Is there a relationship between varicocele and testosterone levels?

OBJECTIVES

The goal of this work was to study the relationship between presence of varicocele and testosterone serum levels in adulthood.

METHODS

A comparative, cross-sectional study of 387 men who consulted for erectile dysfunction. Age, body mass index (BMI), diabetes (DM), and presence of varicocele were related to testosterone levels through uni- and multi-variate analysis.

RESULTS

A total of 248 cases (70.8%) had no varicocele, 46 (13.1%) had grade I varicocele, 36 (10.3%) grade II, and 20 (5.7%) grade III. The mean total testosterone levels were 4.77 ng/mL in the non-varicocele group and 4.34 ng/mL in the varicocele group (p = .91), while free testosterone levels were 69.81 and 73.24 pg/mL (p = .18), respectively. In the multivariate analysis, BMI> = 30 was related to low total testosterone levels (OR: 2.94, p < .001) and low free testosterone (OR: 2.01, p = .01), while advanced age associated with low levels of free testosterone (OR: 1.04, p < .001).

CONCLUSIONS

We were not able to establish a relationship between the presence of varicocele and decreased serum testosterone levels. Other factors already described, such as obesity and age, were related to low levels of total and free testosterone.

Satisfaction and treatment adherence in erectile dysfunction in the medium and long term

INTRODUCTION

The aim of this study was to show the satisfaction and treatment adherence in erectile dysfunction (ED) in the medium and long term.

MATERIAL AND METHODS

A descriptive, comparative study was conducted in 2 centres through telephone interviews with patients who came for an initial visit between 2012 and 2014 for ED. A complete case history review was conducted on the use of and withdrawal from treatment. For current use, the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and the Global Assessment Questionnaire (GAQ) were filled out; for past use, only the GAQ was filled out. For the statistical analysis, we employed Fisher's exact test for comparisons of percentages and the Kruskal-Wallis test to compare means.

RESULTS

The study included 250 patients; 20.8% were prescribed intraurethral alprostadil (ALP-IU), 17.2% were prescribed intracavernous alprostadil (ALP-IC), 92.8% were prescribed a first IPD5, and 24.8% were prescribed at least a second IPD5. The treatment withdrawal rate was 62.07% for the first IPD5, 41.94% for the last IPD5, 69.23% for the ALP-IU and 65.11% for the ALP-IC (P=.007). The main reason for withdrawal for the IPD5 was a lack of response (32.76% of those who took IPD5). In addition to withdrawal, there were adverse reactions for ALP-IU and ALP-IC (28.85% and 11.63%, respectively). The mean duration of use until withdrawal was 4.3 months for IPD5, 2.2 months for ALP-IU and 5.5 months for ALP-IC (P=.064). The most favourable GAQ and EDITS scores were observed for IPD5 (EDITS score of 74). Sildenafil and tadalafil had the longest usage times (mean >5 months).

CONCLUSIONS

The withdrawal rate for treating ED is high, with short usage times of a few months. A lack of response and adverse reactions were the main causes for withdrawal. The drugs that provide greater satisfaction are the IPD5, although there are no significant differences in the mean usage time between the different types and in aspects such as the mean usage time to withdrawal or the withdrawal rates.

[Paratesticular sarcoma: An infrequent genitourinary tumor]

OBJECTIVE

To expose the features related to the diagnosis, therapy and follow-up of paratesticular sarcomas, through the presentation of three cases with different histologies.

METHODS

Description of the clinical cases, surgical management, and pathological results of the surgical specimens.

RESULTS

We present three cases of paratesticular sarcomas, one case being a rhabdomyosarcoma and two liposarcomas. Two patients underwent a single successful surgery, while the third one required a second intervention after recurrence. Today all three patients are free of disease.

CONCLUSIONS

Malignant paratesticular sarcomas are infrequent neoplasias in urology. It is essential that the urologist is aware of this possibility when faced with a paratesticular tumor, since radicalness of surgery will be the most decisive factor in the success of the treatment. Adjuvant therapies must be individualized in each case, and the follow-up after surgery should be close, given the poor evolution of these tumors in many cases.