UroToday.com - The report, one of four published articles from a population-based cross-sectional study principally on male erectile dysfunction (ED), is based on the responses of 1,580 participants to questions on their alcohol drinking behaviour. To assess the effects of alcohol on erectile function was not the primary objective of the study.

The finding that alcohol consumption within the current guidelines for low-risk drinking was associated with lower odds of ED provides rationale for counseling alcohol drinkers with ED in day-to-day clinical practice. Men with ED need not harbour a sense of guilt about their past or current drinking if they consume alcohol within guidelines.

This should not be interpreted as encouragement for non-drinkers to commence alcohol drinking. A decision by a non-drinker to commence drinking warrants careful consideration and informed decision, as it may be associated with multiple medical, socioeconomic and other implications, some of which could be serious.

Written by Kew-Kim Chew, MD as part of Beyond the Abstract on UroToday.com

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Copyright © 2009 - UroToday

Copyright: Medical News Today

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The panel initially covering the topic of Erectile Dysfunction have broadened the scope of their guidelines and have taken in the treatment of premature ejaculation in their updated document.

Since the prior limited update of this guideline considerable data have become available regarding the various drugs on the market for the treatment of erectile dysfunction. The current guidelines include information on the efficacy and non-responders to PDE5 inhibitors, combination and continuous dosage and also touches on drug preference.

Most patients who had to undergo a (nerve-sparing) radical prostatectomy suffer from varying degrees of erectile dysfunction. For a considerable number of these patients PDE5 inhibitors offer improvement.

In their guidelines the panel clearly stress the need for a professional assessment of all patients presenting with ED, where also psychological aspects have to be taken into account. Self-medication and the recreational use of what in many countries are still prescription medications without taking possible side-effects into account are not advocated.

The panel consists of an expert group chaired by E. Wespes and includes E. Amar, I. Eardley, F. Giuliano, D. Hatzichristou, K. Hatzimouratidis, F. Montorsi and Y. Vardi.

Updated guidelines

A number of updated guidelines will be presented at the 24th Annual Congress of the European Association of Urology (EAU) held in Stockholm, from 17 through 21 March. The abridged versions - Pocket Guidelines which are based on the extended text documents will also be available in Stockholm to all EAU members.

Production of clinical guidelines is one of the core activities of the organisation. Close to 150 experts split up over 18 different topic-oriented panels, are involved in this ongoing process. Guidelines aim to present the best evidence available on a given pathology and provide a standardized approach to the treatment of urological conditions. Ultimately, healthcare professionals must make their own decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgment, knowledge and expertise.

European Association of Urology
http://www.uroweb.org

South Asians with type 2 diabetes are significantly more at risk of losing their eyesight and losing it at an earlier age, compared to White Europeans with the same condition.

A UK study carried out by the University of Warwick shows diabetic retinopathy (damage to the retina) is more prevalent in South Asians and occurs earlier than in White European people with diabetes.

The study, published in the latest issue of Diabetes Care, looked at 1.035 patients with type 2 diabetes, 421 were of South Asian origin and 614 were White Europeans. The results showed 45% of South Asians had retinopathy, compared to 37% of White Europeans, and 16% of the South Asian group had sight threatening retinopathy, compared to 12% White Europeans.

South Asian diabetes patients were also significantly younger than the White European group. The average age of the South Asian group at diagnosis of diabetes was 53 years, compared to 57 years for White Europeans. The study also suggested South Asians developed diabetic retinopathy about seven years earlier than White Europeans.

This study is part of the UK Asian Diabetes Study, a randomised controlled trial designed to evaluate the benefits of an enhanced diabetes care package for people of South Asian ethnicity with type 2 diabetes in Coventry and Birmingham.

For this project, researchers collected clinical data from 10 GP practices in the Foleshill area of Coventry. Details on risk factors including blood pressure, duration of diabetes, age at onset of diabetes and cholesterol were recorded.

One of the study’s authors Professor Sudhesh Kumar, Professor of Medicine, Diabetes & Endocrinology at Warwick Medical School, said the results emphasised the need for effective screening and earlier diagnosis of diabetes among the South Asian population.

He said: “The South Asian participants in this study had significantly higher systolic and diastolic blood pressures and cholesterol levels. Systematic screening for retinopathy, combined with intensive management of diabetes, including reduction of blood glucose and blood pressure, could help to reduce the incidence of visual impairment and blindness in ethnic minority groups across the world, addressing an important health inequality.”

In adults, the systolic pressure should be less than 120 mmHg and the diastolic pressure should be less than 80 mmHg. In this study, the South Asian participants recorded 144 mmHg systolic pressure and 84 mmHg diastolic pressure.

Professor Kumar added: “Health care professionals in developed and developing countries need to be aware of the potential contribution of diabetic retinopathy to visual loss in South Asian communities.”

Fellow author Dr Paul O’Hare, from Warwick Medical School, said: “Screening for diabetic retinopathy is becoming more systematic across the UK and the developed world. However, coverage rates and uptake among ethnic minority groups in inner city areas may be much lower than those for white Europeans. We need to address this to try and rectify these important health inequalities.”

Diabetes Care, volume 32, number 3, March 2009

Warwick University
http://www.warwick.ac.uk

Men with premature ejaculation who used a topical spray five minutes before intercourse were able to delay their orgasm six times longer than normal, according to a study in the April issue of BJU International.

Three hundred men with clinically diagnosed lifelong premature ejaculation (PE) from 31 centres in the UK, Czech Republic, Hungary and Poland, were randomised into two groups. Two hundred used the PSD502 spray, which contains 7.5mg of lidocaine and 2.5mg of prilocaine, and 100 used a placebo spray with no active ingredients.

Every time they had intercourse during the three-month study period, each couple measured the time from vaginal penetration to ejaculation with a stopwatch. The men were asked to abstain from sexual activity or masturbation for 24 hours before each recorded encounter.

The time from penetration to ejaculation increased from an average of 0.6 minutes to 3.8 minutes in the medicated group and to just 1.1 minutes in the placebo group.

When these figures were adjusted to take account of any variations between the two groups, these showed that the treatment group were able to last 6.3 times longer after penetration when they used the spray. The placebo group lasted 1.7 times longer.

“Premature ejaculation can be a very distressing condition for men and can cause distress, frustration and make them avoid sexual intimacy” says lead researcher Professor W Wallace Dinsmore from the Royal Victoria Hospital, Belfast, UK.

The research team used the evidence-based definition of lifelong PE developed by the International Society for Sexual Medicine to select their study subjects. This states that ejaculation occurs within about one minute of vaginal penetration in the majority of encounters.

“Because this definition was only launched in 2008, studies have yet to determine the prevalence of lifelong PE in the male population” says Professor Dinsmore. “But previous research suggests that as many as 40% of men will experience premature ejaculation at some time in their lives.”

The 300 men who took part in the phase three, multicentre, double-blind, randomised study had an average age of 35. The majority had used other treatments before, the most common being oral antidepressants.

After three months of treatment the researchers reported that:

– 90% of the men in the treatment group were able to delay ejaculation for more than one minute following vaginal penetration, compared with 54% in the placebo group.

– 74% of men in the treatment group managed to last more than two minutes before ejaculation, compared with 22% in the placebo group.

– 62% of men in the treatment group said their orgasms were ‘good’ or ‘very good’ after three months, compared with 20% before the study started. The figures for the placebo group were slightly lower at the end (19%) than at the start (21%).

– 66% of men in the treatment group said the medication was ‘good’ or ‘excellent’ compared with 15% in the placebo group.

– A significantly higher percentage of the patients and partners in the treatment group reported improvements when it came to perceived control, personal distress, satisfaction with sexual intercourse and interpersonal difficulties.

– There were no serious adverse events reported during the study. Adverse treatment-related reactions were reported by five men and six women from the treatment group and one man from the placebo group. The most common problems were loss of erection and a burning sensation in the vagina.

“Our study shows that when the PSD502 spray was applied to the man’s penis five minutes before intercourse it improved both sexual performance and sexual satisfaction, which are key factors in treating premature ejaculation” says Professor Dinsmore.

“It was well tolerated by both patients and their partners, with no systemic side effects and a low incidence of localised effects and was rated favourably by the majority of users.

“We believe that this shows that PSD502 offers significant advantages over other therapies being developed for the treatment of premature ejaculation.”

Source: Wiley - Blackwell

Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that although surveyed primary care physicians (PCPs) are generally satisfied with the efficacy of available phosphodiesterase type 5 (PDE5) inhibitors such as Pfizer’s ED drugs and Bayer Healthcare/Schering-Plough/GlaxoSmithKline’s Levitra (vardenafil), they are less satisfied with the efficacy of this drug class in difficult-to-treat patient subpopulations. PCPs’ satisfaction with available PDE5 inhibitors on key measures of clinical efficacy suggests that opportunity exists for improvement in the treatment of erectile dysfunction patients with comorbid conditions such as hypertension and diabetes.

The new report entitled Erectile Dysfunction: Physicians Seek Improvements in Efficacy for Underserved Patients and Product Differentiation on Onset and Duration of Action finds that a therapy that provides greater improvement in erectile function than Levitra in patients with hypertension and that is priced at a five percent discount to Levitra would earn a 50 percent patient share in the United States and a 40 percent patient share in Europe, according to surveyed U.S. primary care physicians and European general practitioners.

Additionally, while there are several second-generation PDE5 inhibitors in clinical trials for the treatment of erectile dysfunction, interviewed experts do not expect these agents to provide efficacy superior to that of currently marketed drugs in this class. The report also finds that limited reimbursement for erectile dysfunction drugs and the availability of less-expensive generic versions of Viagra beginning in 2012, will constrain the uptake of emerging PDE5 inhibitors.

“Most therapies for erectile dysfunction do not qualify for reimbursement by third-party payers,” said Decision Resources Analyst Kathryn Benton, B.S. “As a result, many patients pay out-of-pocket for treatment — this will be among the factors that will cause premium-priced emerging therapies to struggle to capture market share.”

About the Report

Erectile Dysfunction: Physicians Seek Improvements in Efficacy for Underserved Patients and Product Differentiation on Onset and Duration of Action is a DecisionBase 2009 report. DecisionBase 2009 is a decision-support tool that provides in-depth analysis of unmet need, physician expectations of new therapies and commercial dynamics to help pharmaceutical companies optimize their investments in drug development.

The report can be purchased by contacting Decision Resources. Members of the media may request an interview with an analyst.

About Decision Resources

Decision Resources is a world leader in market research publications, advisory services and consulting designed to help clients shape strategy, allocate resources and master their chosen markets. Decision Resources is a Decision Resources, Inc. company.

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions.

All company, brand, or product names contained in this document may be trademarks or registered trademarks of their respective holders.

Source: Decision Resources

UroToday.com - The concept behind nerve grafting is to make use of one’s own nerves, which play a minimal functional role, as conduits to promote the regrowth of new nerve fibers. In certain patients with prostate cancer, the nerves crucial for erectile function (cavernous nerves) may need to be cut in the interest of removing high-risk cancer. In these situations, the genitofemoral nerve can be interposed (grafted) as a conduit to promote regrowth of new nerve fibers. Our study examined the feasibility and success of this in patients with prostate cancer as well as those with bladder cancer, in which the prostate is also removed.

Although ours was a relatively small study, its strength lies in that we used a person independent from the surgeon who performed the surgery to assess patients on their outcomes. We found detectable rates of erectile potency in 38% of patients with a single bundle of nerves cut then grafted compared to 30% when both nerve bundles are cut and grafted. It is important to keep in mind that these patients may or may not have been using a medication that assists in erectile function such as Viagara®, Cialis (tadalafil) or Levitra (vardenafil). 

The important direction from this study is the attention it has drawn for the need to conduct a larger, randomized-controlled study to make final conclusions. Nevertheless, the study has reiterated that Urologic surgeons can perform this procedure. We recommend that the option for cavernous nerve interposition grafting should be discussed with select patients including those undergoing surgery for bladder cancer.

Written by Raj Satkunasivam, Sree Appu, Rami Al-Azab, Karen Hersey, Gina Lockwood, Joan Lipa and Neil E. Fleshner as part of Beyond the Abstract on UroToday.com

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:
www.urotoday.com

Copyright © 2009 - UroToday

Tadalafil may improve lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH). Researchers from Nashville, Dallas, San Antonia and Indianapolis presented these findings during the 104th Annual Scientific Meeting of the American Urological Association (AUA).

In this study, researchers randomly separated 200 men, with an age equal to or older than 40 years and at least a six month diagnosis of BPH-LUTS with an International Prostate Symptom Score (IPPS) greater than or equal to 13, into two groups taking either 20 mg of tadalafil once daily or a placebo. After 12 weeks of treatment, the men taking tadalafil experienced improved detrusor pressure at urinary flow rate, peak flow rate (Qmax), bladder capacity, post-void residual volume and bladder voiding efficiency. Relative symptom improvement in the IPSS also was significantly better in the tadalafil group. At the end of the study, the proportion of obstructed patients in the placebo group increased, while the proportion in the tadalafil group decreased.

“Dr. Dmochowski, the study author, and colleagues have added further evidence to the growing body of research that suggests that in addition to their well known effect on erectile dysfunction, PDE-5 inhibitors may be able to help with management of bladder outlet symptoms as well. This is an exciting concept for men’s health,” said Anthony Y. Smith, MD, an AUA spokesman.

Dmochowski, R; Roehrborn, C; Kraus, S; Klise, S. Changes in bladder outlet obstruction index in men with signs and symptoms of benign prostatic hyperplasia treated with tadalafil. J Urol, suppl. 2009: 181, 4, abstract 1924.

Source:
Lacey Dean

American Urological Association

Statins, drugs widely prescribed to lower cholesterol, may have protective effects on prostate health. This large Mayo Clinic cohort study looked at three different aspects of urological health — prostate cancer, erectile dysfunction and prostate enlargement. Initial research results are being presented April 25-30, 2009, at the American Urological Association (AUA) meeting in Chicago.

These Mayo Clinic study findings came from data in the Olmsted County Study of Urinary Health Status among Men, a large cohort study of men living in Olmsted County, Minn. This study has followed 2,447 men ages 40 to 79 from 1990 to the present to assess various urologic outcomes among aging men.

“One of the major advantages of this large cohort study is that the men have participated in this study for over 15 years. Because of this, we have the ability to look at associations between statin use, how long statins were used and multiple aspects of urologic function,” says Jennifer St. Sauver, Ph.D., Mayo Clinic epidemiologist and study author.

Three significant abstracts are being presented at the AUA meeting:

Statins May Reduce Risk of Prostate Cancer (April 26, 3:30-5:30 p.m. CDT)

In the first study, researchers followed the 2,447 men for over 15 years and discovered that men taking statins were less likely to develop prostate cancer, compared to men who did not take statins.

Of the statin users, 38 (6 percent) were diagnosed with prostate cancer. Comparatively, non-statin users were three times more likely to develop prostate cancer, suggesting statin use may prevent development of prostate cancer.

“In recent years, it has been suggested that statin medications may prevent development of cancer. However, until now, there has been limited evidence to support this theory,” says Rodney Breau, M.D., a Mayo Clinic urologic oncology fellow who led the study. “Our research provides evidence that statin use is associated with a threefold reduced risk of being diagnosed with prostate cancer.”

Statin medications are currently used to lower cholesterol or to help prevent heart attack and stroke in high-risk patients. In the laboratory setting, researchers have observed that statin medications prevent cancer cells from dividing and, in fact, may cause some cancer cells to die.

“In the United States, one in six men will develop prostate cancer; however, far more will develop heart disease,” says Jeffrey Karnes, M.D., Mayo Clinic urologist and senior author on the study. “I tell my patients to take care of their heart - because what’s good for the heart is also good for the prostate.”

The investigators emphasize that these results are preliminary. To determine if statins are protective for prostate cancer, randomized controlled trials are necessary, says Dr. Karnes.

Statin Use May Protect Against Erectile Dysfunction (April 27, 10:30 a.m.-12:30 p.m. CDT)

Hyperlipidemia, high cholesterol and other risk factors for heart disease have been shown to put men at risk for erectile dysfunction (ED). With this in mind, Mayo Clinic researchers studied 1,480 men from the Olmsted County cohort to determine if men who used statins were less likely to develop erectile dysfunction, compared to men who did not use statins.

Overall, statin use was not significantly associated with a decreased risk of developing ED. However, statins were associated with a decreased risk of ED among older men (>60 years). Men in this age category who used statins were less likely to develop ED, compared to older men who did not use statins. Additionally, men who took statins for a longer time were more protected against developing ED. For example, men who took statins for nearly nine years or more were 64 percent less likely to develop ED, while men who took statins for less than three years had about the same risk of developing ED. compared to men who did not take statins.

“Protection of vascular health remains an important concomitant of preserving erectile health. Our data suggest that longer use of statins may result in the lowest risk of erectile dysfunction,” says Ajay Nehra, M.D. , Mayo Clinic urologist and senior study author.

ED is common, and prevalence increases with age. It affects 5 to 10 percent of men at age 40. By age 70, from 40 to 60 percent of men have the condition.

Statin Use May Prevent Prostate Enlargement (April 28, 1:00-3:00 p.m. CDT)

Benign prostatic enlargement affects one in four men ages 40 to 50 and almost half of 70- to 80-year-old men. The condition is most often diagnosed when men visit their physicians due to urinary problems prompted by prostate enlargement. Mayo Clinic researchers have found that taking statins may prevent or delay benign prostatic enlargement.

Of the 2,447 men studied, 729 (30 percent) were statin users; researchers found that statin users were 63 percent less likely to develop lower urinary tract problems and 57 percent less likely to develop an enlarged prostate.

“Statins have been shown to have anti-inflammatory effects, and previous research suggests inflammation may be associated with benign prostate disease,” says Dr. St. Sauver. “This study suggests that men’s urinary health could be improved by taking statin medications.”

Further Study Needed

The researchers note that further studies, particularly clinical trials, are necessary to determine whether taking statins might prevent development of this common condition.

“If you are taking a statin for a heart condition or to lower cholesterol, these studies suggest that statins could have other benefits,” says Dr. St. Sauver. “However, it’s very clear we need more information before men are advised to start taking statins for their urological health.”

Source:
Traci Klein

Mayo Clinic

Men taking generic drugs may be more likely to have less effective results and more adverse events than if they were using branded medications, according to new data from researchers in New York. Researchers presented a study at the 104th Annual Scientific Meeting of the American Urological Association (AUA) showing that generic substitutes for alpha blockers and 5-alpha reductase inhibitors (5-ARIs), two classes of medications used to treat lower urinary tract symptoms (LUTS) in men, are less effective than their branded counterparts.

Over eight weeks, the study tested 212 men taking branded alpha blockers or 5ARIs with an average age of 64, who were switched to generic alternatives by their primary care physician or due to insurance coverage. The researchers measured the efficacy of the medications using several parameters, including the International Prostate Symptom Score (IPSS), peak flow rate (Qmax), post-void residual urine (PVR), voiding diary information, International Index of Erectile Function (IIEF), ejaculatory function and the prevalence of adverse events.

In the men who were switched to generic medications, the IPSS and PVR rates increased and Qmax decreased. In addition, the men experienced several new side effects, including dizziness (4.6 percent), nasal congestion (3.2 percent) and ejaculatory dysfunction (3.6 percent) for those switching alpha blockers, and ejaculatory dysfunction (4.7 percent) and erectile dysfunction (5.8 percent) for those switching to generic 5-ARIs.

“This preliminary study shows that some generics are not as effective as their branded counterparts and that men should consult a physician if a generic alternative is not providing results. Given that this is an early study, interpretation should be cautious as patients were not blinded as to which medication they were receiving and there may be a bias against generic medications on the part of patients,” said Kevin McVary, MD, an AUA spokesman. “Often, men switch because of cost or insurance company regulations; but, it is important to ensure efficacy and consider potential side effects prior to switching medications. A physician should be able to monitor the patient and may recommend switching back to the branded medication if efficacy decreases or side effects increase while taking a generic medication.”

Kaplan, S; Chung, D; Sandhu, J; Te, A. Generic substitutes are neither as safe nor effective as branded medications: experience in men treated for lower urinary tract symptoms (LUTS). J Urol, suppl. 2009: 181, 4, abstract 1799

Source:
Lacey Dean

American Urological Association

Many men suffer from loss of libido but in most cases if the man is not suffering from serious illness, they can boost libido quickly with some proven herbs which can improve both sexual health and overall wellness at the same time.

So what causes lack of libido? Let’s look at the most common problems and the herbs which will cure them which can all be found combined, in potent men’s sexual health pills.

All men need testosterone for both overall health and sexual health; it declines with age so you need to top it up. The best herbs to increase testosterone are, Tongkat Ali which has been used for centuries in China and Tribulus Terrestris which is the favorite herb of bodybuilders, due to its ability to dramatically increase testosterone production.

Blood circulation to the genitals and into the penis, is the foundation of sexual health. If you have poor blood circulation, you will simply not be able to get hard or have a high sex drive. To boost blood flow around the body, the best herbs are Ginseng and Ginkgo Biloba which increase blood circulation and also keep the blood vessels healthy and free of obstructions such as furring.

You also need to secrete the key chemical nitric oxide which allows the blood vessels of the penis to relax and expand enough, to allow an extra flow of blood into the penis, to swell it and harden it. No erection is possible without it and it declines with age, so you need to top it up. The best herbs for nitric oxide increase are -Horny Goat Weed and Cnidium.

Both these herbs increase the release of nitric oxide while inhibiting PDE-5 and they perform the same function as synthetic drugs which is to allow extra blood into the penis to harden it, when you become aroused.

Your mind also plays a role in sex drive and it needs to be free of stress and worry so you are relaxed and can focus on sex. Great all round tonic herbs are, Jujube Fruit, Schizandra Berries and Maca. These herbs combined will relieve stress and anxiety and give your body energy a lift, to put you in the mood for sex.

Get them ALL in the best Natural Sex Pills

You can get all the herbs above in the best natural sex pills for men and they will give you a whole host of nutrients which you don’t find in your everyday diet. These nutrients will increase your libido and boost overall wellness at the same time, safely and naturally, just like nature intended.