Biomedical subjects

A Athanasopoulos

Publications and source records attributed to A Athanasopoulos.

29 records · Page 2Linked to original sources

PubMed2001

Sildenafil test: changes in the diagnostic and therapeutic management of erectile dysfunction.

OBJECTIVE: To assess the efficacy of sildenafil as a first-step diagnostic and therapeutic tool for erectile dysfunction (ED) and to evaluate the consequent changes in the management of male sexual insufficiency. MATERIALS AND METHODS: Sildenafil in titrating doses up to 100 mg was prescribed to 50 men presenting to a sexual dysfunction clinic with medically documented ED. They had not undergone any specific diagnostic test before starting sildenafil. RESULTS: Of the 50 men, 24 (48%) responded to sildenafil. Of these, 8 (33.3%) responded to 50 mg and 16 (66.7%) to 100 mg of sildenafil. Of the responders, 9 representing 18% of all studied men were discharged achieving spontaneous erections in a mean follow-up of 5.3 months. Men with no medical history, men with hypertension and men with mild coronary artery disease responded better. CONCLUSIONS: The sildenafil test revealed that 48% of men responded to this therapy with no requirement for more invasive tests and that 18% of men required no further treatment at all. In addition this test reduced the overall cost of the diagnostic investigation. It is proposed that the sildenafil test should be used in cases with no significant medical history or in men with hypertension or mild coronary artery disease although almost all men with ED could be categorized as sildenafil-responders or sildenafil-resistant. It is also suggested that the sildenafil test would result in the ability for more men with ED to be managed exclusively in the primary care sector.

Erectile Dysfunction↗

PubMed2001

Diabetic impotence treated by intracavernosal injections: high treatment compliance and increasing dosage of vaso-active drugs.

AIMS: To compare patient compliance with treatment and the dosages of vaso-active drugs used, for the management of impotence in diabetic and non-diabetic patients. METHODS: Eighteen diabetic and a control group of 22 non-diabetic men were followed up regularly for 7 years after they had begun self-injections for severe erectile dysfunction. Rigiscan was used for the objective determination of the initial dosage and then doses were regulated in order to introduce an erection suitable for penetration and maintenance of erection for 30 min. RESULTS: Sixteen of 18 diabetic men are still using self-injections successfully after 7 years while of the 22 non-diabetic men, only 7 still continue injections. Compliance of diabetic men with treatment is significantly higher compared to the control group (p = 0.001). Doses of prostaglandin E(1) (PGE(1)) or mixtures of PGE(1) and papaverine (PAP) had to be increased over time. Although self-injections were a safe kind of treatment and no major complications were observed in both groups, a decrease in the frequency of injections was observed, particularly in the diabetic group, but this was not statistically significant (p = 0.15). CONCLUSIONS: Diabetic patients with severe erectile dysfunction have much higher compliance with self-injections than the non-diabetic patients. They respond initially to reasonable doses of PGE(1) but over time need increasing doses of PGE(1) or mixtures of PGE(1) and PAP. Frequent follow-up visits and the adjustment of dosage to continue the success of therapy may prevent patient dissatisfaction and drop-out from treatment. Patients treated with self-injections decrease the frequency of injections over time. They are satisfied with less frequent but successful intercourse and have a low risk of side-effects.

Alprostadil↗

PubMed2001

Effect of subinguinal varicocelectomy on sperm parameters and pregnancy rate: a two-group study.

OBJECTIVE: To evaluate the changes in semen parameters and pregnancy rates after varicocelectomy. METHODS: We evaluated the results of surgery in 146 men with primary infertility and palpable left varicoceles, compared with 62 men who refused surgery and were treated with tamoxiphene. Patients were selected with strict criteria in order to exclude any other infertility factor in the couple. They were followed up for at least 1 year after treatment. Statistical analyses were performed with the Wilcoxon signed rank test, Kolmogov-Smirnof two-sample test and paired samples t test. RESULTS: After 1 year, the differences in the median values were significant for all parameters. The partners of 62 of the operated men (46.6%) and 8 of the nonoperated (12.9%) became pregnant within 1 year (p<0.001). Thus, the difference between the true 1-year pregnancy rates was 33.7%. Overall, 83.2% of the operated men improved their semen parameters compared to 32.3% of the nonoperated. CONCLUSIONS: Varicocelectomy improves all semen parameters and pregnancy rates significantly. Palpable varicoceles should be operated upon when found in infertile couples.

Adult↗

PubMed2001

The incidence of pharmacologically induced priapism in the diagnostic and therapeutic management of 685 men with erectile dysfunction.

OBJECTIVE: To evaluate the incidence of pharmacologically induced priapism in the diagnostic and therapeutic management of erectile dysfunction. PATIENTS AND METHODS: Over a period of 7 years, 685 men were investigated for erectile failure. They underwent a simple test with vaso-active drugs, and the nonresponders were further investigated. Eventually, 83 men began autoinjections and 45 still continue. RESULTS: Eight (1.2%) cases of priapism presented during the simple test with vaso-active drugs in these patients, while none occurred during self-injection treatment. Three were prolonged erections induced by prostaglandin E1 (PGE1) and 5 by papaverine (Pap). Six were treated safely with intracavernosal injection of etilephrine without blood aspiration. CONCLUSION: Priapism is always a potential phenomenon where no individual, no particular drug and no specific dose are completely safe. It may be caused even with 5 microg of PGE1 or 7.5 mg of Pap. Auto-injection therapy however is a safe kind of treatment in well-experienced patients. Careful regulation of the doses and practice in the use of vaso-active drugs may reduce the priapism rate.

Adult↗

PubMed2000

Interstitial cystitis: bladder training with intravesical oxybutynin.

PURPOSE: We assess the efficacy of intravesical administration of oxybutynin chloride in patients with interstitial cystitis. MATERIALS AND METHODS: The study included 36 women with a mean age of 45 years with a diagnosis of interstitial cystitis. Patients were treated with gradual intravesical instillation of saline oxybutynin solution (oxybutynin group) or gradual filling of simple saline (control group). Evaluation parameters consisted of symptom problem index, voids per day, volume per void, functional bladder capacity, volume at first sensation, cystometric bladder capacity and cystometric volume at first sensation. RESULTS: Statistically significant improvement of all evaluated parameters was found in both groups. When comparing the outcomes statistically significant improvement of parameters favored the oxybutynin group. CONCLUSIONS: Bladder training alone produces a satisfactory result by gradually expanding the bladder, and an additional statistically significant improvement is evident with intravesical oxybutynin.

Administration, Intravesical↗

PubMed1997

Gore-Tex sling urethral suspension in type III female urinary incontinence: clinical results and urodynamic changes.

The authors prospectively evaluated 24 consecutive female patients with type III stress urinary incontinence, ranging in age from 36 to 70 years (mean 55 years). All patients were operated upon and had a vesicourethral suspension by a Gore-Tex suburethral sling. All were evaluated urodynamically 6 and 30 months after surgery. In this group of patients clinical cure of incontinence was observed in 83.3% (20) and in the remaining 4 patients it was significantly improved. In 2 patients there was an erosion of the urethra and the sling had to be removed 3.5 years later. Five other women remained dry but complained of occasional irritative symptoms, and several urinary tract infections were recorded (2-3 per year), which were documented by positive urine cultures. In the remaining 17 patients no erosion was observed and no irritative symptoms were reported. The urodynamic evaluation revealed an excellent postoperative result both 6 months and 30 months after surgery.

Adult↗

PubMed1996

Transvaginal colposuspension for the treatment of genuine stress incontinence combined with vaginal hysterectomy: a preliminary report.

The authors used a new, simple, modified transvaginal needle colposuspension technique in combination with vaginal hysterectomy for uterine prolapse and cystocele repair. The technique was used in 20 women with genuine stress incontinence which was urodynamically proven. One year after operation, 90% of patients were clinically normal and 85% were urodynamically cured. The advantages of this new technique are that the cost of the needle is low, it can be applied in all cases where a vaginal approach is necessary, and the method of needle insertion avoids perforation of the bladder.

Female↗

PubMed1992

Prostatectomy in the very aged.

The number of very aged men who demand prostatectomy for benign disease is increasing. We have assessed surgery results in 79 patients operated during the last four years. Sixty-two underwent endoscopic and 17 open procedure. Mortality rate was 3.7%. Two patients died in the first week and one patient three weeks after surgery. Morbidity rate was 61% but did not significantly affect the final operative outcome. Operative success rate six weeks postoperatively was 87%, satisfactory for this age group. After detailed preoperative evaluation and postoperative care by specialized age care team, prostatectomy is safe, effective and involves low-cost treatment.

Age Factors↗

PubMed1991

Unusual echinococcal cyst.

We report a case of a single echinococcal cyst that originated from the liver, and occupied the upper right retroperitoneal space and kidney. The diagnostic problems and the surgical procedure are discussed.

Aged↗

PubMed1991

Idiopathic granulomatous orchitis.

Our paper reports 7 cases of idiopathic granulomatous orchitis. Testicular trauma and genitourinary tract infection were the only important conditions in the past history, and were possibly related to the etiology of this disease. The clinical appearance of idiopathic granulomatous orchitis varies, and it is difficult to differentiate from testicular cancer, the diagnosis usually being made on histological examination after orchiectomy. For young patients and those with single testis, inguinal exploration and frozen section are recommended.

Adult↗

PubMed1990

Sarcoidosis of the ureter.

We present a case of sarcoidosis of the ureter which caused obstruction. This 'one-organ' localization is very rare and raises diagnostic problems.

Aged↗