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ABSTRACT: We report the first known case of concurrent partial cystectomy and cesarean delivery in a pregnant female with bladder pheochromocytoma. A 28-year-old G4P2 female presented at 28 weeks gestation with labile blood pressures requiring three antihypertensive medications. Urinary catecholamines were elevated, and a subsequent MRI showed a 2.6 cm x 3.2 cm bladder wall mass. She underwent combined cesarian section and partial cystectomy at 37 weeks. Fluid resuscitation and vasopressors were required in the immediate postoperative period. While bladder pheochromocytoma with pregnancy is a rare occurrence, concurrent delivery and removal of the bladder tumor can be performed safely.
The Canadian Journal of Urology 02/2013; 20(1):6646-8. · 0.64 Impact Factor
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ABSTRACT: Introduction. Erectile dysfunction (ED) is a significant problem among aging men. ED is independently associated with cardiovascular (CV) events (angina, myocardial infarction, and stroke). Aim. We sought to determine if ED was associated with CV death. Main Outcome Measures. Risk of CV death in men with ED. Methods. Exactly 31,296 men in Washington aged 50-76 completed a questionnaire in 2000-2002 on supplements, diet, exercise, personal health, and ED. ED was determined by one question: "Have you experienced impotence in the last year?" We excluded patients with a history of coronary artery disease or stroke. Participants linked yearly through 2008 to the Washington State Death Certificate System. CV death was defined by death certificates listing CV-related deaths (International Classification of Diseases 10th Revision [ICD-10] codes: I00-I15, I20-I52, and I60-I99). We performed multivariate Cox proportional hazard regression adjusting for age, marital status, race, education, self-rating of health, body mass index (BMI), antihypertensive/lipid-lowering drug use, diabetes, family history of CV disease, smoking, and exercise. Results. About 7,762 men had ED and there were 486 CV deaths over 7.8-year average follow-up. The typical man who suffered CV death was older, single, reporting poor health, taking antihypertensives, higher BMI, a smoker, a diabetic, and had a family history of CV disease. When adjusting for age, marital status, and education only, men with ED had a 23% increased risk of CV death (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.01, 1.49). With further adjustment for known risk factors for CV disease (diabetes, treatment for hypertension or hyperlipidemia, family history of myocardial infarction/stroke, BMI, and exercise), ED no longer predicted CV death (HR 0.93, 95% CI 0.76, 1.15). Conclusions. In this community-based cohort, ED was not independently associated with an elevated risk of CV death. These data do not contradict prior data associating ED and CV events but rather suggest that ED may be a manifestation of other known risk factors for CV disease. Hotaling JM, Walsh TJ, Macleod LC, Heckbert S, Pocobelli G, Wessells H, and White E. Erectile dysfunction is not independently associated with cardiovascular death: Data from the Vitamins and Lifestyle (VITAL) study. J Sex Med **;**:**-**.
Journal of Sexual Medicine 07/2012; · 3.55 Impact Factor
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ABSTRACT: We identified genetic predictors of diabetes associated erectile dysfunction using genome-wide and candidate gene approaches in a cohort of men with type 1 diabetes.
We examined 528 white men with type 1 diabetes, including 125 with erectile dysfunction, from DCCT (Diabetes Control and Complications Trial) and its observational followup, the EDIC (Epidemiology of Diabetes Interventions and Complications) study. Erectile dysfunction was identified from a single International Index of Erectile Function item. A Human1M BeadChip (Illumina®) was used for genotyping. A total of 867,125 single nucleotide polymorphisms were subjected to analysis. Whole genome and candidate gene approaches were used to test the hypothesis that genetic polymorphisms may predispose men with type 1 diabetes to erectile dysfunction. Univariate and multivariate models were used, controlling for age, HbA1c, diabetes duration and prior randomization to intensive or conventional insulin therapy during DCCT. A stratified false discovery rate was used to perform the candidate gene approach.
Two single nucleotide polymorphisms located on chromosome 3 in 1 genomic loci were associated with erectile dysfunction with p <1 × 10(-6), including rs9810233 with p = 7 × 10(-7) and rs1920201 with p = 9 ×10(-7). The nearest gene to these 2 single nucleotide polymorphisms is ALCAM. Genetic association results at these loci were similar on univariate and multivariate analysis. No candidate genes met the criteria for statistical significance.
Two single nucleotide polymorphisms, rs9810233 and rs1920101, which are 25 kb apart, are associated with erectile dysfunction, although they do not meet the standard genome-wide association study significance criterion of p <5 × 10(-8). Other studies with larger sample sizes are required to determine whether ALCAM represents a novel gene in the pathogenesis of diabetes associated erectile dysfunction.
The Journal of urology 06/2012; 188(2):514-20. · 4.02 Impact Factor
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ABSTRACT: To evaluate a large national database of free-standing pediatric institutions to define the characteristics of patients who have both unintentional and sexual abuse-related pediatric female genital trauma (PFGT), to describe variation in practice across institutions and between trauma and nontrauma hospitals, and to determine factors associated with diagnostic evaluation and surgical repair of PGFT.
We performed a retrospective cohort using the Pediatric Health Information System (PHIS) discharge database with information from 41 freestanding children's hospitals. We identified inpatient and emergency department visits for female patients younger than 18 years of age with International Classification of Diseases, Ninth Revision diagnosis codes for nonobstetric PFGT discharged in the 5-year period between January 1, 2003 and December 31, 2007.
We identified 5664 patients with PFGT, with 64% having been evaluated in state-designated trauma centers. Although overall only 4.2% (236/5664) underwent a diagnostic evaluation, independent of age, mechanism of injury, associated injuries, and insurance status, patients evaluated in a trauma center were 2.6 times more likely to have a diagnostic evaluation. Patients who underwent a diagnostic evaluation were 18 times more likely to have a surgical repair. Other factors associated with increased odds of diagnostic evaluation included age group and specific mechanisms of injury.
Among institutions in PHIS, diagnostic evaluation and surgical repair is rarely performed and is defined by variability in approach between hospitals--especially between trauma vs nontrauma institutions. This study of PFGT suggests that aggressive diagnostic evaluation in the operating room may be beneficial for this population.
Urology 06/2012; 80(2):417-22. · 2.43 Impact Factor
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ABSTRACT: We examined the success of early endoscopic realignment of pelvic fracture associated urethral injury after blunt pelvic trauma.
A retrospective review was performed of patients with pelvic fracture associated urethral injury who underwent early endoscopic realignment using a retrograde or retrograde/antegrade approach from 2004 to 2010 at a Level 1 trauma center. Followup consisted of uroflowmetry, post-void residual and cystoscopic evaluation. Failure of early endoscopic realignment was defined as patients requiring urethral dilation, direct vision internal urethrotomy, posterior urethroplasty or self-catheterization after initial urethral catheter removal.
A total of 19 consecutive patients (mean age 38 years) with blunt pelvic fracture associated urethral injury underwent early endoscopic realignment. Twelve cases of complete urethral disruption, 4 of incomplete disruption and 3 of indeterminate status were noted. Mean time to realignment was 2 days and mean duration of urethral catheterization after realignment was 53 days. One patient was lost to followup after early endoscopic realignment. Using an intent to treat analysis early endoscopic realignment failed in 15 of 19 patients (78.9%). Mean time to early endoscopic realignment failure after catheter removal was 79 days. The cases of early endoscopic realignment failure were managed with posterior urethroplasty (8), direct vision internal urethrotomy (3) and direct vision internal urethrotomy followed by posterior urethroplasty (3). Mean followup for the 4 patients considered to have undergone successful early endoscopic realignment was 2.1 years.
Early endoscopic realignment after blunt pelvic fracture associated urethral injury results in high rates of symptomatic urethral stricture requiring further operative treatment. Close followup after initial catheter removal is warranted, as the mean time to failure after early endoscopic realignment was 79 days in our cohort.
The Journal of urology 05/2012; 188(1):174-8. · 4.02 Impact Factor
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ABSTRACT: We examined the initial management of renal trauma and assessed patterns of management based on hospital trauma level designation.
The National Trauma Data Bank is a comprehensive trauma registry with records from hospitals in the United States and Puerto Rico. Renal injuries treated at a member hospital from 2002 to 2007 were identified. We classified initial management as expectant, minimally invasive (angiography, embolization, ureteral stent or nephrostomy) or open surgical management based on ICD-9 procedure codes. The primary outcome was use of secondary therapies.
Of 3,247,955 trauma injuries in the National Trauma Data Bank 9,002 were renal injuries (0.3%). High grade injuries demonstrated significantly higher rates of definitive success with the first urological intervention at level I trauma centers vs other trauma centers (minimally invasive 52% vs 26%, p <0.001), and were more likely treated successfully with conservative management (89% vs 82%, p <0.001). When adjusting for other known indices of injury severity, and examining low and high grade injuries, level I trauma centers were 90% more likely to offer an initial trial of conservative management (OR 1.90; 95% CI 1.19, 3.05) and had a 30% lower chance of patients requiring multiple procedures (OR 0.70; 95% CI 0.52, 0.95).
Following multivariate analysis conservative therapy was more common at level I trauma centers despite the patient population being more severely injured. Initial intervention strategies were also more definitive at level I trauma centers, providing additional support for tiered delivery of trauma care.
The Journal of urology 12/2011; 187(2):536-41. · 4.02 Impact Factor
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ABSTRACT: Unexplained variation in outcomes after common surgeries raises concerns about the quality and appropriateness of surgical care. Understanding variation in surgical outcomes may identify processes that could affect the quality of surgical and postoperative care. The authors of this report examined hospital-level variation in outcomes after inpatient urologic oncology procedures.
Patients who underwent radical cystectomy, radical nephrectomy, and radical prostatectomy were identified from the Washington State Comprehensive Hospital Abstract Reporting System for the years 2003 through 2007. The postoperative length of stay (LOS) was measured, and LOS that exceeded the 75th percentile was classified as prolonged. The occurrence of Agency for Healthcare Quality patient safety indicators (PSIs), readmissions, and deaths also were measured. Analyses were adjusted for patient age and comorbidity in random effects, multilevel, multivariable models that assessed hospital-level outcomes.
The authors identified 853 patients from 37 hospitals who underwent cystectomy, 3018 patients who underwent nephrectomy from 51 hospitals, and 8228 patients who underwent prostatectomy from 51 hospitals. Complications captured by PSIs were rare. Hospital-level variation was most profound for LOS outcomes after nephrectomy and prostatectomy (variance in prolonged LOS, 8.1% and 26.7%, respectively), thromboembolic events after nephrectomy (8% of variance), and mortality after cystectomy (7.1% of variance).
Hospital-level variation confounds the care of urologic cancer patients in the state of Washington. The authors concluded that transparent reporting of surgical outcomes and local quality-improvement initiatives should be considered to ameliorate the observed variation and improve the quality of cystectomy, nephrectomy, and prostatectomy care.
Cancer 07/2011; 118(4):987-96. · 4.77 Impact Factor
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ABSTRACT: We determined whether intensive glycemic therapy reduces the risk of erectile dysfunction in men with type 1 diabetes enrolled in the Diabetes Control and Complications Trial.
The Diabetes Control and Complications Trial randomized 761 men with type 1 diabetes to intensive or conventional glycemic therapy at 28 sites between 1983 and 1989, of whom 366 had diabetes for 1 to 5 years and no microvascular complications (primary prevention cohort), and 395 had diabetes for 1 to 15 years with nonproliferative retinopathy or microalbuminuria (secondary intervention cohort). Subjects were treated until 1993, and followed in the Epidemiology of Diabetes Interventions and Complications study. In 2003 we conducted an ancillary study using a validated assessment of erectile dysfunction in 571 men (80% participation rate), 291 in the primary cohort and 280 in the secondary cohort.
Of the participants 23% reported erectile dysfunction. The prevalence was significantly lower in the intensive vs conventional treatment group in the secondary cohort (12.8% vs 30.8%, p = 0.001) but not in the primary cohort (17% vs 20.3%, p = 0.49). The risk of erectile dysfunction in primary and secondary cohorts was directly associated with mean HbA1c during the Diabetes Control and Complications Trial, and Epidemiology of Diabetes Interventions and Complications combined. Age, peripheral neuropathy and lower urinary tract symptoms were other risk factors.
A period of intensive therapy significantly reduced the prevalence of erectile dysfunction 10 years later among those men in the secondary intervention cohort but not in the primary prevention cohort. Higher HbA1c was significantly associated with risk in both cohorts. These findings provide further support for early implementation of intensive insulin therapy in young men with type 1 diabetes.
The Journal of urology 03/2011; 185(5):1828-34. · 4.02 Impact Factor
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ABSTRACT: To our knowledge data on diagnostic angiography and angioembolization after renal trauma have been limited to single institution series with small numbers. We used the National Trauma Data Bank® to investigate national patterns of diagnostic angiography and angioembolization after blunt and penetrating renal trauma.
All renal injuries treated between 2002 and 2007 were identified in the National Trauma Data Bank by Abbreviated Injury Scale codes and converted to American Association for the Surgery of Trauma renal injury grades. Diagnostic angiography and angioembolization were identified by ICD-9 codes and examined. Initial angioembolization was considered a failure if subsequent therapy was needed. Repeat diagnostic angiography was not considered a failure.
A total of 9,002 renal injuries were available for analysis. A total of 165 patients (2%) underwent diagnostic angiography after renal injury, including 77 (47%) who underwent concomitant angioembolization. Of the patients 78% sustained grade III-V renal injuries. Of the 77 patients with initial angioembolization 68 required successive therapy. Repeat angioembolization was the most common management choice (29% of patients). Secondary angioembolization was durable during the index hospitalization with success in 35 of 36 cases. Successive therapy was required after initial angioembolization for all grade IV and V renal injuries in 48 patients. The overall renal salvage rate was 92%, including 88% for grade IV and V injuries.
Successive therapy is common after initial management of renal injury by angioembolization. Close observation is highly recommended after initial angioembolization for grade IV-V renal injuries. National agreement on the use of diagnostic angiography and angioembolization is needed since these procedures may be overused after grade I-III renal injuries.
The Journal of urology 02/2011; 185(4):1316-20. · 4.02 Impact Factor
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ABSTRACT: Posterior urethra reconstruction can be a challenging proposition for both patient and surgeon. The vast majority of urethras can be successfully reconstructed with either anastomosis or grafting. However, there are some patients who have recurrent urethral strictures that require more complex reconstruction. There is some speculation that microsurgical penile revascularization may allow subsequent graft reconstruction with lower stricture rates, but this is not yet proven. For the most tenacious urethral strictures, free tissue transfer may be required. The free radial forearm flap is well suited for urethral reconstruction, and the free anterolateral thigh flap may also have a role for these patients. This article will review urethral trauma and strictures and microsurgery's role in reconstruction of the posterior urethra.
Journal of Reconstructive Microsurgery 12/2010; 27(3):179-86. · 1.43 Impact Factor
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ABSTRACT: Cell-seeded synthetic polymer scaffolds constitute an emerging technology for urethroplastic applications. The study goal was to identify urethral proteins appropriate for cell attachment and optimize their adsorption onto two types of scaffolds: porous poly(ester urethane) with a poly(caprolactone) soft segment (PEU-PCL) and poly-(96% L/4% D)-lactic acid (P96L/4DLA). Specimens from eight men undergoing urethral reconstruction for stricture diseases were subjected to immunohistochemical analysis. Type I collagen, type IV collagen and vitronectin were detected at the interface between the epithelium and its basement membrane. Electrophoresis confirmed that polypeptide chains in the starting material were also present in fractions eluted from adsorbed scaffolds. Over a 4 week incubation assay, only vitronectin exhibited 100% retention levels for all scaffolds. The saturation point for each protein on each scaffold type was determined by titration and ELISA. The collective evidence indicates the concept that vitronectin > type IV collagen > type I collagen are preferred adsorption proteins for PEU-PCL and P96L/4DLA.
Biomaterials 10/2010; 32(3):797-807. · 7.40 Impact Factor
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ABSTRACT: Erectile function is a major determinant of quality of life. The prevalence of erectile dysfunction is increasing and costs of care represent a significant burden on healthcare systems. Options for the treatment of erectile dysfunction include lifestyle interventions, oral phosphodiesterase 5 inhibitors, intracavernosal or intraurethral prostaglandins, vacuum constrictive devices and penile implants. We review the evidence that supports the use of oral phosphodiesterase 5 inhibitors, intracavernosal and intraurethral prostaglandins and surgical penile implants for the treatment of erectile dysfunction as well as the role of penile rehabilitation after radical prostatectomy. Oral therapy is efficacious across a wide variety of etiologies but effective second line therapies also exist. Improved trial design and instruments to measure ED symptoms have enhanced the quality of evidence available to guide decision making
07/2010: pages 134 - 145; , ISBN: 9781444323146
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ABSTRACT: Diet-induced obesity (DIO) in mice causes vascular inflammation and insulin resistance that are accompanied by decreased endothelial-derived NO production. We sought to determine whether reduced NO-cGMP signaling contributes to the deleterious effects of DIO on the vasculature and, if so, whether these effects can be blocked by increased vascular NO-cGMP signaling.
By using an established endothelial cell culture model of insulin resistance, exposure to palmitate, 100 micromol/L, for 3 hours induced both cellular inflammation (activation of IKK beta-nuclear factor-kappaB) and impaired insulin signaling via the insulin receptor substrate-phosphatidylinositol 3-kinase pathway. Sensitivity to palmitate-induced endothelial inflammation and insulin resistance was increased when NO signaling was reduced using an endothelial NO synthase inhibitor, whereas endothelial responses to palmitate were blocked by pretreatment with either an NO donor or a cGMP analogue. To investigate whether endogenous NO-cGMP signaling protects against vascular responses to nutrient excess in vivo, adult male mice lacking endothelial NO synthase were studied. As predicted, both vascular inflammation (phosphorylated I kappaB alpha and intercellular adhesion molecule levels) and insulin resistance (phosphorylated Akt [pAkt] and phosphorylated eNOS [peNOS] levels) were increased in endothelial NO synthase(-/-) (eNOS(-/-)) mice, reminiscent of the effect of DIO in wild-type controls. Next, we asked whether the vascular response to DIO in wild-type mice can be reversed by a pharmacological increase of cGMP signaling. C57BL6 mice were either fed a high-fat diet or remained on a low-fat diet for 8 weeks. During the final 2 weeks of the study, mice on each diet received either placebo or the phosphodiesterase-5 inhibitor sildenafil, 10 mg/kg per day orally. In high-fat diet-fed mice, vascular inflammation and insulin resistance were completely prevented by sildenafil administration at a dose that had no effect in mice fed the low-fat diet.
Reduced signaling via the NO-cGMP pathway is a mediator of vascular inflammation and insulin resistance during overnutrition induced by high-fat feeding. Therefore, phosphodiesterase-5, soluble guanylyl cyclase, and other molecules in the NO-cGMP pathway (eg, protein kinase G) constitute potential targets for the treatment of vascular dysfunction in the setting of obesity.
Arteriosclerosis Thrombosis and Vascular Biology 04/2010; 30(4):758-65. · 6.37 Impact Factor
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Hunter Wessells
The Journal of urology 12/2009; 183(2):597; discussion 597. · 4.02 Impact Factor
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ABSTRACT: We provide an overview of basic, clinical and epidemiological research in the field of erectile dysfunction and important research priorities presented at the 2009 National Institute of Diabetes and Digestive and Kidney Diseases symposium on Urological Complications of Diabetes and Obesity.
Experts in molecular biology, physiology, pharmacology, clinical trials, epidemiology and urological surgery highlighted current knowledge on erectile dysfunction associated with diabetes mellitus and obesity.
Predictable associations between erectile dysfunction, and poor diabetic control and modifiable risk factors, including body mass index, have not yet been translated into randomized trials in the United States. The relationship between erectile dysfunction and metabolic syndrome, and surrogate markers for erectile dysfunction requires further investigation. Basic research aimed at discovering disease mechanisms and therapeutic targets has focused on autonomic neuropathy, vascular dysfunction, smooth muscle contractile function and matrix. However, significant gaps exist in regard to the integration of molecular, cellular and functional data. Animal models of type 2 diabetes and obesity associated erectile dysfunction require investigation because most basic science studies have used rodent models of type 1 diabetes.
Studies are needed to synthesize a systems biology understanding of erectile function/dysfunction, and characterize and disseminate rodent models of erectile dysfunction associated with type 2 diabetes and obesity. Clinical studies are needed of promising intervention and prevention strategies. Leveraging existing and future cohort phenotypes, and biological samples is needed for risk factor analysis, biomarker discovery and genome wide association studies.
The Journal of urology 12/2009; 182(6 Suppl):S45-50. · 4.02 Impact Factor
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ABSTRACT: The Fournier's gangrene literature comes almost exclusively from tertiary referral centers. We used a population based database to evaluate variations in management and outcomes.
Inpatients with Fournier's gangrene who underwent surgical débridement or died were identified from select states in the State Inpatient Databases. Multivariate logistic regression analysis was done to evaluate patient and hospital related predictors of mortality.
We identified 1,641 males with Fournier's gangrene treated at a total of 593 hospitals. At teaching hospitals more Fournier's gangrene cases were treated per year, and more surgical procedures, débridements and supportive care were reported. Patients treated at teaching hospitals had longer length of stay, greater hospital charges and a higher case fatality rate. Patient related predictors of mortality were increasing age (adjusted OR 4.0 to 15.0), Charlson comorbidity index (adjusted OR 1.20 per additional comorbidity), preexisting conditions, ie congestive heart failure (adjusted OR 2.1), renal failure (adjusted OR 3.2) and coagulopathy (adjusted OR 3.4), and hospital admission via transfer (adjusted OR 1.9), after adjusting for hospital factors and Fournier's gangrene experience. Teaching hospitals had higher mortality due primarily to more acutely ill patients (adjusted OR 1.9). Hospitals where more than 1 Fournier's gangrene case per year were treated had 42% to 84% lower mortality after adjusting for patient age, race, Charlson comorbidity index and admission via transfer (p <0.0001).
Teaching and nonteaching hospitals differ substantially in the populations, case definitions, and severity and management of Fournier's gangrene. Hospitals where more patients with Fournier's gangrene were treated had lower mortality rates, supporting the rationale for regionalized care for this rare disease.
The Journal of urology 12/2009; 182(6):2742-7. · 4.02 Impact Factor
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ABSTRACT: To determine specific molecular features of endothelial cells (ECs) relevant to the physiological process of penile erection we compared gene expression of human EC derived from corpus cavernosum of men with and without erectile dysfunction (HCCEC) to coronary artery (HCAEC) and umbilical vein (HUVEC) using Affymetrix GeneChip microarrays and GeneSifter software. Genes differentially expressed across samples were partitioned around medoids to identify genes with highest expression in HCCEC. A total of 190 genes/transcripts were highly expressed only in HCCEC. Gene Ontology classification indicated cavernosal enrichment in genes related to cell adhesion, extracellular matrix, pattern specification and organogenesis. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis showed high expression of genes relating to ECM-receptor interaction, focal adhesions, and cytokine-cytokine receptor interaction. Real-time PCR confirmed expression differences in cadherins 2 and 11, claudin 11 (CLDN11), desmoplakin, and versican. CLDN11, a component of tight junctions not previously described in ECs, was highly expressed only in HCCEC and its knockdown by siRNA significantly reduced transendothelial electrical resistance in HCCEC. Overall, cavernosal ECs exhibited a transcriptional profile encoding matrix and adhesion proteins that regulate structural and functional characteristics of blood vessels. Contribution of the tight junction protein CLDN11 to barrier function in endothelial cells is novel and may reflect hemodynamic requirements of the corpus cavernosum.
Physiological Genomics 08/2009; 39(2):100-8. · 2.73 Impact Factor
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ABSTRACT: This study aimed to investigate the prevalence and risk factors associated with sexual dysfunction in a well-characterized cohort of women with type 1 diabetes.
The study was conducted in women enrolled in the long-term Epidemiology of Diabetes Interventions and Complications (EDIC) study, a North American study of men and women with type 1 diabetes. At year 10 of the EDIC study, 652 female participants were invited to complete a validated self-report measure of sexual function, standardized history and physical examinations, laboratory testing, and mood assessment.
Of the sexually active women with type 1 diabetes in the EDIC study, 35% met criteria for female sexual dysfunction (FSD). Women with FSD reported loss of libido (57%); problems with orgasm (51%), lubrication (47%), and arousal (38%); and pain (21%). Univariate analyses revealed a positive association between FSD and age (P = 0.0041), marital status (P = 0.0016), menopausal status (P = 0.0019), microvasculopathy (P = 0.0092), and depression (P = 0.0022). However, in a multivariate analysis, only depression (P = 0.004) and marital status (P = 0.003) were significant predictors of FSD.
FSD is common in women with type 1 diabetes and affects all aspects of sexual function and satisfaction. Depression is the major predictor of sexual dysfunction in women with type 1 diabetes. These findings suggest that women with type 1 diabetes should be routinely queried about the presence of sexual dysfunction and possible co-association with depression.
Diabetes care 06/2009; 32(5):780-5. · 8.09 Impact Factor
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ABSTRACT: Male sexual dysfunction is a common complication of diabetes (DM), but the relative impact of erectile dysfunction (ED), orgasmic dysfunction (OD), and/or decreased libido (DL) on global sexual bother has not been assessed.
To assess the relationship between ED, OD, and DL and overall sexual satisfaction in men with type 1 DM, and determine which form of dysfunction causes the most bother.
The study cohort consisted of 713 men with type 1 DM who completed the Diabetes Control and Complication Trial and then participated in the follow-up Epidemiology of Diabetes Interventions and Complications Study. In year 10 of EDIC, 583 (83%) completed a validated instrument assessing ED, OD, and DL and the bother these conditions cause. Statistical tests determined the concordance of function and bother in each domain, and the impact of each domain on overall sexual satisfaction.
Patient-reported outcomes using responses to individual items of the International Index of Erectile Function (IIEF).
ED was present in 34%, OD in 20%, and DL in 55%. When correlated with overall sexual satisfaction, ED had the highest weighted kappa (0.84, 95% confidence interval [CI] = 0.80-0.87), while OD (0.57, 95% CI = 0.51-0.63) and DL (0.55, 95%CI = 0.48-0.62) were considerably lower. Furthermore, the single item assessing confidence in getting and keeping an erection had the strongest correlation with overall sexual bother as well as specific erectile bother.
ED, OD, and DL are highly prevalent in men with long-standing type I diabetes. All three sexual dysfunctions cause bother in men with DM, but ED causes more general sexual bother and likely has a greater overall impact on quality of life. Our data underscore the importance of asking men with DM about their sexual function and point to the need for further research to investigate disorders of orgasm and desire.
Journal of Sexual Medicine 05/2009; 6(7):1969-78. · 3.55 Impact Factor
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ABSTRACT: Case series have shown a Fournier's gangrene mortality rate of 20% to 40% with an incidence of as high as 88% in some studies. Because to our knowledge there are no population based data, we used a national database to investigate the epidemiology of Fournier's gangrene.
We used the State Inpatient Databases, the largest hospital based database available in the United States, which includes 100% of hospital discharges from participating states. Inpatients diagnosed with Fournier's gangrene (ICD-9 CM 608.83) who underwent genital/perineal débridement or died in the hospital were identified from 13 participating states in 2001 and from 21 in 2004. Population based incidence, regional trends and case fatality rates were estimated.
We identified 1,641 males and 39 females with Fournier's gangrene. Cases represented less than 0.02% of hospital admissions. The overall incidence was 1.6/100,000 males, which peaked in males who were 50 to 79 years old (3.3/100,000) with the highest rate in the South (1.9/100,000). The overall case fatality rate was 7.5%. Patients with Fournier's gangrene were rarely treated at hospitals (mean +/- SD 0.6 +/- 1.2 per year, median 0, range 0 to 23). Overall 0 to 4 and 5 or greater cases were treated at 66%, 17%, 10%, 4%, 1% and 1% of hospitals, respectively.
Patients with Fournier's gangrene are rarely treated at most hospitals. The population based mortality rate of 7.5% was substantially lower than that reported in case series from tertiary care centers.
The Journal of urology 04/2009; 181(5):2120-6. · 4.02 Impact Factor
