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Biomedical subjects

Alberto Briganti

Publications and source records attributed to Alberto Briganti.

At least 55 records · Page 3Linked to original sources
PubMed2005

Vardenafil for the treatment of erectile dysfunction: a critical review of the literature based on personal clinical experience.

OBJECTIVE: To critically review the literature on vardenafil in the treatment of erectile dysfunction while integrating the clinical findings with the personal experience of the authors. METHODS: Analysis of published full-length papers that were identified through Medline search from January 2000 through May 2004. Abstracts published in peer-reviewed journals from the same period were also considered. RESULTS: Efficacy, tolerability and safety, as reported in the peer-reviewed literature compares well with the authors' personal experience. Authors' personal observations include discussions on potency, selectivity, selection of initial dose, counselling for patients characteristically considered difficult-to-treat (diabetes, prostatectomy, depression), including the determination of the maximal efficacious dose and the possible role of daily dosing, optimisation of the use of vardenafil according to its pharmacokinetic and pharmacodynamic profiles (onset and reliability), and management of ED patients with or at risk for cardiovascular disease. CONCLUSIONS: Extensive experience with vardenafil as reported in peer reviewed literature confirms the important role of vardenafil in the management of patients with ED. The development of each physician's own experience with vardenafil is key to optimise overall satisfaction of this therapy by the patient and his partner.

Clinical Competence↗
PubMed2005

Comparison of the effect of sildenafil and apomorphine SL on nocturnal erections in healthy volunteers: a placebo-controlled study.

OBJECTIVE: To compare the effects of sildenafil and sublingual (sl) apomorphine on nocturnal erections. METHODS: In a prospective, single-blinded, placebo-controlled at-home study we compared the effect of apomorphine sl and sildenafil on sleep-related erectile activity in 30 healthy potent volunteers (mean age, 26.4 years; range, 23-35 years; Erectile Function domain of the International Index of Erectile Function > or =26), not reporting any subjective sleep abnormality during 4 consecutive nights with rigidity monitoring (NPTR) with the RigiScantrade mark device. After the first night of adaptation, they were randomized to receive placebo or apomorphine sl 2mg or sildenafil 50mg taken at bedtime during the following 3 consecutive nights. RESULTS: Sildenafil increased the mean+/-SE number of erections, overall length of erectile events, and the time of erections with rigidity >60% at both tip and base, as compared to placebo. The same parameters were reduced after administration of apomorphine sl. Similar findings were observed with regards to Rigidity Activity Units and Tumescence Activity Units. CONCLUSIONS: Our results confirm that sildenafil taken at bedtime might increase nocturnal erectile activity also in young potent men as compared to placebo. Apomorphine sl taken at bedtime seems to have the opposite effect.

Adult↗
PubMed2005

Predictors of prostate cancer after initial diagnosis of atypical small acinar proliferation at 10 to 12 core biopsies.

OBJECTIVES: To evaluate the factors that predict prostate cancer detection by means of 10 to 12 core repeat biopsies in patients with atypical small acinar proliferation (ASAP) results on initial biopsy. METHODS: From 1998 to 2004, 110 of 127 patients (87%) with a diagnosis of ASAP were rebiopsied with the same technique plus additional biopsies on the ASAP site (12.6 +/- 1.1 cores [mean +/- standard deviation]). Each histologic slide was reviewed blindly by a single experienced pathologist, who also differentiated highly suspicious (ASAPH) and not highly suspicious (ASAPB) lesions for cancer. RESULTS: On initial biopsy, a concomitant high-grade prostatic intraepithelial neoplasia (HGPIN) was present in 26 patients (23%) with ASAP. The overall cancer detection rate was significantly higher in patients who had ASAP associated with HGPIN (58%), compared with patients who had isolated ASAP (35%; P = 0.04). The cancer detection rate was not significantly higher in patients with ASAPH than in those with ASAPB (49% versus 33%, respectively; P = 0.11). In the group of patients who had isolated ASAP, the rate of cancer detection was significantly higher in patients who had a prostatic volume less than 50 mL (56%) than in patients with a prostatic volume of 50 mL or more (27%; P = 0.03). CONCLUSIONS: The cancer detection rate was significantly higher in patients with an ASAP associated with HGPIN on initial biopsy than in patients with isolated ASAP. In ASAP patients, the detection rate was lower for patients with a larger prostate than in those with a smaller prostate.

Adenocarcinoma↗
PubMed2005

Drug Insight: oral phosphodiesterase type 5 inhibitors for erectile dysfunction.

Erectile dysfunction (ED) is a common medical condition that affects the sexual life of millions of men. At present, first-line oral pharmacotherapy for most patients with ED is a phosphodiesterase type 5 (PDE-5) inhibitor, of which three are currently available worldwide. Sildenafil (Viagra, Pfizer) has a very satisfactory efficacy-safety profile in all patient categories. The first PDE-5 inhibitor to reach the market, it is now the most widely prescribed oral agent for ED. Tadalafil (Cialis, Lilly ICOS) and vardenafil (Levitra, Bayer/GlaxoSmithKline) were introduced to the European Union and the US in 2003 and 2004, respectively. These three PDE-5 inhibitors share many characteristics, but each has unique features. This review describes the chemical, pharmacologic and clinical features of sildenafil, vardenafil and tadalafil as oral first-line treatments for ED. First, we describe the physiology of penile erection and PDE-5 inhibitor pharmacology, including chemistry, PDE selectivity, pharmacokinetics, and possible drug interactions. We then summarize data on the efficacy and safety profiles of the three PDE-5 inhibitors for the treatment of ED in the general population, in patients with diabetes mellitus and in men that have undergone bilateral nerve-sparing retropubic radical prostatectomy.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2005

Association between erectile dysfunction and coronary artery disease: a case report study.

Evidence is accumulating in favor of classifying erectile dysfunction (ED) as a vascular disorder. There are three main clinical scenarios in which ED and coronary artery disease (CAD) may coexist: the patient with ED who later develops CAD, the patient with overt CAD who is casually found to have ED, and the patient with acute coronary syndrome who has normal sexual function. This study presents three cases and discusses a "putative" pathophysiological mechanism underlying all these clinical presentations. Further studies, coupling functional and structural changes of coronary circulation with those of penile (i.e., dynamic penile test) circulation in each of these situations are mandatory to support this hypothesis.

Aged↗
PubMed2005

Safety and tolerability of oral erectile dysfunction treatments in the elderly.

Erectile dysfunction (ED) is a common medical condition that affects the sexual life of millions of men worldwide. It is generally accepted that sexual function tends to decline with aging, which is often associated with a higher prevalence of sexual problems, including ED and loss of libido. As the mean age of men seeking medical help for sexual dysfunction continues to increase, it is important to assess the safety and tolerability of currently available medical treatments in elderly men, who often share other co-morbidities that should be carefully evaluated when any type of ED therapy is considered. With this aim in mind, a MEDLINE search was conducted from 1 January 1998 to 31 May 2004 to identify studies assessing the efficacy, safety and tolerability of treatments for ED in the elderly. Particular care was taken to assess the cardiovascular safety of oral drugs for ED in this subset of patients, who often have multiple cardiovascular risk factors which contribute to a complicated clinical scenario. The most important conclusion of the paper is that the high efficacy, reliability, safety and tolerability of oral ED treatments makes them appropriate first-line therapies for elderly patients with ED.

Administration, Oral↗
PubMed2005

Atypical small acinar proliferation (ASAP) on extended prostatic biopsies: predictive factors of cancer detection on repeat biopsies.

OBJECTIVE: To evaluate the clinical and histopathologic factors that may help to predict cancer detection by means of extended repeated prostate needle biopsies in patients with Jumma atypical small acinar proliferation (ASAP) results on initial prostate biopsy. MATERIALS AND METHODS: From 1998 to September 2003, 105 out of 121 (86%) patients with a diagnosis of ASAP after a first set of 10 to 12 systematic biopsies, were rebiopsied using the same technique plus additional biopsies on the ASAP site (mean number of repeat biopsy samples, 12.6). The median time until a second and third biopsy was 7.04 months (95% confidence interval [CI], 5.5-8.5), and 13.3 months (95% CI, 8.8-17.7; 19 patients), respectively. Each histological slide was reviewed blindly by a single experienced pathologist (M.F) who differentiated highly suspicious (ASAPH) and not highly suspicious (ASAPB) lesions for cancer. RESULTS: On initial biopsy, a concomitant HGPIN was present in 18 patients (17%) with ASAP The overall cancer detection rate in those who underwent two or three sets of biopsies was 39% (41/105); it was 35% (37/105) and 21% (4/19) in second and third biopsies, respectively. The overall cancer detection rate was higher in patients who had ASAP associated with HGPIN (50%) compared with patients who had isolated ASAP (37%) (p = 0.3). Statistical analysis showed that levels of prostate-specific antigen (PSA), PSA density, prostatic volume, digital rectal examination results, transrectal ultrasound findings, time until rebiopsy (less vs. more than 6 months), and histological level of suspicion were not significant predictors of prostate cancer at the time of rebiopsy. In particular, the cancer detection rate was not significantly higher in patients with ASAPH than those with ASAPB (49% vs. 33%, respectively; p = 0.11). In a univariate analysis, the mean prostate volume was statistically different in patients with cancer compared with those without (56.4 +/- 6.3 and 78.9 +/- 5.3 respectively; p = 0.009), but only in the group of patients who had isolated ASAP In these patients, the rate of cancer detection was significantly higher in patients who had a prostatic volume less than 60 mL (56%) than in patients with a prostatic volume greater than or equal to 60 mL (27%) (p = 0.03). CONCLUSIONS: Patients with an initial ASAP diagnosis after extended biopsies had an overall cancer detection rate less than 40% after two sets of extended biopsy. ASAPH lesions did not indicate a significantly higher risk of cancer than ASAPB lesions on repeated extended biopsies. Despite the extended rebiopsy plus the additional biopsies targeted to the ASAP lesion, the detection rate was lower for patients with a larger prostate than those with a smaller prostate.

Aged↗
PubMed2004

Menstrual cycle-related changes in plasma oxytocin are relevant to normal sexual function in healthy women.

Circulating levels of the neuro-hypophysial nonapeptide oxytocin increase during sexual arousal and orgasm in both men and women. A few studies have evaluated the effect of the menstrual cycle on plasma oxytocin in normally cycling, sexually active, healthy fertile women using or not using contraceptive pills. In 20 ovulating women and 10 women taking an oral contraceptive (group 1 and group 2, respectively), sexual function, hormonal profile, and plasma oxytocin (OT) were evaluated throughout the menstrual cycle. In group 1, plasma OT was significantly lower during the luteal phase in comparison with both the follicular and ovulatory phases. Plasma oxytocin was significantly correlated with the lubrication domain of the Female Sexual Function Index (FSFI) during the luteal phase and showed a trend towards statistical significance during the follicular phase. In group 2, plasma OT did not show any significant fluctuation throughout the menstrual cycle, even though a significant correlation was evident with both the arousal and the lubrication domain of the FSFI during the assumption of the contraceptive pill. These findings suggest that plasma OT fluctuates throughout the menstrual cycle in normally cycling healthy fertile women with adequate sexual activity but not taking any oral contraceptive pill. Moreover, plasma OT levels significantly relates to the genital lubrication in both women taking and not taking oral contraceptive pill apparently confirming its role in peripheral activation of sexual function.

Adult↗
PubMed2004

Current and future strategies for preventing and managing erectile dysfunction following radical prostatectomy.

INTRODUCTION AND OBJECTIVES: As radical prostatectomy remains a commonly used procedure in the treatment of clinically localized prostate cancer, we critically analyzed current and future strategies for preventing and managing postoperative erectile dysfunction. METHODS: Systematic literature review using Medline and CancerLit from January 1997 to June 2003. Abstracts published in the journals European Urology, The Journal of Urology and the International Journal of Impotence Research as official proceedings of internationally known scientific societies held in the same time period were also assessed. RESULTS: Patient selection and surgical technique are the major determinants of postoperative erectile function. Apoptosis of corporeal smooth muscle cells plays a role in the development of cavernous veno-occlusive dysfunction following radical prostatectomy. Pharmacological prophylaxis and treatment of postoperative erectile dysfunction is effective and safe. The concepts of cavernous nerve reconstruction and neuroprotection have been associated to promising results. CONCLUSIONS: In the hands of experienced surgeons, properly selected patients undergoing a nerve sparing radical prostatectomy should achieve unassisted or medically assisted erections postoperatively.

Erectile Dysfunction↗
PubMed2004

Sexual dysfunction is common in women with lower urinary tract symptoms and urinary incontinence: results of a cross-sectional study.

OBJECTIVE: The aim of this study was to determine the prevalence of sexual dysfunctions in women with urinary incontinence and/or lower urinary tract symptoms as compared to a general female population. METHODS: We extensively evaluated 227 consecutive women (mean age 52; age range 19-66) complaining of urinary incontinence (UI) and/or lower urinary tract symptoms (LUTS) with a comprehensive history (including several validated questionnaires), a complete physical examination and a urodynamic multichannel evaluation. Two hundred and sixteen patients were eligible for sexual function investigation because 11 out of 227 (5%) were not interested in dealing with questions regarding their own sexuality and were thus excluded from the final evaluation results. A group of 102 age-matched women (mean age 54; age range 19-63) assessed for a yearly routine gynaecological evaluation and not complaining of urinary symptoms were enrolled as cross-sectional controls and investigated in accordance with the Female Sexual Function Index (FSFI). RESULTS: Sexual dysfunction was diagnosed in 99 out of 216 patients (46%). Of these, 34 (34%) reported hypoactive sexual desire, 23 (23%) reported sexual arousal disorder; 11 patients (11%) complained of orgasmic deficiency, and 44 (44%) suffered from sexual pain disorder (e.g., dyspareunia or non-coital genital pain). Women reporting low sexual desire commonly suffered from stress incontinence (47%). We found that 60% of the women with sexual arousal disorders and 61% of those with sexual pain disorders also complained of recurrent bacterial cystitis. Forty-six percent of those complaining of orgasmic phase difficulties also reported a troublesome urge incontinence. The FSFI values in both groups scored as follows (patients versus controls; median value; p value): desire: 2.0 vs. 3.2 (p<0.01); arousal: 2.8 vs. 3.6 (p=n.s.); lubrication: 3.2 vs. 4.4 (p=0.01); orgasm: 4.1 vs. 4.4 (p=n.s.); sexual satisfaction: 2.7 vs. 4.0 (p<0.01); sexual pain: 1.8 vs. 4.0 (p<0.001). CONCLUSIONS: Women reporting UI or LUTS also complained of sexual dysfunctions in a significantly higher number than a general, healthy female population not complaining of urinary symptoms. Investigation of female sexuality is suggested for these patients.

Adult↗
PubMed2004

Common grounds for erectile dysfunction and coronary artery disease.

PURPOSE OF REVIEW: Evidence is accumulating to consider erectile dysfunction as a vascular problem. This review focuses on background, pathophysiological mechanisms and clinical evidence of the link between erectile dysfunction and coronary artery disease. RECENT FINDINGS: The link between erectile dysfunction and coronary artery disease is suggested by the following. (1) Common risk factors for atherosclerosis are frequently found in erectile dysfunction. (2) Erectile dysfunction is frequently found in vascular syndromes such as coronary artery disease, hypertension, cerebrovascular disease, peripheral arterial disease and diabetes. (3) A similar pathogenic involvement of the NO pathway leading to impairment of endothelium-dependent vasodilatation and late structural vascular abnormalities is shared by erectile dysfunction and vascular disorders. Given this background, the "artery-size hypothesis" is a recently proposed pathophysiological mechanism to explain the link between sexual dysfunction and myocardial ischemia. SUMMARY: Erectile dysfunction and coronary artery disease appear to be linked tightly each other.

Coronary Artery Disease↗
PubMed2004

The role of the urologist in the management of female sexual dysfunctions.

PURPOSE OF REVIEW: The present minireview is aimed at investigating the association between female sexual dysfunction and urinary incontinence or lower urinary tract symptoms, two of the most frequently encountered urological disorders. RECENT FINDINGS: Sexual dysfunction in women is a multifactorial and multidimensional condition combining several biological, psychological, medical, interpersonal and social components. According to the National Health and Social Life Survey, approximately 43% of American women suffer from sexual disorders. There have been few investigations about the prevalence and predictors of female sexual function or sexual dysfunction across Europe. Based on everyday clinical practice and according to the most recent peer-reviewed publications, there is a critical correlation between urogynaecological conditions and women's sexual disorders. Interestingly, an increasing number of papers have raised the issue of women's sexual function in patients who have undergone urogynaecological radical pelvic surgery for urological malignancies. The role of the urologist in treating the couple covers the third part of this paper, and attempts to show the significant correlation between the presence of any female sexual dysfunction and so-called patient-partner satisfaction. SUMMARY: This minireview underlines the significant role of the urologist in the management of female sexual dysfunctions, mainly in women with urogynaecological disorders. Evaluation by the patient's partner and its impact on urological patients has also been stressed.

Cystectomy↗
PubMed2004

Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia.

PURPOSE: To our knowledge we report the first multicenter, prospective, randomized study comparing holmium laser enucleation (HoLEP) and transurethral prostate resection (TURP) for obstructive benign prostatic hyperplasia. MATERIALS AND METHODS: From January to October 2002, 100 consecutive patients with symptomatic obstructive benign prostatic hyperplasia were randomized at 2 centers to surgical treatment with HoLEP (52 in group 1) or TURP (48 in group 2). Patients in the 2 groups were preoperatively assessed by scoring subjective symptoms questionnaires. Preoperative and perioperative parameters were also evaluated, the latter at 1, 6 and 12 months of followup. RESULTS: At baseline all patients had obstruction (Schäfer grade greater than 2). At the 1, 6 and 12-month followups no statistically significant differences were observed between the 2 groups in terms of urodynamic findings and subjective symptom scoring. In the HoLEP group mean total time in the operating room +/- SD was significantly longer than for TURP (74 +/- 19.5 vs 57 +/- 15 minutes, p < 0.05), while catheterization time (31 +/- 13 vs 57.78 +/- 17.5 minutes, p < 0.001 and hospital stay (59 +/- 19.9 vs 85.8 +/- 18.9 hours, p < 0.001) were significantly shorter in the HoLEP group. Transient stress and urge incontinence were more common in the HoLEP group, although at the 12-month followup results were comparable. The overall complication rate was comparable in the 2 groups. Erectile function was also maintained in the followup period from baseline in each group, as expected. CONCLUSIONS: HoLEP and TURP were equally effective for relieving obstruction and lower urinary tract symptoms. HoLEP was associated with shorter catheterization time and hospital stay. At 1 year of followup complications were similar in the 2 groups.

Aged↗
PubMed2004

Emerging oral drugs for erectile dysfunction.

Erectile dysfunction (ED) is a common medical condition that affects the sexual life of millions of men worldwide. Many drugs are now available for the treatment of ED, with oral pharmacotherapy representing the first-line option for most patients. Sildenafil citrate, an inhibitor of the enzyme phosphodiesterase type 5 (PDE5), is the most widely prescribed oral agent and has a very satisfactory efficacy-safety profile in all patient categories. Tadalafil (Cialis; Eli Lilly & Co., ICOS) and vardenafil (Levitra; Bayer Pharmaceuticals, GlaxoSmithKline) are new PDE5 inhibitors that have recently been approved worldwide. Both have been associated with significant positive efficacy-safety profiles. Apomorphine sublingual is a dopamine D1 and D2 receptor agonist, which has been approved for marketing in Europe. It is best selected for treating patients with mild-to-moderate ED, but it is seldom used in clinical practice due to its limited efficacy and side effects, particularly nausea. Patients who do not respond to oral pharmacotherapy or who are unable to use it are appropriate candidates for intracavernosal and intraurethral therapy. The efficacy of second-line treatment is high, but the attrition rate remains significant. For the purpose of this review, clinical and pharmacological analysis focuses on the recent advances in the field of oral therapy, including PDE5 inhibitors and sublingual apomorphine.

Administration, Oral↗