Erectile dysfunction in hyperuricemia: A prevalence meta‐analysis and meta‐regression study

AbstractBackgroundWhether and to what extent an association exists between hyperuricemia and erectile dysfunction (ED) has not yet been fully determined.ObjectiveTo define pooled prevalence estimates and correlates of erectile dysfunction in men with hyperuricemic disorders.Materials and methodsA thorough search of Medline, Scopus, and Cochrane Library databases was performed. Data were combined using random‐effects models and the between‐study heterogeneity was assessed by Cochrane's Q and I2 tests. A funnel plot was used to assess publication bias.ResultsOverall, 8 studies included gave information about 85,406 hyperuricemic men, of whom 5023 complained of erectile dysfunction, resulting in a pooled erectile dysfunction prevalence estimate of 33% (95% Confidence Interval: 13–52%; I² = 99.9%). The funnel plot suggested the presence of a publication bias. At the meta‐regression analyses, among the available covariates that could affect estimates, only type 2 diabetes mellitus was significantly associated with a higher prevalence of erectile dysfunction (β = 0.08; 95% Confidence Interval: 0.01, 0.15, p = 0.025). At the sub‐group analysis, the pooled erectile dysfunction prevalence decreased to 4% (95% Confidence Interval: 0%–8%) when only the largest studies with the lowest prevalence of type 2 diabetes mellitus were included and increased up to 50% (95% Confidence Interval: 17%–84%) when the analysis was restricted to studies enrolling smaller series with higher prevalence of type 2 diabetes mellitus.ConclusionsA not negligible proportion of men with hyperuricemia can complain of erectile dysfunction. While a pathogenetic contribution of circulating uric acid in endothelial dysfunction cannot be ruled out, the evidence of a stronger association between hyperuricemia and erectile dysfunction in type 2 diabetes mellitus points to hyperuricemia as a marker of systemic dysmetabolic disorders adversely affecting erectile function

Female Sexual Dysfunctions and Urogynecological Disorders

Female sexual dysfunctions are a highly prevalent and often-underestimated health problem and include disorders of sexual desire, arousal, orgasm and sexual pain, associated with self-distress. Pathophysiology of female sexual dysfunctions is complex and still poorly understood, although it has been related to several biological, medical and psychological factors. Amongst women, urogynecological disorders such as urinary incontinence, overactive bladder syndrome, bladder pain syndrome and pelvic organ prolapse, have been found to be associated with sexual dysfunctions, although the biological and psychological bases of these associations are poorly investigated. Data on sexual function impact of these conditions come from several cross-sectional or community-based, epidemiological studies based on self-administered validated psychometric tools. This review focuses on the most relevant available evidence on the impact of urogynecological disorders and related surgical treatments on female sexual function

Discovery history and clinical development of mirabegron for the treatment of overactive bladder and urinary incontinence

Overactive bladder (OAB) and urinary incontinence, although not life-threatening, are very bothersome chronic health conditions. The limitations of current pharmacological treatment urge the need for novel drugs with alternative mechanisms of action. Huge efforts in this area of research led to the synthesis of several selective and potent \u3b23-adrenoceptor agonists that gained relevance through research during the late 80s and 90s. Mirabegron was the first compound of this new class of drugs that showed preclinical efficacy in several models of storage bladder dysfunction, together with a favorable human pharmacological profile. Having passed the proof-of-concept stage, an extensive clinical development and pharmacology program was performed during the last 10 years, involving >10,000 individuals, before mirabegron was granted marketing approval

Urological complications following inguinal hernioplasty

Aim of this paper is to report a systematic review of the literature about the incidence and putative mechanisms of genital tract injuries following open and laparoscopic herniorraphy and their effects on sexual function and fertility and to point out the measures of prevention and of treatment. The most frequently described events have been intraoperative complications as bladder or spermatic cord structure damage, immediate postoperative complications as ischaemic orchitis, urinary retention, urinary tract infection, hydrocele or scrotal haematoma and bacterial orchitis, or long-term complications as chronic orchialgia, testis atrophy, sexual dysfunction and infertility. The evidence of literature shows that urological complication after hernioplasty are under-reported. Only a small number of studies to date have essentially dealt with sexual quality of life after inguinal hernia surgical repair. The sexual needs of patients with groin hernias are rarely discussed. Extensive laparoscopic procedures, due to the need of learning curve, have increased the risk of vas damage and infertility in young patients candidate to hernioplasty. Early diagnosis prevents urological complication as well as possible legal claims after hernia repair: it should be include careful history, objective and subjective symptoms and signs of uro-genital pathologies, lab data when necessary, immediate eco-color-Doppler imaging and urgent urological consultation. Despite the lack of prospective randomized trials, there is a growing evidence in literature about positive impact of hernioplasty on sexual function, encouraging future studies on this issu

Efficacia di un programma supervisionato perioperatorio di fisioterapia del pavimento pelvico per il miglioramento del recupero della continenza dopo prostatectomia radicale: trial randomizzato controllato

scopo del lavoro dimostrare l\u2019efficacia di un programma perioperatorio di fisioterapia del pavimento pelvico (Pfmt) per migliorare il recupero della continenza dopo prostatectomia radicale retropubica (PrAd). materiali e metodi \uc8 stato pianificato uno studio randomizzato controllato, prospettico, monocentrico. da novembre 2009 a marzo 2010, 32 pazienti (et\ue0 media 66\ub15,8 anni) sono stati sottoposti a PrAd e sono stati assegnati in modo randomizzato al gruppo di trattamento (t) o di controllo (c) e seguiti per almeno 6 mesi. il gruppo t ha ricevuto, il giorno prima della PrAd ed il giorno successivo la rimozione del catetere vescicale, una sessione supervisionata di training con biofeedback elettromiografico, oltre ad istruzioni orali e scritte riguardanti gli esercizi di Kegel ed un programma di training domiciliare dei muscoli del pavimento pelvico. il gruppo c ha ricevuto, dopo la rimozione del catetere, solo istruzioni orali e scritte sugli esercizi di Kegel. i pazienti del gruppo t dopo la rimozione del catetere si sono sottoposti a visite di controllo mensili con singola seduta di Pfmt con biofeedback ad ogni visita. tutti i pazienti sono stati sottoposti a questionari standardizzati: iciQ-ui, iciQ-oAb, uclA-Pci. l\u2019endpoint primario \ue8 stato il tasso di recupero della continenza a 6 mesi definita dal risultato dello score iciQ-ui=0. gli endpoint secondari sono stati il numero degli episodi di incontinenza e dei pannolini utilizzati a settimana, valutati attraverso gli score iciQ-oAb e uclA-Pci. le differenze tra i gruppi sono state analizzate usando il test t di student e il test non parametrico di mann-whitney (soglia p=0,05). il tempo di recupero della continenza \ue8 stato analizzato usando le curve di sopravvivenza di Kaplan-meier. risultati nel gruppo t, la continenza \ue8 stata raggiunta da 6/16 (37,5%), 8/16 (50%) e 10/16 (62,5%) pazienti al primo, terzo e sesto mese, rispettivamente, dalla rimozione del catetere. sei pazienti (37,5%) non hanno recuperato la continenza. nel gruppo c solo 1 paziente (6,25%) era continente a sei mesi; la differenza con il gruppo t era statisticamente significativa (p<0,000). dall\u2019analisi di Kaplan-meier (fig. 1) una differenza statisticamente significativa \ue8 stata osservata nella probabilit\ue0 di recuperare lo stato di continenza a 6 mesi (p=0,0007); hazard ratio=12,9154; 95% ci=2,5123-32,0673). l\u2019analisi dei punteggi degli uclA-Pci e iciQ-oAb ha mostrato differenze statisticamente significative a favore del gruppo t al follow-up a 3 (403,81 vs 272,44 con p=0,006 e 10,12 vs 13,19 con p=0,03, rispettivamente) e a 6 mesi (422,50 vs 274,25 con p=0,003 e 9,06 vs 12,62 con p=0,01, rispettivamente). il numero di episodi di incontinenza alla settimana e il numero di pannolini alla settimana sono stati inferiori per i pazienti nel gruppo t sia a 3 (3,84 vs 14 e 1,50 vs 4,56, rispettivamente) sia a 6 mesi (2,72 vs 13,06 e 1,31 vs 4,12, rispettivamente). discussione l\u2019uso di un programma supervisionato ma sostenibile di Pfmt riduce significativamente la frequenza, la durata e la gravit\ue0 dell\u2019incontinenza urinaria in pazienti sottoposti a PrAd. messaggio conclusivo il Pfmt \ue8 consigliabile in tutti i pazienti sottoposti a PrAd anche utilizzando un programma prevalentemente domiciliare

Efficacy of a supervised low-intensity regimen of perioperative pelvic floor muscle training in reducing postprostatectomy urinary incontinence: A randomized controlled trial

Introduction & Objectives To evaluate the efficacy of preoperative biofeedback combined with an assisted low-intensity regimen of postoperative pelvic floor muscle training (PFMT) in reducing the incidence, duration and severity of urinary incontinence in patients undergoing open radical prostatectomy (RP). Material & Methods Design: Single-center, randomized control trial. The intervention group received the day before RP a training session with biofeedback, supervised oral and written instructions on Kegel exercises and a structured program of postoperative PFMT; patients underwent control visits, including a session of biofeedback, at monthly intervals only. As standard of care, the control group received, after catheter removal, only oral and written instructions on Kegel exercises to be performed at home and underwent control visits at 1, 3 and 6 months follow-up. At each visit the number of incontinence episodes and of diapers per week and patient-reported outcome measures (ICIQ-UI, OAB-ICIQ, UCLA-PCI, IPSS-QoL) were assessed in both groups. All participants were followed-up for a period of at least six months after catheter removal. The primary outcome was the recovery of continence strictly defined as a ICIQ-UI score of zero. The differences between groups were analyzed using Fisher test and non-parametric statistics and significance threshold was set at p<0.05. The software used was GraphPad Prism 5 for Windows. Results Of 38 screened patients, 34 were eligible and 32 were available for the final analysis, 16 patients for each study group. The two groups were homogeneous for all pre, intra and postoperative relevant parameters. In the intervention group, continence has been achieved by 6 (37,5%), 8 (50%) and 10 (62,5%) patients at 1, 3 and 6 month follow-up, respectively, versus 0 (p= 0,02), 1 (6.25%; p= 0,01) and 1 (6.25%; p= 0,002) in the control group. The analysis of the UCLA-PCI and ICIQ-OAB scores, the number of incontinence episodes and of diapers per week showed statistically significant differences in favor of patients in the intervention group at 3 and 6 months. Patients in the intervention group reported better IPSS-QoL scores at all follow-up time but the difference did not reach the statistical significance. Conclusions Preoperative biofeedback combined with our supervised, low-intensity regimen of PFMT is a treatment strategy significantly more effective, but not excessively time-consuming, than usual care in improving recovery of continence in patients undergoing RP. The impact on QoL appeared less evident, although a trend for a better QoL was observed in the intervention group