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Summary: Some evidences have supported the link between benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and inflammation. In this study, we aimed to evaluate the association between prostatic inflammation (PI) and non‐alcoholic steatohepatitis (NASH) evaluated by a non‐invasive scores in a cohort of patients affected by BPH/LUTS. Between January 2012 and January 2016, we conducted a prospective study in a single academic outpatient clinic on 132 consecutive patients who underwent surgery for lower urinary tract symptoms (LUTS) due to bladder outlet obstruction (BOO). A non‐invasive non‐alcoholic steatohepatitis score (NASH score) was calculated, and PI was evaluated through the Irani score. Patients with a NASH score > 1.05 had an average larger prostate volume (55 vs. 45 cc, p < 0.05), a greater waist circumference (103 vs. 93.5 cm, p < 0.01), and high values of blood glucose, triglycerides, insulin, and BMI compared to patients without NASH; 36% of patients with an Irani score ≥ 4 had NASH compared to 16.1% of patients who had a NASH score < 1.05 (p < 0.05). We found that non‐alcoholic steatohepatitis (NASH ≥ 1.05) was an independent risk factor for Irani score ≥4 (OR: 3.24; p < 0.05) and of prostate volume ≥ 40 cc (OR: 13.99; p < 0.01). LUTS/BPH and NASH can be closely related, underlying common triggers of induction. In particular, inflammation seems to be associated with both conditions and with prostate gland overgrowth. Early identification of this class of patients could play a key role in preventing complications related to disease progression. [ABSTRACT FROM AUTHOR]

Several intralesional therapeutic protocols have been proposed for the treatment of Peyronie's disease. Among all, hyaluronic acid ( HA) and verapamil have been differently tested. We aimed to evaluate the efficacy of intralesional verapamil ( ILVI) compared with intralesional HA in patients with early onset of Peyronie's disease ( PD). This is a multi-centre prospective double-arm, randomized, double-blinded study comparing ILVI vs. intralesional HA after 12-weeks. Sexually active men, older than 18 years and affected by the acute phase of PD were eligible for this study. Patients have been double-blinded randomly divided into two groups (1 : 1 ratio): Group A received intralesional treatment with Verapamil (10 mg in 5 mL of normal saline water) weekly for 12 weeks, while group B received intralesional treatment with HA (0.8% highly purified sodium salt HA 16 mg/2 mL) weekly for 12 weeks. The primary efficacy outcome was the change from the baseline to the endpoint (12 weeks after therapy) for the penile curvature (degree). The secondary outcome was the change in the plaque size and in the International Index of erectile Function ( IIEF-5) score. The difference between post- and pre-treatment plaque size was −1.36 mm ( SD ± 1.27) for Group A and −1.80 mm ( SD ± 2.47) for Group B ( p-value = NS). IIEF-5 increased of 1.46 points ( SD ± 2.18) in Group A and 1.78 ( SD ± 2.48) in Group B ( p-value ± NS). No difference in penile curvature was observed in Group A, while in Group B the penile curvature decreased of 4.60° ( SD ± 5.63) from the baseline ( p < 0.001) and vs. Group A. According to PGI-I results, we found significant difference as concerning patient global impression of improvement ( PGI-I) (4.0 vs. 2.0; p < 0.05). This prospective, double-arm, randomized, double-blinded study comparing ILVI vs. HA as intralesional therapy showed greater efficacy of HA in terms of penile curvature and PGI-I. [ABSTRACT FROM AUTHOR]

Background and purpose Sexual dysfunction (SD) is prevalent in multiple sclerosis (MS) patients and affects quality of life. Furthermore, lower urinary tract dysfunction (LUTD) is common in MS patients. Our aim was to determine the relationship between urodynamic findings and SD in a cohort of MS patients with LUTD. Methods From January 2011 to September 2013, 135 consecutive patients with MS in remission phase and LUTD underwent a first urodynamic examination, according to the International Continence Society criteria. Neurological impairment was assessed using the Expanded Disability Status Scale and SD was investigated with the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF-15). Multivariate logistic regression analysis was performed to identify predictors of female SD (FSFI < 26.55) or moderate−severe erectile dysfunction (ED) (IIEF-EF ≤ 16), after adjusting for confounding factors including urodynamic findings. Results Subjects with maximum detrusor pressure during involuntary detrusor contraction (PdetmaxIDC) ≥20.0 cmH2O had lower IIEF-EF, IIEF overall satisfaction (IIEF-OS), FSFI-Arousal, FSFI-Lubrication and FSFI-Orgasm. Subjects with maximum cystometric capacity (MCC) ≥135 ml had higher IIEF-EF, intercourse satisfaction (IIEF-IS), orgasmic function (IIEF-OF), sexual desire (IIEF-SD), FSFI-Arousal, FSFI-Lubrication, FSFI-Orgasm, FSFI-Satisfaction and FSFI-Pain. On multivariate logistic regression analysis, PdetmaxIDC ≥20 cmH2O [odds ratio (OR) 6.7; P < 0.05] and MCC <135 ml (OR 6.80; P < 0.05) were predictors of moderate−severe ED. In a model including all previous variables, compliance ≤3 ml/cmH2O was an independent predictor of moderate−severe ED (OR 14.49; P < 0.01). No relationship was found between the previous variables and FSFI <26.55. Conclusions Neurogenic bladder is associated with SD in MS patients. The presence of PdetmaxIDC ≥20 cmH2O, MCC <135 ml and compliance ≤3 ml/cmH2O may significantly predict the presence of moderate−severe ED. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the efficacy of the association of intralesional verapamil ( ILV) injection with oral antioxidants compared with ILV monotherapy in patients with early onset of Peyronie's disease ( PD) at 12-week follow-up. Group A ( n = 52) received ILV 10 mg weekly for 12 weeks, while group B ( n = 53) received ILV 10 mg weekly for 12 weeks + antioxidants orally one tablet once a day for 3 months. The main efficacy outcomes were the change in plaque size ( PS), penile curvature ( PC), visual analogue score ( VAS), IIEF-15 and IIEF-15 subdomains. Both groups showed significant improvement from baseline to week 12 relative to PS and PC, while group B also in IIEF-15 score (mean difference: 5.51, P < 0.01) and VAS (mean difference: −2.71, P < 0.01). No significant differences were observed between both groups in PS and PC. Finally, both groups showed significant increase in orgasmic function ( IIEF- OF) and overall satisfaction ( IIEF- OS), while group B showed significant improvement also in intercourse satisfaction ( IIEF- IS). Significant differences were found relative to IIEF- OF, IIEF- IS, IIEF- OS and VAS scores in the group B compared with group A. Patients affected by PD may benefit from combination treatment with ILV and oral antioxidants thanks to the improvement in IIEF- OF, IIEF- IS and IIEF- OS at 12 weeks. [ABSTRACT FROM AUTHOR]

Arterial erectile dysfunction ( ED) is commonly associated with classic cardiovascular and metabolic risk factors, such as smoking, hypertension, diabetes mellitus, dyslipidaemia and obesity. However, some patients with arterial ED do not present any cardiovascular risk factor. As mean platelet volume ( MPV) has been shown to be directly related to the cardiovascular risk and the percentage of platelets expressing the vitronectin receptor (αVβ3), involved in the early stages of platelet adhesion, is higher in patients with ED, the present study was undertaken to evaluate MPV and αVβ3 in 15 patients with arterial ED not associated with any cardiovascular risk factor. Their MPV and αVβ3 values were compared with those of men with normal penile haemodynamic. Patients with arterial ED had a mean value of MPV (11.25 vs. 9.88 fL; p < 0.001) and a percentage of platelets expressing the αVβ3 (7.39 vs. 2.07%; p < 0.001) significantly higher compared to controls. A negative correlation was observed between peak systolic velocity and MPV ( r = 0.916; p < 0.001) or αVβ3 ( r = 0.930; p < 0.001), whereas MPV and αVβ3 correlated positively ( r = 0.908; p < 0.001). In conclusion, this study showed for the first time that MPV and the percentage of platelet expressing αVβ3 are significantly higher in patients with arterial ED compared to controls. We speculate that these parameters of platelet function may be envisaged as markers of cardiovascular risk in patients with arterial ED. [ABSTRACT FROM AUTHOR]

The pharmacological treatment of erectile dysfunction ( ED) is mainly represented by the administration of inhibitors of phosphodiesterase-5 ( PDE5). However, in the clinical practice many patients do not benefit from such a treatment, hence the scientific interest extends to other therapeutic strategies; in particular, to the vascular regenerative therapy. This review describes the main acquisitions related to this approach represented by the mesenchymal stem cell or adipose tissue stem cell transplantation and endothelial nitric oxide synthase or vascular endothelial growth factor gene therapy. Moreover, there are other two aspects of wide interest represented by the potential vascular regenerative effects exerted by the PDE5 inhibitors and the therapeutic strategies for a category of patients who more frequently do not respond to the conventional treatment for ED, the patients with diabetes mellitus. [ABSTRACT FROM AUTHOR]

We have previously reported that infertile patients with diabetes mellitus (DM) have a particular ultrasound features of the seminal vesicles (SV) characterized by higher fundus-to-body ratio and lower pre- and post-ejaculatory difference in body antero-posterior diameter (APD). Based on these premises the aim of the present study was to investigate possible ultrasound SV changes in infertile patients with DM and diabetic neuropathy (DN), after prolonged administration of tadalafil (TAD) (a specific phosphodiesterase-5 inhibitor). To accomplish this, 20 infertile patients with symptomatic DN and erectile dysfunction were selected and arbitrarily divided into two groups which were assigned to: daily administration of 5 mg TAD for 3 months (Group A) (n = 10) and administration of placebo (Group B) (n = 10). All patients underwent to scrotal and prostate-vesicular transrectal ultrasound evaluation and semen analysis (Laboratory Manual for the Examination and Processing of Human Semen, WHO, 2010) before and after treatment. The following SV US parameters were recorded: (i) body APD; (ii) fundus APD; (iii) parietal thickness of the right and left SVs; and (iv) number of polycyclic areas within both SVs. We then calculated the following parameters: (i) fundus/body (F/B) ratio; (ii) difference of the parietal thickness between the right and the left SV and (iii) pre- and post-ejaculatory APD difference. In addition, we also evaluated the SV ejection fraction. Group A patients showed a significant reduction in F/B ratio and higher pre- and post-ejaculatory body SV APD difference compared with baseline or Group B after 3 months. These patients showed also a significant increase in SV ejection fraction and a significant improvement of the total sperm count, progressive motility, seminal levels of fructose, leucocytes and ejaculate volume. In conclusion, these results suggest that infertile DM patients with DN and erectile dysfunction had an improvement of ultrasound features suggestive of diabetic neuropathy after daily treatment with low doses of TAD. [ABSTRACT FROM AUTHOR]