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Purpose: Metabolic syndrome is a risk factor for several diseases. The relationship between metabolic syndrome and hypogonadism is well known. Our objetive is to assess whether a low carbohydrate diet can increase total serum testosterone and improve erectile function in hypogonadal men with metabolic syndrome., Methods: An open label randomized clinical trial was conducted comparing a low carbohydrate diet and controls, during three months, in hypogonadal men with metabolic syndrome. Anthropometric measurements were evaluated as well as total serum testosterone levels, and symptoms of hypogonadism, using the ADAM and AMS scores, and sexual function using IIEF-5 score., Results: Eighteen men were evaluated. Anthropometric measures were improved only in low carbohydrate diet group. The intervention group also had a statistically increase in IIEF-5 score and a significant reduction in AMS and ADAM scores (p < 0.001). The increase in serum total testosterone levels was statistically significant in the low carbohydrate group compared to the control group as well as calculated free testosterone (p < 0.001)., Conclusions: Low carbohydrate diet may increase serum levels of testosterone and improve erectile function in hypogonadal men with metabolic syndrome. However, larger studies are necessary to strongly prove the effectiveness of low carbohydrate diet in treating male hypogonadism., (© 2023. The Author(s).)

Introduction: Male obesity has a negative correlation with plasma testosterone (T) levels and sexual function (SF)., Aim: To evaluate the effect of weight loss through bariatric surgery (BS) on SF, low T symptoms, and hormonal profiles in obese men., Methods: Thirty-three men who underwent BS participated in this cohort study. Before surgery, all participants underwent clinical examinations, including anthropometric, lipid, glycemic, and hormonal evaluations. SF was evaluated using the International Index of Erectile Function (IIEF) questionnaire; low T symptoms were evaluated using the Aging Males' Symptoms (AMS) and Androgen Deficiency in the Aging Male (ADAM) questionnaires. The participants were reevaluated 6 months post-surgery., Main Outcome Measures: Sex hormone profile, SF, and low T symptoms RESULTS: After BS, a significant increase in mean total T (201 ± 111-548 ± 190 ng/dL, P < .001), free T (5.8 ± 2.8-9.3 ± 3.4 ng/dL, P < .001), bioavailable T (110.3 ± 57.8-198.6 ± 74.3 ng/dL, P < .001), and sexual hormone-binding globulin (19.8 ± 13.7-54.6 ± 23.2 nmol/L, P < .001) levels. There was a significant decrease in estradiol (64.6 ± 27.4-29.2 ± 20.0 [pg/mL], P < .001). SF significantly improved. The total IIEF score increased 5.2 points (62.3 ± 7.4-67.5 ± 7.4, P = .004), erectile function subdomain increased 2.4 points (25.7 ± 4.1-28.1 ± 3.9, P = .011), desire subdomain increased 1.0 points (8.3 ± 1.5-9.3 ± 1.6, P = .006), and intercourse satisfaction subdomain increased 1.2 points (11.4 ± 1.9-12.6 ± 1.8, P = .012). Post-surgery, a 44% reduction (P = .001) was observed in the positive ADAM questionnaire, and improvements in all domains of the AMS questionnaire were found (P < .001)., Conclusion: Significant weight loss through BS improves erectile function, hormonal profile, and symptoms of T deficiency. Machado FP, Rhoden EL, Pioner SR, et al. Weight Loss Through Bariatric Surgery in Men Presents Beneficial Effects on Sexual Function, Symptoms of Testosterone Deficiency, and Hormonal Profile. Sex Med 2021;9:100400., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP., Materials and Methods: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively., Results: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05)., Conclusion: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not signifi cantly improve urinary continence or erectile function at 3 months after RP., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Purpose: This study aims to evaluate the link between preoperative parameters and oxidative stress (OS) markers in the bladder wall of men undergoing open prostatectomy., Materials and Methods: From July 2014 to August 2016, men aged ≥ 50 years and presenting with LUTS were prospectively enrolled. Preoperative assessment included validated questionnaires (IPSS and OAB - V8), lower urinary tract ultrasound and urodynamics. Bladder biopsies were taken during open prostatectomy for determination of OS markers. Increased OS was defined by increased concentration of malondialdehyde (MDA) and / or decreased concentration of antioxidant enzymes (superoxide dismutase and / or catalase). P<0.05 was regarded as statistically significant., Results: Thirty - eight consecutive patients were included. Mean age was 66.36 ± 6.44 years, mean prostate volume was 77.7 ± 20.63 cm3, and mean IPSS was 11.05 ± 8.72 points. MDA concentration was increased in men with severe bladder outlet obstruction (BOO grade V - VI according to the Schaefer's nomogram) in comparison with BOO grade III - IV (p = 0.022). Patients with severe LUTS also had higher MDA concentration when compared to those with mild LUTS (p = 0.031). There was a statistically significant association between increased post - void residual urine (cut off ≥ 50 mL) and not only higher levels of MDA, but also reduced activity of SOD and catalase (p < 0.05)., Conclusions: This pilot study showed that severity of LUTS and BOO were associated with increased MDA concentration in the bladder wall of men undergoing open prostatectomy. Further studies are still needed to assess the role of non - invasive biomarkers of OS in predicting bladder dysfunction in men with LUTS., Competing Interests: Conflict of interest: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Background and Objectives: Advances in neonatal care promoted increased survival rates of preterm infants, with a consequent increase in the number of children affected by retinopathy of prematurity (ROP). This study estimates the incidence of ROP and evaluates potential risk factors associated., Methods: A retrospective cohort study of preterm infants born in a tertiary neonatal intensive care unit was conducted from March 2005 to August 2015. Six hundred and thirty-nine newborns were included based on the following criteria: infants born with less than 32 weeks' gestation or birth weight below 1500 g; or neonates born with 32-37 weeks' gestation or birth weight above 1500 g and any of the following associated: multiple gestation, respiratory distress syndrome, sepsis, blood transfusions or intraventricular hemorrhage. Neonates were followed up until disease resolution or until treatment criteria was achieved., Results: A total of 602 newborns were evaluated after applying the exclusion criteria. Mean gestational age was 30.7 ± 2.5 weeks. The incidences of ROP at any stage and of type 1 prethreshold ROP were 33.9 and 5.0% respectively. Logistic regression analysis revealed that risk factors associated with ROP at any stage were extremely low birth weight (ELBW) (odds ratio [OR] = 3.10; 95% confidence interval [95% CI]:1.73-5.55), pulmonary diseases (OR = 2.49; 95% CI: 1.35-4.59), intraventricular hemorrhage (OR = 2.17; 95% CI: 1.10-4.30), and low gestational age (OR = 0.81; 95% CI: 0.73-0.91). The main risk factors associated with type 1 prethreshold ROP were pulmonary diseases (OR = 9.58; 95% CI: 1.27-72.04) and ELBW (OR = 3.66; 95% CI: 1.67-8.00)., Conclusion: This study found a significant incidence of ROP (33.9%) in the studied population, and highlighted pulmonary diseases as a significant risk factor for type 1 prethreshold ROP.

Aims: To evaluate the collagen content in the bladder wall of men undergoing open prostate surgery., Methods: From July 2014 to August 2016, men aged ≥ 50 years, presenting LUTS and undergoing open prostate surgery due to benign prostatic enlargement (BPE) or prostate cancer were prospectively enrolled. Preoperative assessment included validated questionnaires (IPSS and OAB-V8), lower urinary tract ultrasound, and urodynamics. Bladder biopsies were obtained during open prostatectomy for determination of collagen content (sirius red-picric acid stain; polarized light analysis). Collagen to smooth muscle ratio (C/M) in the detrusor was measured and its relationship with preoperative parameters was investigated. The level of significance was P < 0.05., Results: Thirty-eight consecutive patients were included in this pilot study. Mean age was 66.36 ± 6.44 years and mean IPSS was 11.05 ± 8.72 points. Men diagnosed with diabetes mellitus (DM2) were found to have higher collagen content in the bladder wall when compared to non-diabetic patients (17.71 ± 6.82% vs 12.46 ± 5.2%, respectively; P = 0.024). Reduced bladder compliance was also marker for higher collagen content (P = 0.042). Bladder outlet obstruction (BOO) was not a predictor of increased collagen deposition in the bladder wall (P = 0.75). Patients with PVR ≥ 200 mL showed a higher collagen to smooth muscle ratio in the bladder wall (P = 0.036)., Conclusions: DM2 and urodynamic parameters, such as increased PVR and reduced bladder compliance, were associated with higher collagen content in the bladder wall of men with LUTS., (© 2017 Wiley Periodicals, Inc.)

Advances in medicine and progressive improvements in the health of the general population in developed countries have led to considerable increases in life expectancy over recent years. Metabolic syndrome (MetS) affects approximately 25% of the adult population and its prevalence is increasing all over the world. Central obesity plays an important role in emergence of MetS. Some studies have suggested that there may be link between low Total Testosterone levels and emergence of MetS. The objective of this review is to analyze the complex network of interactions between MetS and low testosterone levels in elderly men, considering etiologic, diagnostic, and therapeutic aspects. Recent evidence confirms that central obesity is the independent MetS component correlated to Total Testosterone Levels. Experimental studies suggest a two way road between Low Testosterone Levels and abdominal obesity. Besides that, Testosterone Replacement Therapy should be restricted to men with biochemical and clinical features of late onset hypogonadism., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Objective: To evaluate the effects of testosterone (T) on the maintenance of corpus cavernosum (CC) structure and apoptosis., Methods: Animals were divided into three groups: sham operation group ( n  = 8) underwent sham operation; Orchiectomized (Orchiec)+ oily vehicle group ( n  = 8) underwent bilateral orchiectomy and received a single dose of oily vehicle by intramuscular injection (i.m.) 30 days after orchiectomy; and Orchiec + T group ( n  = 8) underwent bilateral orchiectomy and received a single dose of T undecanoate 100 mg/kg i.m. 30 days after the surgery. Animals were euthanized 60 days after the beginning of the experiment with an anesthetic overdose of ketamine and xylazine. Blood samples and penile tissue were collected on euthanasia. Azan's trichrome staining was used to evaluate smooth muscle, Weigert's Fucsin-Resorcin staining was used to evaluate elastic fibers and Picrosirius red staining was used to evaluate collagen. Apoptosis was evaluated using TUNEL technique., Results: T levels decreased in Orchiec + oily vehicle when compared to sham operation and Orchiec + T groups ( p  < 0.001). T deprivation reduced trabecular smooth muscle content and penile diameter and T replacement maintained both parameters ( p  = 0.005 and p  = 0.001, respectively). No difference was observed in the content of sinusoidal space ( p  = 0.207), elastic fibers ( p  = 0.849), collagen ( p  = 0.216) and in apoptosis ( p  = 0.095)., Conclusion: Normal testosterone levels maintain CC smooth muscle content and do not influence elastic fibers, collagen content and apoptotic index. Further studies should be performed in order to investigate the mechanisms by which androgen mediates its effects on CC structure.

Introduction: Metabolic syndrome (MetS) is a constellation of interrelated risk factors of metabolic origin. Some studies suggest a possible link between low total testosterone (TT) levels and the presence of MetS., Aim: To analyze the strength and independence of associations between TT and MetS components in non-diabetic men., Methods: In this cross-sectional study, 143 non-diabetic men older than 40 were analyzed., Main Outcomes Measure: Blood samples were collected to evaluate metabolic profile and TT levels. MetS was defined as the presence of three or more of the following characteristics: fasting blood glucose levels ≥ 100 mg/dL, triglyceride ≥ 150 mg/dL, HDL-c < 40 mg/dL, hypertension or blood pressure ≥ 130/85 mmHg, and waist girth > 102 cm., Results: Mean age of the study population was 61.5 ± 8.61 years old. MetS was present in 47.9% of the individuals. Thirty-four men had low TT and MetS was observed in 23 (70%) against 50 (46%) in those with normal TT (≥ 300 ng/dL) (OR 4.94, p < 0.01), adjusted to confounder's factors. In multiple linear regression analysis, only waist circumference (Beta: -0.395; p = 0.03) and HDL-c (Beta: 0.19; p = 0.04) remained significantly correlated with TT levels., Conclusions: Low TT levels were associated with MetS diagnosis. Abdominal obesity was the MetS component independently correlated to low TT levels.

Purpose: To evaluated the effects of L-arginine (a NO donor) and L-NAME (Nw-nitro-L-arginine methyl ester - a NOS inhibitor) on ischemia-reperfusion in rat livers., Methods: One hundred fifty two male Wistar rats were divided into four groups: control (simulated surgery); hepatic IR; pretreatment with L-arginine plus hepatic IR; and L-NAME plus hepatic IR. The hepatocellular damage was evaluated at the first, third and seventh days after the procedures through the alanine-aminotransferase (ALT) and aspartate-aminotransaminase (AST) levels, as well as histopathological features: vascular congestion (VC); steatosis (STE); necrosis (NEC); and inflammatory infiltration (INF). The mortality rate was also evaluated., Results: The pretreatment with L-NAME significantly worsened the AST levels after hepatic IR (p<0.05) at first day and L-arginine demonstrated an attenuating effect on ALT levels at seventh day (p<0.05). Furthermore, the administration of L-arginine was able to reduce the VC and STE in the seventh day after hepatic IR (p<0.05). The analysis of the mortality rates did not demonstrate any difference between the groups. Nevertheless, there was not effect of L-arginine and L-NAME on the mortality of the animals., Conclusion: L-arginine/NO pathway has a role in the hepatic IR because the pretreatment with L-arginine partially had attenuated the hepatocellular damage induced by hepatic IR in rats.

Objective: To evaluate the concordance between the Gleason scores of prostate biopsies and radical prostatectomy specimens, thereby highlighting the importance of the prostate-specific antigen (PSA) level as a predictive factor of concordance., Methods: We retrospectively analyzed 253 radical prostatectomy cases performed between 2006 and 2011. The patients were divided into 4 groups for the data analysis and dichotomized according to the preoperative PSA, <10 ng/mL and ≥10 ng/mL. A p-score <0.05 was considered significant., Results: The average patient age was 63.3±7.8 years. The median PSA level was 9.3±4.9 ng/mL. The overall concordance between the Gleason scores was 52%. Patients presented preoperative PSA levels <10 ng/mL in 153 of 235 cases (65%) and ≥10 ng/mL in 82 of 235 cases (35%). The Gleason scores were identical in 86 of 153 cases (56%) in the <10 ng/mL group and 36 of 82 (44%) cases in the ≥10 ng/mL group (p=0.017). The biopsy underestimated the Gleason score in 45 (30%) patients in the <10 ng/mL group and 38 (46%) patients in the ≥10 ng/mL (p=0.243). Specifically, the patients with Gleason 3 + 3 scores according to the biopsies demonstrated global concordance in 56 of 110 cases (51%). In this group, the patients with preoperative PSA levels <10 ng/dL had higher concordance than those with preoperative PSA levels ≥10 ng/dL (61% x 23%, p=0.023), which resulted in 77% upgrading after surgery in those patients with PSA levels ≥10 ng/dl., Conclusion: The Gleason scores of needle prostate biopsies and those of the surgical specimens were concordant in approximately half of the global sample. The preoperative PSA level was a strong predictor of discrepancy and might improve the identification of those patients who tended to be upgraded after surgery, particularly in patients with Gleason scores of 3 + 3 in the prostate biopsy and preoperative PSA levels ≥10 ng/mL.

Purpose: To evaluate the relationship among aFT, cFT, and total testosterone (TT) and the best method in diagnosing subnormal levels of TT., Methods: A total of 213 men were analyzed. Fasting blood samples were drawn for the determination of the lipid profile as well as of plasmatic glucose and serum levels of albumin, TT, aFT, and sex hormone-binding globulin (SHBG). The values of cFT were determined by Vermeulen's formula., Results: No correlation between aFT and cFT was observed (r = 0.062; P = 0.368), except after controlling for confounders (r = 0.188; P = 0.007). Only 44.8% of hypogonadal men (TT ≤ 300 ng/dL) were classified by aFT, whereas 72.4% of hypogonadal men were classified by both TT and cFT. Sensitivity, specificity, positive and negative predictive values, and positive likelihood ratio were greater in cFT when compared with aFT., Conclusions: Our results suggest that cFT is more accurate in diagnosing subnormal levels of TT. Furthermore, we do not recommend using aFT due to its lack of accuracy. Further studies should be performed in order to evaluate the correlation between aFT and cFT with clinical signs and symptoms of androgen deficiency.

Introduction: Flow-mediated vasodilation (FMD) of the brachial artery is a noninvasive tool used for endothelial function evaluation. There is increasing evidence that endothelial dysfunction is a common etiological factor for erectile dysfunction (ED) and cardiovascular events., Aim: To evaluate endothelial function with a high-resolution ultrasound device, to assess FMD in men diagnosed with ED and without clinical evidence of significant atherosclerotic disease, classified as "intermediate risk" according to the Framingham risk score (FRS)., Methods: This is a case-control study that included 52 consecutive men. In all men with ED evaluated by a score less than 22 on International Index of Erectile Function-5 questionnaire (IIEF-5), clinical parameters such as blood pressure, waist circumference, hip circumference, body mass index, lipid profile, fasting glucose, and serum total testosterone were obtained. These parameters were compared with those men without diagnosis of ED (IIEF-5 score≥22) (age-matched, also classified as "intermediate risk" according to the FRS). All underwent brachial artery ultrasound for assessment of FMD, as a noninvasive method to evaluate endothelial function. Statistical analysis was performed considering a P<0.05., Main Outcome Measures: Endothelium-dependent FMD was evaluated in the right brachial artery with a high-resolution ultrasound machine following reactive hyperemia., Results: Thirty-four men were included in the ED group, and 18 were included in the group without ED. The mean ages were 59.61±9.87 and 56.18±10.93, respectively (P=0.27). Clinical and laboratory evaluations were similar between men with and without ED (P>0.05) except for waist circumference that was greater in patients with ED (mean=100.85 cm vs. 96.05; P<0.05). The percentage of FMD was higher in men without ED when compared with those with ED (mean FMD 11.33±6.08% vs. 4.24±7.06%, respectively; P=0.001)., Conclusions: Men without established atherosclerotic disease presenting with ED demonstrated a worse endothelial function., (© 2012 International Society for Sexual Medicine.)

Excess of adiposity is a risk factor for coronary artery disease, but it remains unclear if the distribution of fat is an effect modifier or if the risk is mediate by hypertension, diabetes and dyslipidemia. We investigated the association of central in addition to general obesity with coronary artery disease (CAD). A case-control study was conducted in 376 patients, aged 40 years or more, with chronic coronary disease, undergoing elective coronary angiography. Excess of adiposity was evaluated by the Body Mass Index (BMI), waist circumference, waist-hip ratio, and neck circumference. Cases (n=155) were patients referred for coronary angiography with at least 50% of coronary stenosis in at least one epicardial vessels or their branches, with diameter greater than 2.5 mm. Controls (n=221) were patients referred for coronary angiography without significant coronary disease. Odds ratios and 95%CI for significant coronary stenosis were calculated using multiple logistic regression, controlling for age, sex, years at school, smoking, hypertension, HDL-cholesterol, diabetes mellitus, and an adiposity index. There was a predominance of men and individuals older than 50 years among cases. The waist-hip ratio increased four times the chance of CAD, even after the control for confounding factors, including BMI. Neck circumference above the 90(th) Percentile doubled the chance of CAD, after adjustment for traditional risk factors. Neck circumference and waist-hip ratio are independent predictors of CAD, even taking into account traditional risk factors for CAD. These findings highlight the need of anthropometric assessment among patients with suspected coronary artery disease.

Purpose: To evaluate the influence of age on serum levels of total testosterone (TT), bioavailable testosterone (BT), free testosterone (FT), and sex-hormone binding globulin (SHBG), considering the presence of fasting blood glucose levels and body mass index (BMI) in a selected male population., Methods: A total of 428 men were analyzed. Anthropometry was taken from all, considering BMI as general obesity indicative variable. Fasting blood samples were drawn for determination of plasma glucose levels and serum levels of albumin, TT, and SHBG. The values of BT and FT were calculated from TT, SHBG, and albumin, by Vermeulen's equation. Statistical significance was set at P ≤ 0.05., Results: Age was negatively correlated to BT (r = -0.301; P < 0.001) and FT (r = -0.273; P < 0.001), but not to TT levels (r = 0.002, P = 0.974). Age was positively correlated to SHBG (r = 0.376; P < 0.001). Age was independently associated with the occurrence of high SHBG levels (OR = 1.07, 95%CI = 1.05-1.10, P < 0.001) and of low BT (OR = 1.04, 95%CI = 1.02-1.07, P < 0.001) and FT levels (OR = 1.05, 95%CI = 1.03-1.08, P < 0.001), but not with low levels of TT (P = 0.08)., Conclusions: Age was significantly associated to high levels of SHBG and to low levels of BT and FT, without significant association to TT. This pattern was independent of BMI and glucose levels.

Objectives: • To compare the influence of a 4-week course of empirical antimicrobial therapy or observation on the prostate-specific antigen (PSA) levels of asymptomatic patients with a raised baseline PSA. • To identify whether a decrease in PSA can predict the risk of prostate cancer (PCa) detection on prostate biopsy., Patients and Methods: • Patients were referred to our ambulatory centre because of a raised PSA level (>2.5 ng/mL) with a normal digital rectal examination. A 12-core prostate biopsy was indicated in these patients and they were offered antibiotic treatment with levofloxacin 500 mg daily for 30 days. • Patients who did not agree to use antibiotics but who still showed interest in participating underwent simple observation, serving as controls. • Total and free PSA levels at baseline and after 45 days were measured. Variation in PSA level was calculated. • All patients underwent a 12-core prostate biopsy 6 weeks after the initial visit., Results: • In all, 245 men were enrolled, but 43 were lost due to follow-up. A total of 145 patients who used antibiotics and 57 controls were included in the analysis. • The median baseline PSA levels were 7.6 and 7.7 ng/mL in the antibiotic and control groups, respectively, with median follow-up levels of 6.8 and 7.0 ng/mL. The follow-up PSA level was significantly lower than the initial PSA level (P = 0.009). • Mean absolute and percentage variation in PSA level were similar in both groups (P = 0.828 and 0.128, respectively). • The overall PCa detection rate was 15.8%, and did not differ among the groups (P = 0.203). Regarding the percentage variation in PSA level, patients diagnosed with PCa tended to have their PSA level increased (22.4 vs -5.3%; P = 0.001). Indeed, a decrease of 20% in PSA was not predictive of a negative prostate biopsy (P = 0.41). • The area under the receiver operating characteristic curve for percentage PSA variation as a predictor of PCa was 0.660., Conclusions: • PSA levels tend to fall when repeated after 45 days, regardless of antibiotic use. • Despite being associated with the chance of PCa, no percentage PSA variation threshold value exhibits satisfactory discriminatory properties., (© 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL.)

Introduction: The association between erectile dysfunction (ED) and coronary artery disease (CAD) has been described in various settings, but it is unclear if there is an independent interaction with age., Aim: To investigate the interaction of age in the association between ED and CAD., Methods: This case-control study was conducted among 242 patients referred for elective coronary angiography. One hundred fourteen patients with significant CAD were identified as cases and 128 controls without significant CAD. ED was evaluated by the erectile function domain of the International Index of Erectile Function (IIEF) questionnaire, determined by a score ≤ 25 points., Main Outcome Measures: Significant CAD was based on stenosis of 50% or greater in the diameter in at least one of the major epicardial vessels or their branches. The analysis was conducted in the whole sample and according to the age strata, controlling for the effects of cardiovascular risk factors, testosterone, and C-reactive protein. Results.  Patients had on average 58.3 ± 8.9 years. CAD and ED were associated exclusively in patients younger than 60 years (ED in 68.8% of patients with CAD vs. 46.7% of patients without CAD, P = 0.009). The association was independent of cardiovascular risk factors, testosterone and C-reactive protein (risk ratio 2.3, 95% confidence interval from 1.04 to 5.19). Severity of CAD was higher in patients younger than 60 years with ED., Conclusions: Men with less than 60 years of age who report ED presented a higher risk of having chronic CAD and more severe disease diagnosed by coronary angiography., (© 2011 International Society for Sexual Medicine.)

Objective: The objective of the present study is to evaluate the histomorphometric characteristics of the prostate of rats submitted to chronic (long-time) treatment with doxazosin mesylate, finasteride and both substances combined., Materials and Methods: Four groups of eight rats each were selected for this study and treated with saline solution (control), doxazosin mesylate, finasteride and combination of the drugs, during 10 months. After this time, the prostate was removed, weighed and sent for histological analysis. Prostate sections were stained with Masson trichrome. With an image analyzer, the percentage of smooth muscle, collagen, epithelium, acinar lumen and interstitial space was measured. Also, the minimum, medium and maximum epithelial thickness, number of acini per field, mean acinar area and the presence of papillary projections were evaluated., Results: The mean prostate weight of rats treated with finasteride and combined treatment was lower when compared to the control group (P < 0.05). Prostate from rats treated with finasteride alone had a lower percentage of the epithelial component and a smaller minimum epithelial thickness than the control group (P < 0.05). The number of acini per field in the combined groups was higher than that observed in all other groups (P < 0.05). Also, rats of the finasteride and combined groups presented a reduced number of papillary projections when compared to the other groups (P < 0.05)., Conclusion: Our study clearly showed the effects of finasteride on prostate tissue, and from a histomorphometric perspective, it was not able to detect any advantage of the combined treatment over the use of finasteride alone.

Introduction: Substantial controversy exists regarding the association between testosterone serum levels and prostate cancer., Objective: To evaluate the levels of hypothalamic-pituitary-testicular axis hormones in the sera of men with prostate cancer and atypical small acinar proliferation as well as those with normal biopsies., Methods: A study cohort of 186 men with suspected prostate cancer who had undergone transrectal prostate biopsies was used in this study. The patients were divided into the following three groups based on the histology of the biopsy samples: no neoplasia, atypical small acinar proliferation or prostate cancer. Demographic data were also collected. Levels of total testosterone, follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, and serum prostate-specific antigen were measured in blood samples., Results: Initially, 123 men were found to be without neoplasia, 26 with atypical small acinar proliferation and 37 with prostate cancer. After a second biopsy was taken from the men diagnosed with atypical small acinar proliferation, the diagnoses were revised: 18 were diagnosed with atypical small acinar proliferation and 45 with prostate cancer. No significant differences between the groups were identified regarding age, smoking history, chronic diseases, body mass index or PSA levels (P >.0.05). The mean serum levels of testosterone, follicle-stimulating hormone, luteinizing hormone, prolactin and estradiol were similar in all of the groups (P >.0.05). Furthermore, in individuals with prostate cancer, the Gleason scores and prevalence of hypogonadism were not significantly different (P.> 0.05)., Conclusion: The present study revealed no difference in the serum levels of testosterone, follicle-stimulating hormone, luteinizing hormone, prolactin or estradiol in men without neoplasia compared with those with atypical small acinar proliferation or prostate cancer.

Introduction: The mechanism by which varicocele interferes in spermatogenesis has not been clearly defined. Germ cell apoptosis and oxidative stress appear to be involved in this process and the use of antioxidants has been proposed to counteract upon these effects. The present study evaluated the effects of N-acetylcysteine (NAC) on spermatogenesis and germ cell apoptosis in an experimental model of varicocele in rats., Materials and Methods: Twenty 30-day-old animals were randomly divided into three groups: sham operation (Group 1), left experimental varicocele (Group 2) and left experimental varicocele group treated with NAC 50 mg/kg/day (Group 3). After 2 months, spermatogenesis was evaluated by absolute and true count of round spermatids, pachytenes, spermatocytes and Sertoli cells. The different cell relations were also analyzed. Germ cell apoptosis was quantified using the TUNEL method. The apoptotic index (AI) was calculated as the number of apoptotic cells per tubule. Statistical analysis was performed by analysis of variance considering P < 0.05., Results: The absolute and true cell counts were similar among the groups (P > 0.05). The round spermatid/pachytene ratio was significantly smaller in Groups 2 and 3 compared to the Group 1 (P = 0.012). The AI values were 0.207 ± 0.09, 0.138 ± 0.11 and 0.298 ± 0.27, respectively (P = 0.256)., Conclusion: Experimental varicocele in rats presented an association with the decreased round spermatid/pachytene ratio, suggesting the loss of germ cells during spermatogenesis. These effects were not influenced by the administration of NAC. Germ cell apoptosis was not influenced by experimental varicocele.

To identify and characterize the most frequently cited articles published in Journals dedicated to Urology over the last 50 years. A Pubmed search was performed of all articles published in the 13 most cited urological journals between 1955 and 2009. Articles with more than 100 citations were identified as "classic", and were analyzed further. Of 97,554 articles published during this time, 1239 articles were cited more than 100 times. The most common topic among classic articles was prostate cancer and prostate-specific antigen (33.5%), followed by bladder cancer and benign prostatic hyperplasia. A further analysis was performed for the 50 most frequently cited articles ("top-50")., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Introduction: Although Peyronie's Disease (PD) was first described over 250 years ago, its precise etiology remains obscure., Aim: Analyze a variety of potential associated factors with PD, including erectile dysfunction., Materials and Methods: This cross-sectional study included 83 consecutive men with PD and 252 age-matched controls. All men completed the International Index of Erectile Function (IIEF) and were evaluated regarding their clinical and demographic characteristics, comorbidities, and used medications. Anthropometric measures included body mass index and waist circumference (WC). Fasting blood glucose, lipid profile, total testosterone, and dehydroepiandrosterone-sulfate were determined., Main Outcome Measures: Clinical and laboratory characteristics associated to PD., Results: The mean age was 59.2 + or - 10 years in the cases and 59.7 + or - 12 years in the controls. Marital status, current smoking, and excessive consumption of alcoholic beverages were similar between groups (P > 0.05). PD was more common among white skin color males (P = 0.001). The mean score for each IIEF domain and the androgen levels were similar in the two groups. Thiazides were the only medication associated to PD (P = 0.03). Dupuytren's disease was more frequent among individuals with PD (P = 0.001). The distribution of all other comorbidities investigated was similar between groups (P > 0.05). The characteristics WC > 102 cm and levels of low-density lipoprotein (LDL) > 130 mg/dL were more prevalent in the controls (P < 0.05). After multivariate analysis, white skin color (OR: 8.47, 95%CI: 1.98-36.24) and thiazide use (OR: 2.29, 95%CI: 1.07-4.90) were associated to PD, and LDL > 130 mg/dL (OR: 0.55, 95%CI: 0.32-0.92) and WC > 102 cm (OR: 0.53, 95%CI: 0.29-0.96) were inversely associated to PD., Conclusions: In this study, PD was more common among white skin colored males. An inverse relationship with the presence of elevated serum levels of LDL and WC was observed. We found no association with medications other than thiazides and comorbidities other than Dupuytren's disease. Androgen serum levels and sexual dysfunction had also no association to PD.

Introduction: Despite increasing medical interest in testosterone therapy (TTh) for men with testosterone deficiency (TD) there is limited information regarding subjective response rates and acceptability of medium- to long-term TTh in routine clinical practice., Aim: To evaluate results in a consecutive series of men in clinical practice treated with TTh., Material and Methods: A chart review was performed for a consecutive series of men for whom TTh was initiated over 1 year for a clinical diagnosis of TD. A diagnosis of TD was based on the presence of symptoms and on laboratory evaluation indicating total testosterone (<300 ng/dL) or free testosterone (FT) (<1.5 ng/dL). Presenting symptoms were noted at baseline, and improvement was documented in domains of erectile function, libido, energy,and mood., Main Outcome Measures: Percentage of men who completed 12 months of TTh, and symptomatic response rates., Results: There were 127 men included in the evaluation. The most common presenting symptoms were the combination of erectile dysfunction (ED) and reduced libido in 82 (64.6%), ED alone in 29 (22.8%), and reduced libido alone in 13 (10.2%). Initial mode of TTh was injections (testosterone enanthate or cypionate) in 70 (55.1%)and transdermal gel (Androgel, Solvay Pharmaceuticals, Marietta, GA, USA) in the remainder. Improvements in erections, libido, energy, and/or mood were reported by 70% of men by 3 months. Eighty men (63%) completed 12 months of TTh with subjective benefit (responders). Treatment was discontinued in 34 (26.8%) who reported no major benefit (non-responders), and 13 (10.2%) were lost to follow-up. Among men who discontinued TTh, 64.7%failed to report benefits by 3 months. Baseline FT was lower among responders than non-responders. One case(1.25%) of prostate cancer was identified after one year of TTh., Conclusion: Approximately two-thirds of men with TD who begin TTh will experience symptomatic benefit and will complete at least 12 months of treatment. Benefit was noted in a majority by 3 months.

Hypogonadism is a clinical and biochemical syndrome which may cause significant detriment in the quality of life. With the increase in life expectancy and prostate cancer survival a significant increase in the number of men with hypogonadism who have undergone presumably curative treatment for PCa is anticipated. Despite the widespread contraindication of testosterone in men with known or suspected prostate cancer, there is no convincing evidence that the normalization of testosterone serum levels in men with low, but not castrate levels, is deleterious. Although further studies are necessary before definitive conclusions can be drawn, the available evidence suggests that testosterone replacement therapy can be cautiously considered in selected hypogonadal men treated with curative intent for low risk prostate cancer and without evidence of active disease.

Hypogonadism is a clinical and biochemical syndrome associated with a range of disease states that has significant effects on morbidity and mortality and also affects quality of life. Because of the increase in life expectancy and prostate carcinoma (PCa) survival, a significant increase in the number of men with hypogonadism who have undergone presumably curative treatment of PCa is anticipated. Despite the widespread belief regarding contraindication of testosterone administration to men with known or suspected PCa, there is no convincing evidence that the normalization of testosterone serum levels in men with low levels presents a deleterious effect on the evolution of the disease. In the few available case series describing testosterone replacement therapy (TRT) after treatment of PCa, no case of clinical or biochemical progression was observed. The available data suggest that TRT can be cautiously considered in selected hypogonadal men previously treated for curative intent of low-risk PCa and without evidence of active disease.

Objective: The present study examined the effects of intraportal infusion of L-arginine on ischemia/reperfusion injury (I/RI) in pig livers, by observing changes in the liver function, liver cell morphology, and changes in the mitochondrial ultrastructure., Background: The involvement of the nitric oxide (NO) pathway in the reperfusion-ischemic phenomenon is complex and not fully understood. Likewise, little is known about the possible benefit of intraportal infusion of L-arginine (substrate for the NO synthesis) on liver I/RI., Methods: A pig model consisting of 90 min of hepatic ischemia and 180 min of reperfusion was employed. Eighteen female hybrid pigs were randomly divided into three groups: sham-operated, non-preconditioned, and pharmacologically preconditioned group (intraportal infusion of L-arginine 400 mg/kg) 10 min before being subjected to ischemia and reperfusion. Serum concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), thiobarbituric acid reactive substances (TBARS), and the bile flow were measured. Liver biopsies were taken 180 min after reperfusion for histology, caspase-3 immunohistochemistry, and ultrastructural examination of mitochondria., Results: In the pharmacologically preconditioned group, we observed increased bile flow (P < 0.01) and improved serum AST levels (P < 0.01) relative to the non-preconditioned group. Serum concentrations of TBARS did not differ between the groups. Sinusoidal congestion (P = 0.02) was more evident in the non-preconditioned group than in the sham operated group. Infiltrating PMNs (P = 0.01) were more evident in the non-preconditioned group than in the sham and pharmacologically preconditioned group. The pharmacologically preconditioned group showed an approximately 2.5-fold decrease in caspase-3 activity relative to the non-preconditioned group (P < 0.01). Notably, damage to the mitochondrial ultrastructure in the pharmacologically preconditioned group was reduced relative to the other groups (P < 0.01)., Conclusions: Pharmacological preconditioning with intraportal L-arginine provided protection against hepatic I/RI in early phases of the reperfusion period. The mechanisms underlying the protective effect may include preservation of the mitochondrial structure and inhibition of caspase-3 activity.

Introduction: Cigarette smoking is highly prevalent among men. Many studies have evaluated the effect of cigarette smoking on levels of male reproductive hormones; however, the findings still remain controversial., Aim: To evaluate the influence of cigarette smoking on serum levels of total testosterone (TT), free testosterone (FT), bioavailable testosterone (BT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH)., Methods: A total of 255 men (90 smokers and 165 nonsmokers), aged 30 to 70 years, were investigated. Weight and height were obtained and body mass index (BMI) was calculated. Also, waist circumference and hip circumference were measured and waist-to-hip ratio was obtained. Fasting blood samples were drawn for determination of plasmatic glucose levels and serum levels of total cholesterol, high-density lipoprotein cholesterol (HDL-c), triglycerides, albumin, prolactin, TT, SHBG, LH, and FSH. The values of low-density lipoprotein cholesterol (LDL-c) were determined by Friedwald equation and the values of FT and BT were calculated from TT, SHBG, and albumin. Statistical significance was set at P < or = 0.05., Main Outcome Measures: The influence of smoking on levels of TT, FT, and BT., Results: No significant difference was observed in the mean values of TT (P = 0.580), FT (P = 0.869), BT (P = 0.933), SHBG (P = 0.279), LH (P = 0.573), and FSH (P = 0.693) in the different levels of pack-years when compared to nonsmokers. Moreover, after multivariate logistic regression, no association between increased pack-years of smoking and increased odds ratio for occurrence of low hormones and SHBG levels was observed., Conclusion: In this study, smokers and nonsmokers had similar mean values of androgens, gonadotropins and SHBG. However, it is necessary to standardize pack-years of smoking in order to elucidate the influence of cigarette smoking on sex hormone levels, as well as to minimize differences among studies and to confirm our results.

Background Data: The beneficial effects of ischemic preconditioning (IPC) on hepatic ischemia-reperfusion injury (I/RI) have been described. However, the way in which IPC causes the changes in mitochondrial ultrastructure seen in hepatic I/RI is not well understood., Objective: The objective of the present study was to determine whether IPC protects the liver from changes in mitochondrial structure and caspase 3 activity in the early phase of post-ischemic injury., Methods: A pig model consisting of 90 min of hepatic ischemia and 180 min of reperfusion was employed. Eighteen female pigs were randomly divided into three groups: sham-operated, non-preconditioned, and ischemic preconditioned (10 min ischemia followed by 10 min reperfusion). Serum concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and thiobarbituric acid reactive substances (TBARS), as well as bile flow, were measured. Liver biopsies were taken after reperfusion for histological, immunohistochemical (anti-caspase 3), and ultrastructural examinations., Results: The IPC procedure increased bile flow (p < 0.01), reduced serum AST level (p < 0.01), and reduced serum concentration of TBARS at 180 min of reperfusion (p = 0.05). Ischemic-preconditioned liver cells had less caspase 3 activity than the non-preconditioning group (p < 0.01), and changes in mitochondrial ultrastructure were reduced (p < 0.01)., Conclusion: IPC exerts a powerful protective effect against hepatic I/RI in the early phase of reperfusion, which may be mediated by preservation of mitochondrial structure and inhibition of caspase-3 activity.

Aim: To investigate the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), while considering multiple risk factors for ED, including an anthropometric evaluation of central obesity., Methods: A cross-sectional study was carried out with 192 consecutive male subjects (>or=40 years old). Conditions clearly associated with ED, other than obesity and age, were considered exclusion criteria. Men were evaluated routinely for clinical history, received a physical examination, and were subjected to blood analysis for fasting serum glucose, lipid profile, and serum testosterone. Patients with previous known history of diabetes mellitus or hypertension were excluded. Anthropometric measures taken included body mass index (general obesity) and waist circumference, waist-hip index, and sagittal abdominal diameter (visceral obesity). Analyses were performed using bivariate and multivariate models (multiple logistic regression). Age, education, alcohol consumption, smoking, sedentary lifestyle, fasting blood glucose level, dyslipidemia, hypogonadism, general obesity, and visceral obesity were taken into account as potential confounding factors., Main Outcome Measures: All men completed the International Index of Erectile Function and International Prostate Symptom Score (IPSS)., Results: IPSS scores were low, intermediate, and high in 89 (46.4%), 76 (39.6%), and 27 (14.1%) men, respectively. Overall IPSS scores were significantly associated with ED (P = 0.002). In addition, an association between the severity of ED and LUTS was observed (P = 0.008). The mean quality of life assessment in the IPSS revealed a statistically significant difference between individuals with varying degrees of ED (P = 0.008). The logistic regression analyses showed that IPSS scores and ED remained independently associated even after the control for confounding factors (odds ratio = 1.07, 95% CI = 1.02-1.13, P = 0.01)., Conclusion: This study suggests that LUTS are independently associated with ED, taking into account various risk factors for ED, including visceral obesity.

Introduction: Hypogonadism is a clinical and biochemical syndrome that may cause significant detriment in the quality of life and adversely affect the function of multiple organ systems. With the increase in life expectancy and prostate cancer (PCa) survival, a significant increase in the number of men with hypogonadism who have undergone presumably curative treatment for PCa is anticipated., Aim: To critically review the literature regarding testosterone replacement therapy (TRT) after PCa treatment with curative intent., Main Outcome Measures: Review of peer-reviewed literature. There was special focus on the potential implications and safety of TRT in men with hypogonadism who have undergone curative treatment for PCa., Methods: English-language relevant publications were identified via electronic medical databases (MEDLINE, EMBASE, and DARE)., Results: Despite the wide spread of contraindication of testosterone replacement in men with known or suspected PCa, there is no convincing evidence that the normalization of testosterone serum levels in men with low but no castrate levels is deleterious. In the few available case series describing testosterone replacement after treatment for PCa, no case of clinical or biochemical progression was observed., Conclusions: Although further studies are necessary before definitive conclusions can be drawn, the available evidence suggests that TRT can be cautiously considered in selected hypogonadal men treated with curative intent for PCa and without evidence of active disease.

Purpose: We determined whether the ratio of serum testosterone to prostate specific antigen might provide diagnostic value regarding the risk of prostate cancer in a population of hypogonadal men undergoing prostate biopsy., Materials and Methods: The study population consisted of 184 consecutive men with symptomatic hypogonadism and prostate specific antigen 4.0 ng/ml or less who underwent prostate biopsy before the anticipated initiation of testosterone therapy. All men had testosterone 300 ng/dl or less. Testosterone concentrations were converted to ng/ml, eg 270 ng/dl equals 2.7 ng/ml, to calculate the testosterone-to-prostate specific antigen ratio., Results: Mean patient age was 58.5 years. There were 154 men with benign biopsies and 30 with cancer. Testosterone concentrations were similar in the prostate cancer and noncancer groups, although mean prostate specific antigen was higher in the prostate cancer group. The testosterone-to-prostate specific antigen ratio was inversely related to prostate cancer risk (OR 0.49, 95% CI 0.33-0.74). On multivariate analysis performed by logistic regression neither age nor prostate specific antigen was be predictive of prostate cancer. However, the testosterone-to-prostate specific antigen ratio remained strongly associated with prostate cancer risk. An ROC for the testosterone-to-prostate specific antigen ratio suggested that a ratio of below 1.8 was diagnostic for prostate cancer, while values below this threshold were associated with an OR of 3.17 (95% CI 1.17-8.59) for prostate cancer., Conclusions: A low ratio of testosterone to prostate specific antigen is an independent predictor of prostate cancer in hypogonadal men with prostate specific antigen 4.0 ng/ml or less. Ratios less than 1.8 were associated with a greater than 3-fold increase in prostate cancer risk.

Objectives: Currently available studies show controversial data between the symptoms of the lower urinary tract and the volume of the prostate gland. The objective of the present study is to evaluate the relationship between the score of the lower urinary tract symptoms assessed according to the International Prostate Symptoms Score (IPSS) and the total (TV) and transitional (TZV) zone volume of the prostate and transitional prostate zone index (TZI)., Materials and Methods: From 223 men with a mean age of 59.3 years (varying from 50 to 75), the scores of lower urinary tract symptoms, measured by the IPSS and TV and TZV, determined by transrectal ultrasonographies, were obtained. Furthermore, the TZI was determined in all cases by the TZV to TV rate of the prostate. The relationship between TV, TZV, and TZI and the data obtained using the symptoms score was statistically determined., Results: The TV of the prostate were 25.5 +/- 10.3, 25.0 +/- 9.3, and 28.9 +/- 13.5 g in individuals with mild, moderate, and severe symptoms, respectively (P = 0.15). Similarly, there was no significant difference when the TZV (7.6 +/- 6.3, 7.6 +/- 5.8, and 9.6 +/- 6.8 g, respectively; P = 0.22) and the TZI (0.26 +/- 0.1, 0.27 +/- 0.1, and 0.30 +/- 0.1, respectively; P = 0.33) were compared in the groups of men with mild, moderate, and severe symptoms of urinary difficulty. However, the quality of life (QoL) scores presented progressively worse values (1.7 +/- 1.3, 3.1 +/- 1.4, and 4.4 +/- 1.2) as the severity of the lower urinary tract symptoms became worse (P < 0.001). The Pearson correlation coefficient between the TV (r = 0.15; P = 0.02), TZV (r = 0.16; P = 0.02), and the TZI (r = 0.14; P = 0.03) with the prostate symptom scores showed low values although they were positive and statistically significant. The highest correlation was observed when the QoL related to urinary symptoms and symptom scores (r = 0.61; P < 0.001) was analyzed., Conclusions: A low correlation was found between the score lower urinary tract symptoms assessed by IPSS and the different volumes of the prostate gland (TV, TZV) and prostate TZI, and, on the other hand, an inverse correlation between the intensity of urinary symptoms and QoL, supporting the idea of multifactorial aspects related to the genesis of urinary symptoms in men.

Purpose: We investigated the effects of subchronic exposure to radio frequency emitted from a conventional cellular telephone on the testicular function in adult rats., Materials and Methods: A total of 16 male Wistar rats at age 30 days were randomly divided into 2 groups, including experimental and control groups. The experimental group was exposed to radio frequency emitted from a conventional GSM (global system for mobile communications) cellular telephone (1,835 to 1,850 MHz) for 1 hour daily during 11 weeks. Rectal temperature was measured before and after the exposure period. Testicular and epididymal weight, lipid peroxidation levels in these organs, serum total testosterone and the epididymal sperm count were evaluated. Maturation phase spermatid retention at stage IX-X, interstitial infiltration, cellular vacuolation and multinucleate giant cells were among the qualitative testicular histopathological end points analyzed. Each rat had 10 consecutive round seminiferous tubules at stage VII-VIII evaluated for the mean seminiferous tubular diameter measurement, the crude histological count of round spermatids, pachytene spermatocytes and Sertoli's cells with evident nucleoli, and the true histological count (Abercrombie's correction factor) of round spermatids and pachytene spermatocytes., Results: Mean rectal temperature did not alter following exposure. There was no statistical difference between the control and experimental groups in any end points evaluated., Conclusions: The current study shows that the low intensity pulsed radio frequency emitted by a conventional cellular telephone does not impair testicular function in adult rats.

Objectives: To determine the prevalence of prostate cancer in hypogonadal men with a prostate-specific antigen (PSA) level of 4.0 ng/mL or less., Methods: A total of 345 consecutive hypogonadal men with a PSA level of 4.0 ng/mL or less underwent evaluation with digital rectal examination and prostate biopsy before initiating a program of testosterone replacement therapy. All men had low serum levels of total or free testosterone, defined as less than 300 and 1.5 ng/dL, respectively., Results: Cancer was identified in 15.1%. The cancer detection rate was 5.6%, 17.5%, 26.4%, and 36.4% for a PSA level of 1.0 or less, 1.1 to 2.0, 2.1 to 3.0, and 3.1 to 4.0 ng/mL, respectively (P < 0.05). Cancer was detected in 26 (30.2%) of 86 men with a PSA level of 2.0 to 4.0 ng/mL. Cancer was detected in 21% of men with a testosterone level of 250 ng/dL or less compared with 12% of men with a testosterone level greater than 250 ng/dL (P = 0.04). Men with free testosterone levels of 1.0 ng/dL or less had a cancer rate of 20% compared with 12% for men with greater values (P = 0.04). The odds ratio of cancer detection for men in the lowest tertile compared with the highest tertile was 2.15 (95% confidence interval 1.01 to 4.55) for total testosterone and 2.26 (95% confidence interval 1.07 to 4.78) for free testosterone., Conclusions: Prostate cancer was present in more than 1 of 7 hypogonadal men with PSA of 4.0 ng/mL or less. An increased risk of prostate cancer was associated with more severe reductions in testosterone.

Purpose: There is a growing body of evidence in the literature correlating erectile dysfunction to obesity. We investigated the correlation of different anthropometric indexes of central obesity to erectile dysfunction., Materials and Methods: A cross-sectional study was performed including 256 consecutive men 40 years old or older. All men completed the International Index of Erectile Function, and were evaluated routinely with a clinical history, physical examination and blood analysis for fasting serum glucose, lipid profile and serum testosterone. Anthropometric measures included body mass index, waist circumference, sagittal abdominal diameter, maximal abdominal circumference, and waist-hip, waist-thigh, waist-height, sagittal abdominal diameter-thigh and sagittal abdominal diameter-height indexes., Results: In men 40 to 60 years old the different anthropometric indexes of central obesity were not correlated with the presence of erectile dysfunction (p > 0.05). Men older than 60 years (41%, range 61 to 81) demonstrated an association among erectile dysfunction and waist-hip index (p = 0.04), waist-thigh index (p = 0.02), sagittal abdominal diameter (p = 0.03), sagittal abdominal diameter-height index (p = 0.02) and maximal abdominal circumference (p = 0.04). After logistic regression analysis an independent effect on the presence of erectile dysfunction was observed for waist-hip index (OR 8.56, 95% CI 1.44-50.73), sagittal abdominal diameter (OR 7.87, 95% CI 1.24-49.75), sagittal abdominal diameter-height index (OR 14.21, 95% CI 1.11-182.32), maximum abdominal circumference (OR 11.72, 95% CI 1.73-79.18) and waist circumference (OR 19.37, 95% CI 1.15-326.55)., Conclusions: This study suggests that central obesity, assessed by several anthropometric indicators, is associated to the presence of erectile dysfunction in men older than 60 years. Sagittal abdominal diameter, sagittal abdominal diameter-height index, maximum abdominal circumference, waist circumference and waist-hip index were useful indicators to predict the presence of erectile dysfunction.

A retrospective study was performed to evaluate how the prostate-specific antigen (PSA) response to testosterone replacement therapy (TRT) varies with age, mode of testosterone treatment, and baseline levels of PSA and testosterone. In total, 48 consecutive hypogonadal men who completed 1 year of TRT were evaluated. All men had a negative prostate biopsy obtained prior to initiating TRT. Men received TRT in the form of intramuscular injections (n = 33) or topical gel (n = 25) based on clinical response. Comparisons in the change in PSA after 1 year of TRT were made based on various thresholds for age and baseline values of PSA, total testosterone (TT), and free testosterone (FT). Baseline levels of TT (297.7+/-156.6 vs 292.7+/-89.7 ng/dl; P = 0.88) and FT (0.95+/-0.3 vs 1.1+/-0.3 ng/dl; P = 0.08) were similar for the injection and transdermal groups, and both groups also had similar baseline PSA values (1.92+/-1.9 vs 1.71+/-1.9 ng/ml, respectively; P = 0.67). After 1 year of TRT, mean PSA values did not differ significantly between groups, nor did the mean increase in PSA (P > 0.05). The overall mean increase in PSA was 0.31+/-0.76 ng/ml. After one year of TRT, PSA was decreased in 21%, unchanged in 22%, and increased in 57%. Only 24% of the entire group demonstrated a PSA increase of 0.5 ng/ml or greater. No statistical difference was found in the change in PSA based on patient age, baseline PSA levels, or baseline levels of TT or FT. TRT causes only a mild increase in PSA in most hypogonadal men, and does not appear to be influenced by the mode of TRT, age, or baseline levels of PSA or testosterone.

Objective: To evaluate the relationship between diabetes mellitus (DM) and serum levels of free (FT) and total (TT) testosterone., Patients and Methods: A cross-sectional study was carried out including 746 men, of whom 116 (15.6%) were diabetics. Both groups, diabetic and nondiabetic, were paired according to age. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated, and a stratification analysis correlating DM and elevated BMI (>25 kg/m(2)) and WHR (>1) with the presence of subnormal FT and TT levels was performed., Results: FT and TT serum levels were subnormal in 46% and 34% of diabetics, respectively, and in 24% and 23% of nondiabetics. Subnormal FT levels were strongly correlated with DM (odds ratio (OR) 2.7; 95% confidence interval (CI) 1.8-4.1) but not with elevated BMI (OR 1.4; 95% CI 1.0-2.0). Subnormal TT levels were more strongly associated with elevated BMI and WHR (OR 2.6; 95% CI 1.7-3.9 and 2.0; 1.4-2.9) than with DM (1.7; 1.1-2.6 and 2.0; 1.3-3.2)., Conclusion: These data strongly suggest that DM is associated with subnormal FT levels, and that TT levels are influenced more by obesity and central adiposity.

Objective: To evaluate the association between the levels of glycosylated haemoglobin (HbA1c) and the severity of erectile dysfunction (ED) in men with diabetes mellitus (DM)., Patients and Methods: This cross-sectional study included sexually active men with a diagnosis of DM attending a urological medical centre from January 2000 to December 2001. The 115 men with ED (95%) completed the International Index of Erectile Function questionnaire, and fasting serum glucose and HbA1c serum levels were measured. The relationship between the severity of ED and serum HbA1c levels was assessed., Results: Of men with HbA1c levels of < 8%, half had mild, and 18% and 32% had moderate and severe ED, respectively (P = 0.038); of men with HbA1c levels of > or = 8%, 25%, 29%, and 46% had mild, moderate and severe ED, respectively (P = 0.008). In addition, men with HbA1c levels of > or = 11% had a statistically higher prevalence of severe ED (P = 0.002). There was no difference in severity of ED in the HbA1c subgroups when the duration of DM was < or = 5 years (P = 0.87), but most men with HbA1c levels of > or = 8% and a history of DM of 6-10 or > 10 years had severe ED (P < 0.03)., Conclusion: This study suggests that the severity of ED is associated with increasing HbA1c levels in diabetic men.

Purpose: To evaluate the hypothesis that a 7-day period of indwelling catheter after radical retropubic prostatectomy is effective and safe without the need of performing cystography., Methods: In the period from January of 2000 to July of 2002, 73 patients underwent radical retropubic prostatectomy, and these patients were prospectively randomized in 2 groups: Group 1-37 patients who had the urethral catheter removed 7 days after the procedure, and Group 2-36 patients who had the catheter removed 14 days after the surgery. The 2 groups were similar, the surgeons and the technique were the same, and no cystography was performed to evaluate the presence of leaks., Results: Two patients in Group 1 had bleeding and clot retention after having the catheter taken out in the seventh postoperative day and were managed by putting the catheter back in for 7 more days. Two patients in Group 2 developed bladder neck stricture and were treated by bladder neck incision with success. The continence rate was the same, with 2 cases of incontinence in each group. About 2 pads a day were used by the patients with incontinence. The average follow-up was 17.5 months (12-36 months). No urinary fistula, urinoma, or pelvic abscesses developed after catheter removal. Two patients were excluded from the analysis of this series: 1 died with a pulmonary embolus in the third postoperative day, and 1 developed a urinary suprapubic fistula before catheter withdrawal, which was maintained for 16 days., Conclusion: Withdrawal of the urethral catheter 7 days after radical retropubic prostatectomy, without performing cystography, has a low rate of short-term complications that are equivalent to withdrawal 14 days after the surgery.

One of the measures adopted to reduce or prevent intestinal bacterial translocation (BT) in patients who are in hemorrhagic shock consists of prophylactic antibiotics. This study attempted to assess the effectiveness of administering systemic antibiotic to suppress BT in rats submitted to hemorrhagic shock. Sixty-eight male Wistar rats were divided into two experiments. In experiment 1 (n = 28), the animals were randomly divided into three groups: group I (n = 7), sham operation; group II (n = 11), constituted by animals that were submitted to hemorrhagic shock by removing 40% of the volemia, and were resuscitated after 40 min of sustained shock, replacing the previously removed blood; and group III (n = 10), animals that, besides hemorrhagic shock and volemic replacement, received 50 mg/kg of sodium ceftriaxone intravenous 1 min after blood readministration. Mesenteric lymph nodes (MLN) for culture tests and segments of the small bowel were removed for histopathological studies 1 day after the operation in the three groups. In experiment 2, the same procedures were performed, except the laparotomy for removing MLN and segments of jejunal and ileal bowel, but the animals were followed during 7 days, in order to evaluate the mortality rate. In the control group (group I), the bacteriological assessment of the MLN was negative in all cases. Only 40% of the animals treated with antibiotics after hypovolemic shock (group III) presented positive bacteriological exams of the MLN, and this rate was 90% in the group of animals that did not receive this substance (group II) (p < .05). Escherichia coli was the bacteria identified most frequently in culture tests (92.8%). The villosities atrophy and inflammatory infiltrate of the lamina propria were the most common histological changes in the bowel, although the intensity was similar in groups II and III (p > .05), but more intense that in group I (p < .05). The mortality rates in groups I, II, and III 7 days after hypovolemic shock were 0%, 20%, and 20%, respectively. Prophylactic antibiotics significantly reduced the presence of bacteria in the MLN in situations of hypovolemic shock, in rats. This was probably related to a lower BT. However, this aspect did not modify the mortality rate of the animals. Also, the possibility that BT may not have a significant influence in this outcome should be considered.

Gynecomastia is an unusual side effect associated with testosterone replacement therapy (TRT) that has been traditionally treated with surgery, radiation, or discontinuation of testosterone supplementation. We report here our experience with two cases of gynecomastia in men undergoing TRT who were successfully treated with the aromatase inhibitor anastrozole.