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Tkocz M, Brzęk A, Marcinek M, Skrzypulec-Plinta V, Ziaja D. Pre and Postoperative Sexual Dysfunction in Patients with Leriche Syndrome—A Prospective Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053091. [PMID: 35270783 PMCID: PMC8910229 DOI: 10.3390/ijerph19053091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 02/06/2023]
Abstract
Background: Recovery of normal arterial inflow in the lower limbs after Leriche’s syndrome surgery does not always improve erection. This study assesses the effects of Leriche syndrome on erectile and ejaculatory dysfunction in patients awaiting surgical treatment and the impact of treatment used on sexual dysfunctions. Methods: 35 men with Leriche syndrome aged 61.3 years (SD = 7.74) were assessed for erectile dysfunction. The patients were classified into three groups: aortofemoral bypass (group 1); stenting of the iliac artery (group 2) and aortobifemoral bypass (group 3). The patients were qualified for surgery based on the TASC II guidelines. Follow-up was done 3 months after treatment. Results: The mean preoperative IIEF-5 score was 14. 69 (+/− 5.30), with better preoperative scores obtained by 54.3% of patients. A total of 51.4% and 48.6% of patients, respectively, reported normal erection enabling satisfactory penetration and normal ejaculation before treatment. After surgical treatment, satisfactory erection was reported by 60% of all surgically treated patients, whereas the presence of ejaculation was reported by only 14.2% of patients. Conclusions: The IIEF-5 score is a tool for careful assessment of vascular erectile dysfunctions, it allows for the evaluation of erectile dysfunctions in relation to atherosclerosis risk factors. The treatment strategy used allowed for slight improvement as evidenced to erection but decreasing normal ejaculation.
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Affiliation(s)
- Michał Tkocz
- Department of Urology, FMS in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (M.T.); (M.M.)
- Department of Urology and Uroonkology, St. Barbara Hospital Politraumatic Centre, 41-220 Sosnowiec, Poland
| | - Anna Brzęk
- Department of Physiotherapy, School of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
- Correspondence: ; Tel.: +48-32-2088712
| | - Mateusz Marcinek
- Department of Urology, FMS in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (M.T.); (M.M.)
- Department of Urology and Uroonkology, St. Barbara Hospital Politraumatic Centre, 41-220 Sosnowiec, Poland
| | - Violetta Skrzypulec-Plinta
- Department of Women’s Health, School of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Damian Ziaja
- Department of Physiotherapy, School of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
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Sznapka M, Brzęk A, Ziaja D, Tkocz M, Pawlicki K, Ziaja K, Skrzypulec-Plinta V, Chudek J, Kuczmik W. Analysis of Sexual Disorders in Men with Infrarenal Abdominal Aortic Aneurysm Treated by Stent-Graft or Prosthesis Implantation-A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E191. [PMID: 32326264 PMCID: PMC7230504 DOI: 10.3390/medicina56040191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/31/2020] [Accepted: 04/15/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: Patients with obstruction or stenosis of the aorta and iliac arteries or with aortic aneurysm, often co-existing with iliac artery aneurysms, suffer from sexual disorders because of insufficient perfusion to the pelvic organs and penis. This is often the cause of visits to a medical doctor's office with reports of a difficult life situation and a problem with the satisfactory completion of sexual intercourse. A low percentage of vascular surgeons or angiologists are prepared to talk about issues related to the hereditary sphere with a patient who qualifies for the treatment of Leriche syndrome or abdominal aortic aneurysm. The aim of this study was to analyze sexual disorders in men with infrarenal abdominal aortic aneurysm treated by stent-graft or prosthesis implantation. Material and methods, Outcomes: 38 patients who completed the IIEF-5 (International Index of Erectile for Men) questionnaire are presented. Initially, 146 qualified for the study after meeting the study inclusion criteria for surgery (Group 1) or for endovascular treatment of abdominal aortic aneurysm (Group 2). Results: In the study, no negative impact of smoking was found; however, over 95% of respondents had been smoking for many years in both groups. Patients who qualified for vascular prosthesis implantation were subject to a more advanced atherosclerotic process involving the aorta and iliac arteries. Patients who qualified for stent-graft implantation were twice as often treated for coronary vessel stenosis. In Group 1, the percentage differences, as shown by questions 1 and 5, were statistically significant (58, i.e., 25%, and 40, i.e., 29%). Conclusions: Education should target medical personnel in terms of conversations with patients, as well as men who are directly affected by this problem, although their partners and families should not be neglected in these activities. The ability to communicate properly allows for an open dialogue on issues that the patient finds difficult, particularly in the field of sexology.
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Affiliation(s)
- Mariola Sznapka
- Department of General and Vascular Surgery, Angiology and Phlebology Faculty of Katowice, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (M.S.); (W.K.)
- Department of General Vascular Surgery, Faculty of Medicine in Katowice, Medical University of Silesia, 40-659 Katowice, Poland
| | - Anna Brzęk
- Department of Physiotherapy, Chair of Physiotherapy, School of Health Sciences in Katowice Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Damian Ziaja
- Department of Physiotherapy, Chair of Physiotherapy, School of Health Sciences in Katowice Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
- Department of Oncologic and Vascular Surgery, Oncological Centre in Katowice, 40-074 Katowice, Poland;
| | - Michał Tkocz
- Urologic Department Governor’s Hospital St. Barbara in Sosnowiec, 41-200 Sosnowiec, Poland;
| | - Krzysztof Pawlicki
- Department of Biophysics Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Krzysztof Ziaja
- Department of Oncologic and Vascular Surgery, Oncological Centre in Katowice, 40-074 Katowice, Poland;
| | - Violetta Skrzypulec-Plinta
- Chair of Woman’s Health in Katowice, School of Health Sciences in Katowice, Medical University of Silesia Katowice, 40-055 Katowice, Poland;
| | - Jerzy Chudek
- Internal and Oncological Department, Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Wacław Kuczmik
- Department of General and Vascular Surgery, Angiology and Phlebology Faculty of Katowice, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (M.S.); (W.K.)
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ALTUNÖREN O, ERKEN E, GÜNGÖR Ö, YAVUZ YC. Hipertansiyon ve Erektil Disfonksiyon. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2019. [DOI: 10.17517/ksutfd.477511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kloner RA, Goldstein I, Kirby MG, Parker JD, Sadovsky R. Cardiovascular Safety of Phosphodiesterase Type 5 Inhibitors After Nearly 2 Decades on the Market. Sex Med Rev 2018; 6:583-594. [DOI: 10.1016/j.sxmr.2018.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/16/2018] [Accepted: 03/29/2018] [Indexed: 12/23/2022]
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Steinke EE, Mosack V, Hill TJ. Depression, Quality of Life, Physical Activity, and the Impact of Drugs on Sexual Activity in a Population-Based Sample, Ages 20-59 Years. Issues Ment Health Nurs 2018; 39:527-532. [PMID: 29370563 DOI: 10.1080/01612840.2017.1413463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sexual quality of life is important for many individuals; therefore, this study examined the frequency of depression in a younger and middle-aged population-based sample, and the impact on physical activity, quality of life, and sexual activity, and the role of antidepressant and cardiac drugs on sexual function. The sample, ages 20 to 59 years, completed relevant items for depression, sexual activity, physical activity, quality of life, and drugs. Data were analyzed using descriptive statistics, Pearson correlations, t-tests, and analysis of variance. Those sexually active had lower mean depression scores and higher ratings of quality of life, while those sexually inactive had greater depression and took more drugs. Thorough assessment of drugs, depression, cardiac and other medical conditions, and interest and engagement in sexual activity should be routinely assessed in all patients, regardless of age.
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Affiliation(s)
- Elaine E Steinke
- a Wichita State University, School of Nursing , Wichita , Kansas , USA
| | - Victoria Mosack
- a Wichita State University, School of Nursing , Wichita , Kansas , USA
| | - Twyla J Hill
- b Wichita State University , Department of Sociology , Wichita , Kansas , USA
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Kloner RA, Goggin P, Goldstein I, Hackett G, Kirby MG, Osterloh I, Parker JD, Sadovsky R. A New Perspective on the Nitrate-Phosphodiesterase Type 5 Inhibitor Interaction. J Cardiovasc Pharmacol Ther 2018; 23:375-386. [PMID: 29739235 DOI: 10.1177/1074248418771896] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Nitrates and nitrate-containing compounds are vasodilators used for the treatment of angina and heart failure. Phosphodiesterase type 5 inhibitors used for the treatment of erectile dysfunction are also vasodilators, and when taken together with nitrates, synergistic effects that enhance hypotensive effects may occur. Phosphodiesterase type 5 inhibitors are therefore contraindicated in patients taking organic nitrates. METHODS AND RESULTS A literature review was performed to provide a historical overview of different phosphodiesterase type 5 inhibitors and nitrates and their interaction. The pharmacologic characteristics of phosphodiesterase type 5 inhibitors and nitrates are reviewed, and clinical recommendations for treating cardiovascular disease in men taking phosphodiesterase type 5 inhibitors are discussed. Pharmacologic and adverse drug reactions between nitrates and phosphodiesterase type 5 inhibitors are dependent on many variables. Organic nitrates remain an absolute contraindication in men treated with phosphodiesterase type 5 inhibitors. In general, nitrates may be taken 24 hours after the last dose of short-acting phosphodiesterase type 5 inhibitors and 48 hours after the last dose of long-acting phosphodiesterase type 5 inhibitors. CONCLUSIONS This literature review determined that the use of phosphodiesterase type 5 inhibitors with nitrates is a contraindication, with the duration between the last dose of phosphodiesterase inhibitor and nitrate use generally varying between short- and long-acting phosphodiesterase type 5 formulations. Patients receiving nitrates who wish to use phosphodiesterase type 5 inhibitors should be educated regarding the interaction and should be evaluated to determine whether nitrate treatment can be discontinued. Further research is needed to determine how soon phosphodiesterase type 5 inhibitors can be restarted after a patient has taken a nitrate and the effect of high and low phosphodiesterase type 5 inhibitor doses on the interaction effect.
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Affiliation(s)
- Robert A Kloner
- 1 Huntington Medical Research Institutes, Pasadena, CA, USA.,2 Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Michael G Kirby
- 6 Health & Human Sciences, Centre for Research in Primary & Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | | | - John D Parker
- 8 Division of Cardiology, Department of Medicine, University of Toronto and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Richard Sadovsky
- 9 State University of New York, Downstate Medical Center, Brooklyn, NY, USA
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Bor S, Valytova E, Yapali S, Yildirim E, Vardar R. Sexual activity does not predispose to reflux episodes in patients with gastroesophageal reflux disease. United European Gastroenterol J 2014; 2:482-9. [PMID: 25452843 DOI: 10.1177/2050640614550851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/16/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The role of sexual activity on gastroesophageal reflux disease (GERD) is an under-recognized concern of patients, and one rarely assessed by physicians. OBJECTIVE The objective of this article is to determine the influence of sexual activity on the intraesophageal acid exposure and acid reflux events in GERD patients. METHODS Twenty-one patients with the diagnosis of GERD were prospectively enrolled. Intraesophageal pH monitoring was recorded for 48 hours with a Bravo capsule. All patients were instructed to have sexual intercourse or abstain in a random order two hours after the same refluxogenic dinner within two consecutive nights. Patients were requested to have sex in the standard "missionary position" and women were warned to avoid abdominal compression. The patients completed a diary reporting the time of the sexual intercourse and GERD symptoms. The percentage of reflux time and acid reflux events were compared in two ways: within 30 and 60 minutes prior to and after sexual intercourse on the day of sexual intercourse and in the same time frame of the day without sexual intercourse. RESULTS Fifteen of 21 GERD patients were analyzed. The percentage of reflux time and number of acid reflux events did not show a significant difference within the 30- and 60-minute periods prior to and after sexual intercourse on the day of sexual intercourse and on the day without sexual intercourse, as well. CONCLUSION Sexual activity does not predispose to increased intraesophageal acid exposure and acid reflux events. Larger studies are needed to confirm our findings in patients who define reflux symptoms during sexual intercourse.
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Affiliation(s)
- Serhat Bor
- Ege University School of Medicine, Division of Gastroenterology, Izmir, Turkey ; Moscow Gastroenterology Research Institute, Russia
| | - Elen Valytova
- Moscow Gastroenterology Research Institute, Russia ; Ege Reflux Study Group, Izmir, Turkey
| | - Suna Yapali
- Ege University School of Medicine, Division of Gastroenterology, Izmir, Turkey ; Moscow Gastroenterology Research Institute, Russia
| | - Esra Yildirim
- Ege University School of Medicine, Division of Gastroenterology, Izmir, Turkey ; Moscow Gastroenterology Research Institute, Russia
| | - Rukiye Vardar
- Ege University School of Medicine, Division of Gastroenterology, Izmir, Turkey ; Moscow Gastroenterology Research Institute, Russia
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Vickery A, Thompson PL. Eight challenges faced by general practitioners caring for patients after an acute coronary syndrome. Med J Aust 2014; 201:S110-4. [PMID: 25390497 DOI: 10.5694/mja14.01250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/24/2014] [Indexed: 11/17/2022]
Abstract
The general practitioner is essential in the management of the patient who has recently been discharged from hospital following an acute coronary syndrome (ACS), particularly as duration of hospital stay is shorter than in previous decades. GPs caring for patients after an ACS face numerous challenges. Often, the first of these is insufficient or delayed documentation from the discharging hospital, although electronic discharge summaries are alleviating this problem. Post-ACS patients often have comorbidities, and GPs play a key role in managing these. Patients taking dual antiplatelet therapy who need surgery, and post-ACS patients with atrial fibrillation, require particular care from GPs. Patients will often approach their GP for advice on the safety of other drugs, such as smoking cessation medication, and phosphodiesterase type 5 inhibitors for erectile dysfunction. For patients complaining of persistent lethargy after an ACS, GPs must consider several differential diagnoses, including depression, hypotension, hypovolaemia, and side effects of β-blockers. GPs play an important ongoing role in ensuring that target cholesterol levels are reached with statin therapy; this includes ensuring long-term adherence. They may also need to advise patients who want to stop statin therapy, usually due to perceived side effects. Many of these challenges can be met with improved and respectful communication between the hospital, the treating cardiologist and the GP. The patient needs to be closely involved in the decision-making process, particularly when balancing the risks of bleeding versus thrombosis.
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Affiliation(s)
- Alistair Vickery
- School of Primary, Aboriginal, and Rural Health Care, University of Western Australia, Perth, WA, Australia.
| | - Peter L Thompson
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
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