James Kashanian

Maimonides Medical Center, Brooklyn, New York, United States

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Publications (12)29.32 Total impact

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    ABSTRACT: Many men with "late-onset hypogonadism" (LOH) experience lower urinary tract symptoms (LUTS) that can be distressing and may decrease quality of life. LUTS often appear in men when testosterone levels begin to decline, which could be a significant association. We investigated whether testosterone replacement could alleviate LUTS in men with LOH. Two hundred and sixty-one hypogonadal patients (mean age 59.5 years) presenting with erectile dysfunction, having also been evaluated for LUTS, received a single testosterone undecanoate injection at day 1, at week 6 and quarterly thereafter. Parameters, including International Prostate Symptom Score (IPSS), post-voiding residual urine volume, transrectal ultrasound, prostate volume and prostate-specific antigen were measured at each treatment visit. Two hundred and fifty-nine patients were included in the full analysis set. These were subsequently divided into weight losers (L ≥ 5 % weight loss at last visit from baseline) and non-losers (NL). t test analyses were used to compare the IPSS means of these subgroups. The potentially confounding effect on IPSS of using the phosphodiesterase-5 inhibitor (PDE5i) vardenafil was also accounted for. Mean IPSS showed a significant decrease with time following initiation of testosterone treatment (p < 0.05). No significant differences were observed in either IPSS between L and NL groups or in mean IPSS between vardenafil users and non-users. Testosterone replacement is associated with improvements in LUTS which are not confounded by weight loss or PDE5i. The mechanisms of this association require further investigation.
    World Journal of Urology 10/2013; 32(4). DOI:10.1007/s00345-013-1187-z · 3.42 Impact Factor
  • The Journal of Urology 04/2012; 187(4):e604. DOI:10.1016/j.juro.2012.02.2014 · 3.75 Impact Factor
  • American journal of men's health 10/2010; 7(3):337-337. DOI:10.1016/j.jomh.2010.09.178 · 1.15 Impact Factor
  • American journal of men's health 10/2010; 7(3):338-338. DOI:10.1016/j.jomh.2010.09.182 · 1.15 Impact Factor
  • American journal of men's health 10/2010; 7(3):339-339. DOI:10.1016/j.jomh.2010.09.183 · 1.15 Impact Factor
  • The Journal of Urology 04/2010; 183(4). DOI:10.1016/j.juro.2010.02.680 · 3.75 Impact Factor
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    ABSTRACT: Background: Significant gender disparities exist in life expectancy and major disease morbidity. There is a need to understand the major issues related to men's health that contributes to these significant disparities. It is hypothesized that, high-risk behaviors and low utilization of all and preventive health services contribute to the higher mortality and the higher and earlier morbidity in men. Methods: Data was collected from CDC: Health United States, 2007; Health Behavior of Adults: United States 2002-04; and National Ambulatory Medical Care Survey: 2005 Summary. Results: In United States, men are more likely to be regular and heavy alcohol drinkers, heavier smokers who are less likely to quit, non-medical illicit drug users, and are more overweight compared to women. Men are less likely to utilize health care visits to doctor's offices, emergency departments (ED), and physician home visits than women. They are also less likely to make preventive care, hospice care, dental care visits, and have fewer hospital discharges and shorter hospital stays than women. Conclusions: High-risk behaviors and low utilization of health services may contribute to the lower life expectancy in men. In the context of public health, behavioral and preventive interventions are needed to reduce the gender disparity.
    International Journal of Clinical Practice 03/2010; 64(4):475-87. DOI:10.1111/j.1742-1241.2009.02290.x · 2.54 Impact Factor
  • American journal of men's health 09/2009; 6(3):275-275. DOI:10.1016/j.jomh.2009.08.188 · 1.15 Impact Factor
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    ABSTRACT: A definitive role of testosterone in erectile function has been controversial; however, recent evidence is becoming available which substantiates a key function for this hormone. Testosterone deficiency is associated with a decline in erectile function and testosterone levels are inversely correlated with increasing severity of erectile dysfunction. Erectile dysfunction can be caused by multifactorial pathologies. In particular, erectile dysfunction may be the first symptom of cardiovascular disease. Animal studies have demonstrated that castration causes vascular smooth muscle cell atrophy, venous leakage, adipocytes in the subtunical space, loss of elastic fibers and increase in collagen deposition. Testosterone increases the expression of nitric oxide synthase and phosphodiesterase type 5, both principal enzymes involved in the erectile process. Testosterone replacement alone in hypogonadal men can restore erectile function. A significant proportion of men who fail to respond to a PDE5 inhibitor are testosterone deficient. Testosterone replacement therapy can convert over half of these men into phosphodiesterase type 5 responders. It is now recommended that testosterone levels should be assessed in all patients with erectile dysfunction.
    Frontiers of hormone research 02/2009; 37:108-22. DOI:10.1159/000176048 · 1.24 Impact Factor
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    ABSTRACT: To re-evaluate the first- and second-line therapies for treating uncomplicated urinary tract infection (UTI), as although fluoroquinolones are commonly used for this purpose, its level of use is thought to be inappropriately excessive and will eventually have a detrimental impact; thus we hypothesise that nitrofurantoin might be the best choice for this indication, due to its low frequency of use and its high susceptibility rate in common UTI pathogens. We retrospectively analysed antimicrobial susceptibility patterns of urinary isolates from 2003 to 2007, taken from a community-based institutional hospital in Brooklyn, NY, USA. In all, 10,417 cultures grew Escherichia coli from 2003 to 2007. Overall, from 2003 to 2007, 95.6% of E. coli urine isolates were susceptible to nitrofurantoin, with an average 2.3% resistance rate. By contrast, E. coli uropathogens had a mean 75.6% and 75.9% susceptibility and 24.2% and 24% resistance rate to both ciprofloxacin and levofloxacin, respectively. Co-trimoxazole (trimethoprim/sulfamethoxazole; 'TMP/SMX') had a mean 29% resistance rate to E. coli over the same 5-year period. We consider that nitrofurantoin is a good fluoroquinolone-sparing alternative to co-trimoxazole; this study shows that nitrofurantoin is bactericidal to a mean of 95% of E. coli UTIs. Nitrofurantoin also has a resistance rate of 2.3%, by contrast to the quinolones (ciprofloxacin and levofloxacin), with resistant rates of approximately 24%, and Co-trimoxazole, with a resistant rate of 29%. Nitrofurantoin is an acceptable treatment for uncomplicated UTIs and should now be considered the first-line treatment. A reconsideration of UTI treatment guidelines might now be appropriate.
    BJU International 12/2008; 102(11):1634-7. DOI:10.1111/j.1464-410X.2008.07809.x · 3.13 Impact Factor
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    ABSTRACT: Prostate cancer is the most common gender-specific malignancy in men in the USA. Androgen-deprivation therapy (ADT) is commonly used in the treatment of metastatic or recurrent prostate cancer. The use of ADT is increasing with the advocacy of adjuvant and neoadjuvant ADT for treating asymptomatic patients with locally advanced prostate cancer. Although the use of ADT has resulted in improved survival in men with advanced prostate cancer, ADT, with its resulting severe hypogonadism, causes profound metabolic side-effects. We comprehensively reviewed previous reports using Medline searches of English-language literature (1950 to the present), with the keywords 'hypogonadism', 'testosterone', 'androgen deprivation therapy', 'hormonal treatment', 'prostate cancer', 'diabetes', 'metabolic syndrome', and 'cardiovascular disease'. Men with prostate cancer who undergo long-term ADT are at greater risk of developing dyslipidaemia, insulin resistance, hyperglycaemia and metabolic syndrome. These metabolic and physiological changes are a direct result of the induced severe hypogonadism and might predispose patients to a greater risk of cardiovascular morbidity and mortality. There is a need for prospective studies aimed and designed to investigate the metabolic and cardiovascular adverse effects of ADT, and assess the benefit/risk ratio, especially in special populations such as diabetics.
    BJU International 09/2008; 102(11):1509-14. DOI:10.1111/j.1464-410X.2008.07933.x · 3.13 Impact Factor
  • The Journal of Urology 04/2008; 179(4):84-84. DOI:10.1016/S0022-5347(08)60245-1 · 3.75 Impact Factor