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Re: Hypogonadism and Mortality in Aged Hospitalized Male Patients: A 5-Year Prospective Observational Study
Urological Survey Male and Female Sexual Function and Dysfunction; Andrology Re: Effect of Levitra on Sustenance of Erection (EROS): An Open-Label, Prospective, Multicenter, Single-Arm Study to Investigate Erection Duration Measured by Stopwatch with Flexible Dose Vardenafil Administered for 8 Weeks in Subjects with Erectile Dysfunction Y. S. Shin, S. W. Lee, K. Park, W. S. Chung, S. W. Kim, J. S. Hyun, D. G. Moon, S. K. Yang, J. K. Ryu, D. Y. Yang, K. H. Moon, K. S. Min and J. K. Park Department of Urology, Chonbuk National University Medical School and Institute for Medical Sciences, Chonbuk National University and Biomedical Research Institute, and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Departments of Urology, Gyeongsang National University School of Medicine, Jinju, Konkuk University School of Medicine, Chungju, Inha University School of Medicine, Incheon, Hallym University College of Medicine, Chuncheon, Yeungnam University College of Medicine, Daegu and Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Departments of Urology, Sungkyunkwan University School of Medicine, Catholic University of Korea College of Medicine and Korea University College of Medicine, and Ewha Womans University School of Medicine, Seoul, and Chonnam National University Medical School, Gwangju, Korea Int J Impot Res 2015; 27: 95e102. doi: 10.1038/ijir.2014.39
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25471318 Editorial Comment: In this interesting study the duration of erection leading to successful sexual intercourse was evaluated. Following the initial screening patients entered a 4-week treatment-free run-in phase and an 8-week treatment period during which they were instructed to attempt intercourse at least 4 times on 4 separate days. A total of 95 men were enrolled at 10 centers. After an 8-week treatment course the duration of erection leading to successful intercourse was 9.39 minutes. There were significant benefits with vardenafil in all domains of the International Index of Erectile Function. Secondary efficacy end points, including success rate of penetration, maintaining erection, ejaculation and satisfaction, were superior when patients were treated with vardenafil. These data provide guidance to the clinician and patient regarding the duration of an erection using vardenfil. Allen D. Seftel, MD
Re: Hypogonadism and Mortality in Aged Hospitalized Male Patients: A 5-Year Prospective Observational Study ~ oz, M. C. Macı´as, M. T. Guerrero, P. Tajada, P. Iglesias, F. Prado, E. Ridruejo, A. Mun valo and J. J. Dı´ez C. Garcı´a-Are Department of Endocrinology, Hospital Ramo n y Cajal, Madrid, and Departments of Geriatrics and Biochemistry, Hospital General, Segovia, Spain Exp Clin Endocrinol Diabetes 2015; 123: 589e593. doi: 10.1055/s-0035-1564119
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26600053 Editorial Comment: These authors studied all patients 65 years or older admitted to the hospital for any reason during 2010 and 2011. Serum testosterone (T) concentrations were quantified in all
0022-5347/16/1956-1854/0 THE JOURNAL OF UROLOGY® Ó 2016 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
1854
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2016.03.052 Vol. 195, 1854-1858, June 2016 Printed in U.S.A.
MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY
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patients, and hypogonadism was defined by the presence of serum T levels less than 200 ng/dl. Number of deaths and all cause and cardiovascular (CV) mortality were registered until December 31, 2014. During the study 150 patients were hospitalized, of whom 103 (68.7%) died during followup. Hypogonadism was positively associated with mortality (p ¼ 0.036). The percentage of hypogonadal patients was significantly higher (p ¼ 0.02) in patients who died in the hospital compared to those who died after discharge home and those who survived. CV disease was the main cause of death in 52 patients (50.5%). Hypogonadism was a strong independent predictor of all cause (adjusted multivariate analysis, HR 3.35, 95% CI 1.55e7.23, p ¼ 0.002) and CV mortality (HR 2.14, 95% CI 1.18e3.86, p ¼ 0.012). It is unclear if hypogonadism was the direct cause of the mortality in this study or an indirect marker of overall health. In either case low serum T, defined as less than 200 ng/dl in this series, is a potential marker for all cause and CV deaths. Allen D. Seftel, MD
Suggested Reading Li H, Benoit K, Wang W et al: Association between use of exogenous testosterone therapy and risk of venous thrombotic events among exogenous testosterone treated and untreated men with hypogonadism. J Urol 2016; 195: 1065.
Re: The Effect of Testosterone on Cardiometabolic Risk Factors in Atorvastatin-Treated Men with Late-Onset Hypogonadism R. Krysiak, W. Gilowski and B. Okopien Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice and Cardiology Department, Chrzanow District w, Poland Hospital, Chrzano Pharmacol Rep 2016; 68: 196e200. doi: 10.1016/j.pharep.2015.08.009
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26721373 Editorial Comment: This study was aimed at investigating whether testosterone treatment had an impact on cardiometabolic risk factors in statin treated men with late onset hypogonadism (LOH). The study included 31 men with LOH who had been treated for at least 6 months with 20 to 40 mg atorvastatin daily. Based on patient preference, atorvastatin treated patients were divided into 2 matched groups consisting of 16 patients receiving 100 mg testosterone enanthate intramuscularly weekly and 15 patients not treated with this hormone. Compared to the 12 age, weight and lipid matched statin na€ıve control subjects with LOH, atorvastatin treated patients were characterized by decreased levels of testosterone. In patients not receiving testosterone therapy plasma lipids, glucose homeostasis markers and plasma levels of the investigated risk factors remained at similar levels throughout the entire period of atorvastatin treatment. In atorvastatin na€ıve patients plasma levels of testosterone were increased and HDL cholesterol was decreased. When administered to atorvastatin treated subjects with LOH, testosterone decreased plasma levels of LDL cholesterol, uric acid, high sensitivity C-reactive protein, homocysteine and fibrinogen, and improved insulin sensitivity. This small study appears to suggest that there may be clinical benefits associated with combination therapy with a statin and testosterone in elderly men with LOH. Allen D. Seftel, MD
Suggested Reading Zhang LT, Shin YS, Kim JY et al: Could testosterone replacement therapy in hypogonadal men ameliorate anemia, a cardiovascular risk factor? An observational, 54-week cumulative registry study. J Urol 2016; 195: 1057.
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25471318 Editorial Comment: In this interesting study the duration of erection leading to successful sexual intercourse was evaluated. Following the initial screening patients entered a 4-week treatment-free run-in phase and an 8-week treatment period during which they were instructed to attempt intercourse at least 4 times on 4 separate days. A total of 95 men were enrolled at 10 centers. After an 8-week treatment course the duration of erection leading to successful intercourse was 9.39 minutes. There were significant benefits with vardenafil in all domains of the International Index of Erectile Function. Secondary efficacy end points, including success rate of penetration, maintaining erection, ejaculation and satisfaction, were superior when patients were treated with vardenafil. These data provide guidance to the clinician and patient regarding the duration of an erection using vardenfil. Allen D. Seftel, MD
Re: Hypogonadism and Mortality in Aged Hospitalized Male Patients: A 5-Year Prospective Observational Study ~ oz, M. C. Macı´as, M. T. Guerrero, P. Tajada, P. Iglesias, F. Prado, E. Ridruejo, A. Mun valo and J. J. Dı´ez C. Garcı´a-Are Department of Endocrinology, Hospital Ramo n y Cajal, Madrid, and Departments of Geriatrics and Biochemistry, Hospital General, Segovia, Spain Exp Clin Endocrinol Diabetes 2015; 123: 589e593. doi: 10.1055/s-0035-1564119
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26600053 Editorial Comment: These authors studied all patients 65 years or older admitted to the hospital for any reason during 2010 and 2011. Serum testosterone (T) concentrations were quantified in all
0022-5347/16/1956-1854/0 THE JOURNAL OF UROLOGY® Ó 2016 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
1854
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2016.03.052 Vol. 195, 1854-1858, June 2016 Printed in U.S.A.
MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY
1855
patients, and hypogonadism was defined by the presence of serum T levels less than 200 ng/dl. Number of deaths and all cause and cardiovascular (CV) mortality were registered until December 31, 2014. During the study 150 patients were hospitalized, of whom 103 (68.7%) died during followup. Hypogonadism was positively associated with mortality (p ¼ 0.036). The percentage of hypogonadal patients was significantly higher (p ¼ 0.02) in patients who died in the hospital compared to those who died after discharge home and those who survived. CV disease was the main cause of death in 52 patients (50.5%). Hypogonadism was a strong independent predictor of all cause (adjusted multivariate analysis, HR 3.35, 95% CI 1.55e7.23, p ¼ 0.002) and CV mortality (HR 2.14, 95% CI 1.18e3.86, p ¼ 0.012). It is unclear if hypogonadism was the direct cause of the mortality in this study or an indirect marker of overall health. In either case low serum T, defined as less than 200 ng/dl in this series, is a potential marker for all cause and CV deaths. Allen D. Seftel, MD
Suggested Reading Li H, Benoit K, Wang W et al: Association between use of exogenous testosterone therapy and risk of venous thrombotic events among exogenous testosterone treated and untreated men with hypogonadism. J Urol 2016; 195: 1065.
Re: The Effect of Testosterone on Cardiometabolic Risk Factors in Atorvastatin-Treated Men with Late-Onset Hypogonadism R. Krysiak, W. Gilowski and B. Okopien Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice and Cardiology Department, Chrzanow District w, Poland Hospital, Chrzano Pharmacol Rep 2016; 68: 196e200. doi: 10.1016/j.pharep.2015.08.009
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26721373 Editorial Comment: This study was aimed at investigating whether testosterone treatment had an impact on cardiometabolic risk factors in statin treated men with late onset hypogonadism (LOH). The study included 31 men with LOH who had been treated for at least 6 months with 20 to 40 mg atorvastatin daily. Based on patient preference, atorvastatin treated patients were divided into 2 matched groups consisting of 16 patients receiving 100 mg testosterone enanthate intramuscularly weekly and 15 patients not treated with this hormone. Compared to the 12 age, weight and lipid matched statin na€ıve control subjects with LOH, atorvastatin treated patients were characterized by decreased levels of testosterone. In patients not receiving testosterone therapy plasma lipids, glucose homeostasis markers and plasma levels of the investigated risk factors remained at similar levels throughout the entire period of atorvastatin treatment. In atorvastatin na€ıve patients plasma levels of testosterone were increased and HDL cholesterol was decreased. When administered to atorvastatin treated subjects with LOH, testosterone decreased plasma levels of LDL cholesterol, uric acid, high sensitivity C-reactive protein, homocysteine and fibrinogen, and improved insulin sensitivity. This small study appears to suggest that there may be clinical benefits associated with combination therapy with a statin and testosterone in elderly men with LOH. Allen D. Seftel, MD
Suggested Reading Zhang LT, Shin YS, Kim JY et al: Could testosterone replacement therapy in hypogonadal men ameliorate anemia, a cardiovascular risk factor? An observational, 54-week cumulative registry study. J Urol 2016; 195: 1057.