6
ESSM
Today
AUA 2014 Men’s health highlights
of Metabolic syndrome was defined accord-
ing to the criteria of the International Diabetes
Federation. The NAFLD diagnosis was assessed
by hepatic ultrasound, performed by a radiolo-
gist (blinded) according to the hepatic steato-
sis index (HSI). A higher value of 0.36 in the
HSI was considered diagnostic of NAFLD. The
analyses of the results found that the presence
of hepatic steatosis was greater in patients
with severe LUTS compared with patients with
moderate and mild LUTS (37.62% vs. 36.07%
and 34.69% respectively, p <0.01). In logistic
regression analysis, HSI values above 0.36
were found to be an independent predictor for
moderate to severe LUTS, after adjustment of
the presence of metabolic syndrome (OR =
2.92, p <0.01). They concluded that those
subjects with metabolic syndrome and HSI>
0.36 in ultrasound, showed up to 2 times more
likely to have moderate or severe LUTS com-
pared with patients diagnosed with metabolic
syndrome. The authors conclude that this work
found new associations between hepatic stea-
tosis, metabolic syndrome and LUTS. Those
subjects with NAFLD (indicator of metabolic
syndrome) should be considered as a risk group
to develop moderate to severe LUTS.
Also there have been developments regarding
the treatment of LUTS / BPH. Here, we highlight
two works:
The first examines the role of behavioral therapy
as a significant treatment option for nocturia in
men (PD 23-10). An analysis in 72 patients
was performed, comparing changes in nocturia,
sleep, and quality of life as a result of a new
multicomponent behavioral therapy + exercise
(M-BET), a therapy with active comparator
(
α
-blocker tamsulosin 0.4 mg), and a combina-
tion of
α
-blocker with M-BET. The authors con-
cluded that behavioral therapy alone or combined
with
α
-blockers showed statistically significant
reductions in nocturia and favorable effects on
quality of life, sleep and other annoyances. These
results suggest that the behavioral therapy can
provide a significant treatment option in men
with nocturia.
The second paper present an analysis of the
results of combined treatment with tadalafil /
finasteride for the treatment of erectile dysfunc-
tion and/or BPH-LUTS (PD 23-04). This post-hoc
analysis identified the proportion of patients
achieving a minimum level of improvement in
erectile function and / or BPH-LUTS when co-
administered tadalafil 5 mg once a day and
finasteride once a day (TAD / FIN). The results
showed that over 50% of patients treated with
TAD / FIN and placebo / FIN showed a clinically
significant improvement in LUTS / BPH. The ma-
jority of sexually active patients with ED treated
with base TAD / FIN showed improvement in
erectile function. It is important to note that
not only patients with LUTS / BPH and DE ex-
perienced a significant improvement in erectile
function, but also those without ED. The authors
conclude that further studies are needed to ac-
curately assess the benefits of this therapeutic
combination.
With regard to the research conducted in the
field of sexual health, first we focus on the field
of clinical research, where we discuss three
interesting papers, about the search for future
therapeutic targets:
In the first study (MP 47-13), the role of stimula-
tion of Calcium-activated potassium (KCa) chan-
nels as a treatment strategy in patients with ED
was investigated. Previously it has been observed
that the KCa stimulation enhances the vasodi-
latory capacity of PDE5 inhibitors. This paper
evaluates the impact of the modulation of KCa
in neurogenic regulation of cavernous smooth
muscle tone. Copora cavernosa samples of both
rats and human were obtained. Organ chamber
was performed with both tissue samples and the
response to electrical stimulation was measured,
demonstrating reproducible contractions and
frequency-dependent used in the corpus caver-
nosum of the rat. Blocking the large-conductance
KCa (BK) markedly potentiated the contractions.
These results were similar to those obtained with
samples of human corpus cavernosum.
The results indicate that BK participates in regu-
lation of neurogenic control of cavernosal smooth
muscle tone. The pharmacological stimulation of
these channels would favor relaxant responses.
Therefore, BK stimulation might be reasonable to
treat ED, especially in situations involving imbal-
EUROPEAN SOCIETY
FOR SEXUAL MEDICINE
SAVE
THE
DATE
17
th
CONGRESS OF THE EUROPEAN
SOCIETY FOR SEXUAL MEDICINE
5 – 7 February 2015
|
Copenhagen, Denmark
