Men With Erection Problems Are Three Times More Likely To Have Inflamed Gums

Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Dentistry
Article Date: 04 Dec 2012 – 0:00 PST

Men With Erection Problems Are Three Times More Likely To Have Inflamed Gums

Men in their thirties who had inflamed gums caused by severe periodontal disease were three times more likely to suffer from erection problems, according to a study published in the Journal of Sexual Medicine.

Turkish researchers compared 80 men aged 30 to 40 with erectile dysfunction with a control group of 82 men without erection problems.
This showed that 53 per cent of the men with erectile dysfunction had inflamed gums compared with 23 per cent in the control group.
When the results were adjusted for other factors, such as age, body mass index, household income and education level, the men with severe periodontal disease were 3.29 times more likely to suffer from erection problems than men with healthy gums.
“Erectile dysfunction is a major public health problem that affects the quality of life of some 150 million men, and their partners, worldwide,” says lead author Dr. Faith Oguz from Inonu University in Malatya, Turkey.
“Physical factors cause nearly two-thirds of cases, mainly because of problems with the blood vessels, with psychological issues like emotional stress and depression accounting for the remainder.
“Chronic periodontitis (CP) is a group of infectious diseases caused predominantly by bacteria that most commonly occur with inflammation of the gums.
“Many studies have reported that CP may induce systemic vascular diseases, such as coronary heart disease, which have been linked with erection problems.”
The average age of the men in both groups was just under 36 and there were no significant differences when it came to body mass index, household income and education.
Their sexual function was assessed using the International Index of Erectile Function and their gum health using the plaque index, bleeding on probing, probing depth and clinical attachment level.

“To our knowledge, erectile dysfunction and CP in humans are caused by similar risk factors, such as ageing, smoking, diabetes mellitus and coronary artery disease,” says Dr. Oguz.

“We therefore excluded men who had systemic disease and who were smokers from this study.

“We particularly selected men aged between 30 and 40 to assess the impact of CP on erectile dysfunction without the results being influenced by the effects of ageing.

“The result of our study support the theory that CP is present more often in patients with erectile dysfunction than those without and should be considered as a factor by clinicians treating men with erection problems.”

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our erectile dysfunction / premature ejaculation section for the latest news on this subject.
“Is There a Relationship Between Chronic Periodontitis and Erectile Dysfunction?” Oguz et al. The Journal of Sexual Medicine 2012. DOI: 10.1111/j.1743-6109.2012.02974.x
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Following Radiation In Prostate Cancer, Risk Markers Discovered For Erectile Dysfunction

Main Category: Prostate / Prostate Cancer
Also Included In: Erectile Dysfunction / Premature Ejaculation;  Radiology / Nuclear Medicine
Article Date: 29 Sep 2012 – 0:00 PDT

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Following Radiation In Prostate Cancer, Risk Markers Discovered For Erectile Dysfunction

In the first study of its kind, a research team led by Mount Sinai School of Medicine and Albert Einstein College of Medicine of Yeshiva University discovered 12 genetic markers associated with the development of erectile dysfunction (ED) in prostate cancer patients who were treated with radiation. The findings, published online in advance of the October 1, 2012 print issue in the International Journal of Radiation Oncology• Biology• Physics, the official scientific journal of the American Society for Radiation Oncology, are an important step towards helping clinicians determine the best course of treatment for prostate cancer patients and may lead to the development of therapies that alleviate side effects.

The main treatments for prostate cancer – surgery, brachytherapy (seed implants) and external beam radiation therapy – are all very effective at curing prostate cancer. Unfortunately, each treatment places patients at risk for ED. According to the National Cancer Institute, the prevalence of erectile dysfunction following external beam radiation for prostate cancer ranges from 65 percent to 85 percent. The Prostate Cancer Foundation estimates prevalence of ED following seed therapy at 25 to 50 percent. Many men will be able to regain their potency with time and treatments, but doctors would like to identify which men may be more likely to develop this side effect.

In the first large scale Genome-Wide Association Study to identify single nucleotide polymorphisms (SNPs) associated with susceptibility for the development of erectile dysfunction following radiotherapy for prostate cancer, researchers conducted a two-part study, first, to discover the candidate genetic markers of side effect risk, and second, to confirm which of those markers are replicated in a second group of patients. In the first group of prostate cancer patients, which included 132 men who developed erectile dysfunction after radiotherapy and 103 men similarly treated who did not develop erectile dysfunction, they found a set of genetic markers associated with erectile dysfunction. In the second part of the study, which examined 128 patients who developed erectile dysfunction after radiotherapy and 102 who did not, researchers confirmed that 12 SNPs were associated with erectile dysfunction.

“Thankfully, current treatments for prostate cancer offer excellent rates of long-term survival, so patients and their physicians have a choice about which treatment path to take,” said Barry Rosenstein, PhD, Professor of Radiation Oncology, Mount Sinai School of Medicine. “However, the risk of developing erectile dysfunction after radiation treatment is highly variable, suggesting there may be a genetic component to determining that risk. Our study confirms that specific markers make certain patients more susceptible to this side effect.”

Patients in the study cohort were given one of three treatments: internal radiotherapy, known as brachytherapy; brachytherapy plus external beam radiation; or external beam radiation alone. They were followed for an average length of nearly four years to determine level of sexual function after treatment.
Interestingly, the 12 SNPs identified in this study were located near genes that seem to be related to erectile function rather than related to radiation response. The researchers conclude that these SNPs may affect genes that sensitize a patient to developing erectile dysfunction when exposed to radiation during therapy.

“Prostate cancer screening and treatment are undergoing major shifts,” said Harry Ostrer, MD, Professor of Pathology and Genetics at Albert Einstein College of Medicine and Director of Genetic and Genomic Testing at Montefiore Medical Center and co-principal investigator of the study. “This is part of our ongoing effort to identify men at highest risk for disease, identify the aggressive tumors that would be responsive to therapy, and to improve quality of life for men with indolent prostate cancers who might benefit from active surveillance, rather than therapy.”

The authors indicate that examination of a large, independent cohort of similarly treated patients will be necessary to definitively determine which SNPs to include as part of a clinically useful predictive test to identify which men are at greatest risk for developing erectile dysfunction following prostate cancer radiotherapy. The researchers are also evaluating the impact of radiation treatment on urinary complications and proctitis, the inflammation of the rectum.

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our prostate / prostate cancer section for the latest news on this subject.
This study was supported by the American Cancer Society, United States Department of Defense, and the National Institutes of Health.
The Mount Sinai Hospital / Mount Sinai School of Medicine
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Knowledge Of The Biochemical Events Needed To Maintain Erection May Lead To New Therapies For Erectile Dysfunction

Main Category: Erectile Dysfunction / Premature Ejaculation
Article Date: 28 Sep 2012 – 0:00 PDT

Knowledge Of The Biochemical Events Needed To Maintain Erection May Lead To New Therapies For Erectile Dysfunction

For two decades, scientists have known the biochemical factors that trigger penile erection, but not what’s needed to maintain one. Now an article by Johns Hopkins researchers, scheduled to be published this week by the Proceedings of the National Academy of Sciences (PNAS), uncovers the biochemical chain of events involved in that process. The information, they say, may lead to new therapies to help men who have erectile dysfunction.

“We’ve closed a gap in our knowledge,” says Arthur Burnett, M.D., professor of urology at Johns Hopkins Medicine and the senior author of the study article. “We knew that the release of the chemical nitric oxide, a neurotransmitter that is produced in nerve tissue, triggers an erection by relaxing muscles that allow blood to fill the penis. We thought that was just the initial stimulus. In our research, we wanted to understand what happens next to enable that erection to be maintained.”

In a study of mice, Burnett and his colleagues found a complex positive feedback loop in the penile nerves that triggers waves of nitric oxide to keep the penis erect. He says they now understand that the nerve impulses that originate from the brain and from physical stimulation are sustained by a cascade of chemicals that are generated during the erection following the initial release of nitric oxide. “The basic biology of erections at the rodent level is the same as in humans,” he says.

The key finding is that after the initial release of nitric oxide, a biochemical process called phosphorylation takes place to continue its release and sustain the erection.

In a landmark study published in the journal Science in 1992, Burnett and his Johns Hopkins co-author, Solomon S. Snyder, M.D., professor of neuroscience (who is also an author on the current study), showed for the first time that nitric oxide is produced in penile tissue. Their study demonstrated the key role of nitric oxide as a neurotransmitter responsible for triggering erections.

“Now, 20 years later, we know that nitric oxide is not just a blip here or there, but instead it initiates a cyclic system that continues to produce waves of the neurotransmitter from the penile nerves,” says Burnett.
With this basic biological information, it may be possible, according to Burnett, to develop new medical approaches to help men with erection problems caused by such factors as diabetes, vascular disease or nerve damage from surgical procedures. Such new approaches could be used to intervene earlier in the arousal process than current medicines approved to treat erectile dysfunction.

In particular, Burnett says, “The target for new therapies would be the protein kinase A (PKA) phosphorylation of neuronal nitric oxide synthase (nNOS). Now that we know the mechanism for causing the ‘activated’ form of nNOS in penile nerves, we can develop agents that exploit this mechanism to help with erection difficulties.”

One of the agents studied by the researchers was forskolin, an herbal compound that has been used to relax muscle and widen heart vessels. They found that forskolin also ramps up nerves and can help keep nitric oxide flowing to maintain an erection.

“It has been a 20-year journey to complete our understanding of this process,” says Snyder. “Now it may be possible to develop therapies to enhance or facilitate the process.”

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our erectile dysfunction / premature ejaculation section for the latest news on this subject.
The new study, “Cyclic AMP Dependent Phosphorylation of Neuronal Nitric Oxide Synthase Mediates Penile Erection,” was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), under grant number RO1DK067223.
In addition to Burnett and Snyder, the study article’s authors are K. Joseph Hurt from the University of Colorado, Sena F. Sezen, Gwen F. Lagoda and Biljana Musicki from Johns Hopkins, and Gerald A. Rameau from Morgan State University.
Johns Hopkins Medicine
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Predicting Erectile Dysfunction From Prostate Cancer Treatment

Main Category: Prostate / Prostate Cancer
Also Included In: Erectile Dysfunction / Premature Ejaculation
Article Date: 27 Sep 2012 – 1:00 PDT

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Predicting Erectile Dysfunction From Prostate Cancer Treatment

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Researchers have identified 12 DNA sequences that may help doctors determine which men will suffer from erectile dysfunction (ED) following radiation therapy for prostate cancer. Identifying these patients in advance of treatment may better inform men and their families as to which prostate cancer treatments are best for their specific cancer and lifestyle, according to a study to be published online September 27, 2012, in advance of the October 1, 2012 print issue, in the International Journal of Radiation Oncology• Biology• Physics (Red Journal), the official scientific journal of the American Society for Radiation Oncology (ASTRO). The findings could also guide doctors in recommending the most effective treatments that carry the least risk of patients developing ED.
The main treatments for prostate cancer – surgery, brachytherapy (seed implants) and external beam radiation therapy – are all very effective at curing prostate cancer. Unfortunately, each treatment places patients at risk for ED. Although many men will maintain their potency, doctors would like to identify which men are at greatest risk for the development of difficulty with sexual function.
In this multi-institutional, multi-national study, researchers from New York’s Mount Sinai School of Medicine, Albert Einstein College of Medicine of Yeshiva University in Bronx, N.Y., New York University School of Medicine, Florida Radiation Oncology Group in Jacksonville, Fla., and Maastricht University Medical Center in Maastricht, the Netherlands, examined 593 men who were treated with brachytherapy and/or external beam radiation therapy and hormone therapy. Of them, 260 reported erectile dysfunction.
“Through a two-stage genome-wide association study, 12 single nucleotide polymorphisms (SNPs) were identified that were associated with the development of erectile dysfunction after radiation treatment for prostate cancer,” said Barry S. Rosenstein, PhD, department of radiation oncology at New York’s Mount Sinai Medical School. “If validated further, these SNPs could provide the basis for a blood test that would enable radiation oncologists to predict more accurately which men are most likely to develop erectile dysfunction after prostate cancer radiation therapy.”
“Prostate cancer screening and treatment are undergoing major shifts,” said Harry Ostrer, MD, professor of pathology and genetics at Albert Einstein College of Medicine, director of genetic and genomic testing at Montefiore Medical Center and co-principal investigator of the study. “This is part of our ongoing effort to personalize and optimize treatment for prostate cancer.”

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our prostate / prostate cancer section for the latest news on this subject.
Disclosures: One author (NS) reports to have received consulting fees or honoraria from Amgen, Ferring, Janssen, Diversified Conference Management, Prologics LLC, and Nihon MediPhysics. Another author (RS) has received fees for developing lectures and educational materials for Bard.

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Cardiometabolic Risks And Sexual Health

Main Category: Cardiovascular / Cardiology
Also Included In: Erectile Dysfunction / Premature Ejaculation;  Heart Disease;  Men’s Health
Article Date: 03 Sep 2012 – 0:00 PDT

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Assessment of sexual function should be incorporated into cardiovascular risk evaluation for all men, regardless of the presence or absence of known cardiovascular disease, according to Dr. Ajay Nehra, lead author of a report by the Princeton Consensus (Expert Panel) Conference, a collaboration of 22 international, multispecialty researchers. Nehra is vice chairperson, professor and director of Men’s Health in the Department of Urology at Rush University Medical Center in Chicago.

Erectile dysfunction (ED) is a red flag in younger men, less than 55 years of age for future cardiac morbidity or mortality – death or disease – for cardiovascular disease (CVD). In some patients, the time window between onset of ED and a cardiovascular event may be two to five years.

“Any man with ED should be considered at a substantially higher increase cardiovascular risk until further testing can be done,” said Nehra. “Erectile dysfunction often occurs in the presence of silent, non-symptomatic cardiovascular disease; and hence this is an opportunity for cardiovascular risk reduction.”

The panel recommends that younger men, more than 30 years old who experience ED receive a thorough, non invasive cardiovascular disease evaluation. As the consensus panel considers all men with ED who are older than 30 to be at increased CVD risk, a thorough noninvasive and, when indicated, invasive evaluation of CVD status is recommended.

They found that younger men who experienced ED were twice as likely to develop cardiovascular disease than men without ED. The highest risk for cardiovascular disease was in younger men.

While controversial, the consensus panel also recommended that testosterone levels be measured in all men diagnosed with organic ED due to an accumulation of recent studies that link low testosterone to ED, CVD and cardiovascular mortality.

“Testosterone levels should be routinely measured. Men with testosterone levels less than 230 have higher risk for all cause and cardiovascular mortality,” said Nehra. In population based studies of 500 or more patients, low testosterone levels have increased mortality level.

These and other recommendations for controlling ED and CVD emerged from the Princeton III Meeting on Cardiometabolic Risks and Sexual Health, held in 2010, that were reported in the August 2012 issue of the Mayo Clinic Proceedings.

The purpose of the Princeton III meeting was to find an approach for optimizing sexual function and preserving cardiovascular health in men with known CVD. The conference updated findings from the Princeton I and Princeton II meetings, held in 2000 and 2005, respectively.

“The conference focused on the predictive value of vascular erectile dysfunction in assigning cardiovascular risk in men of all ages, the objective being development of a primary approach to cardiovascular risk assessment in younger men with erectile dysfunction and no cardiovascular disease,” Nehra said.

The panel’s approach broadens the use of the 2010 American College of Cardiology/American Heart Association guideline for assessment of cardiovascular risk in asymptomatic adults to address an at-risk population that the guideline does not mention – men with ED. Even long-term observational studies, such as the well-known Framingham Heart Study, include few data from patients younger than 40 years.

“Experts have been considering the connection between erectile dysfunction and cardiovascular disease for a while,” said Nehra. “Recent data and publications about the connection have become more consistent in linking the two.”

There is a growing body of scientific evidence that ED is a particular precursor of CVD in men younger than 40. One study found that men 40 to 49 years of age with ED had a 50-fold higher incidence of new-incident coronary artery disease than those without ED.

In light of this evidence, the panel recommended that the cardiovascular evaluation include an assessment of important indicators of risk that can be seen in certain blood and urine tests, patient and family history and a review of lifestyle factors. Such an evaluation will help stratify the patient’s CV risk and guide the next steps in evaluation and treatment.

“That means that doctors treating men for erectile dysfunction can play a critical role in helping monitor and start reducing a patient’s cardiovascular risk, even when the patient has no symptoms,” said Nehra.

The new recommendations also emphasize using exercise ability before prescribing treatment for ED to ensure that each man’s cardiovascular health is consistent with the physical demands of sexual activity, especially for those who have been identified as having a high risk for CVD.

The panel encouraged a collaborative approach to management of men’s sexual function and cardiovascular risk, incorporating general, urologic, endocrine and cardiologic expertise. Scientific evidence suggests that a comprehensive approach to cardiovascular risk reduction will improve overall vascular health, including sexual function, the report said.

The Princeton III panel also strongly urges physicians to inquire about ED symptoms in all men older than 30 years of age with CVD risk factors. “Identification of ED, particularly in men younger than 60, represents an important first step toward CVD detection and reduction,” the panel concluded.

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Erectile Dysfunction Linked to Increased Cardiovascular Risk

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Main Category: Cardiovascular / Cardiology
Also Included In: Erectile Dysfunction / Premature Ejaculation;  Heart Disease
Article Date: 30 Aug 2012 – 16:00 PDT

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According to a recent report by the Princeton Consensus (Expert Panel) Conference, men’s sexual function should be evaluated and taken into account when they are being tested for risk factors of cardiovascular problems.

Lead author of the study Dr. Ajay Nehra, vice chairperson, professor and director of Men’t Health in the Department of Urology at Rush University Medical Center in Chicago, worked with over 20 other experts to determine their findings.

The study explains that erectile dysfunction (ED) is a risk factor in men younger than 55 for eventual cardiovascular disease. In some men diagnosed with ED, a cardiovascular event may occur within 2 to 5 years.

Nehra explains:

“Any man with ED should be considered at a substantially higher increase cardiovascular risk until further testing can be done. Erectile dysfunction often occurs in the presence of silent, symptomatic cardiovascular disease; and hence this is an opportunity for cardiovascular risk reduction.”

The researchers recommend that men over 30 who suffer from ED should be evaluated closely for cardiovascular disease, because they believe that any man over 30 who has ED has a large risk for CVD (cardiovascular disease).

The experts determined that men who experience ED are at twice the risk of having cardiovascular disease than men who do not have ED. The younger then men are, the higher the risk of CVD.

Recent trials have shown that low testosterone levels may be associated with ED, CVD and cardiovascular death. Therefore, the team says men should also be tested to determine their testosterone levels.

Trials of over 500 patients have shown that low levels of testosterone result in a higher risk of mortality. Nehra continues: “Testosterone levels should be routinely measured. Men with testosterone levels less than 230 have higher risk for all cause and cardiovascular mortality.” These findings, along with advice for patients with ED and CVD were been published in Mayo Clinic Proceedings in the August 2012 issue.

The goal of the Princeton III meeting, which updated data presented at Princeton I and Princeton II meetings in 2000 and 2005, was to discover a method for optimizing sexual function in men and improving cardiovascular health in patients who have CVD.

Nehra commented:

“The conference focused on the predictive value of vascular erectile dysfunction in assigning cardiovascular risk in men of all ages, the objective being development of a primary approach to cardiovascular risk assessment in younger men with erectile dysfunction and no cardiovascular disease.”

The team’s approach adds to the 2010 American College of Cardiology/American Heart Association recommendation to screen asymptomatic adults at risk of cardiovascular disease. However, this did not involve men with ED. Other studies, including the Framingham Heart Study, only include minimum information about patients under the age of 40.

“Experts have been considering the connection between erectile dysfunction and cardiovascular disease for a while. Recent data and publications about the connection have become more consistent in linking the two”, said Nehra.

Evidence of ED being linked with CVD in men under the age of 40 is rapidly growing. One trial explained that men between the ages of 40 and 49 who had ED had a 50% higher likelihood of coronary artery disease than the men who did not have the disorder.

The team notes that it would be beneficial for the cardiovascular evaluations to involve looking at blood and urine tests and lifestyle habits, as well as history of family health to determine if risk factors are present in the patient. This will assist in deciding appropriate treatment.

Nehra said: “That means that doctors treating men for erectile dysfunction can play a critical role in helping monitor and start reducing a patient’s cardiovascular risk, even when the patient has no symptoms.”

The panel recommends evaluating whether men who have ED have cardiovascular health persistent with the physical action needed for sexual activity. This is more important for men who have a very high risk of developing CVD.

The report said: “Scientific evidence suggests that a comprehensive approach to cardiovascular risk reduction will improve overall vascular health, including sexual function.”

The Princeton III team recommends that doctors ask patients, especially men older than 30, if they have any symptoms of ED.

They conclude: “Identification of ED, particularly in men younger than 60, represents an important first step toward CVD detection and reduction.”

Written by Christine Kearney

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

  • Additional
  • References
  • Citations

The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease.

Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham GR, Ganz P, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis J, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel AD, Shabsigh R, Vlachopoulos C, Wu FC.
Mayo Clinic Proceedings, August 2012

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Kidney Removal Increases Risk Of Erectile Dysfunction

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Main Category: Urology / Nephrology
Also Included In: Erectile Dysfunction / Premature Ejaculation;  Transplants / Organ Donations
Article Date: 01 Aug 2012 – 12:00 PDT

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According to a multi-center study featured online in the British Journal of Urology International, California University’s San Diego School of Medicine researchers have found that patients undergoing a total nephrectomy, i.e. a complete removal of a kidney, have a higher chance of developing erectile dysfunction.

Senior author of the study, Ithaar Derweesh, MD, an associate professor of surgery at the UC San Diego School of Medicine and urologic surgeon at UC San Diego Health System, said: “This is the first study in medical literature to suggest that surgery for kidney removal can negatively impact erectile function while partial kidney removal can protect sexual function.”

The researchers evaluated two cohorts of men who underwent surgery for renal cell carcinoma in a retrospective study. The total number of patients involved in the study was 432. The patients were divided into those who had a complete nephrectomy and those who had kidney-preserving surgery. They assessed the patients’ sexual function before and after their surgery by using a sexual health questionnaire, known as the International Index of Erectile Function.

Derweesh said: “What we are seeing is a dramatic yet delayed effect. Approximately six years after surgery, patients who had a total nephrectomy were 3.5 times more likely to develop erectile dysfunction compared to those who had kidney reconstruction.”

Leading researcher Ryan Kopp, MD, who is a chief resident at UC San Diego School of Medicine’s Urology Division, explained:

“The primary argument for kidney-sparing surgery over total kidney removal has been to preserve the kidney filtration function. However, we are also beginning to understand that total kidney removal may also increase the risk of metabolic diseases and significantly decrease quality of life.”

Derweesh concluded that this is the latest research in a series of studies, which suggests that it is wiser to save a patient’s kidney whenever possible, rather than removing it. Earlier research led by Derweesh demonstrated that a partial nephrectomy could lower the risk of osteoporosis and chronic kidney insufficiency, which can potentially lead to cardiac events and metabolic disturbances. He continued saying that further research is required to predict the potential occurrence and to prevent erectile dysfunction in these patients.

Written by Petra Rattue

Copyright: Medical News Today

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Link Identified Between Kidney Removal And Erectile Dysfunction

Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Urology / Nephrology
Article Date: 01 Aug 2012 – 0:00 PDT

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Researchers at the University of California, San Diego School of Medicine have identified a link between patients who undergo total nephrectomy – complete kidney removal – and erectile dysfunction. Results from the multi-center study were recently published online in the British Journal of Urology International.

“This is the first study in medical literature to suggest that surgery for kidney removal can negatively impact erectile function while partial kidney removal can protect sexual function,” said Ithaar Derweesh, MD, senior author, associate professor of surgery, UC San Diego School of Medicine and urologic surgeon at UC San Diego Health System.

The retrospective study evaluated two cohorts of men, totaling 432 patients, who underwent surgery for renal cell carcinoma. One group underwent complete removal of the kidney while the other had kidney-sparing surgery. Sexual function was accessed pre- and post-operatively with a sexual health questionnaire known as the International Index of Erectile Function.

“What we are seeing is a dramatic yet delayed effect. Approximately six years after surgery, patients who had a total nephrectomy were 3.5 times more likely to develop erectile dysfunction compared to those who had kidney reconstruction,” said Derweesh.

“The primary argument for kidney-sparing surgery over total kidney removal has been to preserve the kidney filtration function. However, we are also beginning to understand that total kidney removal may also increase the risk of metabolic diseases and significantly decrease quality of life,” said lead author Ryan Kopp, MD, chief resident, Division of Urology, UC San Diego School of Medicine.

Derweesh added that this is the latest in a series of studies that point to the wisdom of saving the kidney in appropriate patients. Prior research led by Derweesh also shows that partial nephrectomy can reduce the risk of osteoporosis and chronic kidney insufficiency which can lead to cardiac events and metabolic disturbances. Further investigation is needed to prevent erectile dysfunction in patients and to predict its potential occurrence.

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Erectile Dysfunction Can Be A Warning Sign For Heart Disease In Younger And Middle-Aged Men And Men With Diabetes

Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Diabetes;  Heart Disease;  Obesity / Weight Loss / Fitness
Article Date: 27 Jul 2012 – 1:00 PDT

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Although erectile dysfunction (ED) has been shown to be an early warning sign for heart disease, some physicians – and patients – still think of it as just as a natural part of “old age.” But now an international team of researchers, led by physicians at The Miriam Hospital, say it’s time to expand ED symptom screening to include younger and middle-aged men.

In an article appearing in the July issue of the American Heart Journal, they encourage physicians to inquire about ED symptoms in men over the age of 30 who have cardiovascular risk factors, such as smoking, obesity or family history, and in all men with type 2 diabetes.

As many as 30 million American men suffer from ED, or the inability to maintain an erection sufficient for sexual intercourse. ED and cardiovascular disease share a common cause: narrowing of the arteries, resulting in reduced or obstructed blood flow to the organs. They also share similar risk factors, including smoking, diabetes, obesity and high blood pressure. Because the penile arteries are just a fraction smaller than the arteries supplying blood to the heart, symptoms of conditions that can narrow the arteries, such as arteriosclerosis, are likely to present first in the form of erection problems. That’s why it is also believed that the more severe the ED, the greater the risk of heart disease-related events, such as heart attack and stroke.

“Erectile dysfunction represents an important first step toward heart disease detection and reduction, yet many health care providers and patients assume it’s just a sign of old age, so it may not be something that comes up during an annual physical with a younger man who doesn’t fit the ED ‘stereotype,'” says lead author Martin Miner, M.D., chief of family medicine and co-director of the Men’s Health Center at The Miriam Hospital.

“That’s why we urge physicians to discuss sexual function with the majority of their male patients – including diabetic men of all ages and men over the age of thirty with some of the traditional heart disease risk factors, like smoking or a family history,” he adds.

Although not all men with ED are at increased risk for cardiovascular disease, Miner says it is the physician’s responsibility to make that determination based on aggressive workup and testing. If the patient is found to be at risk, the patient can then receive intensive risk factor management.

Miner and colleagues conducted a literature review of 40 studies that suggest ED is a significant predictor for cardiovascular disease in two populations: men under the age of 60 and men with diabetes. Their analysis supports several widely-held theories, including the role of ED as a significant red flag for cardiovascular disease in younger and middle-aged men.

For example, in the Mayo Clinic’s Olmsted County Study, a large, epidemiological study cohort of men from Olmsted County, Minnesota, men 40 to 49 years old with ED were twice as likely to develop coronary artery disease as those who did not have ED. However, ED had less predictive value for men 70 years and older.

Several studies, including a large analysis of more than 6,300 men enrolled in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial, suggest ED is a particularly powerful indicator of cardiovascular disease in diabetic men as well, prompting researchers to call for ED symptom screening in all men with type 2 diabetes.

Miner points out early identification of men at risk for cardiovascular disease has the potential to lower health care costs and improve outcomes.

“There may be a ‘window of curability’ in which we can intervene early and stop the progression of heart disease,” he says. “Also, it may be possible to someday use erectile function as a measurement to tell us if preventive interventions for heart disease are working.”

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Miner’s co-authors on the paper include Mark Sigman, M.D., co-director of the Men’s Health Center and chief of urology at Rhode Island and The Miriam hospitals; Peter Tilkemeier, M.D., interim chair, division of cardiology at Rhode Island and The Miriam hospitals; Allen D. Seftel, M.D., FACS, of the University of Medicine and Dentistry, New Jersey-Robert Wood Johnson Medical School; Ajay Nehra, M.D., of Mayo Clinic; Peter Ganz, M.D., of San Francisco General Hospital and University of California at San Francisco; Robert A. Kloner, M.D., Ph.D., of Good Samaritan Hospital, Los Angeles; Piero Montorsi, M.D., of the University of Milan; Charalambos Vlachopoulos, M.D., of Athens Medical School; Melinda Ramsey, Ph.D., of Melinda Ramsey, LLC; and Graham Jackson, M.D., FRCP, of Guys and St. Thomas Hospitals, London.

Miner is also a clinical associate professor of family medicine and surgery (urology) at The Warren Alpert Medical School of Brown University. In addition, Sigman is a professor of surgery (urology) and Tilkemeier is an associate professor of medicine at Alpert Medical School.
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Sexual Dysfunction May Be A Tip-off To Heart Disease In Diabetic Men

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Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Diabetes;  Heart Disease
Article Date: 21 Jul 2012 – 9:00 PDT

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Sexual dysfunction may be a marker of cardiovascular disease in men with longstanding type 1 diabetes, investigators announced at the 72nd Scientific Sessions of the American Diabetes Association (ADA).

Sara Turek, MPH, and colleagues examined the association of sexual dysfunction with clinical markers of vascular disease in 301 men from the ongoing 50-Year Medalist Study who have had type 1 diabetes for more than 50 years. Turek is a coordinator for the study, which is being conducted at the Joslin Diabetes Center in Boston.

In prior analyses, only about half of the Medalist population has been shown to develop diabetic nephropathy, retinopathy, and neuropathy, which are complications that occur in nearly all type 1 diabetic patients in the general population by about 30 years after their initial diagnosis. The rate of cardiovascular disease in Medalists, however, is similar to that reported in age-matched patients with type 2 diabetes.

Research has also demonstrated that participants in the Medalist Study have usually maintained good long-term glycemic control.

One issue that had not been addressed in the Medalist cohort was sexual dysfunction. “We have noticed that while sexual dysfunction is a common complaint among male Medalists that significantly impairs their quality of life, there is a paucity of data on sexual dysfunction in men with long-duration type 1 diabetes,” Turek commented.

Overall, 210 male Medalists, or 69.8%, had sexual dysfunction as determined by an affirmative response to the question: “Have you ever had sexual problems?”

Males reporting a positive response had a hemoglobin (Hb)A1c of 7.1± 0.9% versus 6.8 ±0.8% in the no-dysfunction cohort (P=0.02). Body mass index (BMI) was 26.1 ±3.8 kg/m2 and. 25.8 ±3.6 kg/m2 (P=0.03) in the two groups, respectively, total cholesterol was 159.3 ±32.1 and 150.1 ±30.6 mg/dL(P=0.02), and high-density lipoprotein (HDL) was 55.1 ±16.2 and 62.1 ±17.8 mg/dL (P

In addition, a history of cigarette smoking was associated with prevalence of sexual dysfunction (51.7% versus 39.3% in the sexual dysfunction and non-sexual dysfunction groups, respectively, P=0.05).

The researchers also examined clinical inflammatory markers that are commonly associated with cardiovascular risk and disease including C-reactive protein (CRP), interleukin (IL-6), and plasminogen activator inhibitor type 1 (PAI-1). Only IL-6 was significantly associated with patient reports of sexual dysfunction (P=0.03), and the association was independent of BMI, age, and glycemic control.

The findings suggest that sexual dysfunction follows the pattern of macrovascular complications seen in the Medalist group, Turek said. Also, the association with Il-6 may provide a pathway linking sexual dysfunction and macrovascular complications in this cohort.

Sara Turek said:

“The clinical message is that sexual dysfunction might be a more overt sign of cardiovascular issues or future cardiovascular issues than other clinical markers of cardiovascular disease symptoms such as hypertension, high cholesterol, and atherosclerosis. So if a patient presents with a complaint of sexual dysfunction, the physician may want to screen for cardiovascular problems since erectile dysfunction may be a predictor of increased cardiometabolic risk in aging men.”

Stephanie Hastings, BA, also a coordinator for the Medalist Study, emphasized that while the determination of erectile dysfunction based on a single question is a limitation to the study, she is confident that the measure provided an accurate assessment of the presence of erectile dysfunction in this group. “Sure, it’s subjective and open to interpretation but we spend a lot of time with our patients, and we find that they are very willing to share whatever information we request in order to help us in our research. We plan to follow up with a lengthier questionnaire, which we expect the majority of the participants to complete openly and honestly,” she said.

Written by: By Jill Stein
Jill Stein is a Paris-based freelance medical writer.

Copyright: Medical News Today

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