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Testosterone deficiency syndrome (TDS) or late-onset hypogonadism is a clinical syndrome marked by symptoms including a reduction in muscle mass and increase in adiposity, decreased sexual function, depressed mood, hot flushes, and fatigue, most often in association with laboratory evidence of decreased testosterone. There is an emerging body of evidence that TDS is an independent cardiovascular risk factor in addition to being a predisposing factor for the development of the metabolic syndrome, dyslipidemia, insulin resistance and type 2 diabetes, hypertension, atherosclerosis, and vascular dysfunction. We sought to assess the knowledge, beliefs and practice patterns of a cohort of general practitioners and cardiologists in Victoria BC with respect to TDS and cardiac health. A questionnaire was distributed to all 20 cardiologists and a cohort of 120 family practitioners in Victoria BC. Of the 13 questions, 10 assessed their knowledge and beliefs with respect to TDS and 3 assessed their current practice patterns. Appropriate statistical analysis was undertaken. Most respondents believed that TDS was medical condition and could have an adverse affect on body composition but a similar majority was unsure to whether it was a cardiac risk factor. While most believed that testosterone replacement therapy (TRT) could improve exercise tolerance, the majority were unsure as to if it was beneficial in patients with congestive heart failure, following myocardial infarction, or to improve myocardial perfusion. Cardiologists were statistically significantly more likely to believe that TRT was not beneficial in preventing recurrent myocardial infarction and improving myocardial perfusion (p = 0.0133, 0.00186, respectively). The vast majority (88%) did not screen male cardiac patients for TDS. If a patient was identified as having TDS, only10% of those surveyed would refer to a urologist. Despite being remarkably common in cardiac patients, both general practitioners and cardiologists lack knowledge as to the significant deleterious cardiovascular effects of testosterone deficiency. In their role as men's health advocates, urologists should consider promoting continuing medical education seminars to inform other relevant medical specialists regarding the correlation between TDS and cardiovascular mortality and risk factors. [ABSTRACT FROM AUTHOR]

Introduction: Testosterone deficiency syndrome (TDS) has been shown to be an independent cardiovascular risk factor and a pre-disposing factor for metabolic syndrome. As general practitioners and cardiologists primarily care for these patients, we sought to assess their knowledge, beliefs and practice patterns with respect to TDS and cardiac health. Methods: We distributed a questionnaire to all 20 cardiologists and a cohort of 128 family practitioners in Victoria, British Columbia. Of the 13 questions, 10 assessed knowledge and beliefs on TDS and 3 assessed current practice patterns. Results: Most respondents believed that TDS is a medical condition (66.7%) and could negatively affect body composition (62%), but a similar majority was unsure whether it was a cardiac risk fac-tor (66.7%). While most believed that testosterone replacement therapy (TRT) could improve exercise tolerance (62%), most were unsure if it was beneficial in cardiac patients. Cardiologists were significantly less likely to believe that TRT was beneficial in pre-venting recurrent myocardial infarction and improving myocardial perfusion (p = 0.0133, 0.00186, respectively). The vast majority (88%) did not screen cardiac patients for TDS. If a patient was identified as having TDS, onlyl 0% of those surveyed would refer these patients to a urologist. Conclusion: Despite its prevalence in cardiac patients, TDS is not well-understood by general practitioners and cardiologists; they lack knowledge on its deleterious cardiovascular effects. In their role as men's health advocates, urologists should educate our col-leagues regarding the correlation between TDS and cardiovascular mortality and risk factors. Limitations of this study include small sample size and restricted geographic scope. [ABSTRACT FROM AUTHOR]

Analogues of the gonadotropin releasing hormone (GnRH) inhibit the hypothalamic-pituitary-gonadal axis. This has provided treatment modalities for advanced and metastatic prostate cancer. The latest group of analogues, the GnRH antagonists, make promising treatments available that avoid the transient surge in testosterone that occurs with the use of GnRH agonists. Such surges may stimulate tumor growth, causing patients to experience new or worsening cancer symptoms and potential serious adverse effects, including increased bone pain, urinary retention, and spinal cord compression and consequently delay the therapeutic benefits of agonist therapy. Degarelix, an antagonist, recently approved in the United States and Europe, achieves faster, more profound and sustained testosterone suppression and with fewer adverse effects when compared with agonists and other antagonists. This review discusses and compares the compounds degarelix, abarelix, and cetrorelix.

Intravesical Bacillus Calmette-Guérin (BCG) is widely used as an adjuvant therapy in the treatment of superficial bladder cancer. BCG is administered as a live, attenuated form of Mycobacterium bovis, and acts as an immunomodulary agent to delay tumor progression. BCG is generally well tolerated, though localized and systemic infectious complications may occur. A literature search revealed that tuberculous epididymitis is a rarely reported complication of intravesical BCG therapy. We report the case of an 82-year-old male who developed tuberculous epididymitis while undergoing intravesical BCG treatment for transitional cell carcinoma of the bladder. Right orchiectomy was performed, followed by rifampin and isoniazid therapy once M. bovis was identified as the infectious agent. The patient responded well to these treatments, and made a full recovery. Tuberculous epididymitis is an uncommon complication resulting from intravesical BCG therapy, which is likely explained by retrograde migration from the prostatic urethra in this case.

High-flow priapism is most often seen following perineal and penile trauma. We report the case of a 32-year-old man who presented with recurrent idiopathic priapism initially treated as low-flow priapism on 8 previous emergency department visits. Pelvic angiography revealed an abnormal communication between the left cavernosal artery and the left corpus cavernosum and led to the diagnosis of high-flow priapism. Treatment involved embolization of the left common penile artery, which resulted in successful resolution of the recurrent priapism. Our patient's case highlights the importance of an appropriate work-up, including imaging, to distinguish high- and low-flow priapism and to provide appropriate care.

INTRODUCTION: High Intensity Focused Ultrasound (HIFU) ablates benign prostatic tissue in a minimally invasive manner with low morbidity. The safety and effectiveness of treating of benign prostatic hypertrophy (BPH) with HIFU using 3 different protocols are reported. METHODS: Forty six male patients with a mean age of 65 (range 47-84) were treated using the Sonablate HIFU device (Focus Surgery, Indianapolis IN) with 3 different protocols at 3 centres (LDS n=20, PJP n=12, RWC n=14). Baseline and outcome measures included AUA symptom score, peak urinary flow rate (Qmax) and quality of life (QOL) score. Early and long term complications were recorded. RESULTS: At 12 months post-HIFU, patients showed improvements in AUA symptom scores of 35% (LDS), 43% (PJP) and 59% (RWC). Qmax improved by 30% (LDS), 37% (PJP) and 63% (RWC). QOL scores improved by 63% (LDS) and 58% (RWC). Minor complications included hematospermia (13%), mild to moderate hematuria (9%), acute retention (4%), perineal pain (11%) and epididymitis (9%). Recatheterization occurred in up to 16% of patients. Eleven patients in the LDS and PJP series required a transurethral resection of the prostate (TURP) for symptoms of urinary obstruction after HIFU treatment. There were no TURP's following HIFU in the RWC series. CONCLUSIONS: HIFU is safe, produces acceptable complications and effectively relieves BPH symptoms.