Biomedical subjects

Francesco Montorsi

Publications and source records attributed to Francesco Montorsi.

117 records · Page 7Linked to original sources

PubMed2002

The ageing male and erectile dysfunction.

Erectile dysfunction (ED) is common in the ageing man and reliable therapies are needed. The pathophysiology of erectile dysfunction in this patient group mainly includes chronic ischaemia, which triggers the deterioration of cavernous smooth muscle and the development of corporeal fibrosis. The assessment of the ageing man with erectile dysfunction who seeks medical treatment should include a thorough medical and sexual history, a systemic and focused physical examination and selected blood tests. An extensive discussion of the various therapeutic options should follow in order to allow the patient to identify the most suitable alternative. Oral drug therapy represents a safe and efficacious option for most elderly patients.

Aging↗

PubMed2002

A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation.

PURPOSE: We compared the efficacy of paroxetine alone and combined with sildenafil in patients complaining of premature ejaculation. MATERIALS AND METHODS: Enrolled in this study were 80 consecutive potent men 19 to 47 years old (mean age 34) with premature ejaculation but without any obvious organic cause. Pretreatment evaluation included a history, self-administration of the International Index of Erectile Function (IIEF) questionnaire, physical examination and the Meares-Stamey test to exclude genital tract infection. The initial 40 patients received 10 mg. paroxetine daily for 21 days and then 20 mg. as needed, that is 3 to 4 hours before planned sexual activity, for 6 months (group 1). The other group of 40 men received 10 mg. paroxetine daily for 21 days and then 20 mg. as needed plus 50 mg. sildenafil as needed, that is 1 hour before planned sexual activity, for 6 months (group 2). Patients were followed 3 and 6 months after beginning therapy and were evaluated using several general assessment questions, IIEF and ejaculatory latency time. RESULTS: Mean ejaculatory latency time +/- SE in group 1 was 0.33 +/- 0.04, 3.7 +/- 0.10 (p <0.01) and 4.2 +/- 0.03 (p <0.01) minutes at baseline, 3 and 6-month followup, while in group 2 it was 0.35 +/- 0.03, 4.5 +/- 0.07 (p <0.01) and 5.3 +/- 0.02 (p <0.001) minutes, respectively. When improvement in ejaculatory latency time was compared in the 2 groups, group 2 results proved to be significantly greater (p <0.05). Baseline, and 3 and 6-month mean intercourse satisfaction domain values of the IIEF were 9, 11 and 11 (p = 0.09, not significant), and 9, 11 and 14 (p <0.05) in groups 1 and 2, respectively. Group 2 patients reported significantly greater intercourse satisfaction than those in group 1 (p <0.05). At baseline, 3 and 6 months there was a mean of 0.9 +/- 0.1, 1.7 +/- 0.3 (not significant) and 2.5 +/- 0.3 (p <0.01) coitus episodes weekly in group 1, and 1 +/- 0.2, 2.3 +/- 0.3 (p <0.01) and 3.2 +/- 0.1 (p <0.001) in group 2, respectively. Group 2 patients reported a significantly higher number of coitus episodes weekly (p <0.05). Side effects in the 40 group 1 cases included anejaculation in 1 (2.5%), gastrointestinal upset and/or nausea in 5 (12.5%), headache in 4 (10%) and decreased libido in 2 (5%). Side effects in the 40 group 2 cases included anejaculation in 1 (2.5%), headache in 8 (20%), gastrointestinal upset and/or nausea in 6 (15%) and flushing in 6 (15%). Group 2 patients reported significantly more headaches (p <0.01) and flushing episodes (p <0.001) than those in group 1. After 6 months of treatment 33 men (82.5%) in group 1 and 36 (90%) in group 2 were willing to continue therapy (not significant). CONCLUSIONS: Paroxetine combined with sildenafil appears to provide significantly better results in terms of ejaculatory latency time and intercourse satisfaction versus paroxetine alone in potent patients with premature ejaculation. However, combined treatment is associated with a mild increase in drug related side effects.

Adult↗

PubMed2002

A 4-year update on the safety of sildenafil citrate (Viagra).

Clinical studies have demonstrated that sildenafil citrate (Viagra) is an effective and well-tolerated oral treatment for erectile dysfunction. Despite its established safety profile, concern about its cardiovascular safety persists among some physicians and the general public. This concern has stemmed primarily from sporadic reports of adverse events published in the literature and sensationalized by the media. However, the only absolute contraindication for sildenafil is concurrent use of nitrates. Because sildenafil has been on the market for 4 years and under clinical investigation for even longer, we can now evaluate its long-term safety in men who have been taking the drug for several years. We review this issue from 3 perspectives. First, we reassess the overall safety profile of sildenafil by reviewing the initial controlled clinical trials and open-label studies. We present new data from patients who have been exposed to sildenafil for up to 4.5 years. We also evaluate the results from independent postmarketing studies. Second, we review the cardiovascular-specific results from the clinical trials, long-term extension, and postmarketing studies. Lastly, we review the specific effects on the visual system based on findings from studies conducted during drug development and post marketing.

Cardiovascular System↗

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↗

PubMed2002

Vestibular flap urethroplasty for strictures of the female urethra. Impact on symptoms and flow patterns.

INTRODUCTION: To assess the impact on subjective symptoms and flow patterns of a new surgical technique designed to correct strictures of the female distal urethra and urethral meatus. MATERIALS AND METHODS: Seventeen patients (mean age 41.2 years) with symptomatic strictures of either the distal urethra or the urethral meatus entered the study. Patients reporting an AUA score >20, a diagnosis of bladder outlet obstruction according to the Abrams-Griffiths nomogram and the Schaefer linPURR diagram, urethral calibration <20 F and radiologic evidence of the stricture, were considered eligible for surgery. A pedicled flap isolated from the vaginal vestibule was anastomosed with two longitudinal running sutures along the two edges of an opened urethra. RESULTS: In all cases, diffuse fibrosis of the urethral wall was demonstrated at histological examination. Mean (+/- SE) preoperative and 12-month follow-up results were as follows: AUA score 25.2 +/- 2.1 vs. 8.4 +/- 1.2 (p < 0.0001); peak flow rate (ml/s) 13.2 +/- 1.2 vs. 36 +/- 1.5 (p < 0.0001); detrusor pressure at Q(max) (cm H(2)O) 45 +/- 5 vs. 17 +/- 3; residual urine volume (ml) 120 +/- 5 vs. 20 +/- 5 (p < 0.0001). Fifteen patients (88%) showed an unobstructed Abrams-Griffiths nomogram and a Schaefer linPURR diagram postoperatively. All but 2 cases (88%) could be calibrated at 28 F postoperatively and showed a normal urethral lumen at voiding cystourethrography. Complications were never noted. CONCLUSIONS: Female patients with symptomatic strictures of the distal urethra or urethral meatus may be treated efficaciously and safely with vestibular flap urethroplasty. Although this technique must be performed under optical magnification it is easy to perform and is not associated with complications.

Adolescent↗

PubMed2002

[Diagnostic value of ultrasound-guided anastomotic biopsies in patients with high PSA (> or = 0,4 ng/ml) after radical prostatectomy].

OBJECTIVES: The authors report their experience on the use of a high number of biopsies for the diagnosis of a vesicourethral anastomosis tumor recurrence in patients who underwent radical prostatectomy with a PSA elevation. METHODS: Sixty-five patients with PSA > or = 0.4 ng/ml after radical prostatectomy received 6 to 8 transrectal ultrasound (TRUS) guided biopsies of the vesicourethral anastomosis. RESULTS: The biopsy scheme with 6 random anastomotic biopsies plus additional biopsies through TRUS detectable lesions was able to diagnose a local recurrence in more than 60% of the cases. In presence of a post-operative PSA < 1.0 ng/ml and in absence of ultrasound detectable or palpable lesions a local neoplastic recurrence was detected in 58% of the cases. In presence of a palpable or ultrasound visible lesions, the detection rate increases to 80% of the cases.

Biopsy↗

PubMed2002

Phosphodiesterase inhibitors for the treatment of erectile dysfunction.

The key event in penile erection is relaxation of the cavernous smooth muscle. As phosphodiesterases (PDEs) are key enzymes of the signaling pathway, knowledge about cavernous PDEs is of major importance in understanding the effects and side-effect profile of new and selective pharmacological agents for erectile dysfunction. Experimental studies revealed that gene transcripts of 14 different PDE isoenzymes are present in human cavernous tissue. Of these, PDE3 and 5 have the most prominent functional role. The effects and side effects of clinically available PDE5 inhibitors can be explained both by the distribution pattern of these two isoenzymes in various tissues, by direct inhibition of PDE5 and indirect inhibition of PDE3 in various tissues, and by the putative selectivity for a cavernous-specific PDE splice variant.

3',5'-Cyclic-AMP Phosphodiesterases↗

PubMed2002

[Role of ultrasonography-guided prostatic biopsy of hypoechoic areas associated with systematic biopsies in patients with normal and high PSA levels].

OBJECTIVE: The aim of the study is to evaluate the need to perform directed biopsies to hypoechoic areas at transrectal ultrasound associated with a prostatic mapping in patients with normal and elevated levels of PSA. MATERIALS AND METHODS: Since January 1987, 517 consecutive patients (mean age: 65.5 +/- 5.2 yrs) underwent selective prostatic biopsies of hypoechoic areas and systematic sextant biopsies with 10 samples in patients with a prostatic volume < 60 g and 12 samples in prostatic volume > 60 g. RESULTS: The median PSA value was 7.2 +/- 4.6 ng/ml (SD). 52% of the patients had a positive digital rectal examination. Cancer was detected in 47% of the patients (245/517), in 18% (14/78) of patients with PSA level < 4.0 ng/ml, in 42% (109/256) with PSA level from 4 to 10 ng/ml, in 66% (122/183) with PSA > 10 ng/ml. The PSA value was statistically higher (PSA = 14.9 +/- 17) in patients with positive prostatic biopsies compared to patients with negative biopsies (PSA = 8.5 +/- 8.3 ng/ml) (p > 0.0001). The PPV (positive predictive value) of the hypoechoic lesions was 36% (187/517). Cancer was detected only in directed biopsies of the hypoechoic areas regardless of PSA value in the 20% of patients (49/245). Sextant biopsies were positive with negative directed biopsies in 24% (58/245) of the patients, while both directed and sextant biopsies were positive in 56% (138/245) of the patients. COMMENTS: The hypoechoic lesion is the prostatic area in which prostatic cancer is most likely to be located in spite of the fact that the PPV of a hypoechoic area is less than 40%. The combination of sextant and lesion-directed biopsies maximizes the detection rate using the lowest possible number of biopsy cores. In the case of a TRUS visible lesion, the optimal number and placement of added systematic biopsies is yet to be defined. Due to the multifocality of prostate cancer, in the future, it is probable that, by adding more biopsies to the sextant standard scheme, the necessity of biopsying single small hypoechoic lesions will no longer be necessary.

Aged↗

PubMed2002

[Role of prostate fossa ultrasonography in the diagnosis of local recurrence after radical prostatectomy in case of PSA failure].

OBJECTIVES: The aim of this study is to verify the diagnostic accuracy of transrectal ultrasound (TRUS) of vesico-urethral anastomosis in patients with PSA elevation (> or = 0.2 ng/mL) after radical prostatectomy, who received 4-6 random anastomotic biopsies of the prostatic fossa plus additional biopsies directed to TRUS detectable lesions. MATERIAL AND METHODS: Since 1992 up to now, 102 patients (mean age: 68.3 +/- 5.4 years) with PSA elevation after radical prostatectomy underwent TRUS of the vesico-urethral anastomosis and 4-6 TRUS-guided random biopsies plus 1-2 additional biopsies directed to TRUS detectable lesions. Pathologic stage was B (ASS classification) in 60% of cases, C in 36% and D in 4% (patients without hormonal treatment who underwent TRUS-guided biopsy because of TRUS detectable or palpable lesion). RESULTS: The mean PSA at biopsy time was 2.1 +/- 4.6 (SD) ng/mL (range: 0.2-31.6 ng/mL) with median PSA of 0.9 ng/mL. DRE was positive in 37% of cases, while TRUS was positive in 73%. Recurrent adenocarcinoma was detected in 51% of all patients and in 45% (26/57) of patients with PSA < 1.0 ng/mL. TRUS sensitivity was higher (80%) than DRE (50%), but specificity was lower (37% vs 81%). The positive predictive value of TRUS detectable lesion was 60%. TRUS sensitivity and specificity increase with PSA elevation and sonographic aspects of prostatic fossa are statistically correlated with histology when PSA > 1.2 ng/mL. CONCLUSIONS: TRUS of the vesico-urethral anastomosis seems to be more sensitive but less specific than DRE for prostatic cancer local recurrence. More than half of TRUS detectable lesions is positive at biopsy. TRUS and TRUS-guided biopsy accuracy are directly correlated with PSA elevation.

Aged↗