this topic remain sparse. AIM The aim of this study is to analyze the prevalence and risk of 36 medical comorbidities in patients with ED compared with the general population. METHODS A total of 2,213 patients with ED and 11,065 matching controls were selected from the Taiwan National Health Insurance Research Dataset. We chose 22 comorbidities from the Elixhauser comorbidity index, 10 highly prevalent medical conditions in an Asian population, and four male gender-specific comorbidities for analysis. MAIN OUTCOME MEASUREMENT Conditional logistic regression analyses conditioned on age group and monthly income were performed to investigate the risk of various comorbidities for patients with and without ED, after adjusting for the geographic region and level of urbanization of the patients community. RESULTS Patients with ED were at an increased risk for multiple systemic comorbidities. Conditional regression analyses showed that patients with ED were at a higher risk for hypertrophy of the prostate (odds ratio [OR] = 12.87), chronic prostatitis (OR = 9.36), alcohol abuse (OR = 3.60), drug abuse (OR = 2.62), urinary incontinence (OR = 2.58), ankylosing spondylitis (OR = 2.19), peripheral vascular disorder (OR = 1.98), ischemic heart disease (OR = 1.94), psychoses (OR = 1.97), depression (OR = 1.88), uncomplicated diabetes (OR = 1.91), complicated diabetes (OR = 1.84), hepatitis B or C (OR = 1.71), hyperlipidemia (OR = 1.69), and chronic pulmonary disease (OR = 1.55) than patients without ED. CONCLUSION The results show that patients with ED have a higher prevalence of multiple noncardiovascular comorbidities than the general population in Taiwan.

Association Between Epilepsy and Erectile Dysfunction: Evidence from a Population‐Based Study

INTRODUCTION Although the association between epilepsy and sexual disorders has long been known, very few studies have attempted to explore the association between epilepsy and erectile dysfunction (ED). AIM This population-based case-control study aimed to investigate the association between ED and a prior diagnosis with epilepsy. METHODS This study used data from the Longitudinal Health Insurance Database 2000 in Taiwan. The cases comprised 6,427 patients with a diagnosis of ED and 32,135 controls who were frequency matched with cases based on 10-year age groups and index year. Conditional logistic regression was used to calculate the odds ratios (ORs) for prior epilepsy. MAIN OUTCOME MEASURE The prevalence and risk of epilepsy between cases and controls. RESULTS Of the sampled patients, 3,861 (14%) were diagnosed before the index date: 1,358 individuals (19.7%) were cases and 2,503 (12.1%) were controls. After adjusting for hypertension, diabetes, hyperlipidemia, renal disease, coronary heart disease, obesity, alcohol abuse/alcohol dependence syndrome, and socioeconomic status, conditional logistic regression analysis revealed that patients with ED were more likely to have been diagnosed with prior epilepsy than controls (OR = 1.83, 95% CI = 1.51-2.21). Compared with controls, the adjusted ORs for prior generalized epilepsy and partial epilepsy for cases were 2.13 (95% CI = 1.52-3.00) and 1.64 (95% CI = 1.31-2.06), respectively. The most pronounced associations were detected in ED cases aged between 30 and 39 who were 3.04 (95% CI = 1.67-5.50) times more likely than controls to have been previously diagnosed with epilepsy. CONCLUSIONS Our findings suggest a positive correlation between ED and a prior diagnosis with epilepsy.

Comorbidities of bladder pain syndrome/interstitial cystitis: a population-based study

Study Type – System prevalence (cohort)

Reflux esophagitis increased the risk of bladder pain syndrome/interstitial cystitis: A 3-year follow-up study

Reflux esophagitis (RE) is a common disease which has been recognized to be associated with several medical co‐morbidities. However, the association between RE and bladder pain syndrome/interstitial cystitis (BPS/IC) is still unknown. The present study aimed to explore the association between these two diseases.

Varicocele Is Associated with Erectile Dysfunction: A Population‐Based Case‐Control Study

INTRODUCTION While many studies have been conducted investigating the efficacy of varicocele treatment on fertility, the literature is comparatively sparse concerning the association between varicocele, varicocelectomy, and erectile dysfunction (ED). AIM This study aimed to estimate the associations between varicocele, varicocelectomy, and ED using a population-based dataset. METHODS This study used data from the Longitudinal Health Insurance Database 2000 in Taiwan. A total of 32,856 cases and 98,568 randomly selected controls were included in this study. Conditional logistic regression analyses were used to examine associations between ED and having been previously diagnosed with varicocele or having underwent a varicocelectomy. MAIN OUTCOME MEASURE The odds of prior varicocele or having underwent a varicocelectomy between cases and controls. RESULTS Of the sampled patients, the prevalence of prior varicocele was 3.3% and 1.2% for cases and controls, respectively (P < 0.001). Conditional logistic regression analysis suggested that the odds ratio (OR) of being previously diagnosed with varicocele for cases was 3.09 (95% confidence interval [CI] = 2.67-3.49) when compared with controls after adjusting for monthly income, geographic location, hypertension, diabetes, coronary heart disease, hyperlipidemia, hypogonadism, obesity, and alcohol abuse/alcohol dependence syndrome. Furthermore, cases were 1.92 (95% CI = 1.52-2.43) times more likely to have undergone a varicocelectomy than controls. Furthermore, subjects aged between 18 and 29 had the highest ORs for prior varicocele among cases when compared with controls (OR = 5.20; 95% CI = 3.27-8.28). CONCLUSION This investigation succeeded in identifying an association between both varicocele and ED. We also realized that varicocele patients who underwent a varicocelectomy had lower magnitudes of association with ED than those who did not.

Lymphoepithelioma-like carcinoma of the urinary bladder.

Lymphoepithelioma-like carcinomas (LELCAs) of the urinary bladder are rare. We report 2 such cases presenting with painless gross hematuria. The first case occurred in a 73-year-old man. Bladder sonography revealed a 2 x 3 cm well-defined tumor beneath the bladder mucosa. Radical cystoprostatectomy revealed lymphoepithelioma-like carcinoma with perivesical soft tissue invasion. Cisplatin-based chemotherapy was given. Computed tomography scan demonstrated no evidence of recurrence 26 months postoperatively. The second case occurred in a 63-year-old man. Cystoscopy revealed a solid tumor at the bladder dome. Transurethral resection of bladder tumor (TUR-BT) demonstrated lymphoepithelioma-like carcinoma with lamina propria invasion. Tumor cells were positive for cytokeratin but negative for leukocyte common antigen. The patient received adjuvant chemotherapy due to suspicious extravesical tumor spread and high-grade tumor characteristics. After tumor recurrence was identified, TUR-BT was performed again and the surgical specimen showed superficial high-grade LELCA. After bacillus Calmette-Guerin instillation, follow-up cystoscopy revealed no recurrence at 10 months postoperatively. Pure LELCA is morphologically different from transitional cell carcinoma and has a more favorable prognosis than high-grade, invasive bladder carcinoma if managed appropriately.

A population-based case-control analysis of the association between Herpes Zoster and Erectile Dysfunction

PURPOSE To date, the occurrence of erectile dysfunction (ED) associating with herpes zoster (HZ) is only based on limited case reports. This case-control study aimed at examining the association between HZ and ED using a population-based dataset in Taiwan. METHODS A total of 6429 adults newly diagnosed with ED were identified as cases, and 38,574 subjects without any medical history of ED were extracted as controls. Conditional logistic regression models were performed. RESULTS In total, 1.03% out of the sampled subjects had been diagnosed with HZ within one year prior to the index date; a higher proportion of prior HZ was found among cases than controls (2.04% vs. 0.86%, p < 0.001). After adjusting for demographic characteristics, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse/alcohol dependence syndrome, conditional logistic regression suggested that cases were more likely to have previously been diagnosed with HZ than controls (OR = 2.24, 95% CI = 1.82-2.75). Furthermore, the odds of having been diagnosed with an HZ infection within one year prior to the index date were dramatically higher among patients with ED than controls among subjects aged 18-29 (OR = 6.07). CONCLUSIONS We conclude that ED was associated with having been previously diagnosed with HZ, particularly among younger males.

Association between chronic kidney disease and urinary calculus by stone location: a population-based study.

Study Type – Disease prevalence study (cohort design)

Monthly variation in acute urinary retention incidence among patients with benign prostatic enlargement in Taiwan.

Acute urinary retention (AUR) is characterized by a sudden and painful inability to pass urine and is the most common urological emergency. However, according to our knowledge, no study to date has attempted to explore the monthly variation of AUR after adjusting for climatic parameters. This study aimed to examine the monthly variation of AUR due to benign prostatic enlargement (BPE) in Taiwan. The data used in this study were sourced from 2 datasets: the Longitudinal Health Insurance Database 2005 and a meteorological dataset supplied by the Taiwan Central Weather Bureau. We identified 1406 patients aged 40 years or more with a diagnosis of BPE that could all be followed throughout a 6-year study period (2003-2008). We used the autoregressive integrated moving average (ARIMA) method to examine the incidence of AUR for seasonality. The results show that January (midwinter) had the highest rates, decreasing in March to a trough in June (early summer). The incidence then increased again and reached a peak in December (early winter). The ARIMA test also revealed significant monthly variation in the incidence of AUR. In addition, the ARIMA regression revealed that January, February, August, October, November, and December had significantly higher monthly incidence rates of AUR compared with June, after adjusting for the time trend effect and climatic parameters. Our study concluded that significant monthly variation in the incidence of AUR occurred, and January (midwinter) had the highest rates.

A Case-Control Analysis on the Association Between Erectile Dysfunction and Sudden Sensorineural Hearing Loss in Taiwan

INTRODUCTION Although the cause of sudden sensorineural hearing loss (SSNHL) is yet to be elucidated, many theories have been proposed regarding potentially contributory etiologies. One increasingly well-supported theory purports an underlying vascular pathomechanism. If this is the case, SSNHL may also associate with conditions comorbid with vascular diseases, such as erectile dysfunction (ED). However, no studies to date have investigated the association between ED and SSNHL. AIM This study set out to estimate a putative association between ED and having been previously diagnosed with SSNHL using a population-based dataset with a case-control design. METHODS This study used administrative claim data from the Taiwan National Health Insurance program. We identified 4,504 patients with ED as the study group and randomly selected 22,520 patients as the comparison group. Conditional logistic regression was used to examine the association between ED and having previously received a diagnosis of SSNHL. MAIN OUTCOME MEASURE The prevalence and risk of SSNHL between cases and controls were calculated. RESULTS Of the sampled patients, 41 (0.15%) had been diagnosed with SSNHL before the index date; 22 (0.49% of the cases) were from the study group and 19 (0.08% of controls) were from the control group. Conditional logistic regression analysis revealed that after adjusting for the patients monthly income, geographic location, hypertension, diabetes, hyperlipidemia, coronary heart disease, obesity, and alcohol abuse/alcohol dependence syndrome status, patients with ED were more likely than controls to have been diagnosed with SSNHL before the index date (odds ratio = 6.06, 95% confidence interval = 3.25-11.29). CONCLUSIONS There was an association between ED and prior SSNHL. The results of this study add to the evidence supporting an underlying vascular pathomechanism regarding the development of SSNHL and highlight a need for clinicians dealing with SSNHL patients to be alert to the development of ED.