Biomedical subjects

Eric Wespes

Publications and source records attributed to Eric Wespes.

10 recordsLinked to original sources

PubMed2007

The influence of age on treatment outcomes in men with erectile dysfunction treated with two regimens of tadalafil: results of the SURE study.

OBJECTIVE: To evaluate whether patterns of sexual activity and efficacy over time to two dosing regimens of tadalafil differ with ageing in men with erectile dysfunction (ED). PATIENTS AND METHODS: The SURE study was a multicentre, crossover, open-label study. In all, 4262 men with ED were randomly assigned to treatment with tadalafil 20 mg on-demand before sexual activity, or three times per week for 5-6 weeks. After a 1-week washout period, patients were crossed over to the alternative regimen for 5-6 weeks. This post hoc analysis evaluated the pattern of sexual attempts, efficacy and safety of these two regimens of tadalafil across several age groups. RESULTS: The mean number of sexual attempts per week decreased from a range of 2.6-2.8 at age < or = 40 years to 1.9 at age >70 years. Age did not significantly influence the time of sexual activity after dosing. A high percentage of attempts occurred >4 h after dosing for all age groups ( approximately 70% for men taking tadalafil three times per week and approximately 50% for men taking tadalafil on-demand). For all age groups, most attempts took place in the late evening. The mean per-patient rate of successful attempts was similar for each interval up to 36 h after dosing and decreased with increasing age (> or =75% at age < or = 60 years, > or = 68% at age >60 to < or = 70 years, and > or = 60% at age >70 years). Tadalafil was well tolerated at all ages. CONCLUSIONS: Patterns of sexual activity with tadalafil 20 mg, taken on-demand or three times per week, were similar in the different age groups. Tadalafil was effective up to 36 h after dosing for all age groups.

Adolescent↗

PubMed2006

Presence of LDL modified by myeloperoxidase in the penis in patients with vascular erectile dysfunction: a preliminary study.

OBJECTIVE: Erectile dysfunction (ED) is a major vascular disorder. Atherosclerosis is closely related to lipoprotein metabolism and especially, oxidative modifications of low-density lipoproteins (LDLs), which are involved in early development of the atherosclerotic lesions. Current major questions include how LDLs are oxidised (OxLDL) in vivo. Myeloperoxidase (MPO) is an enzyme present in the azurophile granules of neutrophils and monocytes that can contribute to LDL oxidation in the presence of H(2)O(2). We have developed a new monoclonal antibody against LDL modified by MPO (Mox-LDL) and have used it on penile biopsies from patients operated on for penile implant. METHODS: Seven patients with vascular ED and one impotent patient after radical prostatectomy (RP) underwent biopsy of the cavernous body during penile implant procedures. An immunohistochemical study with a monoclonal antibody against Mox-LDL and an antibody against apoprotein B (ApoB), the protein moiety of LDL, to confirm the presence of LDL was performed. RESULTS: The staining was positive for Mox-LDL and ApoB and was present between the endothelial cells of the sinusoid spaces and the smooth muscle cells in the seven patients with vascular ED. The patient with RP was negative for Mox-LDL. DISCUSSION: Because it is known that modified LDL could decrease nitric oxide production, Mox-LDL could be one of the agents responsible for ED. Further studies are needed to confirm this hypothesis.

Aged↗

PubMed2006

Ureteral mullerian carcinosarcoma (mixed mullerian tumor) associated with endometriosis occurring in a patient with a concentrated soy isoflavones supplementation.

Malignant transformation and particularly malignant mixed mullerian tumor arising in extragenital endometriosis is extremely rare and occurs in the majority of cases after estrogen replacement therapy. We present a case of a 75-year-old woman who developed a ureteral malignant mullerian carcinosarcoma in a context of florid endometriosis. The patient had a history of total hysterectomy with bilateral salpingo-oophorectomy 30 years earlier for extensive endometriosis. Since 5 years, the patient has been on phytoestrogen supplementation consisting of 72 mg/day of superconcentrated soy isoflavones. This is the first case of ureteral mullerian carcinosarcoma arising in endometriosis foci after extensive phytoestrogen supplementation. Our data suggest that phytoestrogens at least in concentrated form may play a role not only in maintenance of endometriosis but also in its malignant transformation. Given the extraordinary popularity and availability of these dietary supplements, several studies are indispensable regarding their safety particularly in women with extensive endometriosis.

Aged↗

PubMed2006

EAU Guidelines on erectile dysfunction: an update.

The introduction of new oral therapies has completely changed the diagnostic and therapeutic approach to erectile dysfunction. A panel of experts in this field has developed guidelines for the clinical evaluation and treatment based on the review of available scientific information.

Erectile Dysfunction↗

PubMed2005

Sildenafil non-responders: haemodynamic and morphometric studies.

OBJECTIVES: Most of the available data on efficacy for sildenafil are based on a questionnaire and erectile dysfunction (ED) is classified with minor or severe organic factors. To better select sildenafil responders and non-responders, we have conducted a haemodynamic and morphometric study in sildenafil non-responders. METHODS: Thirty patients with ED aged from 28 to 74 years-old did not respond to 8 attempts of 100 mg of sildenafil. They underwent hormonal measurements, intracavernous injection (ICI 20 microg PgE1) followed by Doppler examination and cavernosometry. A penile biopsy was performed under local anesthesia. A quantification of the cavernous smooth muscle (SMC) was performed with a computerized image analysis after staining with actin anti-actin. RESULTS: Twenty-eight patients had a very poor ICI response. Five patients were diabetic and 2 had low testosterone level. Eight patients had arterial lesions, 15 had venous leak and 5 both lesions. They all had reduction of SMC (<35%). No biological and vascular abnormality was observed in two patients. They had a percentage of SMC of 38% and 42%. No complication was observed with the penile biopsy. CONCLUSIONS: Severe vascular lesions and atrophy of SMC are mainly observed in sildenafil non-responders. The age, diabetes and low testosterone level seem not to be related with the failures.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed2005

An evaluation of an alternative dosing regimen with tadalafil, 3 times/week, for men with erectile dysfunction: SURE study in 14 European countries.

OBJECTIVE: To examine the preference for 2 dosing regimens (on demand or 3 times/week) for tadalafil, a phosphodiesterase 5 inhibitor with a duration of effectiveness up to 36 hours in men with erectile dysfunction (ED). DESIGN AND METHODS: SURE is a 14 European country, multicenter, crossover, and open-label study. Men with ED (N=4262) were randomized to tadalafil 20mg treatment on demand (maximum one dose per day and before sexual activity) or 3 times/week for 5-6 weeks. After a 1-week washout period, patients were crossed over to the alternate regimen for 5-6 weeks. The patient's response to a treatment preference question (TPQ) was used to determine the preferred treatment regimen. RESULTS: The mean age of the randomized patients was 55 years and 85.2% reported a history of ED for one year or greater. Overall, the responses of 3861 men to the TPQ assessment showed that 57.8% preferred the on-demand regimen and 42.2% preferred the 3 times/week dosing. Both regimens were efficacious and well tolerated. CONCLUSIONS: In this study, while 57.8% of men preferred the on-demand regimen of tadalafil 20mg, a substantial number (42.2%) preferred the 3 times/week treatment. The two regimens provide additional treatment options by giving men with erectile dysfunction unique flexibility in dosing with tadalafil.

Carbolines↗

PubMed2005

Sexual intercourse attempt patterns with two dosing regimens of tadalafil in men with erectile dysfunction: results from the SURE study in 14 European countries.

OBJECTIVE: To describe the pattern of sexual attempts by men with erectile dysfunction (ED) taking tadalafil 20 mg on demand or on an alternative dosing regimen, 3 times/week, and to assess changes in sexual behavior when the patients were exposed to the alternative regimen. DESIGN AND METHODS: Scheduled use versus on-demand regimen evaluation (SURE) is a multicenter, crossover, open-label study conducted in 14 European countries. Men with ED (N = 4,262) were randomized to tadalafil 20 mg on-demand treatment (maximum one dose per day and before sexual activity) or 3 times/week for 5-6 weeks. After a 1-week washout period, patients were crossed over to the alternative regimen for 5-6 weeks. RESULTS: Nearly half (47%) of the attempts on the on-demand regimen and 71% of the attempts on the 3 times/week treatment were performed by patients more than 4 hours post dosing. Sexual activity occurred throughout the week on both regimens, with the highest percentage of attempts made during the weekend (50% on on-demand and 48% on 3 times/week) and evening and morning hours. The efficacy of tadalafil was more than 70% mean-per-patient success rate (Sexual Encounter Profile question 3) regardless of the time interval post dosing. CONCLUSIONS: Patients on tadalafil changed their sexual behavior significantly when on an alternative dosing regimen (3 times/week) and had sexual attempts distributed over a wide period of time post dosing. A substantial number of sexual attempts were performed beyond the first 4 hours post dosing on both regimens (47% for on-demand and 71% for 3 times/week) and preferably in the evening and morning hours. Tadalafil was efficacious regardless of the time interval post dosing-i.e., up to 36 hours. The two treatment regimens, on-demand and 3 times/week, provide an additional option and unique flexibility in dosing for men with ED and their partners.

Carbolines↗

PubMed2003

Radical prostatectomy: a prospective comparison of oncological and functional results between open and laparoscopic approaches.

We prospectively compared, within the same center and during the same period of time, the perioperative parameters as well as the oncological and functional results of both open retropubic (ORP) and laparoscopic radical prostatectomy (LRP). From September 1999 to September 2001, 162 patients with prostate cancer were treated with radical prostatectomy, 77 using an open retropubic technique, and 85 by the laparoscopic extraperitoneal approach. We prospectively recorded pre-, per- and postoperative parameters and complications, and evaluated the carcinological and functional results, comparing both approaches. There were no significant differences in the preoperative characteristics of the two groups. Mean operative time was statistically longer with LRP than with ORP (288 vs 168 min, P<0.0001) but median blood loss was decreased (400 vs 1,300 ml, P<0.0001). Major complications occurred in a similar number of cases (5% vs 2.4%, NS) while minor complications occurred more frequently with ORP (24.6 vs 11.8%, P=0.003). Pathological examination revealed a similar distribution of Gleason scores and stages in each group. Positive surgical margins in pT2 cases occurred in 7.8% of LRP and 7.3% of ORP. Continence rates (no pad and no leakage at all) were similar (83.9% in ORP vs 80.7% in LRP, NS). Potency rates were similar after 1 year in patients undergoing bilateral nerve sparing (55% in ORP vs 65% in LRP, NS). However, patients operated by LRP had more spontaneous erections. We conclude that this prospective, comparative study shows that LRP, when performed in specialized centers, gives oncological and functional results comparable to open surgery.

Aged↗

PubMed2003

The place of surgery for vascular impotence in the third millennium.

PURPOSE: With the arrival of new oral therapies the question arises about the role of surgery in patients with vascular impotence. We compared the sexual satisfaction rate in patients with arterial and/or venous impotence treated with 4 surgical techniques with long-term followup. MATERIALS AND METHODS: Surgery was performed in 130 patients with vascular erectile dysfunction by 1 surgeon. Two young patients (2%) with traumatic arterial lesions underwent penile revascularization (group 1), while 128 with arterial and/or venous impotence were also treated with surgery, including 11 of 130 (8%) with deep dorsal penile vein resection (group 2), 39 (30%) with arterialization of the deep dorsal penile vein (group 3) and 78 (60%) with penile implants (group 4). Sexual satisfaction, defined as the possibility of satisfactory sexual intercourse without any additional treatment or pain, was evaluated by patient interview. RESULTS: Of the 130 patients 111 (85%) participated in the sexual life events interview, including 2 of 2 (100%) in group 1, 7 of 11 (63.6%) in group 2, 33 of 39 (85%) in group 3 and 69 of 78 (88%) in group 4. Mean followup was 50, 48, 46 and 54 months for groups 1 to 4, respectively. The sexual satisfaction rate was 2 of 2 (100%) for penile revascularization, 1 of 7 (14%) for venous resection, 4 of 33 (12%) for arterialization and 64 of 69 (93%) for penile implantation. Complications occurred in 9.5%, 12.5% and 20.5% of the patients in groups 2 to 4, respectively. CONCLUSIONS: Except for young patients with traumatic arterial lesions this study demonstrated the poor sexual satisfaction rate in impotent patients treated with the vasculogenic approach and the high rate of satisfaction in those treated with penile implants. Better selection criteria must be applied for vascular surgical treatment for impotence.

Adult↗

PubMed2002

Guidelines on erectile dysfunction.

The introduction of new oral therapies has completely changed the diagnostic and therapeutic approach to erectile dysfunction. A panel of experts in this field have developed guidelines for clinical evaluation and treatment based on the review of available scientific information.

Adult↗