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Re: Erectile Dysfunction and Cardiovascular Events in Diabetic Men: A Meta-Analysis of Observational Studies
MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY
Re: Erectile Dysfunction and Cardiovascular Events in Diabetic Men: A Meta-Analysis of Observational Studies T. Yamada, K. Hara, H. Umematsu, R. Suzuki and T. Kadowaki Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan PLoS One 2012; 7: e43673.
Background: Several studies have shown that erectile dysfunction (ED) influences the risk of cardiovascular events (CV events). However, a meta–analysis of the overall risk of CV events associated with ED in patients with diabetes has not been performed. Methodology/Principal Findings: We searched MEDLINE and the Cochrane Library for pertinent articles (including references) published between 1951 and April 22, 2012. English language reports of original observational cohort studies and cross-sectional studies were included. Pooled effect estimates were obtained by random effects meta-analysis. A total of 3,791 CV events were reported in 3 cohort studies and 9 cross-sectional studies (covering 22,586 subjects). Across the cohort studies, the overall odds ratio (OR) of diabetic men with ED versus those without ED was 1.74 (95% confidence interval [CI]: 1.34 –2.27; P⬍0.001) for CV events and 1.72 (95% CI: 1.5–1.98; P⬍0.001) for coronary heart disease (CHD). The funnel plot, Begg’s test, and Egger’s test did not show evidence of publication bias (all P⬎0.05). Moreover, meta-regression analysis found no relationship between the method used to assess ED (questionnaire or interview), mean age, mean hemoglobin A(1c), mean body mass index, or mean duration of diabetes and the risk of CV events or CHD. In the cross-sectional studies, the OR of diabetic men with ED versus those without ED was 3.39 (95% CI: 2.58 – 4.44; P⬍0.001) for CV events (N ⫽ 9), 3.43 (95% CI: 2.46 – 4.77; P⬍0.001) for CHD (N ⫽ 7), and 2.63 (95% CI: 1.41– 4.91; P ⫽ 0.002) for peripheral vascular disease (N ⫽ 5). Conclusion/Significance: ED was associated with an increased risk of CV events in diabetic patients. Prevention and early detection of cardiovascular disease are important in the management of diabetes, especially in view of the rapid increase in its prevalence.
Re: Erectile Dysfunction as a Cardiovascular Risk Factor in Patients with Diabetes G. Gandaglia, A. Salonia, N. Passoni, P. Montorsi, A. Briganti and F. Montorsi Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy Endocrine 2012; Epub ahead of print.
Erectile dysfunction (ED) is a highly prevalent disorder among patients with diabetes mellitus (DM). In most cases, ED is considered a vascular disease and its development is significantly related to the exposure to CVD risk factors. In this context, ED and coronary artery disease (CAD) have been proposed as different manifestations of the same systemic disease; in nondiabetic patients, ED has progressively emerged as an important sentinel marker of the subsequent onset of CVD events. The aim of this review was to evaluate the association between ED and CAD in diabetic patients and to evaluate the role of ED as an independent CVD risk factor in these patients. Three large prospective studies confirmed that ED is a powerful predictor of CAD and cardiac mortality in patients with DM. Overall, diabetic patients with ED had roughly 1.4-fold higher risk of CAD as compared with those without ED. Interestingly, in diabetic patients, CAD is often silent and CAD screening according to the current guidelines can miss up to 40 % patients with occult myocardial perfusion abnormalities. Indeed, patients with ED have higher risk of silent myocardial ischemia compared to those without ED, and when ED is added to the risk factors, it can even improve the sensitivity of screening for asymptomatic CAD. Therefore, ED should be considered an independent CVD risk factor, and it could improve the identification of diabetic patients suitable for screening, leading to an early detection of CAD, and thus potentially enhancing the therapeutic effectiveness. Editorial Comment: These 2 studies are useful additions to the literature. They present further evidence for ED as a predictor of CVD events, specifically in diabetic men. Many
1037
1038
MALE INFERTILITY
high quality studies are cited, and the data appear to be quite convincing. Thus, ED should be assessed in all men and, importantly, men with diabetes. Allen D. Seftel, M.D.
Male Infertility Re: Tissue Engineering of Reproductive Tissues and Organs A. Atala Department of Urology, Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina Fertil Steril 2012; 98: 21–29.
Regenerative medicine and tissue engineering technology may soon offer new hope for patients with serious injuries and end-stage reproductive organ failure. Scientists are now applying the principles of cell transplantation, material science, and bioengineering to construct biological substitutes that can restore and maintain normal function in diseased and injured reproductive tissues. In addition, the stem cell field is advancing, and new discoveries in this field will lead to new therapeutic strategies. For example, newly discovered types of stem cells have been retrieved from uterine tissues such as amniotic fluid and placental stem cells. The process of therapeutic cloning and the creation of induced pluripotent cells provide still other potential sources of stem cells for cell-based tissue engineering applications. Although stem cells are still in the research phase, some therapies arising from tissue engineering endeavors that make use of autologous adult cells have already entered the clinic. This article discusses these tissue engineering strategies for various organs in the male and female reproductive tract. Editorial Comment: The era of growing organs from scratch is nigh, and Atala is leading the way. This is a superb, enjoyable and thoroughly readable overview of where we are in tissue engineering for reproductive organs. The future truly is now. Craig Niederberger, M.D.
Re: Side Effects of Intradetrusor Botulinum Toxin Injections on Ejaculation and Fertility in Men with Spinal Cord Injury: Preliminary Findings R. Caremel, F. Courtois, K. Charvier, A. Ruffion and N. M. Journel Hospices Civils de Lyon, Saint-Genis Laval, France BJU Int 2012; 109: 1698 –1702.
Objective: To investigate the effect of botulinum neurotoxin A on ejaculation potential and fertility. Intradetrusor injection of botulinum neurotoxin A is most commonly used nowadays to treat overactive bladder in patients with spinal cord injury (SCI). Patients and Methods: Retrospective analyses were carried out of 11 patients with complete lesions from C5 to T6 who had received botulinum (BT) injections for their overactive bladder and who had undergone ejaculation tests before and after BT treatment. Results: BT treatment was found effective in improving bladder function in up to 85% of the cases. While no patients maintained natural ejaculation following their SCI, BT treatment was found to increase the incidence of retrograde ejaculation (vibrostimulation) in 46% of cases and to diminish semen volume in 77% of cases, from an average of 1.8 mL to 1 mL. Semen quality was slightly improved following BT treatment, sperm mobility increased in 67% of cases, sperm vitality in 50% and semen culture improved in 43%. Conclusions: BT treatment has beneficial and detrimental effects on ejaculation function. The detrimental effects involve retrograde ejaculation and reduced
Re: Erectile Dysfunction and Cardiovascular Events in Diabetic Men: A Meta-Analysis of Observational Studies T. Yamada, K. Hara, H. Umematsu, R. Suzuki and T. Kadowaki Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan PLoS One 2012; 7: e43673.
Background: Several studies have shown that erectile dysfunction (ED) influences the risk of cardiovascular events (CV events). However, a meta–analysis of the overall risk of CV events associated with ED in patients with diabetes has not been performed. Methodology/Principal Findings: We searched MEDLINE and the Cochrane Library for pertinent articles (including references) published between 1951 and April 22, 2012. English language reports of original observational cohort studies and cross-sectional studies were included. Pooled effect estimates were obtained by random effects meta-analysis. A total of 3,791 CV events were reported in 3 cohort studies and 9 cross-sectional studies (covering 22,586 subjects). Across the cohort studies, the overall odds ratio (OR) of diabetic men with ED versus those without ED was 1.74 (95% confidence interval [CI]: 1.34 –2.27; P⬍0.001) for CV events and 1.72 (95% CI: 1.5–1.98; P⬍0.001) for coronary heart disease (CHD). The funnel plot, Begg’s test, and Egger’s test did not show evidence of publication bias (all P⬎0.05). Moreover, meta-regression analysis found no relationship between the method used to assess ED (questionnaire or interview), mean age, mean hemoglobin A(1c), mean body mass index, or mean duration of diabetes and the risk of CV events or CHD. In the cross-sectional studies, the OR of diabetic men with ED versus those without ED was 3.39 (95% CI: 2.58 – 4.44; P⬍0.001) for CV events (N ⫽ 9), 3.43 (95% CI: 2.46 – 4.77; P⬍0.001) for CHD (N ⫽ 7), and 2.63 (95% CI: 1.41– 4.91; P ⫽ 0.002) for peripheral vascular disease (N ⫽ 5). Conclusion/Significance: ED was associated with an increased risk of CV events in diabetic patients. Prevention and early detection of cardiovascular disease are important in the management of diabetes, especially in view of the rapid increase in its prevalence.
Re: Erectile Dysfunction as a Cardiovascular Risk Factor in Patients with Diabetes G. Gandaglia, A. Salonia, N. Passoni, P. Montorsi, A. Briganti and F. Montorsi Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy Endocrine 2012; Epub ahead of print.
Erectile dysfunction (ED) is a highly prevalent disorder among patients with diabetes mellitus (DM). In most cases, ED is considered a vascular disease and its development is significantly related to the exposure to CVD risk factors. In this context, ED and coronary artery disease (CAD) have been proposed as different manifestations of the same systemic disease; in nondiabetic patients, ED has progressively emerged as an important sentinel marker of the subsequent onset of CVD events. The aim of this review was to evaluate the association between ED and CAD in diabetic patients and to evaluate the role of ED as an independent CVD risk factor in these patients. Three large prospective studies confirmed that ED is a powerful predictor of CAD and cardiac mortality in patients with DM. Overall, diabetic patients with ED had roughly 1.4-fold higher risk of CAD as compared with those without ED. Interestingly, in diabetic patients, CAD is often silent and CAD screening according to the current guidelines can miss up to 40 % patients with occult myocardial perfusion abnormalities. Indeed, patients with ED have higher risk of silent myocardial ischemia compared to those without ED, and when ED is added to the risk factors, it can even improve the sensitivity of screening for asymptomatic CAD. Therefore, ED should be considered an independent CVD risk factor, and it could improve the identification of diabetic patients suitable for screening, leading to an early detection of CAD, and thus potentially enhancing the therapeutic effectiveness. Editorial Comment: These 2 studies are useful additions to the literature. They present further evidence for ED as a predictor of CVD events, specifically in diabetic men. Many
1037
1038
MALE INFERTILITY
high quality studies are cited, and the data appear to be quite convincing. Thus, ED should be assessed in all men and, importantly, men with diabetes. Allen D. Seftel, M.D.
Male Infertility Re: Tissue Engineering of Reproductive Tissues and Organs A. Atala Department of Urology, Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina Fertil Steril 2012; 98: 21–29.
Regenerative medicine and tissue engineering technology may soon offer new hope for patients with serious injuries and end-stage reproductive organ failure. Scientists are now applying the principles of cell transplantation, material science, and bioengineering to construct biological substitutes that can restore and maintain normal function in diseased and injured reproductive tissues. In addition, the stem cell field is advancing, and new discoveries in this field will lead to new therapeutic strategies. For example, newly discovered types of stem cells have been retrieved from uterine tissues such as amniotic fluid and placental stem cells. The process of therapeutic cloning and the creation of induced pluripotent cells provide still other potential sources of stem cells for cell-based tissue engineering applications. Although stem cells are still in the research phase, some therapies arising from tissue engineering endeavors that make use of autologous adult cells have already entered the clinic. This article discusses these tissue engineering strategies for various organs in the male and female reproductive tract. Editorial Comment: The era of growing organs from scratch is nigh, and Atala is leading the way. This is a superb, enjoyable and thoroughly readable overview of where we are in tissue engineering for reproductive organs. The future truly is now. Craig Niederberger, M.D.
Re: Side Effects of Intradetrusor Botulinum Toxin Injections on Ejaculation and Fertility in Men with Spinal Cord Injury: Preliminary Findings R. Caremel, F. Courtois, K. Charvier, A. Ruffion and N. M. Journel Hospices Civils de Lyon, Saint-Genis Laval, France BJU Int 2012; 109: 1698 –1702.
Objective: To investigate the effect of botulinum neurotoxin A on ejaculation potential and fertility. Intradetrusor injection of botulinum neurotoxin A is most commonly used nowadays to treat overactive bladder in patients with spinal cord injury (SCI). Patients and Methods: Retrospective analyses were carried out of 11 patients with complete lesions from C5 to T6 who had received botulinum (BT) injections for their overactive bladder and who had undergone ejaculation tests before and after BT treatment. Results: BT treatment was found effective in improving bladder function in up to 85% of the cases. While no patients maintained natural ejaculation following their SCI, BT treatment was found to increase the incidence of retrograde ejaculation (vibrostimulation) in 46% of cases and to diminish semen volume in 77% of cases, from an average of 1.8 mL to 1 mL. Semen quality was slightly improved following BT treatment, sperm mobility increased in 67% of cases, sperm vitality in 50% and semen culture improved in 43%. Conclusions: BT treatment has beneficial and detrimental effects on ejaculation function. The detrimental effects involve retrograde ejaculation and reduced