Anthony J Bella

Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

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Publications (111)353.59 Total impact

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    ABSTRACT: Introduction: Although clinical evidence supports an association between cardiovascular/metabolic diseases (CVMD) and erectile dysfunction (ED), scientific evidence for this link is incompletely elucidated. Aim: This study aims to provide scientific evidence for the link between CVMD and ED. Methods: In this White Paper, the Basic Science Committee of the Sexual Medicine Society of North America assessed the current literature on basic scientific support for a mechanistic link between ED and CVMD, and deficiencies in this regard with a critical assessment of current preclinical models of disease. Results: A link exists between ED and CVMD on several grounds: the endothelium (endothelium-derived nitric oxide and oxidative stress imbalance); smooth muscle (SM) (SM abundance and altered molecular regulation of SM contractility); autonomic innervation (autonomic neuropathy and decreased neuronal-derived nitric oxide); hormones (impaired testosterone release and actions); and metabolics (hyperlipidemia, advanced glycation end product formation). Conclusion: Basic science evidence supports the link between ED and CVMD. The Committee also highlighted gaps in knowledge and provided recommendations for guiding further scientific study defining this risk relationship. This endeavor serves to develop novel strategic directions for therapeutic interventions. Musicki B, Bella AJ, Bivalacqua TJ, Davies KP, DiSanto ME, Gonzalez-Cadavid NF, Hannan JL, Kim NN, Podlasek CA, Wingard CJ, and Burnett AL. Basic science evidence for the link between erectile dysfunction and cardiometabolic dysfunction. J Sex Med **;**:**-**.
    No preview · Article · Dec 2015 · Journal of Sexual Medicine
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    ABSTRACT: IntroductionThe advent of the penile prosthesis revolutionized the treatment of erectile dysfunction (ED), resulting in near-complete treatment efficacy and high patient satisfaction rates. While several types of penile prosthesis are available, the inflatable penile prosthesis (IPP) is the most commonly used device in the United States. AimsTo describe the key modifications to IPPs from the two major manufacturersAmerican Medical Systems (AMS) and Coloplastsince the invention of the IPP, and to relate these changes to improvements in prosthesis function and patient outcomes based on available literature. Methods Review and evaluation of the literature between 1973 and present describing modifications in IPP design and the influence of these modifications on IPP durability and patient-related factors. Main Outcome MeasuresData describing the impact of iterative improvements in three-piece IPP design on device function, durability, and patient outcomes. ResultsThere were progressive improvements in IPP technology from both major manufacturers not only on the durability of the prosthesis but also on patient outcomes, with fewer device failures and lower infection rates. Notable improvements include incorporation of kink-resistant tubing, changes in the weave or addition of shear- and infection-resistant coatings to cylinder layers, pump and tubing connection modifications, the addition of rear tip extenders, and the incorporation of lockout valves to prevent autoinflation. Conclusions Numerous incremental modifications to the IPP from both major manufacturers since its invention have increased its durability and improved patient outcomes. Pastuszak AW, Lentz AC, Farooq A, Jones L, and Bella AJ. Technological improvements in three-piece inflatable penile prosthesis design over the past 40 years. J Sex Med 2015;12(suppl 7):415-421.
    No preview · Article · Nov 2015 · Journal of Sexual Medicine
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    ABSTRACT: Heretofore, the published data on penile implant patients consisted generally of small series of single-surgeon, retrospective experiences rather than prospective or large, multicenter evaluations. This study establishes a baseline of data collection from PROPPER (Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration). PROPPER is the first large, prospective, multicenter, multinational, monitored, and internal review board (IRB) -approved study of real-world outcomes for penile implant patients. Data from the PROPPER study was examined to determine patient baseline characteristics and primary and secondary etiologies prior to ED treatment, to include: type and size of implant received; surgical steps/techniques utilized during implantation; and duration of hospital stay. Through April 2, 2015, a total of 1019 patients were enrolled in the study at 11 sites, withradical prostatectomy (RP) being the predominant etiology in 285 (28%) subjects. Of those 285 RP patients, 280 (98.2%) received an AMS 700. Of these patients, 65.0% (182/280) had placement of the reservoir in the traditional retropubic space, versus 31.8% (89/280) in a submuscular location. For those non-RP patients receiving an AMS 700, less patients underwent reservoir placement in the submuscular location (17.7% (124/702), versus 80.9% (568/702), p-value:<0.001). For those patients receiving an AMS 700, RP and diabetic patients had more outpatient admissions (<24 hours) (56.8% and 52.1%) compared with cardiovascular and Peyronie's disease patients (42.0%and 35.6%, p-value: <0.001). This first-of- its-kind, large, prospective, multi-center study reveals most penile implant patients in North America receive an IPP and that RP is the most common primary etiology of penile implant surgery. Moreover, RP patients were more likely to have the reservoir placed in a submuscular location, experience longer OR time, and be admitted overnight as compared with other patient groups. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Aug 2015 · The Journal of urology

  • No preview · Article · May 2015 · Journal of Sexual Medicine

  • No preview · Article · May 2015 · Journal of Sexual Medicine
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    Full-text · Article · Apr 2015 · The Journal of Urology
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    Full-text · Article · Apr 2015 · The Journal of Urology

  • No preview · Article · Apr 2015 · The Journal of Urology
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    ABSTRACT: Erectile dysfunction (ED) is the preferred clinical term describing the persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months. • The initial diagnosis and treatment of ED is most commonly performed in Canada by primary care physicians (PCPs). • PCPs, urologists, internists, psychiatrists, and other treating healthcare professionals should be encouraged to initiate an open dialogue of sexual issues to identify men with ED who may not otherwise volunteer their sexual concerns. • Frequently a careful history, physical exam, serum glucose or hemoglobin A1C, lipid profile and optional hormonal testing facilitate the diagnosis of ED and effective therapy. Patient history can differentiate ED from other male sexual dysfunctions, including ejaculatory disorders (premature ejaculation and other abnormalities), hypogonadism, disorders of orgasm, and Peyronie’s disease. • Organic (physical) causes of ED are present in most men, but situational or psychosocial contributing factors often play a contributory role. Addressing these issues may enhance treatment efficacy. • Underlying risk factors associated with ED are common to cardiovascular disease in general, and should be identified during evaluation as they may represent the initial clinical sign of generalized endothelial disease (vascular insufficiency). Evaluation of family history, nicotine use, blood pressure, lipid profile, and glucose is required or should be documented if previously performed. Active management of identified cardiac risk factors should be instituted (i.e., smoking cessation, blood pressure treatment). • Once reversible causes of ED are ruled out, a trial of oral medication is recommended as first-line therapy, based on treatment efficacy, side effect profile, and minimal invasiveness. Specialized testing and referral are generally reserved for cases where oral first-line treatments fail or are not appropriate, of if greater insight into the etiology is desired by the patient/physician. • Second-line therapies, although more invasive than oral agents, are generally well-tolerated and effective. • Surgery remains an important option for men refractory to medical management, offering effective and durable ED treatment outcomes.
    Preview · Article · Feb 2015
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    ABSTRACT: IntroductionErectile dysfunction is a major complication of radical prostatectomy, commonly associated with penile neuropathy. In animal models of peripheral nerve injury, glial growth factor-2 (GGF2), a member of the neuregulin family of growth factors, has neuroprotective and neurorestorative properties, but this potential has not been established after cavernous nerve (CN) injury.AimsThe effectiveness of GGF2 in preserving axonal integrity and recovering erectile function in a rat model of radical prostatectomy-associated CN injury.Methods Adult male Sprague-Dawley rats underwent bilateral CN crush injury (BCNI) or sham surgery. Rats were administered GGF2 (0.5, 5, or 15 mg/kg) or vehicle subcutaneously 24 hour pre and 24-hour post-BCNI, and once weekly for 5 weeks. Erectile function was assessed in response to electrical stimulation of the CN. CN survival was assessed by fluorogold retrograde axonal tracing in major pelvic ganglia (MPG). Unmyelinated axons in the CNs were quantitated by electron microscopy.Main Outcome MeasuresErectile function recovery, CN survival, and unmyelinated CN axon preservation in response to GGF2 treatment following BCNI.ResultsErectile function was decreased (P < 0.05) after BCNI, and it was improved (P < 0.05) by all doses of GGF2. The number of fluorogold-labeled cells in the MPG was reduced (P < 0.05) by BCNI and was increased (P < 0.05) by GGF2 (0.5 and 5 mg/kg). The percentage of denervated Schwann cells in the BCNI group was higher (P < 0.05) than that in the sham-treated group and was decreased (P < 0.05) in the GGF2-treated (5 mg/kg) BCNI group. In the BCNI + GGF2 (5 mg/kg) group, the unmyelinated fiber histogram demonstrated a rightward shift, indicating an increased number of unmyelinated axons per Schwann cell compared with the BCNI group.ConclusionsGGF2 promotes erectile function recovery following CN injury in conjunction with preserving unmyelinated CN fibers. Our findings suggest the clinical opportunity to develop GGF2 as a neuroprotective therapy for radical prostatectomy. Burnett AL, Sezen SF, Hoke A, Caggiano AO, Iaci J, Lagoda G, Musicki B, and Bella AJ. GGF2 is neuroprotective in a rat model of cavernous nerve injury-induced erectile dysfunction. J Sex Med **;**:**–**.
    No preview · Article · Feb 2015 · Journal of Sexual Medicine
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    ABSTRACT: Alternative reservoir site placement (ARP) has become an accepted technique for inflatable penile prosthesis (IPP) patients. There have been no prospective evaluations of this technique, which is currently off-label. The authors performed a prospective, multicenter, multinational, and internal review board (IRB)-approved study to evaluate the effectiveness and safety of ARP MATERIAL AND METHODS: The PROPPER registry was initiated in June, 2011, and is a database containing patient outcomes for IPP implantation. Patients with American Medical Systems (AMS) penile prostheses continue to be enrolled at 13 North American sites. Data from the PROPPER study was examined to determine surgical implantation use patterns for the AMS 700 series. Reservoir implantation site and complications by implantation site were evaluated.
    No preview · Article · Jul 2014
  • Anthony J Bella · Rany Shamloul
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    ABSTRACT: Introduction: There has been a long history of man's fascination with better and stronger sex drive and performance across different cultures. Several literature texts from the Hindu, Egyptian, Chinese and Roman civilizations document the human endless search for substances that can enhance sexual experiences and/or treat erectile dysfunction. Aim: This review will discuss the current research done on the most popular plant aphrodisiacs and provide evidence to support or discourage the use of any of them to enhance sexual desire and/or function in men. Methods: We review the current evidence on the use of natural substances as aphrodisiacs. Results: We found very little evidence to support the use of plant aphrodisiacs in the treatment of male sexual dysfunction. The vast majority of studies were conducted on animals with very few clinical studies. Available data suggest a beneficial effect of ginseng as a pro-sexual supplement and not an independent treatment for male sexual dysfunction. Conclusions: Trans-culturally, many herbal therapies show some potential benefits in improving men's sexual function; however, adequate studies on the specific benefits and health risks associated with their use are needed. We strongly recommend the design and execution of well-controlled clinical studies to determine the efficacy and safety of plant aphrodisiacs. Copyright (c) 2013 John Wiley & Sons, Ltd.
    No preview · Article · Jun 2014 · Phytotherapy Research
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    ABSTRACT: There are several contraceptive methods to prevent pregnancy, reversible as well as nonreversible ones. The sexual satisfaction of couples is affected by many types of contraceptives used. The aim of this study was to evaluate prospectively the effect of vasectomy on the sexual life and satisfaction of couples. Seventy-six couples took part in this evaluation and filled out respective questionnaires before and after vasectomy. All the questionnaires were evaluated statistically for differences in the respective sexual domain scores. Standardized questionnaires were used. The International Index of Erectile Function (IIEF) as well as postoperative pain score were completed by men. Female Sexual Function Index (FSFI) was completed by the female partner. For statistical analysis, the T-Square Test was used. The average age of couples, who chose the vasectomy procedure, was 37 years for women and 39 years for men. The contraception method most frequently used prior to the vasectomy was the birth control pill. For the male partner, the IIEF showed no significant change in the respective domains. Out of the 76 couples, 93% of the males and 96% of their female partners would recommend and do vasectomy again. The postoperative pain score was 3.5 on 0-10 scale, and there were no postoperative complications reported. The best improvement of the sexual function was noticed for the female partners. The FSFI showed a significant improvement in the domains desire (P < 0.05), arousal (P < 0.05), orgasm (P < 0.05), lubrication (P < 0.05), and satisfaction (P < 0.05). This is the first report to our very best knowledge that showed the positive impact of vasectomy on sexual satisfaction of couples. Vasectomy is a safe operation with minimal complication rates. Mohamad Al-Ali B, Shamloul R, Ramsauer J, Bella A, Scrinzi U, Treu T, and Jungwirth A. The effect of vasectomy on the sexual life of couples. J Sex Med **;**:**-**.
    No preview · Article · May 2014 · Journal of Sexual Medicine
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    Anthony J Bella · Rany Shamloul
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    ABSTRACT: Sexual dysfunction (SD) is common in patients taking antipsychotics, and is the most bothersome symptom and adverse drug effect compromising treatment compliance. Mechanisms involved in psychotropics-induced SD are either largely unknown or poorly understood. The aim of this review is to present an updated analysis of SD associated with the use of psychotropic drugs in psychiatric patients. Contemporary evidence from available studies demonstrates that SD rates are drug-related rather than drug-class specific, and that these rates vary widely. Mechanisms involved in psychotropics-induced SD are either largely unknown or poorly understood. Our understanding of psychotropics-induced SD is limited by the inability to differentiate whether these effects are really drug-induced or due to different inclusion criteria. Rigorous research, basic and clinical, is needed to understand the exact incidence, severity and mechanisms involved in the development of SD induced by various psychotropic treatment regimens.
    Preview · Article · Apr 2014 · Central European Journal of Urology
  • Anthony De Jesus · Rany Shamloul · Anthony J. Bella

    No preview · Article · Apr 2014

  • No preview · Article · Apr 2014 · The Journal of Urology
  • Rany Shamloul · Anthony Bella

    No preview · Article · Apr 2014 · Journal of Sexual Medicine
  • Rany Shamloul · Anthony J Bella

    No preview · Article · Mar 2014
  • Adham Zaazaa · Anthony J Bella · Rany Shamloul
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    ABSTRACT: This article attempts to review the most current and the well-established facts concerning drug addiction and sexual dysfunction. Surprisingly, even though alcohol is prevalent in many societies with many myths surrounding its sexual-enhancing effects, current scientific research cannot provide a solid conclusion on its effect on sexual function. Unfortunately, the same concept applies to tobacco smoking; however, most of the current knowledge tends to support the notion that it, indeed, can negatively affect sexual function. Similar ambiguities also prevail with substances of abuse.
    No preview · Article · Sep 2013 · Endocrinology and metabolism clinics of North America
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    ABSTRACT: To issue a consensus document on the prevention, management, and research of infection associated with penile prostheses, as neither professional associations nor governmental entities have issued guidelines that are specific to this infection. Sixteen North American experts on infection of penile prostheses were identified and assembled to select and discuss certain issues related to infection of penile prostheses. After performing an extensive search of clinically important issues in published reports, the 16 experts met twice in person to finalize the selection, discuss the issues that were deemed most important, and issue pertinent recommendations. Although many subjects relevant to infection of penile prostheses were initially identified, the experts selected 10 issues as currently being the most important issues and for which there exists some support in the published data. The examined issues involved prevention, management, or research of infections associated with penile prostheses. In the absence of pertinent guidelines, the consensus document issued by experts in the field of prosthetic urology is anticipated to improve the quality of patient care, streamline the prevention and management of infected penile prostheses, and stimulate collaborative research. Although this consensus document could serve as best practice recommendations, the lack of adherence to these recommendations would not indicate improper care.
    No preview · Article · Aug 2013 · Urology

Publication Stats

1k Citations
353.59 Total Impact Points

Institutions

  • 2014-2015
    • Ottawa Hospital Research Institute
      Ottawa, Ontario, Canada
  • 2007-2015
    • University of Ottawa
      • Department of Surgery
      Ottawa, Ontario, Canada
  • 2012
    • The Ottawa Hospital
      Ottawa, Ontario, Canada
  • 2006-2009
    • University of California, San Francisco
      • • Department of Medicine
      • • Department of Urology
      San Francisco, California, United States
    • Johannes Gutenberg-Universität Mainz
      Mayence, Rheinland-Pfalz, Germany
  • 2002-2006
    • The University of Western Ontario
      • • Division of Urology
      • • Department of Surgery
      • • Division of Medical Oncology
      London, Ontario, Canada