Να διερευνηθεί η επίδρασης μίας τροποποιημένης τεχνικής ριζικής προστατεκτομής, με διατήρηση της ουρήθρας μέχρι το επίπεδο του σπερματικού λοφιδίου, στα μετεγχειρητικά ογκολογικά και λειτουργικά αποτελέσματα. Ασθενείς και μέθοδοι: Στην προοπτική αυτή μελέτη, 360 ασθενείς που υποβλήθηκαν σε ανοικτή οπισθοηβική ριζική προστατεκτομή από τον Ιανουάριο του 2008 μέχρι τον Απρίλιο του 2012 χωρίστηκαν σε δύο ομάδες. Στους ασθενείς της ομάδας Α πραγματοποιήθηκε η κλασσική ριζική προστατεκτομή ενώ οι ασθενείς της ομάδας Β υποβλήθηκαν στην τροποποιημένη χειρουργική επέμβαση. Τα ογκολογικά αποτελέσματα αξιολογήθηκαν με την παρακολούθηση του PSA και τον έλεγχο βιοχημικής υποτροπής καθώς και με την ύπαρξη θετικών χειρουργικών ορίων. Η μετεγχειρητική ακράτεια εκτιμήθηκε με τον αριθμό πανών/ημέρα καθώς και με τη συμπλήρωση των ερωτηματολογίων ICIQ-SF και IIQ-SF. Η μετεγχειρητική στυτική δυσλειτουργία εκτιμήθηκε με τη συμπλήρωση των ερωτηματολογίων IIEF και SEAR. Επίσης καταγράφηκε και αναλύθηκε η επίδραση της χειρουργικής τροποποίησης στην εμφάνιση μετεγχειρητικών συμπτωμάτων αποθήκευσης των ούρων. Αποτελέσματα: Ογδόντα πέντε ασθενείς εξαιρέθηκαν από τη μελέτη. Από τους 244 ασθενείς που πληρώσουν τα κριτήρια εισόδου, στην ομάδα Α και Β συμπεριλήφθηκαν 115 (47,1%) και 129 (52,9%) ασθενείς, αντίστοιχα. Δεν παρατηρήθηκαν στατιστικά σημαντικές διαφορές στα ποσοστά εμφάνισης θετικών χειρουργικών ορίων (p=0,562) και βιοχημικής υποτροπής (p=0,321). Παρατηρήθηκαν σημαντικά υψηλότερα ποσοστά ακράτειας (p=0,026), επιτακτικότητας (p<0,001) και νυκτουρίας (p<0,001) στους ασθενείς της ομάδας Α στον 1ο μήνα μετεγχειρητικά. Επίσης, υπήρξε στατιστικά σημαντική διαφορά στον αριθμό πανών/ημέρα υπέρ της ομάδας Β στον 1ο (p=0,037), 3ο (p=0,003) και 6ο (p=0,032) μήνα μετά το χειρουργείο. Η διαφορά αυτή, ωστόσο, εξαλείφθηκε στους 12 μήνες μετεγχειρητικά. Παρόμοια αποτελέσματα παρατηρήθηκαν με τις βαθμολογίες των ερωτηματολογίων ICIQ-SF και IIQ-SF, αναδεικνύοντας βελτιωμένα αποτελέσματα στους ασθενείς της ομάδας Β για τους πρώτους 6 μήνες. Δεν παρατηρήθηκαν διαφορές στα ποσοστά εμφάνισης μετεγχειρητικής στυτικής δυσλειτουργίας καθώς και στις βαθμολογίες των ερωτηματολογίων IIEF και SEAR. Συμπεράσματα: Η τροποποιημένη χειρουργική τεχνική με διατήρηση της ουρήθρας μέχρι το επίπεδο του σπερματικού λοφιδίου αποτελεί μία νέα τροποποίηση της κλασσικής τεχνικής, η οποία μπορεί να μειώσει το χρόνο ανάκτησης της εγκράτειας των ούρων σε ασθενείς που υποβάλλονται σε ριζική προστατεκτομή, χωρίς να μειώνει το ογκολογικό αποτέλεσμα και την πρόγνωση της νόσου. / To investigate the effect of a modified surgical technique of open retropubic radical prostatectomy, with preservation of maximal urethral length to the level of verumontanum, in postoperative oncological and functional outcomes. Patients and methods: In this study, 360 patients who underwent open retropubic radical prostatectomy from January 2008 until April 2012 were divided into two groups. Patients of group A underwent the classical procedure of radical prostatectomy as it has been described by Walsh and Donker, while patients of group B underwent the modified technique. The oncological outcomes were evaluated by monitoring PSA value for biochemical failure and by recording the incidence of positive surgical margins. Postoperative incontinence was evaluated by the number of pads/day and through ICIQ-SF and IIQ-SF questionnaires. Postoperative erectile dysfunction was assessed by completing IIEF and SEAR questionnaires. We also recorded and analyzed the effect of the surgical modification in postoperative irritative urinary symptoms. Results: Eighty five patients were excluded from the study. Of the 244 patients who fulfill the inclusion criteria, 115 (47.1%) and 129 (52.9%) patients were included in group A and B, respectively. There was no statistically significant difference in the incidence rates of positive surgical margins (p=0.562) and biochemical recurrence (p=0.321) between the groups. There were significantly higher rates of incontinence (p=0.026), urgency (p<0.001) and nocturia (p<0.001) in patients of group A within the first postoperative month. There was also statistically significant difference in the number of pads/day in favor of group B in 1st (p=0.037), 3rd (p=0.003) and 6th (p=0.032) month after the operation. However, this difference disappeared at 12 months postoperatively. Similar results were observed in the scores of ICIQ-SF and IIQ-SF questionnaires, demonstrating improved outcomes in patients of group B within the first 6 months. There were no differences in the incidence rates of postoperative erectile dysfunction and in the scores of IIEF and SEAR questionnaires, as well. Conclusions: We proposed a modified surgical technique with preservation of maximal urethral length until the anatomical landmark of verumontanum. This technique may reduce the time continence recovery in patients undergoing radical prostatectomy, without compromising the oncological outcome and disease prognosis.

Mokslinis konsultantas: doc. dr. Vidmantas Alekna (Vilniaus universiteto Eksperimentinės ir klinikinės medicinos institutas, biomedicinos mokslai, medicina – 07 B). Darbo tikslas: ištirti Vilniaus mieste gyvenančių senyvo amžiaus vyrų šlapimo nelaikymo ir erekcijos sutrikimų ypatumus bei gyvenimo kokybę. Tyrimo objektas ir metodai. Tiriamųjų grupė sudaryta sluoksninės imties metodu. Apklausti 788 asmenys, gyvenantys Vilniaus m. bendruomenėje ir 168 vyrai – globos įstaigose. Respondentai buvo tiriami interviu metodu, naudojant specifinius ir bendrus klausimynus. Statistinė duomenų analizė atlikta „SPSS 12.0 for Windows“. Pagrindinės išvados. Šlapimo nelaikymo dažnumas tarp Vilniaus m. bendruomenėje gyvenančių 55 metų amžiaus ir vyresnių vyrų yra 17,8 proc., o tarp globos įstaigose gyvenančių vyrų – 38,1 proc. Su amžiumi šlapimo nelaikymo dažnumas didėja. Šlapimo nelaikymo riziką didina gerybinė prostatos hiperplazija, patirtas insultas, depresija, pažinimo sutrikimas, Parkinsono liga, obstipacija ir kai kurių vaistų vartojimas. Erekcijos sutrikimai nustatyti 79,2 proc. šlapimo nelaikančių 55 metų amžiaus ir vyresnių vyrų ir 36,7 proc. sveikų vyrų, gyvenančių Vilniaus m. bendruomenėje. Esant šlapimo nelaikymui yra blogesnės šios gyvenimo kokybės sritys: fizinė sveikata, psichologinė būsena, socialiniai santykiai ir aplinka. Po 2 metų gyvenimo kokybė pablogėjo fizinės sveikatos bei socialinių santykių srityse. / Scientific adviser: Assoc. Prof. Dr. Vidmantas Alekna (Institute of Experimental and Clinical Medicine at Vilnius University, Biomedical sciences, Medicine - 07 B). The aim: To estimate the frequency of urinary incontinence (UI) in men residing in Vilnius city community and nursing institutions, to assess risk factors for UI, to determine the frequency of erectile dysfunction in men with UI, and to analyse their quality of life. Object and methods: 788 elderly men residing in Vilnius city community and 168 - in nursing institutions were interviewed. The respondents were interviewed with the specific and general questionnaires for UI and quality of life. Statistical data analysis was performed by applying SPSS 12.0 for Windows. Conclusions: Frequency of UI among the men living in Vilnius city community amounts to 17.8% and 38.1% - in nursing institutions. The benign prostatic hyperplasia, stroke, senile cognition disorder, Parkinson’s disease, depression, constipation and use of the some medications increase the risk of UI among elderly men. Erectile dysfunction was diagnosed in 79.2% of the men with UI aged 55 and over and in 36.7% of the healthy men of the same age. In men with UI the physical health, psychological state, social relations and the environment domains of quality of life were disturbed. After two years the quality of life of the men with UI became lower in the areas of physical health and social relations.

Scientific adviser: Assoc. Prof. Dr. Vidmantas Alekna (Institute of Experimental and Clinical Medicine at Vilnius University, Biomedical sciences, Medicine - 07 B). The aim: To estimate the frequency of urinary incontinence (UI) in men residing in Vilnius city community and nursing institutions, to assess risk factors for UI, to determine the frequency of erectile dysfunction in men with UI, and to analyse their quality of life. Object and methods: 788 elderly men residing in Vilnius city community and 168 - in nursing institutions were interviewed. The respondents were interviewed with the specific and general questionnaires for UI and quality of life. Statistical data analysis was performed by applying SPSS 12.0 for Windows. Conclusions: Frequency of UI among the men living in Vilnius city community amounts to 17.8% and 38.1% - in nursing institutions. The benign prostatic hyperplasia, stroke, senile cognition disorder, Parkinson’s disease, depression, constipation and use of the some medications increase the risk of UI among elderly men. Erectile dysfunction was diagnosed in 79.2% of the men with UI aged 55 and over and in 36.7% of the healthy men of the same age. In men with UI the physical health, psychological state, social relations and the environment domains of quality of life were disturbed. After two years the quality of life of the men with UI became lower in the areas of physical health and social relations. / Mokslinis konsultantas: doc. dr. Vidmantas Alekna (Vilniaus universiteto Eksperimentinės ir klinikinės medicinos institutas, biomedicinos mokslai, medicina – 07 B). Darbo tikslas: ištirti Vilniaus mieste gyvenančių senyvo amžiaus vyrų šlapimo nelaikymo ir erekcijos sutrikimų ypatumus bei gyvenimo kokybę. Tyrimo objektas ir metodai. Tiriamųjų grupė sudaryta sluoksninės imties metodu. Apklausti 788 asmenys, gyvenantys Vilniaus m. bendruomenėje ir 168 vyrai – globos įstaigose. Respondentai buvo tiriami interviu metodu, naudojant specifinius ir bendrus klausimynus. Statistinė duomenų analizė atlikta „SPSS 12.0 for Windows“. Pagrindinės išvados. Šlapimo nelaikymo dažnumas tarp Vilniaus m. bendruomenėje gyvenančių 55 metų amžiaus ir vyresnių vyrų yra 17,8 proc., o tarp globos įstaigose gyvenančių vyrų – 38,1 proc. Su amžiumi šlapimo nelaikymo dažnumas didėja. Šlapimo nelaikymo riziką didina gerybinė prostatos hiperplazija, patirtas insultas, depresija, pažinimo sutrikimas, Parkinsono liga, obstipacija ir kai kurių vaistų vartojimas. Erekcijos sutrikimai nustatyti 79,2 proc. šlapimo nelaikančių 55 metų amžiaus ir vyresnių vyrų ir 36,7 proc. sveikų vyrų, gyvenančių Vilniaus m. bendruomenėje. Esant šlapimo nelaikymui yra blogesnės šios gyvenimo kokybės sritys: fizinė sveikata, psichologinė būsena, socialiniai santykiai ir aplinka. Po 2 metų gyvenimo kokybė pablogėjo fizinės sveikatos bei socialinių santykių srityse.

Erectile dysfunction and cardiovascular disease share etiologies, and commonly coexist. One unifying concept is that the arterial insufficiency in hypertension is also the primary basis for blunted sexual responses. The objective of these studies was to characterize the age-related changes in the structure and function of the pudendal artery (the main resistance vessel) in young and old normotensive and hypertensive animals in relation to erectile function. In addition, we assessed the impact of antihypertensive treatments and lifestyle modifications, such as exercise and/or caloric restriction, on erectile responses and the structure and function of the pudendal artery. In 30 week old hypertensive rats or following re-challenges at 50 and 70 weeks, antihypertensive treatment (enalapril or hydralazine) did not prevent the age-related decline in erectile function. Experiments involving cross-over kidney transplantations between treated and untreated young hypertensive rats revealed that changes in penile vasculature and not the level of arterial pressure were important for normalizing erectile responses. In addition, intervention with exercise and caloric restriction showed that these treatments substantially improved erectile responses in normotensive and hypertensive rats. The pudendal artery in young normotensive rats was found to have a thick medial layer but a relatively small lumen. With age, the pudendal lumen didn’t change, but all components of the medial layer were markedly increased. Of interest, the smooth muscle cells within the pudendal medial layer became more disorganized with aging, although iii contractions were similar. In contrast, endothelium-dependent relaxation decreased with age. Young hypertensive rats also had an increased wall thickness, but not lumen diameter or extracellular matrix. Antihypertensive therapy significantly decreased the pudendal wall thickness. In aging hypertensive rats, the pudendal artery walls were even thicker, lumen decreased and extracellular matrix greatly enhanced compared to younger rats. In addition, there were numerous regions of intimal thickening associated with marked disruptions of the internal elastic lamina. Moreover, pudendal smooth muscle cells bordering the intima and in the neointima were round in shape, and electron microscopy confirmed their synthetic state. Taken together, these findings provide key evidence of the importance of the structure and function of the pudendal artery in facilitating erectile responses. / Thesis (Ph.D, Pharmacology & Toxicology) -- Queen's University, 2009-05-19 12:55:30.469

The aims of this study were to determine the effects of smoking on the incidence and prognosis of erectile dysfunction (ED) and that of ED on smoking behavior, and to find out whether smoking either directly or through vascular diseases causes ED. The target population comprised of all men born in 1924, 1934 or 1944 and residing in the city of Tampere or 11 adjacent municipalities in Finland. Questionnaires were mailed to 3,143 men in 1994, to 2,864 in 1999 and to 2,510 men in 2004. The response rates were 70%, 75% and 75% respectively. ED was assessed using two questions on subjects’ erectile capacity. Logistic and Poisson regression models were used in the multivariable analyses. Current smoking was associated with ED (Adjusted prevalence odds ratio (POR) = 1.7, 95% CI 1.2-2.4), but not with ex smoking. The incidence of ED non-significantly increased (incidence density ratio (IDR)=1.4) and that of ED recovery reduced (IDR=0.7) with current smoking. A dose-response relationship was found between smoking and ED. Although the relative risks estimates were not statistically significant, probably due to small numbers. Only heavy smokers were significantly at higher risk of ED. Compared with non-smokers, confounder-adjusted IDR was 1.6 (95% CI 1.0-2.6) for men who smoked 21 cigarettes or more daily. Both quitting (IDR=1.7) and starting smoking (IDR=1.9) were rare and higher in men with ED. However, the IDRs estimates were not statistically significant. Current smokers at baseline (1994) who developed vascular disease during 1994-1999 were three times (Confounder-adjusted IDR=3.1, 95% CI 1.3-7.5) at higher risk of ED during 1999-2004 compared with never or ex smokers who did not develop vascular diseases. On the other hand, current smokers who did not develop vascular diseases were not at higher risk of ED (IDR=1.0). There were two bi-directional relations between smoking and ED. Smoking caused ED though vascular diseases and ED caused smoking. The recovery from ED was less in smokers than in non-smokers, and current smokers with ED were more likely to stop smoking compared with men free from ED. / <p>ISBN 91-7997-124-5</p>

Enhanced external counterpulsation (EECP) is a noninvasive treatment modality which can increase arterial blood flow in peripheral and coronary arterial disease. Several studies have demonstrated an increase in the flow of the internal iliacal artery and in carotid and renal perfusion during EECP treatment. We investigated the effect of EECP in patients with erectile dysfunction (ED). Thirteen patients were treated with EECP for 20 days, 1 h per day. Patients reported a significant improvement of penile rigidity after completion of the EECP treatment and a significant improvement of penile peak systolic flow was measured by Doppler sonography. No adverse effects were observed. In conclusion, EECP seems to be an effective treatment modality in patients with ED. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Sammanfattning Bakgrund: Orsakerna till att prostatacancer uppstår är i dagsläget inte fastställt, men ärftlighet har visat sig ha en betydelse. Prostatacancer är den vanligaste typen av cancer i världen bland män, där patienterna drabbas av såväl fysiska som psykiska besvär vilket har en påverkan på individernas sexuella hälsa. Syfte: Syftet var att beskriva patienters upplevelser av sexuell hälsa vid prostatacancer.  Metod: En litteraturöversikt baserad på artiklar med kvalitativa data användes. Resultat: Resultatet redovisade tre huvudkategorier som ger en insyn i individernas upplevelse av sexuell hälsa: Att förlora en del av sin identitet, Upplevd påverkan på relationer samt Att kunna anpassa sin livssituation. Det var främst den försämrade förmågan till erektion som påverkade individernas identitet, deras relationer och skapade ett behov av anpassning till den nya situationen. Slutsats: Patienter som lever med prostatacancer upplever en försämrad sexuell hälsa till följd av sin sjukdom. Det resulterar i konsekvenser där patienterna drabbas fysiskt, psykiskt, och socialt, vilket leder till svåra utmaningar för individerna. Litteraturöversikten kan bidra till att ge vårdpersonal en ökad insikt i hur patienterna upplever sin situation, vilket kan resultera i att patienterna får en bättre och mer individanpassad vård. / Summary Background: The causes why the prostate cancer occurring are currently not determined, but heredity has been shown to be of importance. Prostate cancer is the most common type of cancer in the world among men, where the patients suffer from physical and mental illness which affect the sexual health of individuals. Purpose: The purpose was to describe patients' experiences of sexual health in prostate cancer. Method: A literature review based on qualitative data was used. Result: The result presented three main categories that provide an insight into the individual's perception of sexual health: Losing a part of one's identity, Experienced effect on relationships, and Being able to adjust one's life. It was primarily the impaired ability of erection that affected the individual’s identity, their relationships and created a need for adaption to the new situation. Conclusion: Patients living with prostate cancer experience impaired sexual health due to their illness. This results in consequences where patients suffer physically, mentally, and socially, leading to difficult challenges for the individuals. This literature review can provide healthcare professionals with an increased insight into how patients experience their situation, which can result in patients getting a better and more individualized care.

Bakgrund: Erektil dysfunktion, [ED] innebär en bristande förmåga att uppnå eller att bibehålla tillräcklig erektion för att genomföra ett tillfredsställande samlag. En relation bygger på ömsesidighet och starka band, vilket kan påverkas av ED. Sexuell hälsa beskrivs som ett tillstånd av fysiskt, mentalt och socialt välbefinnande i relation till sexualitet och kan skapa ett lidande då den uteblir. Syfte: Att beskriva hur parrelationen och sexualiteten påverkas av ED. Metod: Litteraturbaserad metod. Resultat: Ur analysen framträdde två teman; känslomässiga utmaningar samt vill gå stärkt ur situationen med fem subteman.  Slutsats: Parrelationen och sexualiteten påverkades av ED. Den erektila dysfunktionen ledde till nedsatt sexualitet och självkänsla hos den enskilde individen men också i parrelationen. Genom att partnern inkluderas i behandling och att det fanns en ärlig och öppen kommunikation om ED kunde ett ökat välbefinnande främjas för paret. Acceptans för situationen och ökad förståelse för varandra som par gjorde att parrelationen kunde förbättras. / Background:  Erectile dysfunction, [ED] implies a lack of ability to achieve or maintain enough erection to complete a satisfactory intercourse. A relationship is based on reciprocity and strong ties, which can be influenced by ED. Sexual health is described as a state of physical, mental and social well-being in relation to sexuality and can create a suffering when it is absent. Purpose: How the relationship and sexuality are affected by erectile dysfunction. Method: Literature based method. Results: From the analysis two themes emerged; emotional challenges and wants to become strengthened from the situation with five subthemes. Conclusion: The relationship and sexuality were affected by ED. The erectile dysfunction led to decreased sexuality and self-esteem of the individual but also in their relationships. When the partners were included in the treatment, and there were an honest and open communication about the ED it could increase the well-being for the couple. Acceptance of the situation and increased understanding of each other as a couple, made it possible to improve the relationship.

O objetivo deste estudo foi analisar os efeitos da carga de trabalho e do tempo de pedalada sobre a área, força, pressão de contato e o conforto no selim e as relações dos hábitos de vida e características da prática esportiva com a função erétil em ciclistas. Quinze ciclistas recreacionais (CR) e 15 amadores competitivos (CC) do sexo masculino foram avaliados antropometricamente e responderam a questionários relacionados à prática esportiva, aos hábitos de vida e ao índice internacional da função erétil (IIEF). Eles completaram os protocolos de ciclismo que consistiram (1) no ajuste do posicionamento corporal sobre a bicicleta (PAP), (2) protocolo de carga incremental (PCI) para determinação da potência máxima (PM), (3) protocolo de carga variável (PCV) e (4) protocolo de carga constante (PCC). Durante o PCV e PCC foi monitorada a área, força e pressão de contato no selim. No PCC, além destas, foi monitorado o grau de desconforto no selim. Os dados foram descritos na forma de média e desvio padrão considerando nível de significância de a=0,05. Os resultados demonstraram que as diferenças antropométricas e de desempenho entre os grupos foram diferentes, corroborando os diferentes níveis de condicionamento procurados. Foi observada correlação positiva e moderada entre o perímetro de quadril com a área de contato com o selim. Não houve diferença entre os grupos quando comparadas a área, força e pressão de contato para o PCV e PCC, sem efeito também do tempo de pedalada. As diferenças ocorreram nas análises intra-grupos. CR, em resposta a alterações na cadência de pedalada, não tem alterada a área, força e pressão de contato com o selim, sendo observado um efeito contrário sobre as mesmas variáveis quando alterada a potência de pedalada. CC, embora sem mudanças sobre a área de contato, tem modificada a força e pressão de contato em resposta tanto a alterações na cadência quanto potência de pedalada. O aumento da cadência e da potência de pedalada acarreta aumento e diminuição, respectivamente, da área, força e pressão de contato. CC parecem ser mais tolerantes ao desconforto durante o PCC. Os grupos não foram diferentes quando comparados os escores relacionados ao IIEF. Portanto, CC tem alterados de maneira mais destacada a área, força e pressão de contato com o selim em resposta a diferentes cargas de trabalho e são mais tolerantes ao desconforto perineal ao longo do tempo, indicativos de uma maior “flutuação” da pelve sobre o selim. Apesar das diferenças que caracterizam a prática de cada grupo, ciclistas recreacionais e competitivos possuem função erétil normal e semelhante. / This study aimed at assessment of exercise load and duration effects on saddle contact area, reaction force, pressure and comfort and its relationships with daily life habits and training characteristic that may underlie erectile dysfunction among cyclists. Fifteen recreational cyclists (CR) and 15 amateur competitive male (CC) athletes performed the trials. They were first tested for anthropometric characteristics and anamneses related to sport practice, life habits and international index of erectly dysfunction. All participants completed cycling protocols for (1) bike fit, (2) incremental maximal test to determine maximal power output, (3) variable power test (PCV) and (4) constant load test (PCC). Saddle area, reaction force, contact pressure and discomfort level were assessed during PCV and PCC. Data were presented for mean and standard-deviation for significance level of 0.05. The results indicated group differences for anthropometric and performance variables, which may results from different level of physical conditioning between groups. There was positive and moderated correlation between hip circumference and saddle contact area. No difference was observed between groups for area, force and pressure during PCV and PCC, as well any effect of exercise duration was observed. Significant differences were observed within-groups. CR did not altered saddle area, force and pressure when pedaling cadence was changed. In other hand, these variables were significantly affected by exercise load, which suggest that power output rather than pedaling cadence affect saddle pressure in CR. For CC, contact area unchanged, whereas force and pressure were influenced by changes in both pedaling cadence and power output. For this group, increase of cadence or power leaded to higher and lower saddle area, force and pressure, respectively. CC were more tolerant for discomforts while pedaling. There were no differences regarding scores related to erectile dysfunction that was normal between groups. In conclusion, CC present changes in saddle area, force and pressure when exercise load was changed. They also were more tolerant to perineal discomfort during prolonged cycling. Despite of differences in saddle pressure variables between groups, recreational and competitive cyclists had similar and normal erectile function.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2014-05-22T13:34:46Z No. of bitstreams: 1 Augusto José Gonçalves de Almeida Papel da disfunção...2014.pdff.pdf: 741862 bytes, checksum: 78e1a73115d8c66327b61fd1807203e3 (MD5) / Made available in DSpace on 2014-05-22T13:34:46Z (GMT). No. of bitstreams: 1 Augusto José Gonçalves de Almeida Papel da disfunção...2014.pdff.pdf: 741862 bytes, checksum: 78e1a73115d8c66327b61fd1807203e3 (MD5) Previous issue date: 2013 / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil / INTRODUÇÃO: A doença cardiovascular é a causa mais comum de morte em todo o mundo. Em homens, 50% das mortes por doença arterial coronariana ocorre em indivíduos sem história prévia de doença cardiovascular. Disfunção erétil e doença arterial coronariana têm uma relação estreita, já que ambas são consequências de disfunção endotelial, levando a limitações no fluxo sanguíneo. A associação entre severidade da disfunção erétil e a extensão das lesões da doença arterial coronariana ao exame angiográfico sugere que homens com disfunção erétil sejam considerados sob risco aumentado de doença arterial coronariana. OBJETIVO: Avaliar o papel da disfunção erétil como manifestação sentinela e/ou marcador de risco para doença arterial coronariana. MÉTODOS: Realizou-se uma análise secundária com dados previamente coletados em dois projetos (“Projeto Avaliar” e “Projeto Ampliar”). Pacientes do sexo masculino, com idade >18 anos, foram convidados a participar das duas pesquisas sobre disfunção erétil ao comparecerem a uma consulta médica ambulatorial em 2002-2003 (Projeto Avaliar) e em 2003-2004 (Projeto Ampliar). Foram selecionados, consecutivamente, 20 pacientes por cada um dos oito mil médicos que colaboraram com o estudo. O grau de disfunção erétil foi avaliado por pergunta única de auto-avaliarão global. A presença de condições médicas foi identificada por auto-relato, os participantes informaram se já haviam recebido diagnóstico médico de: hipertensão arterial, diabetes, depressão, hiperplasia benigna ou câncer de próstata, hipercolesterolemia ou doença arterial coronariana e qual a idade quando o problema foi diagnosticado. Análise multivariada através de regressão logística foi usada para calcular a razão de prevalência de “odds” para as associações testadas. RESULTADOS: No total, foram avaliados 148.685 pacientes, 71.503 no Projeto Avaliar e 77.182 no Projeto Ampliar. A prevalência de disfunção erétil foi 58,8% e a de doença arterial coronariana 8,1%. Diagnóstico de diabetes, depressão, hiperplasia benigna ou câncer de próstata, doença arterial coronariana, hipertensão e hipercolesterolemia foram significativamente associados com prevalência aumentada de disfunção erétil. Doença arterial coronariana foi reportada em 11,3% dos homens com disfunção erétil, comparado a 3,6% naqueles sem esta disfunção (p<0,001). A razão de "odds" ajustada entre doença arterial coronariana e disfunção erétil foi de 1,33 (IC 95% 1,27-1,39). Aproximadamente, 50% dos diagnósticos de doença arterial coronariana ocorreu antes do diagnóstico de disfunção erétil, enquanto a outra metade aconteceu ao mesmo tempo ou depois do diagnóstico da disfunção. CONCLUSÕES: Nossos dados sugerem que disfunção erétil pode ser um marcador, manifestação "sentinela", de doença arterial coronariana. As implicações destes resultados são: deve-se enfatizar a importância da investigação de rotina da função erétil nas visitas médicas em qualquer especialidade, e em homens apresentando disfunção erétil, deve-se investigar a presença de outros fatores de risco para doença arterial coronariana e, conforme as circunstâncias, tratá-los ou introduzir medidas de redução/controle de risco, conforme as recomendações e diretrizes específicas. / INTRODUCTION: Cardiovascular disease is the most common cause of death worldwide. In men, 50% of deaths due to coronary artery disease occur among those without previous history of cardiovascular disease. Erectile dysfunction and coronary artery disease are closely related, since they are both consequences of endothelial dysfunction, leading to restrictions on the blood flow. The association between the severity of erectile dysfunction and the angiographic extension of coronary artery disease suggests that men with erectile dysfunction be considered at increased risk for coronary artery disease. OBJECTIVES: To evaluate the role of erectile dysfunction as a sentinel sign and/or surrogate of risk for coronary artery disease. METHODS: We performed a secondary analysis on data previously collected in two research projects (“Projeto Avaliar” e “Projeto Ampliar”). Male patients, age 18 years old or more, were invited to participate in two surveys about erectile dysfunction while attending a routine office visit or consultation in 2002-2003 (Projeto Avaliar) and in 2003-2004 (Projeto Ampliar). Twenty patients were consecutively recruited by each one of the eight thousands doctors collaborating with the survey team. Erectile dysfunction was assessed by a single global self-rating question. The presence of selected medical conditions was self-identified by survey participants who informed whether they had ever been diagnosed by a physician with: hypertension, diabetes, depression, benign hyperplasia or prostate cancer, hypercholesterolemia or coronary artery disease, and at what age they were diagnosed with each problem. Multivariate logistic regression analyses were carried out to calculate prevalence odds for the associations tested. RESULTS: Overall, 148,685 patients were enrolled, 71,503 in "Projeto Avaliar" and 77,182 in "Projeto Ampliar". The prevalence of erectile dysfunction was 58.8% and the prevalence of coronary artery disease was 8.1%. Being diagnosed with diabetes, depression, benign prostate hyperplasia or prostate cancer, coronary artery disease, hypertension, and hypercholesterolemia were significantly associated with increased prevalence of erectile dysfunction. Coronary artery disease was reported by 11.3% of men with erectile dysfunction, as compared to 3.6% of males without this dysfunction (p<0.001). The adjusted odds-ratio of the association between coronary artery disease and erectile dysfunction was 1.33 (CI 95% 1.27-1.39). Approximately, half of the coronary artery disease diagnosis occurred before erectile dysfunction had begun, the other half occurred either after or at the same time erectile dysfunction had begun. CONCLUSIONS: Our data suggest that erectile dysfunction may be a surrogate, sentinel sign, for coronary artery disease. The implications of our results are: more emphasis should be given to the routine assessment of erectile function during a medical consultation, regardless of the specialty; and in men presenting with erectile dysfunction, other risk factors for coronary artery disease should be ruled out, and, according to the circumstances, they should be treated or proper risk reducing measures adopted as recommended by specific guidelines.