AIMTo evaluate whether the response to sildenafil administration in patients with arterial erectile dysfunction (ED) was related to their peak systolic velocity (PSV), peripheral atherosclerosis, cardiovascular risk factors (RF) and/or comorbidities at low cardiovascular risk.

METHODSWe enrolled 97 patients with 1-2 RF and comorbidities, combined with arterial ED alone (group A, n = 27), ED plus atherosclerotic carotid artery (group B, n = 23), ED plus lower limb artery abnormalities (group C, n = 25), and ED plus carotid and lower limb artery abnormalities (group D, n = 22). Sildenafil efficacy (100 mg twice a week for 12 weeks) was also examined in patients with =or>3 RF, peripheral atherosclerosis and no cardiovascular comorbidities (group E, n = 20).

RESULTSMedian PSV was 24.1, 21.0, 19.3, 14.5 and 17.5 cm/s in groups A, B, C, D and E, respectively. Sildenafil response was higher in group A patients (77.8%), intermediate in groups B and C (65.2% and 56%) and lowest in groups D (45.4%) and E (50%), and the response in latter two groups was significantly lower than in the other three groups. In addition, sildenafil response was negatively influenced by: =or>3 RF, peripheral atherosclerosis and no systemic comorbidity, or presence of 1-2 RF associated with extended atherosclerosis and comorbidities. The number of comorbidities was positively related to atherosclerosis localization or extension (25, 35, 38 and 47 in groups A, B, C and D, respectively).

CONCLUSIONLow sildenafil efficacy in patients with arterial ED was associated with extended atherosclerosis. These patients should undergo extensive ultrasonography and a full cardiovascular examination.

Aged ; Arterial Occlusive Diseases ; complications ; drug therapy ; physiopathology ; Atherosclerosis ; complications ; Cardiovascular Diseases ; complications ; drug therapy ; Erectile Dysfunction ; drug therapy ; etiology ; physiopathology ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Physical Examination ; Piperazines ; therapeutic use ; Purines ; therapeutic use ; Regional Blood Flow ; physiology ; Retrospective Studies ; Risk Factors ; Sildenafil Citrate ; Sulfones ; therapeutic use ; Treatment Outcome ; Vasodilator Agents ; therapeutic use

AIMTo identify and define prostate and seminal vesicle abnormalities in patients with chronic male accessory gland infection (MAGI) who failed to respond to antibacterial treatment.

METHODSWe selected 67 consecutive patients with MAGI and persistently elevated bacteriospermia (=or>10(6) colony forming units [CFU]/mL) after three antibiotic courses. Fourteen infertile patients with initial chronic microbial (=or>10(6) CFU/mL) MAGI who responded to antibacterial treatment (<10(3) CFU/mL) served as a control group. All patients and controls underwent transrectal ultrasonography (TRUS) scans and semen analysis. Patients with low seminal plasma volume (<1.5 mL) underwent both pre-ejaculatory and post-ejaculatory TRUS examination.

RESULTSTRUS revealed multiple abnormalities indicative of: (i) bilaterally extended prostato-vesiculitis (group A: 52 cases, 77.6%) (nine of these patients also had micro-emphysematous prostate abscess); and (ii) prostato-vesiculitis with unilateral or bilateral sub-obstruction of the ejaculatory ducts (group B: 15 cases, 22.4%). Mean sperm concentration, total sperm number, ejaculate volume and pH value were significantly higher in group A than in group B. In addition, sperm forward motility and the percentage of normal forms were significantly worse than in controls, whereas leukocyte concentration was significantly higher in group A. Group B patients had all sperm parameters, but their pH values, significantly different from those of controls.

CONCLUSIONAlthough antibiotic therapy is considered suitable when microbial MAGI is suspected, it is impossible to account for a poor response to antibiotics merely on the basis of conventional criteria (clinical history, physical and ejaculate signs). Thus, TRUS may be helpful in the follow-up of these patients.

Adult ; Anti-Bacterial Agents ; therapeutic use ; Bacterial Infections ; complications ; drug therapy ; Epididymis ; diagnostic imaging ; microbiology ; Epididymitis ; complications ; diagnostic imaging ; Follow-Up Studies ; Humans ; Infertility, Male ; diagnostic imaging ; microbiology ; Male ; Prostate ; diagnostic imaging ; microbiology ; Prostatitis ; complications ; diagnostic imaging ; Rectum ; diagnostic imaging ; Seminal Vesicles ; diagnostic imaging ; microbiology ; Ultrasonography ; methods