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March 2011

Recent Literature in Sexual Medicine

Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis.

Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA.

BMJ. 2011 publ.online Feb 22;

Department of Community Health Sciences, Faculty of Medicine, Calgary Institute for Population and Public Health, University of Calgary, Alberta, Canada.

Abstract OBJECTIVE: To conduct a comprehensive systematic review and meta-analysis of studies assessing the effect of alcohol consumption on multiple cardiovascular outcomes.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES: A search of Medline (1950 through September 2009) and Embase (1980 through September 2009) supplemented by manual searches of bibliographies and conference proceedings. Inclusion criteria Prospective cohort studies on the association between alcohol consumption and overall mortality from cardiovascular disease, incidence of and mortality from coronary heart disease, and incidence of and mortality from stroke. Studies reviewed Of 4235 studies reviewed for eligibility, quality, and data extraction, 84 were included in the final analysis.

RESULTS: The pooled adjusted relative risks for alcohol drinkers relative to non-drinkers in random effects models for the outcomes of interest were 0.75 (95% confidence interval 0.70 to 0.80) for cardiovascular disease mortality (21 studies), 0.71 (0.66 to 0.77) for incident coronary heart disease (29 studies), 0.75 (0.68 to 0.81) for coronary heart disease mortality 2

(31 studies), 0.98 (0.91 to 1.06) for incident stroke (17 studies), and 1.06 (0.91 to 1.23) for stroke mortality (10 studies). Dose-response analysis revealed that the lowest risk of coronary heart disease mortality occurred with 1-2 drinks a day, but for stroke mortality it occurred with ≤1 drink per day. Secondary analysis of mortality from all causes showed lower risk for drinkers compared with non-drinkers (relative risk 0.87 (0.83 to 0.92)).

CONCLUSIONS: Light to moderate alcohol consumption is associated with a reduced risk of multiple cardiovascular outcomes.

Editorial Comment by the ESSM President : Although this scrutinized review focus not on sexual function but on the impact of regular alcohol intake on cardiovascular disease outcome it is justified that the findings, reported here, may also apply for the prevention of vascular , one of the major causes of middle aged and elderly men with ED because both conditions are sharing the same pathophysiological mechanisms. Therefore the advice to have 1-2 drinks per day for prevention of vascular ED in addition to other lifestyle adjustments may be reasonable for all those men who are at risk for ED both from their history and their individual clinical/laboratory findings.

Male Sexual Dysfunktion: Basic Research 3

Improvement of penile , sperm count and seminal fructose levels in vivo and nitric oxide release in vitro by ayurvedic herbs

M. Thakur1,2,3, D. Thompson1, P. Connellan1, M. A. Deseo1, C. Morris1, V. K. Dixit2

Andrologia 2011, Article first published online: 28 MAR 2011

Keywords : Aphrodisiac;nitric oxide;penile erection index;seminal fructose concentration;sperm count;Vajikaran-rasayana

Summary

In the present study, the effect of four Vajikaran Rasayana herbs on penile erection, sperm count, seminal fructose content in vivo and nitric oxide (NO) release in vitro was assessed. Lyophilised aqueous extracts of Asparagus racemosus Willd. (AR), Chlorophytum borivilianum Sant. F. (CB), Curculigo orchioides Gaertn. (CO), and Dactylorhiza hatagirea (D. Don) Soo (DH) were orally administered at 100 mg/kg body weight to Wistar strain male albino rats. Penile erection index and sperm count were determined by visual observation; the seminal fructose concentration was measured spectrophotometrically using resorcinol reagent; and NO release was assessed in a mouse macrophage cell line (RAW264) spectrophotometrically using a commercial Griess reagent kit. Penile erection index, sperm count, seminal fructose concentration and in vitro NO release were the parameters measured. A significant effect on the sperm count, seminal fructose content and penile erection index was observed upon treatment with the extracts. The effect of extracts on inducible NO release in vitro directly correlated with the enhanced erectile function in vivo. The aphrodisiac claims attributed to the four Vajikaran Rasayana herbs were tested and a distinctive effect of all extracts tested was observed, with C. borivilianum showing a highly significant response for all parameters measured in vivo and in vitro. The present study also provides a good correlation between the in vivo improvement of penile erection and in vitro NO releasing activity of the extracts. Increase in seminal fructose levels and sperm count further validates the role of these herbs in improving reproductive function. Erectile Dysfunction

Efficacy and Tolerability of Tadalafil for Treatment of Erectile Dysfunction in Men Taking Serotonin Reuptake Inhibitors Yalçın Evliyaoğlu, Kazım Yelsel, Murat Kobaner, Ergün Alma, Melike Saygılı

Urology 2011, published online 14 February 2011.

Objectives

To evaluate the efficacy and safety of tadalafil in men with treatment-emergent due to serotonin reuptake inhibitors. 4

Methods

The present prospective, double-blind, 12-week study, randomized in a 1:1 ratio to tadalafil 20 mg or placebo taken on demand, included 50 men. The efficacy measures were the changes in total and domain scores of the International Index of Erectile Function questionnaire, Sexual Encounter Profile diary questions 2-6, and the Global Assessment questions (GAQs) 1 and 2. The safety analyses included the evaluation of adverse events, vital signs, serum chemistry results, and electrocardiography findings.

Results

For the patients who took tadalafil 20 mg, the net median score change from baseline to the endpoint compared with placebo was 26 for the 15-item International Index of Erectile Function; 10, 4, 4, 3, and 3 for the erectile function, intercourse satisfaction, overall satisfaction, orgasmic function, and sexual desire domains; and 3 and 5 points for “yes” responses to the Sexual Encounter Profile 2 and Sexual Encounter Profile 3 questions, respectively. All comparisons between tadalafil and placebo were significant ( P < .001). At the endpoint, 92% of the tadalafil group responded affirmatively to both GAQs 1 and 2 compared with 8% of the placebo group ( P < .001, for each). In the safety measures, no clinically significant changes attributable to tadalafil use were found.

Conclusions

Tadalafil 20-mg treatment significantly improved sexual function in patients who were taking serotonin reuptake inhibitors for depression, with mild to moderate, well-tolerable adverse events.

Regular Nonsteroidal Anti-Inflammatory Drug Use and Erectile Dysfunction Joseph M. Gleason, Jeffrey M. Slezak, Howard Jung, Kristi Reynolds, Stephen K. Van Den Eeden, Reina Haque, Virginia P. Quinn, Ronald K. Loo , Steven J. Jacobsen

J.Urol.2011, 185, Issue 4 , Pages 1388-1393, April 2011

Abstract

Purpose

Previous data suggest a potential relationship between inflammation and erectile dysfunction. If it is causal, nonsteroidal anti-inflammatory drug use should be inversely associated with erectile dysfunction. To this end we examined the association between nonsteroidal anti-inflammatory drug use and erectile dysfunction in a large, ethnically diverse cohort of men enrolled in the California Men's Health Study.

Materials and Methods

This prospective cohort study enrolled male members of the Kaiser Permanente managed care plans who were 45 to 69 years old beginning in 2002. Erectile dysfunction was assessed by questionnaire. Nonsteroidal anti-inflammatory drug exposure was determined by automated pharmacy data and self-reported use.

Results 5

Of the 80,966 men in this study 47.4% were considered nonsteroidal anti-inflammatory drug users based on the definitions used and 29.3% reported moderate or severe erectile dysfunction. Nonsteroidal anti-inflammatory drug use and erectile dysfunction strongly correlated with age with regular drug use increasing from 34.5% in men at ages 45 to 49 years to 54.7% in men 60 to 69 years old with erectile dysfunction increasing from 13% to 42%. The unadjusted OR for the association of nonsteroidal anti-inflammatory drugs and erectile dysfunction was 2.40 (95% CI 2.27, 2.53). With adjustment for age, race/ethnicity, smoking status, diabetes mellitus, hypertension, hyperlipidemia, peripheral vascular disease, coronary artery disease and body mass index, a positive association persisted (adjusted OR 1.38). The association persisted when using a stricter definition of nonsteroidal anti- inflammatory drug exposure.

Conclusions

These data suggest that regular nonsteroidal anti-inflammatory drug use is associated with erectile dysfunction beyond what would be expected due to age and comorbidity.

Key Words: penis, erectile dysfunction, anti-inflammatory agents, non-steroidal, age factors, comorbidity

Abbreviations and Acronyms: AMI, acute myocardial infarction, BMI, body mass index, CAD, coronary artery disease, CMHS, California Men's Health Study, COX, cyclooxygenase, ED, erection dysfunction, KP, Kaiser Permanente Medical Care Program, NSAID, nonsteroidal anti-inflammatory drug

Can simvastatin improve erectile function and health- related quality of life in men aged >40 years with erectile dysfunction? Rationale and design of the Erectile Dysfunction and Statins (EDS) Trial [ISRCTN66772971] Daksha Trivedi1,*, Michael Kirby1, Felicity Norman1, Izabela Przybytniak1, Shehzad Ali2, David M. Wellsted3

BJU International 2011 Article first published online: 3 MAR 2011

Keywords: erectile dysfunction; simvastatin; cardiovascular risk; health related quality of life Abstract

OBJECTIVE • To describe the rationale and design of the Erectile Dysfunction and Statins (EDS) Trial which aims to evaluate the effectiveness of simvastatin on erectile function and health- related quality of life in men aged ≥40 years with erectile dysfunction.

PATIENTS AND METHODS • The study is a randomized, double-blind, placebo-controlled trial to test the hypotheses that statins improve endothelial function and reduce cholesterol and may improve erectile function in men with untreated erectile dysfunction (ED). 6

• Study subjects are men ≥40 years who are not receiving lipid-lowering or anti-hypertensive medication and have no other cardiovascular disease (CVD) risk factors.

• Eligible men with untreated ED are randomized to double-blind treatment with 40 mg simvastatin or placebo once daily for 6 months.

• Data are collected at baseline, mid-trial and at the final follow-up visit at 30 weeks.

• The main outcome is erectile function measured by the five-item version of the International Index of Erectile Function. Secondary outcomes include sexual-health-related quality of life and endothelial function.

RESULTS • Ten general practices have been recruited in the east of England.

• We have randomized 173 men for a power of 90% to assess the main outcome.

• To date there have been no serious unexpected adverse events.

• Study findings will be available in September 2011.

CONCLUSIONS • If simvastatin improves erectile function it would provide an inexpensive treatment for ED suitable for most men, and reduce the risk of future CVD.

Sexual dysfunction among married couples living in Kumasi metropolis, Ghana Nafiu Amidu , William K.B.A. Owiredu , Christian K. Gyasi-Sarpong , Eric Woode and Lawrence Quaye

BMC 2011 Published:2 March 2011

Abstract (provisional)

Background Sexuality and its manifestation constitute some of the most complex of human behaviour and its disorders are encountered in community. Sexual dysfunction is more prevalent in women than in men. While studies examining sexual dysfunction among males and females in Ghana exist, there are no studies relating sexual problems in males and females as dyadic units. This study therefore investigated the prevalence and type of sexual disorders among married couples.

Method 7

The study participants consisted of married couples between the ages of 19 and 66 living in the province of Kumasi, Ghana. Socio-demographic information and Golombok-Rust Inventory of Sexual Satisfaction (GRISS) questionnaires were administered to 200 couples who consented to take part in the study. All 28 questions of the GRISS are answered on a five-point (Likert type) scale from "always", through "usually', "sometimes", and "hardly ever", to "never". Responses are summed up to give a total raw score ranging from 28-140. The total score and subscale scores are transformed using a standard nine point scale, with high scores indicating greater problems. Scores of five or more are considered to indicate SD. The study was conducted between July and September 2010.

Results Out of a total of 200 married couples, 179 completed their questionnaires resulting in a response rate of 89.5%. The mean age of the participating couples as well as the mean duration of marriage was 34.8 +/- 8.6 years and 7.8 +/- 7.6 years respectively. The husbands (37.1 +/- 8.6) were significantly older (p < 0.0001) than their corresponding wives (32.5 +/- 7.9). After adjusting for age, 13-18 years of marriage life poses about 10 times significant risk of developing SD compared to 1-6 years of married life among the wives (OR: 10.8; CI: 1.1 - 49.1; p = 0.04). The total scores (6.0) as well as the percentage above the cut-off (59.2) obtained by the husbands compared to the total score (6.2) and the percentage above cut-off (61.5) obtained by the wives, indicates the likely presence of sexual dysfunction. The prevalence of impotence and premature ejaculation were 60.9% and 65.4% respectively from this study and the prevalence of vaginismus and anorgasmia were 69.3% and 74.9% respectively. The highest prevalence of SD subscales among the men was dissatisfaction with sexual act followed by infrequency, whereas the highest among the women was infrequency followed by anorgasmia. Dissatisfaction with among men correlated positively with anorgasmia and wife's non-sensuality and infrequency of sex.

Conclusion The prevalence of sexual dysfunction in married couples is comparable to prevalence rates in the general male and female population and is further worsened by duration of marriage. This could impact significantly on a couple's self-esteem and overall quality of life. Long-term efficacy and safety of self-intracavernous injection of prostaglandin E1 for treatment of erectile dysfunction in China

L. He, J. Wen, X. Jiang, H. Chen, Y. Tang

Andrologia, Article first published online: 24 MAR 2011 Abstract

Keywords: Erectile dysfunction; , pharmacologic treatment of erectile dysfunction; , prostaglandin E 1

Summary The study evaluated the long-term efficacy and safety profiles of self-intracavernous injection of prostaglandin E1 (PGE1) for erectile dysfunction (ED). Four hundred and sixteen ED patients were treated with self-intracavernous injection of PGE1 from January 1998 to 8

December 2007 in our outpatient service. Follow-up was made to investigate the efficacy and side effects of this treatment. It was found that 261 patients (62.7%) felt satisfied and kept using this treatment due to its advantages of satisfactory efficacy and reasonable expense. Twenty-seven of them (6.5%) got rid of PGE1 treatment after five times injections and did not need any other drugs to maintain satisfactory sexual lives. Two hundred and fourteen (51.4%) patients kept using this treatment for over 1 year, 26 (6.2%) over 5 years, 12 (2.9%) over 8 years and 7 (1.7%) over 10 years. The major complications of self-intracavernous injection of PGE1 include fibrosis of corpus cavernosum (three cases), ecchymosis associated with vascular injury due to injection (23 cases) and pain associated with injection (295 cases). There were no patients displaying . It is concluded that self- intracavernous injection of PGE1 is a safe and effective treatment for ED with various aetiologies and a broad range of severity, and no serious complications were observed after long-term application.

Ejaculatory/Orgasmic Disorders

Research Highlight

Sexual dysfunction: Postorgasmic illness syndrome

Suzanne J. Farley

Nature Reviews Urology 8, 121 (March 2011) | doi:10.1038/nrurol.2011.17

Abstract

New evidence supports the hypothesis that postorgasmic illness syndrome (POIS) in men involves a hyper-reactive immune response of the mucosal epithelium that lines the urinary tract to seminal fluid.The term 'POIS' was coined 9 years ago by the Netherlands-based duo Marcel Waldinger and Dave Schweitzer.

Oncology and Sexual Disorders

Testosterone Therapy in Men With Untreated Cancer Abraham Morgentaler, Larry I. Lipshultz, Richard Bennett, Michael Sweeney, Desiderio Avila Jr., Mohit Khera

J.Urol.2011, 1256-1261 9

Abstract

Purpose

A history of has been a longstanding contraindication to the use of testosterone therapy due to the belief that higher serum testosterone causes more rapid prostate cancer growth. Recent evidence has called this paradigm into question. In this study we investigate the effect of testosterone therapy in men with untreated prostate cancer.

Materials and Methods

We report the results of prostate biopsies, serum prostate specific antigen and prostate volume in symptomatic testosterone deficient cases receiving testosterone therapy while undergoing active surveillance for prostate cancer.

Results

A total of 13 symptomatic testosterone deficient men with untreated prostate cancer received testosterone therapy for a median of 2.5 years (range 1.0 to 8.1). Mean age was 58.8 years. Gleason score at initial biopsy was 6 in 12 men and 7 in 1. Mean serum concentration of total testosterone increased from 238 to 664 ng/dl (p <0.001). Mean prostate specific antigen did not change with testosterone therapy (5.5 ± 6.4 vs 3.6 ± 2.6 ng/ml, p = 0.29). Prostate volume was unchanged. Mean number of followup biopsies was 2. No cancer was found in 54% of followup biopsies. Biopsies in 2 men suggested upgrading, and subsequent biopsies in 1 and radical prostatectomy in another indicated no progression. No local prostate cancer progression or distant disease was observed.

Conclusions

Testosterone therapy in men with untreated prostate cancer was not associated with prostate cancer progression in the short to medium term. These results are consistent with the saturation model, ie maximal prostate cancer growth is achieved at low androgen concentrations. The longstanding prohibition against testosterone therapy in men with untreated or low risk prostate cancer or treated prostate cancer without evidence of metastatic or recurrent disease merits reevaluation.

Key Words: testosterone, prostatic neoplasms, androgens

Abbreviations and Acronyms: DHT, dihydrotestosterone, FSH, follicle-stimulating hormone, FT, free testosterone, LH, luteinizing hormone, PCa, prostate cancer, PSA, prostate specific antigen, SHBG, sex hormone-binding globulin, T, testosterone, TD, testosterone deficiency, TTh, testosterone therapy, TT, total testosterone

On-demand use of erectile aids in men with preoperative erectile dysfunction treated by whole gland prostate cryoablation

M Kimura, C F Donatucci, M Tsivian, J R Caso, D M Moreira, V Mouraviev, T Satoh, S Baba and T J Polascik

International Journal of Impotence Research , (3 March 2011) 10

Abstract

Prostate cryoablation is an established minimally invasive treatment for localized prostate cancer (PCa). However, the impairment of erectile function (EF) is considered a serious of the procedure. To investigate the efficacy of erectile aids following cryotherapy, 93 patients who underwent whole gland prostate cryoablation with required complete medical records were analyzed. The changes in postoperative EF were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire. Additionally, independent factors that could have a correlation to the postoperative IIEF-5 score or postoperative Expanded Prostate Cancer Index Composite (EPIC) score were assessed. In the entire cohort, the mean preoperative IIEF-5 score was 7.0±6.2. A total of 72 (77.4%) patients had moderate-to-severe preoperative erectile dysfunction. In longitudinal investigation, the patients using erectile aids showed the ability to recover to baseline after 24 months from cryoablation compared with the patients not using erectile aids. There were significant differences of IIEF-5 scores between these groups at 24 months (7.5 vs 3.0; P=0.025) and 36 months (8.5 vs 3.5; P=0.010). In multivariate analysis, the use of erectile aids correlated with restoration of IIEF-5 scores (odds ratio, 5.11; confidence interval (CI), 1.87–13.96; P<0.001) and lower EPIC sexual bother (coef, 19.61; CI, 0.32–38.89; P=0.046). Our data indicate that on-demand use of erectile aids could help restore EF and reduce sexual bother after whole gland prostate cryoablation. Although, erectile aids could not play a role as an adequate treatment for ED after whole gland prostate cryoablation, these results may aid in the decision-making process for PCa patients with preoperative and postoperative ED who have concern about sexual health-related quality of life.

Classification of the distribution of cavernous nerve fibers around the prostate by intraoperative electrical stimulation during laparoscopic radical prostatectomy

A Takenaka, H Soga, N Hinata, M Honda, T Sejima, M Muramaki, H Miyake, K Tanaka and M Fujisawa

International Journal of Impotence Research , (10 March 2011)

Abstract

We investigated the distribution of cavernous nerve (CN) fibers around the prostate by electrical nerve stimulation during laparoscopic radical prostatectomy to classify the distribution of the CN fibers. Electrical stimulation was performed on 30 consecutive patients with localized prostate cancer; middle of the neurovascular bundle (NVB, point A), base of the NVB (point B), the rectal wall 1 cm posterolateral to the NVB (point C) and the lateral aspect of the prostate (point D). We measured the intraurethral pressure at the midportion to detect the changes in intracavernosal pressure. The mean maximum changes were

10.5±7.9, 11.6±8.8, 9.6±7.4 and 6.7±7.0 cm H 2O at points A, B, C and D, respectively. The 11

patterns of CN fiber distribution were divided into four groups: type 1 (23%), the bundle corresponding to the NVB; type 2 (7%), the bundle from the rectal wall to the prostate; type 3 (27%), the plate including NVB and posterolateral to NVB; and type 4 (43%), the plate between the rectal wall posterolateral to the NVB and the lateral aspect of the prostate. Distribution of the CNs in a bundle-like formation was considered to account for 30%, whereas a plate-like formation accounted for 70%. Understanding these four patterns of CN fiber distribution should facilitate accurate CN-sparing radical prostatectomy.

Priapism

Priapism in hematological and coagulative disorders: an update

Belinda F. Morrison & Arthur L. Burnett

Nature Reviews Urology , | doi:10.1038/nrurol.2011.28

Abstract

Priapism is a true urological emergency that is typified by a persistent and painful erection. High-risk groups include patients with hematological or coagulative disorders; for example, those with sickle cell disease, leukemia or glucose-6-phosphate dehydrogenase deficiency. The diagnosis for priapism must be made urgently using patient history, physical examination and blood gas findings on corporal aspiration. Emergency treatment is needed to avoid erectile dysfunction. However, in high-risk groups, prophylaxis must be encouraged. A number of prophylactic measures are emerging based on progress in the understanding of the pathophysiology of priapism in these particular patients. In this Review, priapism as it relates to hematological disorders is discussed, focusing on treatment and prophylaxis.

Various Penile Disorders

Penile Fracture: Long-Term Results of Surgical and Conservative Management

Journal of Trauma, 02/04/2011, Published Ahead-of-Print

12

Abstract

Background: Penile fracture usually results from direct trauma to the erected penis. We evaluate the outcomes of surgical and conservative treatment.

Methods: Between February 2000 and February 2007, 77 patients with mean age 29 +/- 2.5 years (range, 20-57 years) with penile fracture were evaluated retrospectively. A total of 56 patients (group A) were treated with immediate surgical repair and 21 patients (group B) were treated conservatively as they refused surgical intervention. Data on erectile function and any penile sequel were obtained during follow-up using the International Index of Erectile Function (IIEF-15) questionnaire, local examination, and color Doppler ultrasonography reports.

Results: Only 69 patients were available for median follow-up period of 20.8 months (range, 17-30 months), 51 patients of the group A and 18 of the group B. Injury involved unilateral and bilateral corporeal rupture in 50 and 6 cases, respectively. Concomitant urethral injury was detected in three cases. During follow-up, 49 cases (96%) of the surgical group (A) and 9 cases (50%) of the conservative group (B) reported erection adequate for intercourse, with no voiding dysfunction and no penile curvature. However, the remaining nine patients (50%) from the conservative group (B) reported erectile dysfunction and penile deviation.

Conclusions: Immediate surgical repair of the penile fracture gave good results and is superior to conservative treatment; however, we cannot distinguish false from true penile fracture accurately to determine on whom we can use the conservative treatment. Testosterone and Male Hormonal Disorders

Testosterone and modifiable risk factors associated with diabetes in men

Evan Atlantis, Kylie Lange , Sean Martin, Matthew T. Haren , Anne Taylor , Peter D. O’Loughlin, Villis Marshall, Gary A. Wittert

Maturitas 68,,279-285, 2011

Abstract

Objective

The role of endogenous testosterone in the pathogenesis of type 2 diabetes mellitus remains vague. We investigated whether associations between endogenous testosterone and diabetes prevalence in men could be partially explained by modifiable risk factors.

Study design 13

A random population-based cross-sectional study of 1195 men aged 35–80 years living in the north-west regions of Adelaide, Australia. Data collections occurred between 2002 and 2005, and response rate was 45.1%.

Materials and methods

Diabetes (non-specific) was classified by either: (1) self-report for doctor diagnosis of diabetes; (2) prescription medication for diabetes; (3) fasting plasma glucose ≥7 mmol/L; or (4) glycosylated haemoglobin ≥6.2%. Logistic regressions were used to estimate odds ratios (OR [with 95% confidence intervals]) for diabetes, with stepwise adjustments for demographic, lifestyle, and clinical factors.

Results

Diabetes prevalence was positively associated with age groups 45–54 years (2.8 [1.4, 5.8]), 55–64 years (3.9 [1.9, 8.3]) and ≥65 years (4.0 [1.8, 8.9]), lowest income group (1.8 [1.0, 3.4]), ex-smoker (1.8 [1.2, 2.9]), lowest (3.2 [1.9, 5.5]) and middle (1.9 [1.1, 3.4]) alcohol tertiles, cardiovascular disease (1.9 [1.2, 2.8]), metabolic syndrome (4.0 [2.6, 6.1]), and lowest plasma total testosterone tertile (1.8 [1.1, 3.0]), but negatively associated with middle (0.5 [0.3, 0.8]) and highest (0.4 [0.3, 0.7]) sugar intake tertiles, arthritis (0.6 [0.3, 1.0]), and elevated LDL cholesterol (0.5 [0.3, 0.8]); ORs showed an inverted ‘U’ shape for middle and highest voiding lower urinary tract symptoms tertiles. Body composition, muscle strength, and cardio-metabolic factors partially explained the association between low plasma total testosterone and diabetes.

Conclusions

Plasma total testosterone was inversely and independently associated with diabetes prevalence, that might have been partially explained by several modifiable risk factors.

Associations of endogenous testosterone and lipid profiles in middle-aged to older Taiwanese men

B-P Jiann, J-T Hsieh, S-P Liu, S H-J Hsu and H-C Wu

International Journal of Impotence Research , (10 March 2011)

Abstract

The relationship between endogenous plasma testosterone and plasma lipids was assessed among 856 Taiwanese men 40 years old originally recruited for an epidemiological study of testosterone deficiency syndrome. Blood samples were drawn from fasting (n=562) and non-fasting (n=294) subjects between 0800 to 1100 hours. With adjustment of age, body mass index and sex hormone-binding globulin, the following results were shown: (i) triglyceride (TG) levels were negatively associated with quartile levels of testosterone, and the magnitudes of associations were greater for postprandial TGs than for fasting TGs; (ii) high-density lipoprotein cholesterol (HDL-C) levels were positively related to quartile levels of testosterone, but the associations became insignificant after further control 14

of TGs; and (iii) the calculated low-density lipoprotein cholesterol (LDL-C) levels were positively associated with quartile levels of testosterone. Similar results were obtained in multivariate linear regression analyses with additional control of hypertension and diabetes. In these Taiwanese men, the favorable association of endogenous plasma testosterone with HDL-C counterbalances the unfavorable association of it with LDL-C, while the net influence of testosterone on plasma lipids for cardiovascular system was still in the beneficial direction due to its negative association with postprandial plasma TG levels.

Varicocele as a risk factor for androgen deficiency and effect of repair

Cigdem Tanrikut1,2,3,*, Marc Goldstein1,4,5, James S. Rosoff1,4, Richard K. Lee1,4, Christian J. Nelson6, John P. Mulhall1,6

BJU International 2011, Article first published online: 24 MAR 2011

Keywords: varicocele; testosterone; hypogonadism; androgen deficiency Study Type – Therapy (case control) Level of Evidence 2b

OBJECTIVE • To determine whether men with varicoceles have lower testosterone levels than those without and to ascertain if testosterone levels increase after varicocelectomy.

PATIENTS AND METHODS • We measured preoperative testosterone levels in 325 men with palpable varicoceles and in 510 men with vasectomy reversal without varicoceles who served as a comparison group.

• The testosterone levels between groups were compared by age. Of the men with varicoceles, 200 had data on both pre- and postoperative testosterone levels, which were compared to assess postoperative changes.

RESULTS • Men with varicocele had significantly lower testosterone levels than the comparison group, with mean ( SD ) levels of 416 (156) vs 469 (192) ng/dL ( P < 0.001). This difference persisted when analysed by age.

• The testosterone levels significantly increased after repair from 358 (126) to 454 (168) ng/dL ( P < 0.001).

• Of the 70% of patients with postoperative improvement in testosterone levels, the mean (SD ) increase in testosterone was 178 (142) ng/dL. The percentage change in testosterone levels was: 30% had no increase, 41% increased by ≤50%, 19% increased between by 51– 100%, and 10% increased by >100%. 15

• There was no association between change in testosterone level and age, laterality of varicocele, or varicocele grade.

CONCLUSIONS • Men with varicoceles had significantly lower testosterone levels than the comparison group of men with vasectomy reversal.

• Microsurgical varicocele ligation resulted in a significant increase in serum testosterone levels in more than two-thirds of men.

• These findings suggest that varicocele is a significant risk factor for androgen deficiency and that repair may increase testosterone levels in men with varicocele and low testosterone levels. STD/AIDS and Venereal Diseases

Discordant results from reverse sequence syphilis screening --- five laboratories, United States, 2006--2010.

Centers for Disease Control and Prevention (CDC).

MMWR Morb Mortal Wkly Rep. 2011 Feb 11;60(5):133-7.

Abstract CDC recommends syphilis serologic screening with a nontreponemal test, such as the rapid plasma reagin (RPR) or Venereal Disease Research Laboratory (VDRL) test, to identify persons with possible untreated infection; this screening is followed by confirmation using one of several treponemal tests. Recently, the availability of automatable treponemal enzyme and chemiluminescence immunoassays (EIA/CIA) has led some laboratories to adopt a reverse sequence of screening in which a treponemal EIA/CIA is performed first, followed by testing of reactive sera with a nontreponemal test. To better understand the performance of reverse sequence screening for syphilis, CDC analyzed data from five laboratories that used reverse sequence screening during 2006--2010. This report describes the results of that analysis, which indicated that among sera reactive on initial screening with a treponemal EIA/CIA, 56.7% had a nonreactive RPR test. Among these discordant sera, 31.6% also were nonreactive by treponemal testing using Treponema pallidum particle agglutination (TP-PA) or fluorescent treponemal antibody absorbed (FTA-ABS) tests. Among discordant sera, the 16

rate of nonreactive confirmatory treponemal tests was 2.9 times higher in a population with low prevalence of syphilis, suggesting that the low-prevalence population had a higher percentage of false-positive test results. Although CDC continues to recommend the traditional algorithm with reactive nontreponemal tests confirmed by treponemal testing, in this report CDC offers additional recommendations if reverse sequence syphilis screening is used.

Incidence and clearance of genital human papillomavirus infection in men (HIM): a cohort study

Prof Anna R Giuliano PhD a, Ji-Hyun Lee DrPH a, William Fulp MS a, Prof Luisa L Villa PhD b, Prof Eduardo Lazcano PhD c, Mary R Papenfuss MS a, Martha Abrahamsen MPH a, Jorge Salmeron MD c, Gabriella M Anic MSPH a, Dana E Rollison PhD a, Danelle Smith MS

The Lancet, Volume 377, Issue 9769, Pages 932 - 940, 12 March 2011

Summary

Background

Human papillomaviruses (HPVs) cause genital warts and cancers in men. The natural history of HPV infection in men is largely unknown, and that information is needed to inform prevention strategies. The goal in this study was to estimate incidence and clearance of type- specific genital HPV infection in men, and to assess the associated factors.

Methods

Men (aged 18—70 years), residing in Brazil, Mexico, and the USA, who were HIV negative and reported no history of cancer were recruited from the general population, universities, and organised health-care systems. They were assessed every 6 months for a median follow-up of 27·5 months (18·0—31·2). Specimens from the coronal sulcus, glans penis, shaft, and scrotum were obtained for the assessment of the status of HPV genotypes.

Findings

In 1159 men, the incidence of a new genital HPV infection was 38·4 per 1000 person months (95% CI 34·3—43·0). Oncogenic HPV infection was significantly associated with having a high number of lifetime female sexual partners (hazard ratio 2·40, 1·38—4·18, for at least 50 17

partners vs not more than one partner), and number of male anal-sexual partners (2·57, 1·46—4·49, for at least three male partners vs no recent partners). Median duration of HPV infection was 7·52 months (6·80—8·61) for any HPV and 12·19 months (7·16—18·17) for HPV 16. Clearance of oncogenic HPV infection decreased in men with a high number of lifetime female partners (0·49, 0·31—0·76, for at least 50 female partners vs not more than one partner), and in men in Brazil (0·71, 0·56—0·91) and Mexico (0·73, 0·57—0·94) compared with the USA. Clearance of oncogenic HPV was more rapid with increasing age (1·02, 1·01—1·03).

Interpretation

The data from this study are useful for the development of realistic cost-effectiveness models for male HPV vaccination internationally.

Funding

National Cancer Institute.

Childhood Abuse and Neglect and the Risk of STDs In Early Adulthood

Abigail A. Haydon, Jon M. Hussey, Carolyn Tucker Halpern

Perspectives on Sexual and Reproductive Health, 43:1:16-22

Abstract

CONTEXT: Given the threat posed by STDs in young adulthood, identifying early predictors of STD risk is a priority. Exposure to childhood maltreatment has been linked to sexual risk behaviors, but its association with STDs is unclear.

METHODS: Associations between maltreatment by parents or other adult caregivers during childhood and adolescence and STD outcomes in young adulthood were examined using data on 8,922 respondents to Waves 1, 3 and 4 of the National Longitudinal Study of Adolescent Health. Four types of maltreatment (sexual abuse, physical abuse, supervision neglect and physical neglect) and two STD outcomes (self-reported recent and test-identified current STD) were assessed. Multivariate logistic regression analyses, stratified by sex, tested for moderators and mediators.

RESULTS: Among females, even after adjustment for socioeconomic and demographic characteristics, self-report of a recent STD was positively associated with sexual abuse (odds ratio, 1.8), physical abuse (1.7), physical neglect (2.1) and supervision neglect (1.6). Additionally, a positive association between physical neglect and having a test-identified STD 18

remained significant after further adjustments for exposure to other types of maltreatment and sexual risk behaviors (1.8). Among males, the only association (observed only in an unadjusted model) was between physical neglect and test-identified STD (1.6).

CONCLUSIONS: Young women who experienced physical neglect as children are at increased risk of test-identified STDs in young adulthood, and exposure to any type of maltreatment is associated with an elevated likelihood of self-reported STDs. Further research is needed to understand the behavioral mechanisms and sexual network characteristics that underlie these associations.

Racial and Ethnic Disparities in Sexual Risk Behaviors And STDs During Young Men’s Transition to Adulthood Jacinda K. Dariotis1,*, Frangiscos Sifakis2, Joseph H. Pleck3, Nan M. Astone1, Freya L. Sonenstein1

Perspectives on Sexual and Reproductive Health, 43:1:51-59

Abstract

CONTEXT: Racial and ethnic health disparities are an important issue in the United States. The extent to which racial and ethnic differences in STDs among youth are related to differences in socioeconomic characteristics and risky sexual behaviors requires investigation.

METHODS: Data from three waves of the National Survey of Adolescent Males (1988, 1990–1991 and 1995) were used to examine 1,880 young men’s history of STDs and their patterns and trajectories of sexual risk behavior during adolescence and early adulthood. Multinomial and logistic regression analyses were conducted to test whether racial and ethnic differences in STDs are due to the lower socioeconomic status and higher levels of risky sexual behavior among minority groups.

RESULTS: Young black men reported the highest rates of sexual risk and STDs at each wave and across waves. Compared with white men, black and Latino men had higher odds of maintaining high sexual risk and increasing sexual risk over time (odds ratios, 1.7–1.9). In multivariate analyses controlling for socioeconomic characteristics, black men were more likely than white men to have a history of STDs (3.2–5.0); disparities persisted in analyses controlling for level of risky sexual behavior.

CONCLUSIONS: Race and ethnicity continue to differentiate young black and Latino men from their white peers in terms of STDs. Prevention programs that target different racial and 19

ethnic subgroups of adolescent men and address both individual- and contextual-level factors are needed to curb STD incidence.

Patterns of Chlamydia/Gonorrhea Positivity Among Voluntarily Screened New York City Public High School Students Jessica S. Han, M.Sc., Meighan E. Rogers, M.P.H., Sophia Nurani, R.N., M.A.

Steven Rubin, B.B.A., Susan Blank, M.D., M.P.H

J Adolescent Health 2011, published online 17 February 2011 Abstract Purpose

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are common sexually transmitted infections that disproportionately affect adolescents. Annual screening for CT for sexually active female adolescents is recommended. In 2006, New York City began conducting CT/GC education, screening, and treatment in public high schools. We examine 3-year programmatic outcomes and the relationship between sexual activity, screening, and CT/GC positivity.

Methods

We describe the epidemiology of students who screened and those infected with CT/GC. Univariate, bivariate, and multivariate logistic regression analyses were performed to assess relationships between sex, race/ethnicity, age, sexual activity, and screening status; and the relationship between sexually transmitted infection positivity and sexual activity.

Results

Between July 2006 and June 2009, we educated 57,418 students and screened 27,353 (47.6%) for CT/GC; 1,736 (6.3%) students were reported to be infected with either organism. Students who screened positive were more likely to be females (8.9%), report black race (8.3%) and be ≥16 years of age (6.6%–9.7%). Screening rates were 70.6% for students who were sexually active, 27.9% for those who had never had sex, and 47.3% for those who did not respond to the sexual activity question; CT/GC positivity was 7.2%, 1.4%, and 6.1%, respectively.

Conclusions

Black, older adolescent females were most likely to screen positive for CT/GC in this population. A large proportion of students who did not answer the sexual activity question chose to screen for CT/GC and screened positive. School screening programs should offer screening to all students regardless of reported sexual activity. Programs should target females and older adolescents. 20

Keywords: Adolescent, Chlamydia, Gonorrhea, Chlamydia screening, sexually transmitted infection, sexually transmitted disease, high school, school health, self-report, sexual behavior Female Sexual Dysfunction

DHEA Replacement for Postmenopausal Women

Susan R. Davis, Mary Panjari and Frank Z. Stanczyk

The Women's Health Research Program (S.R.D., M.P.), School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia; and Reproductive Endocrine Research Laboratory (F.Z.S.), University of Southern California Keck School of Medicine, Los Angeles, California 90033

Address all correspondence and requests for reprints to: Susan R. Davis, Women's Health Research Program, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia. E-mail: [email protected] .

The Journal of Clinical Endocrinology & Metabolism 2011,publ. online March 16

Context : It has been proposed that because dehydroepiandrosterone (DHEA) and its sulfate, DHEAS, are important precursors for estrogen and androgen production, treatment with DHEA is a physiologically based strategy for the alleviation of hormone deficiency symptoms in postmenopausal women. We have summarized the physiology of DHEA in women and reviewed the findings from randomized controlled trials (RCT) of the effects of DHEA therapy in postmenopausal women with normal adrenal function.

Evidence Acquisition : We reviewed the medical literature for key papers investigating DHEA physiology and RCT of the use of DHEA in postmenopausal women through November 2010. The focus was on sexual function, well-being, metabolic parameters, and cognition as study endpoints.

Evidence Synthesis : Although cross-sectional studies have indicated a link between low DHEA levels and impaired sexual function, well-being, and cognitive performance in postmenopausal women, placebo-controlled RCT do not show benefits of oral DHEA for any of these outcomes or favorable effects on lipids and carbohydrate metabolism.

Conclusions : Taken together, findings from this review of the published literature of studies do not support the use of DHEA in postmenopausal women at this time.

Mixed Topics 21

Modified-release sildenafil reduces Raynaud's phenomenon attack frequency in limited cutaneous systemic sclerosis.

Herrick AL, van den Hoogen F, Gabrielli A, Tamimi N, Reid C, O'Connell D, Vázquez-Abad MD, Denton CP.

University of Manchester, Manchester Academic Health Science Centre, Salford Royal Hospital, Salford, UK. [email protected]

Arthritis Rheum. 2011 Mar;63(3):775-82

Abstract OBJECTIVE: To examine the effect of sildenafil in patients with Raynaud's phenomenon (RP) secondary to limited cutaneous systemic sclerosis (lcSSc).

METHODS: In this double-blind, placebo-controlled study, 57 patients with RP secondary to lcSSc were randomized to receive modified-release sildenafil 100 mg once daily for 3 days followed by modified-release sildenafil 200 mg once daily for 25 days or placebo. The primary assessment was the percentage change in the number of RP attacks per week in the per-protocol population. Secondary end points included Raynaud's Condition Score, duration of attacks, RP pain score, endothelial dysfunction assessed by a peripheral arterial tonometric (PAT) device, and serum biomarker levels.

RESULTS: The mean percentage reduction from baseline to day 28 in attacks per week was greater for modified-release sildenafil than for placebo (-44.0% versus -18.1%, P = 0.034); the mean number of attacks per week improved from 25.0 at baseline to 19.3 after placebo treatment and from 30.5 to 18.7 after modified-release sildenafil treatment (P = 0.244). Decreases from baseline in Raynaud's Condition Score, duration of attacks, and RP pain score were not significantly different between groups. Mean values and changes from baseline in PAT responses and serum biomarker levels were similar between groups. The most frequent adverse events were headache and dyspepsia; the majority of adverse events were mild or moderate. 22

CONCLUSION: Our findings indicate that modified-release sildenafil reduced attack frequency in patients with RP secondary to lcSSc and was well tolerated. Modified-release sildenafil may be a treatment option in this patient population.

Copyright © 2011 by the American College of Rheumatology.

Timing of pubertal maturation according to the age at first conscious ejaculation

A. Tomova1, C. Lalabonova2, R. N. Robeva1, P. T. Kumanov1

Andrologia Article first published online: 25 FEB 2011

Keywords :Ejaculation;pubertal development

Summary

The first conscious ejaculation (ejacularche) is an important event in the somatic and psychic development of boys. The aim of this study was to reveal the age at first ejaculation in Bulgarian boys and to observe the secular trend of this marker for puberty. A total of 1582 (901 from urban and 681 from rural origin respectively) gave a positive answer admitting the age in years at the first ejaculation. The mean age ± standard deviation (SD) of ejacularche was 13.27 ± 1.08 years, and the median was 13.0. It was found a significant difference between the urban (13.34 ± 1.07) and rural (13.18 ± 1.08) inhabitants in relation to the age of their remembered first ejaculation (P = 0.003). A secular trend in appearance of ejacularche was revealed when our results were compared with those from the previous studies in Bulgaria. We can suggest that in the presence of testicular volume ≥6 ml asking about ejaculation is reasonable and not superfluous. Self-reported spontaneous ejaculation can be used as an index of male pubertal timing.

The use of penile skin graft versus penile skin flap in the repair of long bulbo-penile urethral stricture: a prospective randomized study

Hussein MM, Moursy E, Gamal W, Zaki M, Rashed A, Abozaid A Urology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt

Urology. 2011 Jan 3. [Epub ahead of print]

• Objectives : To evaluate the use of penile circular skin graft versus flap as a ventral onlay for bulbo-penile stricture .

Material and Methods: Between 2003 and 2009, 37 patients with bulbo-penile stricture were randomized to penile methods circular skin graft (PCG = 18) or flap 23

(PCF = 19). Inclusion criteria included postinstrumentation or idiopathic stricture. Exclusion criteria were unhealthy skin and previous urethrotomy/urethroplasty. Patients had urethrogram at three weeks, three months, one year, and urethroscopy when needed. Any subsequent urethrotomy/urethroplasty was considered a failure. Chi-square and Student’s t test were used for analysis.

Results : Patients’ ages were 45.3 (range: 30-65) and 45.5 (35-60) yr in PCG&PCF respectively. Stricture length was 15.2 (10-22) &14.1 (9-21) cm in PCG&PCF respectively. The stricture was postinstrumentation in 9 and 11 and idiopathic in 9 and 8 patients in PCG&PCF respectively. Mean follow up was 36.2 (12-60) and 37.1 (range: 13-24) months in PCG and PCF respectively. Operative time was significantly shorter in PCG than in PCF (203.3 and 281.6 min, respectively; P = .000). Early postoperative complications were similar in both groups. Superficial skin necrosis occurred only in the PCF group (3 cases). Late complications of mild postvoid dribbling occurred similarly in both groups. One patient in PCF had a urethro- cutaneaous fistula at the level of fossa navicularis that was repaired later. Stricture recurred in 5 (27.7%) and 4(21%) patients in PCG and PCF, respectively (P = .249). Four patients had visual internal urethrotomy (2, 2), four needed anastmotic urethroplasty (2, 2) in PCG and PCF, respectively, and one needed buccal mucosal graft in the PCG group.

Conclusions: At intermediate follow-up, both penile circular graft and flap had similar and high success as a ventral onlay for repair of long bulbo-penile stricture with a low rate of complications.

• Editorial Comment Hussein et al. raise the bar in reconstructive urology research by completing a randomized clinical trial of distal penile fasciocutaneous skin flap urethroplasty vs. distal penile skin graft urethroplasty for non- strictures of the bulbo- penile urethra. They chose to compare two surgical techniques, which were similar in many ways but distinct in one important way. Similarities included the circumcising incision, the distal penile skin and the ventral onlay approach. The difference was in whether a graft or flap was used. The similarities in technique were likely helpful in recruiting patients. The similarities were also important in helping isolate the treatment effect of interest – flap vs. graft. Indeed, they did not detect a difference between the two groups in their primary outcome – a subsequent procedure to treat a stricture recurrence (21% for flap vs. 28% for graft). Here is where some additional planning could have strengthened the study. In order to detect a 10% difference at a significance level of p = 0.05 at a power of 0.8 they would have needed to randomize 353 patients to each arm of the study, rather than 19 patients as done here. Indeed, with only 19 patients in each arm they would have only been able to detect a massive difference between the recurrence rates. Additionally, the primary outcome of interest – need for additional procedures – introduces significant subjectivity into the success rates. A more objective outcome measure would have been preferable. Still, this study represents a great advance for the field of reconstructive urology and hope it will stimulate others to contribute randomized studies to the literature.

Dr. Sean P. Elliott Department of Urology University of Minnesota Minneapolis, Minnesota, USA E-mail: [email protected] 24

Conditional survival predictions after surgery for patients with penile carcinoma

Rodolphe Thuret MD1,2,†, Maxine Sun BSc1,†, Firas Abdollah MD1,3, Jan Schmitges MD1,4, Shahrokh F. Shariat MD1,5, François Iborra MD2, Jacques Guiter MD2, Jean- Jacques Patard MD6, Paul Perrotte MD7, Pierre I. Karakiewicz MD1,7,*,‡

Cancr 2011 , Article first published online: 24 FEB 2011 Keywords: squamous cell carcinoma;penile neoplasm;nomogram;conditional survival;Surveillance;Epidemiology;End Results (SEER) program

Abstract BACKGROUND: Conditional survival (CS) implies that, on average, long-term cancer survivors have a better prognosis than newly diagnosed individuals. The objective of the current study was to devise an accurate predictive tool that accounts for CS in men diagnosed with .

METHODS:

Overall, 1245 patients treated with primary tumor excision (PTE) for pT 1-3M0 squamous cell carcinoma of the penis (SCCP) between 1998 and 2006 were identified. Cox regression models were fitted for prediction of cancer-specific mortality (CSM). Nomogram development for prediction of CSM using CS methodology at 2 and 5 years was performed on 670 patients. External validation and calibration of the conditional nomogram was performed in 575 patients.

RESULTS: The 5-year CSM-free survival of patients at surgery was 84.3% and increased to 95.0% and 97.8% after 2 and 5 years of disease-free survival (DFS), respectively. The predicted probabilities varied by as much as 49% (57% vs 85%) when, for example, predictions of CSM-free survival at 5 years were made after PTE versus after 2 years of DFS. Within the external validation cohort, the accuracy of the conditional nomogram was 75.3% and 78.1% at 2 and 5 years after PTE.

CONCLUSIONS: The authors developed and externally validated the first conditional nomogram for predicting SCCP CSM-free survival that allows consideration of the length of survivorship. Cancer 2011;. © 2011 American Cancer Society.

25

Coercive Forms of Sexual Risk and Associated Violence Perpetrated by Male Partners of Female Adolescents Jay G. Silverman1,*, Heather L. McCauley1, Michele R. Decker2, Elizabeth Miller3, Elizabeth Reed4, Anita Raj5

Perspectives on Sexual and Reproductive Health, 43:1:60-65

CONTEXT: Partner violence is associated with STDs among female adolescents, but the mechanisms underlying this association remain unclear. Sexually coercive and deceptive behaviors of male partners that increase female STD risk may be factors in this relationship.

METHODS: A sample of 356 females aged 14–20 who attended adolescent health clinics in Greater Boston between April and December 2006 were assessed for physical and sexual violence perpetrated by male partners and for exposure to sexual risk factors. Adjusted logistic regression models were used to examine the associations between intimate partner violence and standard sexual risk behaviors (e.g., multiple partnerships) and coercive or deceptive sexual risk factors (e.g., coerced condom nonuse).

RESULTS: More than two-fifths of the sample had experienced intimate partner violence. In adjusted analyses, adolescents reporting intimate partner violence were more likely than others to report standard sexual risk behaviors—multiple partners, anal sex and unprotected anal sex (odds ratios, 1.7–2.2). They also were more likely to report coercive or deceptive sexual risk factors—partner sexual infidelity, fear of requesting condom use, negative consequences of condom request, and coerced condom nonuse (2.9–5.3).

CONCLUSION: The high prevalence of intimate partner violence against young women attending adolescent clinics strongly indicates the need to target this population for abuse- related interventions. This need is underlined by the observed association between partner violence and sexual risk involving coercion or deception by male partners. Clinic-based STD and pregnancy prevention efforts should include assessment of sexual risk factors that are beyond the control of young women, particularly for those experiencing abuse.

Analysis of Six Single Nucleotide Polymorphisms in the Androgen Receptor Gene in Chilean Patients with Primary Spermatogenic Failure

Alexis Parada-Bustamante , Maria Cecilia Lardone , Raúl Valdevenito , Mauricio Ebensperger , Patricia V. López , Marcia Madariaga , Antonio Piottante , and Andrea Castro *

* To whom correspondence should be addressed. E-mail: [email protected] .

J.Andriol 2011, Published-Ahead-of-Print March 10, 2011 26

Androgens are essential for spermatogenesis. It has been postulated that androgen activity is modulated directly or indirectly by genetic variability in the androgen receptor gene sequence, including CAG/GGN polymorphisms and single nucleotide polymorphisms (SNPs). In this study, the frequency of six SNPs, which constitute a haplotype in the androgen receptor sequence, was determined by enzyme restriction assays and allele-specific polymerase chain reactions in 117 secretory azo/oligozoospermic men (93 idiopathic and 24 ex-cryptorchidic) and in 121 controls with normal spermatogenesis (42 obstructive and 79 normozoospermic men), whose hormonal measurements and length of CAG/GGN polymorphisms were previously determined. The frequency of these six SNPs was not different between cases and controls. A total of ten haplotypes (HAP1-10) formed by these six SNPs were found, and one of these haplotypes was observed with high frequency in the total population (HAP1= 83.2%; P<0.001, Chi square test). The frequency of the ten haplotypes was not different between cases and controls, except for HAP5, which was only detected in one patient with a history of bilateral cryptorchidism ( P=0.014, Bonferroni test). On the other hand, no associations were found between the haplotypes studied and shorter or longer CAG or GGN polymorphisms. Interestingly, we found that the CAG 21 allele, which was previously correlated with an increased risk of idiopathic spermatogenic impairment, was more frequently found among the less common haplotypes that have higher FSH serum levels. In summary, we did not find an increased frequency of particular haplotypes in infertile men with idiopathic spermatogenic impairment compared to control men; however, we found that the CAG 21 allele, which appears to be associated with , is observed at a significantly higher proportion among the less common AR haplotypes.

Key words: Androgen • Infertility • Reproductive Genetics • Spermatogenesis • SNP • androgen receptor • haplotypes

Does androgen stimulation prior to hypospadias surgery increase the rate of healing complications? – A preliminary report Daniela B. Gorduza, Claire-Lise Gay, Elisângela de Mattos E. Silva, Delphine Demède, Frédéric Hameury, Julien Berthiller, Pierre-Yves Mure, Pierre D. Mouriquand

Journal of Pediatric Urology 2011 Volume 7, Issue 2 , Pages 158-161,

Abstract

Objective

Androgens have a positive effect on penile growth in children, but they may also have a repressive effect on the healing process. The aim of this prospective study was to compare the outcomes of onlay urethroplasty with and without preoperative androgen stimulation in patients with severe hypospadias.

Patients and method

Of 300 severe hypospadias cases treated at a single institution, 126 operated on by the same surgeon had complete follow-up data, and 30 of these received preoperative androgen treatment (human chorionic gonadotrophin and/or systemic testosterone) 1–24 months before surgery. 27

Results

Thirty-five patients presented with a complication (27.7%) of whom 26 (20.6%) had a fistula or dehiscence. Among patients on androgen stimulation there was a 30% healing complication rate (9/30) whereas for those without this was 17.7% (17/96). When androgenic treatment was given > 3 months prior to surgery the healing complication rate was 21.7% (5/23), and when < 3 months prior to surgery the rate reached 57% (4/7). Mean follow up was 41 months (10–97).

Conclusion

Although the numbers were too small in this series to reach statistical significance, the tissular interactions of androgens in the healing process reported by dermatologists should alert the hypospadiologists and lead to a further prospective study to define the optimal protocol for stimulation of the penis in specific cases without affecting outcome.