Urologic complications of nonurologic medications

Screening and identification of critical biomarkers in erectile dysfunction: evidence from bioinformatic analysis

Purpose

Erectile dysfunction (ED) is one of the most common male-disease globally. Despite efforts to explain its pathogenesis, the molecular mechanisms of ED are still not well understood.

Methods

The microarray dataset GSE10804 was downloaded from the Gene Expression Omnibus (GEO) to find candidate genes in ED progression. After differentially expressed genes (DEGs) were identified, functional enrichment analysis was performed. In addition, a protein-protein interaction network (PPI) was established and module analysis was performed through the STRING and Cytoscape.

Results and Conclusions

A total of 618 DEGs were identified in all, containing 430 downregulated genes and 188 upregulated genes. The enriched functions and pathways of the DEGs include transcription from RNA polymerase II promoter, cell adhesion, calcium ion binding, receptor binding, Akt signaling pathway, receptor interaction, protein digestion, and absorption. We picked out twenty-five hub genes, with biological process (BP) analyses revealing that the genes were principally associated with cellular responses to amino acid stimuli, extracellular matrix structural constituent, collagen trimer, protein digestion and absorption, ECM-receptor interaction and PI3K-Akt signaling pathway. To sum up, DEGs and hub genes distinguished in this study not only help us understand the molecular mechanisms behind the carcinogenesis and progression of ED, but also play a part in the diagnosis and treatment of ED by providing candidate targets.

Epidemiologic Profile of Erectile Dysfunction in Patients with Systemic Lupus Erythematosus: The Latin American Landscape

Objective.

The aim of this study was to describe the prevalence of erectile dysfunction (ED), as well as associated demographic and clinical features, in men with systemic lupus erythematosus (SLE), by means of a systematic, standardized evaluation.

Methods.

We performed a transversal study in 8 tertiary care centers in Latin America. We included male patients ≥ 16 years who fulfilled ≥ 4 American College of Rheumatology criteria for SLE and had regular sexual activity, and evaluated them with the International Index of Erectile Function-5 questionnaire. Relevant demographic, clinical, and serological characteristics were recorded. We included 2 control groups: the first was made up of healthy men and the second of men with autoimmune diseases other than SLE (non-SLE group).

Results.

We included 590 subjects (174 SLE, 55 non-SLE, and 361 healthy controls). The prevalence of ED in the SLE group was 69%. Mean age in that group was 36.3 ± 1.03 years. Among SLE patients with and without ED, these factors were significantly different: the presence of persistent lymphopenia (p = 0.006), prednisone dose (9.3 ± 1.2 vs 5.3 ± 1.3 mg, p = 0.026), and the Systemic Lupus International Collaborating Clinics damage score (1.25 ± 0.14 vs 0.8 ± 0.16 points, p = 0.042). Independent risk factors for ED in patients with SLE were persistent lymphopenia (OR 2.79, 95% CI 1.37–5.70, p = 0.001) and corticosteroid use in the previous year (OR 2.15, 95% CI 1.37–3.37, p = 0.001).

Conclusion.

Regardless of comorbidities, treatment (excluding steroids), and type of disease activity, patients with SLE have a high prevalence of ED, especially considering that most patients are young. Recent corticosteroid use and persistent lymphopenia, which could be related to endothelial dysfunction, are risk factors for this complication in men with SLE.

An overlooked issue: sexual dysfunctions in men addicted to alcohol

Introduction According to the data obtained in the EZOP Poland study (2015), the prevalence of alcohol dependence in lifetime in Poland amounts to about 2.2% of the population, entailing enormous social, family and personal harm, including health damage. It is estimated that about 72% of alcohol-dependent patients complain about one or more problems related to the sexual sphere, which may result from both the development of somatic complications in the course of alcohol dependence, and from psychiatric complications that themselves can lead to sexual dysfunction. There are reports and clinical observations indicating that the occurrence of sexual dysfunction (SD) can affect the shortening or interruption of the period of abstinence.

Aim The aim of this work is to show sexual dysfunctions in alcohol-dependent men and to discuss the factors that may affect the occurrence of the above-mentioned dysfunctions.

Material and methods The available literature was reviewed using Medline, Google Scholar and ScienceDirect browsers by entering the keywords: alcohol dependence, sexual dysfunction, comorbidity, alcohol-caused diseases and time descriptors: 1979-2016.

Results

• Alcohol dependence is associated with the occurrence of various types of sexual dysfunctions (SD).

• The diagnosis of SD should take into account all possible causes that may lead to the development of SD in this group of patients, including the comorbidity of somatic diseases or the negative impact of drugs on sexual function.

• Occurrence of SD is connected with a higher risk of abstinence interruption.

• There is a need to carry out more research in order to better understand the relationship between alcohol dependence and the prevalence of sexual dysfunctions.

[Ejaculatory disorders except premature ejaculation, orgasmic disorders]

INTRODUCTION

Disorders of ejaculation and orgasm apart from premature ejaculation are pretty uncommon.

METHODS

Medical literature was reviewed and combined with expert opinion of the authors.

RESULTS

The semiology of these disorders is essential: aspermia, hypospermia, retrograde ejaculation, delayed or absent ejaculation with or without orgasm. Whether this is a lifelong or acquired condition, it is essential to assess the side-effects of medications i.e. psychotropic drugs, including antidepressant, neuroleptics, tramadol, alphablockers: tamsulosin and silodosin must always be surveyed.

CONCLUSION

The management is often difficult, especially with a parenthood perspective. The management of lifelong disorders must rely on psychosexual therapies.

Erectile dysfunction

Erectile dysfunction is a common clinical entity that affects mainly men older than 40 years. In addition to the classical causes of erectile dysfunction, such as diabetes mellitus and hypertension, several common lifestyle factors, such as obesity, limited or an absence of physical exercise, and lower urinary tract symptoms, have been linked to the development of erectile dysfunction. Substantial steps have been taken in the study of the association between erectile dysfunction and cardiovascular disease. Erectile dysfunction is a strong predictor for coronary artery disease, and cardiovascular assessment of a non-cardiac patient presenting with erectile dysfunction is now recommended. Substantial advances have occurred in the understanding of the pathophysiology of erectile dysfunction that ultimately led to the development of successful oral therapies, namely the phosphodiesterase type 5 inhibitors. However, oral phosphodiesterase type 5 inhibitors have limitations, and present research is thus investigating cutting-edge therapeutic strategies including gene and cell-based technologies with the aim of discovering a cure for erectile dysfunction.

Acute epididymo-orchitis: staging and treatment

Introduction

Acute epididymo-orchitis (AEO) is an acute inflammatory disease of the epididymis and ipsilateral testis. Treatment should be started immediately after diagnosis and includes antibiotics, analgesics, and, if necessary, surgery.

Materials and methods

After AEO diagnosis, patients were treated conservatively with analgesics and antibiotics. If no clinical improvement was observed within the first 48-72 hours of conservative treatment, patients underwent surgery. Depending on examination results, 254 patients (pts.) were divided into three groups: 1) with palpable differences between the epididymis and testis (E/T+), and without neither hydrocele, local softening (malacia), nor abscess of the epididymis or testis; 2) with E/T+, absence of malacia, presence of hydrocele, and none, one, or a few small abscesses within the epididymis/testis and 3) without palpatory differentiation between the epididymis and testis, with or without malacia, with hydrocele, and none, one, or more abscesses of any size. We analyzed the clinical outcomes in each group.

Results

All of patients from the first group were successfully treated with antibiotics. In the second group, conservative treatment was effective in 70 pts. (85.4% of this group), but the other 12 pts. (14.6%) did not show clinical improvement and underwent organ-sparing surgery. The majority of patients from the third group did not demonstrate an objective response to antibacterial treatment during the first 48-72 hours and, therefore, underwent surgery. Based on examination results and clinical outcomes we developed a classification system for AEO, which divides AEO into three stages and recommends an approach to its treatment.

Conclusions

Our classification is able to systematize treatment approaches in patients with AEO.

Priapism as a complication after total hip arthroplasty: a case report and review of the literature

Priapism is defined as a prolonged engorgement or erection of the penis or clitoris that is unrelated to sexual arousal. Recent studies have determined the incidence of priapism to be between 1.5 and 2.9 per 100,000 person years. The incidence of priapism following elective orthopedic surgery is rare. Defining the etiology of a case of postoperative priapism following orthopedic surgery can be difficult, and many times cannot be determined. This case represents the first report of priapism following an elective total hip arthroplasty (THA) performed under spinal anesthesia, and focuses on a review of the literature and potential etiologies of this rare complication. A 44-year-old man with a history of right hip osteoarthritis underwent elective minimally invasive cementless right THA under spinal anesthesia (1 mg of Intrathecal Morphine and 100 mg of intravenous Fentanyl) without initial complication. A preoperative Foley catheter was placed without incident and the patient was placed into the left lateral decubitus position. Surgical time was recorded at 60 minutes. Nine hours after the Foley catheter was removed, the patient developed a persistent painless erection. Successful emergent treatment included a penile Winter shunt, to irrigate blood from the corpora. A computed tomography scan of the pelvis ruled out pelvic deep vein thrombosis as an etiology. This case represents the first report of priapism after an elective THA. The incidence of priapism as a complication is well described and has been associated with numerous medical conditions discussed in this article.

Bladder dysfunction in type 2 diabetic patients

AIMS

To reevaluate urodynamic findings of bladder dysfunction (BD) in type 2 diabetic patients with patient characteristics and concommittant chronic complications.

METHODS

Patients (M/F:27/27) with lower urinary tract symptoms (LUTS) underwent a detailed urodynamic investigation. Urodynamic findings were classified as diabetic cystopathy [DC, characterized by impaired bladder sensation, increased post-void residual urine (PVR) and increased bladder capacity and decreased bladder contractility], detrusor overactivity, bladder outlet obstruction (BOO), urge and stress urinary incontinence or BD in which one of the alterations was included. Glycated hemoglobin (HbA1C), diabetic retinopathy, nephropathy, sensorimotor, and autonomic neuropathies were evaluated.

RESULTS

BD was present in 74.07% of men (DC, 50%; BOO, 25%; detrusor overactivity, 25%) and in 59.26% of diabetic women (DC, 43.75%; detrusor overactivity, 31%; urge incontinence, 12.5%; stress urinary incontinence 12.5%). In men, age, duration of diabetes and HbA1C threshold values predicting BD were >64 years, >9 year, >7.9%, while in women, they were >56 years, >8 years, >7%, respectively. Prolongation of QTc, abnormal esophageal transit and gastric emptying times, diabetic retinopathy, and microalbuminuria were associated with an increased risk of PVR >or= 100 ml.

CONCLUSIONS

DC was the most frequent finding in patients. Ageing, duration of diabetes, worse metabolic control, PVR 100 ml, cardiac, esophageal and gastric parasympathetic autonomic neuropathies, retinopathy, and microalbuminuria provided a means to predict BD in patients in order to investigate by urodynamics. The establishment of DC in at least 8-9 years after the diagnosis of type 2 DM was an important parameter to inform our diabetic patients.

Priapism associated with routine use of quetiapine: case report and review of the literature

We report a case of priapism occurring in a patient taking a standard daily dose of the atypical antipsychotic quetiapine (Seroquel). To our knowledge, this represents the second published report associating quetiapine with priapism, and the first to associate priapism with routine dosing of the drug. Previously published studies have suggested that alpha-adrenergic blockade may be the mechanism of action for this side effect. We report successful management in this case with cavernosal aspiration followed by intracavernosal injection of phenylephrine.

Retroperitoneal fibrosis presenting as acute renal failure

BACKGROUND

A 60-year-old man with a history of atherosclerotic disease of the carotid and coronary vasculature presented with lower back pain and acute renal failure. Imaging studies revealed bilateral ureteral obstruction by a large retroperitoneal mass.

INVESTIGATIONS

Physical examination, urine and blood analysis, catheterization, radiography of the chest, abdominal and pelvic CT, magnetic resonance angiography, renal ultrasound and biopsy of mass.

DIAGNOSIS

Retroperitoneal fibrosis.

MANAGEMENT

Ureteral stenting, laparoscopic ureterolysis, and immunosuppressive therapy with prednisone and mycophenolate mofetil.

Nocturia: when is it not related to overactive bladder?

This article reviews the different nonurologic causes of nocturia. It also discusses the diagnostic algorithms necessary to identify specific factors underlying a patient's symptoms.