A review of the use of tadalafil in the treatment of benign prostatic hyperplasia in men with and without erectile dysfunction

Epidemiological data link erectile dysfunction (ED) and benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS), two highly prevalent conditions in aging men, assuming common pathophysiological pathways. Tadalafil 5 mg once daily has been approved for the treatment of men with LUTS with or without comorbid ED. The aim of this review is to provide an overview of current knowledge on the epidemiological and pathophysiological links between ED and LUTS and to focus on tadalafil as a new treatment option in men with BPH-associated LUTS. A Medline search was completed using the Medical Subject Headings (MESH® keywords) ‘prostatic hyperplasia’ and ‘phosphodiesterase inhibitors’. This search revealed 125 relevant references (entire Medline database up to 11 March 2014). The efficacy of tadalafil 5 mg once daily for the treatment of LUTS has been reported by several well-designed studies. Tadalafil improves significantly the total International Prostate Symptom Score (IPSS), the voiding and storage subscores, the IPSS Quality of Life (QoL) and the BPH Impact Index (BII). Its efficacy is irrelevant to the erectile function status of the patients. However, in the majority of these studies tadalafil is not associated with improvement in maximum urine flow or post-void residual volume (PVR). Its safety profile is well established and no new or unexpected adverse events other than those reported in ED studies have been recorded. Tadalafil is today a new treatment alternative to other established drugs for LUTS such as the α-adrenergic antagonists or 5α-reductase inhibitors. However, it is not just an alternative, since sexual adverse events associated with these drugs are avoided and tadalafil is the only drug that can treat both ED and LUTS at the same time

The impact of Diabetes Mellitus on Lower urinary tract symptoms (LUTS) in both male and female patients

Introduction Contemporary studies examine the connection of Diabetes Mellitus (DM) with Lower urinary tract symptoms (LUTS), alone or associated with other factors of the metabolic syndrome. However, little research has occurred concerning patients with diabetes of both genders and sexes without other diseases of the lower urinary tract. The aim of this study is to examine the relationship between DM and LUTS. Methods The study enrolled 110 patients with DM and 134 healthy individuals. The IPSS questionnaire was used for the evaluation of symptoms from lower urinary tract. Data was analyzed with univariate and multivariate logistic regression using SPSS v.24. Results Analysis with moderate/severe LUTS as dependent variable and plausible confounding factors (age group, BMI, hypertension, dyslipidemia, years with DM and reported HbA1c) as covariates revealed that only HbA1c levels correlated independently with the presence of moderate/severe LUTS (p = 0,024, OR:2,729, CI:1,144–6,509) in diabetic women, while there was no statistically significant difference between male groups. HbA1c levels' correlation with IPSS-voiding and IPSS- storage score was not statistically significant. Quality of life is also affected in women with diabetes mellitus (p: 0,02). Conclusion Only an increase in HbA1c was independently connected with a deterioration of LUTS in the female group

Urology during a Crisis: A Management Algorithm

As of March 11, 2020, Coronavirus disease (COVID-19) has been declared a pandemic from WHO organization. On June 30, 2020, the disease has already spread in all continents numbering 10 million confirmed cases and 500.000 deaths(1). In regions with limited cases, health-care units suffice to provide routine services and manage infected with coronavirus patients simultaneously. However, during an epidemic outbreak, the high number of cases compared to the shortage of health workforce increases the risk of system collapse. In order to respond adequately, hospitals should reprioritize their services, including operations and outpatient clinics and protect its personnel from infection(2) Shrinkage of surgical activity in emergency surgeries saves equipment and personnel necessary for the care of COVID-19 patients and protects high risk patients from getting infected(3). In order to maximize the provided urological surgeries, 4 parameters should be considered: the emergency of the operation, the risk of infection, the capacity of the hospital and cooperation between different urological departments. Initially, all emergency surgeries should be performed promptly in order to ameliorate the health status of the patient and reduce hospital stay (Table 1). In case the results of COVID-19 test, are not readily available the operation should be performed without delay in special operating rooms and the patient treated in separate wards. Regarding elective operations, all non-oncological surgeries should be postponed. In oncological diseases, where possible, opt for alternative treatments, such as radiotherapy with ADT in prostate cancer or ablation of renal tumors. Next, all surgical candidates should be tested for COVID-19 before surgery. In case of positive result, the surgery should be rescheduled. In countries where this measure is not feasible, preoperative evaluation of the respiratory tract from an internist, including a chest x-ray is suggested. Following that, the operating program should be adapted to hospital capacities. In case of small number of COVID-19 cases, surgical candidates should continue to be treated according to oncological severity. On the contrary, when hospital capabilities are overwhelmed by the inflow of COVID-19 patients consider treating patients with the longest expected survival, irrespective of the underline disease. Otherwise, urologist must consider maximizing the number of treated patients and minimizing the hospital stay, possibly by performing less time-consuming surgeries particularly in patients without good performance status. The expertise of each center should also be evaluated and candidates for radical, time-consuming operations referred to specialized centers (Figure 1). During de-escalation phase, special attention should be given in patients with urolithiasis and ureteral stents, since they are at increased risk of encrustation and complicated pyelonephritis (4). All previous measures could reduce attendance in hospitals with the cost of increasing waiting lists. Despite, closure of outpatient departments prevents crowding and hinders dispersion of the virus(5), the demand for urological services is ongoing and, also expected to increase during the de-escalation phase of COVID-19 pandemic. However, there is no single protocol in the management of urological patients. In order to preserve general population healthy and face current demands the urologist should consider the following questions (Figure 2). 1. Is this case an emergency? In order to provide consultation in urological patient urologists are encouraged to use telemedicine(6). Through video-communications urologist can diagnose effectively common urological disease and even prescribe medications and tests. Additionally, urologists can screen patients with acute urological problems and symptoms of COVID-19 infection referring appropriately. Particularly patients at increased risk for severe COVID-19 pneumonia such as renal transplant patients, oncological patients and those with renal dysfunction should have their clinical evaluation through telemedicine(7). On the contrary, the inability to perform clinical and diagnostic tests, along with the lack of experience in teleconsultation lowers diagnostic accuracy. 2. Is there a possibility of COVID-19 infection? Screening for COVID-19 is necessary for all urological patients. Regarding outpatients, phone screening about respiratory symptoms within the last 14 days (fever, cough, myalgia, fatigue, dyspnea), travel history and fever could detect high risk patients requiring further referral to special units

The impact of burnout and occupational stress on sexual function in both male and female individuals: a cross-sectional study

Burnout and occupational stress are common problems in the modern society. The aim of the study was to investigate the association of burnout and occupational stress with sexual dysfunction. The study enrolled 251 residents, 143 males and 108 females. The personal medical history, demographics, and professional data of the participants were recorded. The Copenhagen Burnout Inventory (CBI) and the job stress measure were used for the evaluation of burnout and occupational stress, correspondingly. The International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) were used for the assessment of sexual function. The majority of the respondents were males (57%), with a mean age of 31 years. From the analysis concerning males, personal burnout, hypertension, and alcohol consumption correlated independently with erectile dysfunction (p = 0.001) and reduced total satisfaction (p < 0.001). With respect to the female participants, the number of children was found to be related to easier arousal (p = 0.009), better lubrication (p = 0.006), and orgasm (p = 0.016). Contrariwise, job stress related negatively with lubrication (p = 0.031) and orgasm (p = 0.012). This is the first study examining the effect of burnout on sexual function. Personal burnout was observed to be associated with sexual dysfunction in men whereas job stress correlated with female sexual problems. Further examination in different occupational groups and a greater number of patients is required

EAU guidelines on penile curvature

Context: Penile curvature can be congenital or acquired. Acquired curvature is secondary due to La Peyronie (Peyronie's) disease. Objective: To provide clinical guidelines on the diagnosis and treatment of penile curvature. Evidence acquisition: A systematic literature search on the epidemiology, diagnosis, and treatment of penile curvature was performed. Articles with the highest evidence available were selected and formed the basis for assigning levels of evidence and grades of recommendations. Evidence synthesis: The pathogenesis of congenital penile curvature is unknown. Peyronie's disease is a poorly understood connective tissue disorder most commonly attributed to repetitive microvascular injury or trauma during intercourse. Diagnosis is based on medical and sexual histories, which are sufficient to establish the diagnosis. Physical examination includes assessment of palpable nodules and penile length. Curvature is best documented by a self-photograph or pharmacologically induced erection. The only treatment option for congenital penile curvature is surgery based on plication techniques. Conservative treatment for Peyronie's disease is associated with poor outcomes. Pharmacotherapy includes oral potassium para-aminobenzoate, intralesional treatment with verapamil, clostridial collagenase or interferon, topical verapamil gel, and iontophoresis with verapamil and dexamethasone. They can be efficacious in some patients, but none of these options carry a grade A recommendation. Steroids, vitamin E, and tamoxifen cannot be recommended. Extracorporeal shock wave treatment and penile traction devices may only be used to treat penile pain and reduce penile deformity, respectively. Surgery is indicated when Peyronie's disease is stable for at least 3 mo. Tunical shortening procedures, especially plication techniques, are the first treatment options. Tunical lengthening procedures are preferred in more severe curvatures or in complex deformities. Penile prosthesis implantation is recommended in patients with erectile dysfunction not responding to pharmacotherapy. Conclusions: These European Association of Urology (EAU) guidelines summarise the present information on penile curvature. The extended version of the guidelines is available on the EAU Web site (www.uroweb.org/guidelines/). © 2012 European Association of Urology.SCOPUS: re.jinfo:eu-repo/semantics/publishe