- Email: [email protected]
Comment to “Association of nocturnal penile rigidity with testosterone, metabolic syndrome, and other variables: A prospective cross-sectional pilot study”
Actas Urol Esp. 2011;35(8):468---469
Actas Urológicas Españolas www.elsevier.es/actasuro
COMMENTARY
Comment to ‘‘Association of nocturnal penile rigidity with testosterone, metabolic syndrome, and other variables: A prospective cross-sectional pilot study’’夽 Comentario a «Asociación de la rigidez peneana nocturna con testosterona, síndrome metabólico y otras variables: un estudio piloto prospectivo transversal» R. Vela-Navarrete Servicio de Urología, Fundación Jiménez Díaz, Madrid, Spain
The extraordinary professional and scientific appeal of the exclusively male condition (gender health), known by the name of erectile dysfunction, has motivated the interest of many specialties: most of them have, no doubt, additional knowledge to better understand and treat this process, more so since it is known that erectile dysfunction often comes very particularly ‘‘accompanied’’ by vascular pathological factors. It is now, apparently, a progressive concept to invent syndromes very far from the postulates set by the traditional anatomo-clinical medicine: a defined and concrete clinical syndrome, sometimes referred exclusively to a population group or genre, having an also specific and concrete anatomical lesion as a basis. The concept of metabolic syndrome was born around a singular type of obesity associated with hypertension, lipid metabolism disorders, and type 2 or insulin resistant diabetes. Progressively, this syndrome has been growing and has eventually included, thanks to initiatives originated in the field of Endocrinology,1 androgen deficiency and erectile dysfunction. When analyzing the evolution of the metabolic syndrome from the perspective of urological clinic, it is found that the cornerstone of the same, type 2 diabetes, is almost exclusively male prevalent, and the rest of the data are much more common in
夽 Please cite this article as: Vela-Navarrete R. Comentario a ‘‘Asociación de la rigidez peneana nocturna con testosterona, síndrome metabólico y otras variables: un estudio piloto prospectivo transversal’’. Actas Urol Esp. 2011;35:468---9. E-mail address: [email protected]
men than in women, to conclude that, apparently, we are talking about male aging.2 The current compromise of Urology and its gender health program is totally in opposition to other professional initiatives, such as those that gradually expand the boundaries of the metabolic syndrome. So far, the usual urological practice has treated the common man and, especially, the aged male, about over 50 years of age, ‘‘to pieces’’, organ by organ: in some it would be in charge of their prostatism, in others of the potential risk of high PSA or erectile or ejaculation dysfunctions, etc. Daily urological practice rarely looks at the patient fully, entirely, at least asking for their blood pressure and hypotensive or antihypertensive medications, diabetes, antiarrhythmics, weight, body mass index (BMI), etc. This overview of the urological patient has been so negative that the concept of ‘‘the ill man behind the prostate’’ has been coined and, in opposition, and now from a modern, progressive, gender health perspective that of retraining the urologist into male generalist.3 And it is now when this future project begins to be recognized as a cornerstone project for the future urological medical practice, when those urologists more interested in a comprehensive view of the patient, represented by andrological practice, start to recognize the similarities between the metabolic syndrome and the urological syndrome that defines the aged man.2 The work by Drs. Rajmil et al.4 on the association of nocturnal penile rigidity with serum testosterone levels, metabolic syndrome, and other variables is the best indicator of this transition that warns on gender health and the
2173-5786/$ – see front matter © 2011 AEU. Published by Elsevier España, S.L. All rights reserved.
Comment to ‘‘Association of nocturnal penile rigidity with testosterone, metabolic syndrome, and other variables ever-increasing interest of Urology in gender health and, especially, in the health of the aged male. This work takes as its point of analysis of correlations and comorbidities, 234 men complaining of erectile function disorders that are subject to a study of existence and intensity of the rigidity of nocturnal erections (NPTR) with the appropriate instrument (Rigiscan). These findings are compared with serum testosterone levels, metabolic syndrome, and BMI. The findings are consistent with the expectations and what was previously reported in the literature, but there are several extremely important points that, as indicated by the same authors, lack of statistical power due to the sample being small. There is indeed a limitation in this analysis, mainly related to the age of the population included, between 18 and 85 years, an absolutely heterogeneous population group. Certainly, if the entire population included had been older than 50, the weaknesses of the statistical analysis would have been overcome, with strong evidence that relations exist between age and erectile dysfunction, testosterone levels, type 2 diabetes, hypertension, markers of endothelial dysfunction, inflammatory, etc.5 Ultimately, this work should be assessed not only from the traditional view of its scientific quality, but from the new perspective that invites the
469
urologist, in general, and even more the person specifically dedicated to Andrology, to consider the urological patient holistically, increasingly approaching in their daily work to the generalist proposal of men.
References 1. Zitzman M. Testosterone deficiency, insulin resistance and the metabolic syndrome. Nat Rev Endocrinol. 2009;5: 673---81. 2. Vela Navarrete R. El síndrome urológico del envejecimiento masculino: una visión integral e integradora. Tiempos Médicos. 2010;667:3---5. 3. Kirby RS, Kirby MG, Farah RN. Men’s Health. Oxford: ISIS Medical Media; 1999. 4. Rajmil O, Fernández M, Blasco A, Arrús JA, Monta˜ nés R, Rodríguez-Espinosa J. Asociación de la rigidez peneana nocturna con testosterona, síndrome metabólico y otras variables: un estudio piloto prospectivo transversal. Actas Urol Esp. 2011;35:459---67. 5. Vela Navarrete R, García Cardoso JV, Pardo Montero M, Jiménez Mateos-Cáceres P, Lopez Farré A. Testosterona, función endotelial, salud cardiovascular y androgenodeficiencia del varón a˜ noso. Arch Esp Urol. 2009;62:173---8.
Actas Urológicas Españolas www.elsevier.es/actasuro
COMMENTARY
Comment to ‘‘Association of nocturnal penile rigidity with testosterone, metabolic syndrome, and other variables: A prospective cross-sectional pilot study’’夽 Comentario a «Asociación de la rigidez peneana nocturna con testosterona, síndrome metabólico y otras variables: un estudio piloto prospectivo transversal» R. Vela-Navarrete Servicio de Urología, Fundación Jiménez Díaz, Madrid, Spain
The extraordinary professional and scientific appeal of the exclusively male condition (gender health), known by the name of erectile dysfunction, has motivated the interest of many specialties: most of them have, no doubt, additional knowledge to better understand and treat this process, more so since it is known that erectile dysfunction often comes very particularly ‘‘accompanied’’ by vascular pathological factors. It is now, apparently, a progressive concept to invent syndromes very far from the postulates set by the traditional anatomo-clinical medicine: a defined and concrete clinical syndrome, sometimes referred exclusively to a population group or genre, having an also specific and concrete anatomical lesion as a basis. The concept of metabolic syndrome was born around a singular type of obesity associated with hypertension, lipid metabolism disorders, and type 2 or insulin resistant diabetes. Progressively, this syndrome has been growing and has eventually included, thanks to initiatives originated in the field of Endocrinology,1 androgen deficiency and erectile dysfunction. When analyzing the evolution of the metabolic syndrome from the perspective of urological clinic, it is found that the cornerstone of the same, type 2 diabetes, is almost exclusively male prevalent, and the rest of the data are much more common in
夽 Please cite this article as: Vela-Navarrete R. Comentario a ‘‘Asociación de la rigidez peneana nocturna con testosterona, síndrome metabólico y otras variables: un estudio piloto prospectivo transversal’’. Actas Urol Esp. 2011;35:468---9. E-mail address: [email protected]
men than in women, to conclude that, apparently, we are talking about male aging.2 The current compromise of Urology and its gender health program is totally in opposition to other professional initiatives, such as those that gradually expand the boundaries of the metabolic syndrome. So far, the usual urological practice has treated the common man and, especially, the aged male, about over 50 years of age, ‘‘to pieces’’, organ by organ: in some it would be in charge of their prostatism, in others of the potential risk of high PSA or erectile or ejaculation dysfunctions, etc. Daily urological practice rarely looks at the patient fully, entirely, at least asking for their blood pressure and hypotensive or antihypertensive medications, diabetes, antiarrhythmics, weight, body mass index (BMI), etc. This overview of the urological patient has been so negative that the concept of ‘‘the ill man behind the prostate’’ has been coined and, in opposition, and now from a modern, progressive, gender health perspective that of retraining the urologist into male generalist.3 And it is now when this future project begins to be recognized as a cornerstone project for the future urological medical practice, when those urologists more interested in a comprehensive view of the patient, represented by andrological practice, start to recognize the similarities between the metabolic syndrome and the urological syndrome that defines the aged man.2 The work by Drs. Rajmil et al.4 on the association of nocturnal penile rigidity with serum testosterone levels, metabolic syndrome, and other variables is the best indicator of this transition that warns on gender health and the
2173-5786/$ – see front matter © 2011 AEU. Published by Elsevier España, S.L. All rights reserved.
Comment to ‘‘Association of nocturnal penile rigidity with testosterone, metabolic syndrome, and other variables ever-increasing interest of Urology in gender health and, especially, in the health of the aged male. This work takes as its point of analysis of correlations and comorbidities, 234 men complaining of erectile function disorders that are subject to a study of existence and intensity of the rigidity of nocturnal erections (NPTR) with the appropriate instrument (Rigiscan). These findings are compared with serum testosterone levels, metabolic syndrome, and BMI. The findings are consistent with the expectations and what was previously reported in the literature, but there are several extremely important points that, as indicated by the same authors, lack of statistical power due to the sample being small. There is indeed a limitation in this analysis, mainly related to the age of the population included, between 18 and 85 years, an absolutely heterogeneous population group. Certainly, if the entire population included had been older than 50, the weaknesses of the statistical analysis would have been overcome, with strong evidence that relations exist between age and erectile dysfunction, testosterone levels, type 2 diabetes, hypertension, markers of endothelial dysfunction, inflammatory, etc.5 Ultimately, this work should be assessed not only from the traditional view of its scientific quality, but from the new perspective that invites the
469
urologist, in general, and even more the person specifically dedicated to Andrology, to consider the urological patient holistically, increasingly approaching in their daily work to the generalist proposal of men.
References 1. Zitzman M. Testosterone deficiency, insulin resistance and the metabolic syndrome. Nat Rev Endocrinol. 2009;5: 673---81. 2. Vela Navarrete R. El síndrome urológico del envejecimiento masculino: una visión integral e integradora. Tiempos Médicos. 2010;667:3---5. 3. Kirby RS, Kirby MG, Farah RN. Men’s Health. Oxford: ISIS Medical Media; 1999. 4. Rajmil O, Fernández M, Blasco A, Arrús JA, Monta˜ nés R, Rodríguez-Espinosa J. Asociación de la rigidez peneana nocturna con testosterona, síndrome metabólico y otras variables: un estudio piloto prospectivo transversal. Actas Urol Esp. 2011;35:459---67. 5. Vela Navarrete R, García Cardoso JV, Pardo Montero M, Jiménez Mateos-Cáceres P, Lopez Farré A. Testosterona, función endotelial, salud cardiovascular y androgenodeficiencia del varón a˜ noso. Arch Esp Urol. 2009;62:173---8.