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Caretta N, Facondo P, Mereu S, Delbarba A, Crepaldi MC, Vedovato M, Avogaro A, Ferlin A. Cardiometabolic indices predict hypogonadism in male patients with type 2 diabetes. J Endocrinol Invest 2023; 46:599-608. [PMID: 36282472 PMCID: PMC9938038 DOI: 10.1007/s40618-022-01941-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/13/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate in men with type 2 diabetes the association of cardiometabolic indices [Visceral Adiposity Index (VAI), Triglyceride Glucose Index (TyG), and lipid accumulation product (LAP)] with total testosterone (TT) levels, and their predictive cut-off values in identifying hypogonadism. METHODS 265 consecutive men aged 40-70 years with type 2 diabetes performed an andrological evaluation; metabolic parameters and TT were determined. Receiver operating characteristic (ROC) curves were used to identify cut-off values of cardiometabolic indices in predicting low testosterone (TT < 12 nmol/l). RESULTS VAI, TyG, and LAP were negatively associated with TT levels. The prevalence of hypogonadism in men in the fourth quartiles of VAI, TyG, and LAP was ~ 70.0-75.0% compared to ~ 10.0-17.0% in men in the first quartiles (p < 0.001). The sensitivity and specificity of the three cardiometabolic indices in predicting TT < 12 nmol/l were significantly higher concerning BMI, waist circumference, lipid profile and HbA1c. Cut off values of VAI ≥ 3.985, TyG ≥ 4.925, and LAP ≥ 51.645 predict hypogonadism with good sensitivity and specificity. CONCLUSION This is the first study evaluating the association of VAI, TyG, and LAP with hypogonadism in men with type 2 diabetes. Alterations in these indices should direct the patients to andrological evaluation.
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Affiliation(s)
- N Caretta
- Unit of Andrology and Reproductive Medicine, University Hospital of Padova, Padua, Italy
| | - P Facondo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - S Mereu
- Department of Medicine, University of Padova, Padua, Italy
| | - A Delbarba
- Unit of Endocrinology and Metabolism, ASST Spedali Civili, Brescia, Italy
| | - M C Crepaldi
- Department of Medicine, Division of Metabolic Diseases, University of Padova, Padua, Italy
| | - M Vedovato
- Department of Medicine, Division of Metabolic Diseases, University of Padova, Padua, Italy
| | - A Avogaro
- Department of Medicine, Division of Metabolic Diseases, University of Padova, Padua, Italy
| | - A Ferlin
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padua, Italy.
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Caretta N, De Rocco Ponce M, Minicuci N, Palego P, Valente U, Garolla A, Ferlin A, Foresta C. Penile doppler ultrasound predicts cardiovascular events in men with erectile dysfunction. Andrology 2018; 7:82-87. [DOI: 10.1111/andr.12561] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/20/2018] [Accepted: 10/02/2018] [Indexed: 12/19/2022]
Affiliation(s)
- N. Caretta
- Department of Medicine Section of Endocrinology and Centre for Human Reproduction Pathology University of Padova Padua Italy
| | - M. De Rocco Ponce
- Department of Medicine Section of Endocrinology and Centre for Human Reproduction Pathology University of Padova Padua Italy
| | | | - P. Palego
- Department of Medicine Section of Endocrinology and Centre for Human Reproduction Pathology University of Padova Padua Italy
| | - U. Valente
- Department of Medicine Section of Endocrinology and Centre for Human Reproduction Pathology University of Padova Padua Italy
| | - A. Garolla
- Department of Medicine Section of Endocrinology and Centre for Human Reproduction Pathology University of Padova Padua Italy
| | - A. Ferlin
- Department of Clinical and Experimental Sciences Endocrine and Metabolic Unit University of Brescia Brescia Italy
| | - C. Foresta
- Department of Medicine Section of Endocrinology and Centre for Human Reproduction Pathology University of Padova Padua Italy
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Ferlin A, Selice R, Angelini S, Di Grazia M, Caretta N, Cavalieri F, Di Mambro A, Foresta C. Endocrine and psychological aspects of sexual dysfunction in Klinefelter patients. Andrology 2018; 6:414-419. [DOI: 10.1111/andr.12474] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/20/2017] [Accepted: 01/23/2018] [Indexed: 12/14/2022]
Affiliation(s)
- A. Ferlin
- Unit of Andrology and Reproductive Medicine; Department of Medicine; University of Padova; Padova Italy
| | - R. Selice
- Unit of Andrology and Reproductive Medicine; Department of Medicine; University of Padova; Padova Italy
| | - S. Angelini
- Unit of Andrology and Reproductive Medicine; Department of Medicine; University of Padova; Padova Italy
| | - M. Di Grazia
- Institute for Maternal and Child Health; IRCCS ‘Burlo Garofolo’; Trieste Italy
| | - N. Caretta
- Unit of Andrology and Reproductive Medicine; Department of Medicine; University of Padova; Padova Italy
| | - F. Cavalieri
- Unit of Andrology and Reproductive Medicine; Department of Medicine; University of Padova; Padova Italy
| | - A. Di Mambro
- Unit of Andrology and Reproductive Medicine; Department of Medicine; University of Padova; Padova Italy
| | - C. Foresta
- Unit of Andrology and Reproductive Medicine; Department of Medicine; University of Padova; Padova Italy
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Milardi D, Luca G, Grande G, Ghezzi M, Caretta N, Brusco G, De Filpo G, Marana R, Pontecorvi A, Calafiore R, Foresta C, Garolla A. Prednisone treatment in infertile patients with oligozoospermia and accessory gland inflammatory alterations. Andrology 2017; 5:268-273. [DOI: 10.1111/andr.12300] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 09/02/2016] [Accepted: 09/26/2016] [Indexed: 02/02/2023]
Affiliation(s)
- D. Milardi
- International Scientific Institute ‘Paul VI’; Catholic University; Rome Italy
| | - G. Luca
- Department of Experimental Medicine; University of Perugia; Perugia Italy
| | - G. Grande
- International Scientific Institute ‘Paul VI’; Catholic University; Rome Italy
| | - M. Ghezzi
- Department of Medicine, Andrology and Reproductive Unit; University of Padova; Padova Italy
| | - N. Caretta
- Department of Medicine, Andrology and Reproductive Unit; University of Padova; Padova Italy
| | - G. Brusco
- Unit of Diagnosis and Treatment of Human Reproduction University of Perugia; Perugia Italy
| | - G. De Filpo
- Department of Experimental Medicine; University of Perugia; Perugia Italy
| | - R. Marana
- International Scientific Institute ‘Paul VI’; Catholic University; Rome Italy
| | - A. Pontecorvi
- Division of Endocrinology; Catholic University; Rome Italy
| | - R. Calafiore
- Department of Medicine; University of Perugia; Perugia Italy
| | - C. Foresta
- Department of Medicine, Andrology and Reproductive Unit; University of Padova; Padova Italy
| | - A. Garolla
- Department of Medicine, Andrology and Reproductive Unit; University of Padova; Padova Italy
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Caretta N, Vigili de Kreutzenberg S, Valente U, Guarneri G, Pizzol D, Ferlin A, Avogaro A, Foresta C. Hypovitaminosis D is associated with lower urinary tract symptoms and benign prostate hyperplasia in type 2 diabetes. Andrology 2015; 3:1062-7. [DOI: 10.1111/andr.12092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/24/2015] [Accepted: 07/16/2015] [Indexed: 01/30/2023]
Affiliation(s)
- N. Caretta
- Department of Medicine; Section of Endocrinology and Centre for Human Reproduction Pathology; University of Padova; Padova Italy
| | - S. Vigili de Kreutzenberg
- Department of Medicine; Section of Diabetes and Metabolic Diseases; University of Padova; Padova Italy
| | - U. Valente
- Department of Medicine; Section of Endocrinology and Centre for Human Reproduction Pathology; University of Padova; Padova Italy
| | - G. Guarneri
- Department of Medicine; Section of Diabetes and Metabolic Diseases; University of Padova; Padova Italy
| | - D. Pizzol
- Department of Medicine; Section of Endocrinology and Centre for Human Reproduction Pathology; University of Padova; Padova Italy
| | - A. Ferlin
- Department of Medicine; Section of Endocrinology and Centre for Human Reproduction Pathology; University of Padova; Padova Italy
| | - A. Avogaro
- Department of Medicine; Section of Diabetes and Metabolic Diseases; University of Padova; Padova Italy
| | - C. Foresta
- Department of Medicine; Section of Endocrinology and Centre for Human Reproduction Pathology; University of Padova; Padova Italy
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Ferlin A, Selice R, Di Mambro A, Ghezzi M, Di Nisio A, Caretta N, Foresta C. Role of vitamin D levels and vitamin D supplementation on bone mineral density in Klinefelter syndrome. Osteoporos Int 2015; 26:2193-202. [PMID: 25963234 DOI: 10.1007/s00198-015-3136-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/07/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED This manuscript describes the role of low vitamin D in bone metabolism of Klinefelter subjects. Low vitamin D is frequent in this condition and seems to be more important than testosterone in inducing low bone mineral density (BMD) and osteoporosis. Supplementation with vitamin D restores BMD after 2 years of treatment, whereas testosterone alone seems to be ineffective. INTRODUCTION Decreased bone mineral density (BMD) in Klinefelter syndrome (KS) is frequent, and it has been traditionally related to low testosterone (T) levels. However, low BMD can be observed also in patients with normal T levels and T replacement therapy does not necessarily increase bone mass in these patients. Nothing is known about vitamin D levels and supplementation in KS. In this study, we determine vitamin D status and bone mass in KS subjects and compare the efficacy of T therapy and vitamin D supplementation on BMD. METHODS A total of 127 non-mosaic KS patients and 60 age-matched male controls were evaluated with reproductive hormones, 25-hydroxyvitamin D, PTH, and bone densitometry by dual-energy X-ray absorptiometry (DEXA). Patients with hypogonadism and/or 25-hydroxyvitamin D deficiency were treated with T-gel 2% and/or calcifediol and re-evaluated after 24 months of treatment. RESULTS 25-hydroxyvitamin D levels were significantly lower in KS patients with respect to controls, and they had significantly lower lumbar and femoral BMD. The percentage of osteopenia/osteoporosis in subjects with 25-hydroxyvitamin D deficiency was higher with respect to subjects with normal 25-hydroxyvitamin D and was not related to the presence/absence of low T levels. Subjects treated with calcifediol or T + calcifediol had a significant increase in lumbar BMD after treatment. No difference was found in T-treated group. CONCLUSIONS These data highlight that low 25-hydroxyvitamin D levels seem to have a more critical role than low T levels in inducing low BMD in KS subjects. Furthermore, vitamin D supplementation seems to be more effective than T replacement therapy alone in increasing BMD.
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Affiliation(s)
- A Ferlin
- Department of Medicine and Centre for Human Reproduction Pathology, University of Padova, Via Giustiniani 2, 35100, Padova, Italy
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Garolla A, Torino M, Miola P, Caretta N, Pizzol D, Menegazzo M, Bertoldo A, Foresta C. Twenty-four-hour monitoring of scrotal temperature in obese men and men with a varicocele as a mirror of spermatogenic function. Hum Reprod 2015; 30:1006-13. [DOI: 10.1093/humrep/dev057] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 02/20/2015] [Indexed: 11/14/2022] Open
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Selice R, Caretta N, Di Mambro A, Torino M, Palego P, Ferlin A, Foresta C. Prostate volume and growth during testosterone replacement therapy is related to visceral obesity in Klinefelter syndrome. Eur J Endocrinol 2013; 169:743-9. [PMID: 24001894 DOI: 10.1530/eje-13-0488] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Klinefelter syndrome (KS) is a chromosomal alteration characterized by increased risk of metabolic syndrome, mainly caused by visceral obesity. In the last years, obesity has been studied as a potential risk factor for prostate disease and recently a link has been demonstrated between visceral adiposity with prostate volume. The aim of this study was to analyze the relationship between obesity and prostate volume and growth during testosterone therapy in KS subjects. DESIGN AND METHODS We evaluated reproductive hormones, metabolic parameters, anthropometric measures, PSA, and prostate volume in 121 naïve non-mosaic KS patients and 60 age-matched healthy male controls. Fifty-six KS hypogonadic subjects were treated with testosterone-gel 2% and reevaluated after 18 months of treatment. RESULTS Prostate volume in KS was positively related to waist circumference (WC). The KS group with WC ≥94 cm had significantly higher prostate volume, BMI, insulin plasma levels, homeostasis model assessment index, total cholesterol, triglycerides, and glycemia with respect to the KS group with WC <94 cm. After testosterone replacement therapy, only hypogonadic KS men with WC ≥94 cm had a statistically significant increase in prostate volume. Furthermore, in untreated KS subjects, prostate volume showed a statistically significant increase after 18 months of follow-up only in subjects with WC ≥94 cm. CONCLUSIONS This study showed that visceral obesity, insulin resistance, and lipid and glucose metabolism alterations are associated with prostate volume and growth during testosterone replacement therapy in KS, independently from androgen or estrogen levels. These latter findings might provide the basis for a better management and follow-up of KS subjects.
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Affiliation(s)
- R Selice
- Department of Molecular Medicine, Section of Clinical Pathology and Center for Human Reproduction Pathology, University of Padova, Via Gabelli 63, 35121 Padova, Italy
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Foresta C, Caretta N, Palego P, Ferlin A, Zuccarello D, Lenzi A, Selice R. Reduced artery diameters in Klinefelter syndrome. ACTA ACUST UNITED AC 2012; 35:720-5. [DOI: 10.1111/j.1365-2605.2012.01269.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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De Toni L, Strapazzon G, Gianesello L, Caretta N, Pilon C, Bruttocao A, Foresta C. Effects of type 5-phosphodiesterase inhibition on energy metabolism and mitochondrial biogenesis in human adipose tissue ex vivo. J Endocrinol Invest 2011; 34:738-41. [PMID: 22234177 DOI: 10.1007/bf03346724] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE An excess of adipose tissue (AT) in obese individuals is linked to increased cardiovascular risk and mitochondria have been shown to be defective in the muscle and AT of patients with metabolic disorders such as obesity and Type 2 diabetes. Nitric oxide (NO) generated by endothelial NO synthase (eNOS) plays a role in mitochondrial biogenesis through cyclic-GMP (cGMP). AT harbors the whole molecular signaling pathway of NO, together with type 5-phosphodiesterase (PDE- 5), the main cGMP catabolising enzyme. AIM Our aim was to evaluate the effect of the modulation of NO pathway, through PDE-5 inhibition, on energy metabolism and mitochondria biogenesis in human omental AT. METHODS AND MEASUREMENTS Cultured human omental AT was stimulated with PDE-5 inhibitor, vardenafil, at different concentration for 24 and 72 h. Analysis of the expression of both key-regulator genes of adipocyte metabolism and mitochondria-biogenesis markers was performed. RESULTS We found an increased gene expression of peroxisome proliferator-activated receptor-γ (PPAR-γ), adiponectin, and proliferator- activated receptor gamma coactivator-1 α (PGC-1α) after a 24-h stimulation with vardenafil at the lowest concentration employed compared to controls (p<0.05). After 72 h of stimulation, a significant increase of mitochondrial DNA was found compared to control samples (p<0.05). CONCLUSION Our data suggest that PDE-5 inhibition could have an impact on mitochondrial content of human AT suggesting a positive effect on energy metabolism and adding new elements in the comprehension of AT pathophysiology.
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Affiliation(s)
- L De Toni
- Department of Histology, Microbiology and Medical Biotechnologies, Section of Clinical Pathology and Centre for Human Reproduction Pathology, University of Padua, Via Gabelli 63, 35121 Padua, Italy
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Abstract
Unilateral orchiectomy (UO) in adult bonnet monkeys and boars elicits a compensatory increase in size and sperm production of the remaining testis. The objective of this study was to investigate whether a similar effect is evident also in humans. We prospectively studied 50 patients from October 2003 to December 2005 who underwent UO for seminomatous tumour, with sperm concentration >20 × 10(6) /mL or total sperm count >40 × 10(6) at diagnosis and without elevation of serum tumour markers. Patients were followed-up with surveillance and they were studied at the time of diagnosis of testicular cancer (T(-1) ), 1 month after unilateral orchiectomy (T(0) ) and yearly for 3 years (T(1) , T(2) , T(3) ) with semen analysis, measurement of plasma levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), inhibin B, total testosterone, and oestradiol and ultrasonographic scanning of the remaining testis. A decline in circulating inhibin B and an increase in FSH levels were evident 1 month after UO. The elevation of FSH was maintained up to 3 years and was associated with a significant increase in testicular volume of 19 and 30%, 2 and 3 years after UO respectively. Although patients had normozoospermia at the time of diagnosis of testicular cancer, they showed a statistically significant increase in total sperm count at T(2) and T(3) with respect to T(-1) and T(0.) In conclusion, we showed that in humans, the testes are not normally operating at their maximal potential in terms of spermatogenesis. Therefore, in physiological situations, FSH secretion is insufficient to stimulate spermatogenesis to its ceiling. A sustained endogenous increase in FSH secretion might drive human testes towards their maximal function.
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Affiliation(s)
- R Selice
- Section of Clinical Pathology, Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, University of Padova, Padova, Italy
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Caretta N, Feltrin G, d'Agostino C, Gambino A, Foresta C, Gerosa G. 287 Erectile Dysfunction, Penile Atherosclerosis and Coronary Artery Disease in Heart Transplant Recipients. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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d'Agostino C, Caretta N, Feltrin G, Tona F, Gambino A, Gerosa G, Foresta C. 286 Erectyle Dysfunction in Heart Transplanted Patients: Correlation with Peripheral and Cardiac Vasculopaty and Role of Endothelial Progenitor Cells. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Selice R, Garolla A, Pengo M, Caretta N, Ferlin A, Foresta C. The response to FSH treatment in oligozoospermic men depends on FSH receptor gene polymorphisms. ACTA ACUST UNITED AC 2010; 34:306-12. [DOI: 10.1111/j.1365-2605.2010.01086.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Di Mambro A, Ferlin A, De Toni L, Selice R, Caretta N, Foresta C. Endothelial progenitor cells as a new cardiovascular risk factor in Klinefelter's syndrome. Mol Hum Reprod 2010; 16:411-7. [DOI: 10.1093/molehr/gaq015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Foresta C, Caretta N, Corona G, Fabbri A, Francavilla S, Jannini E, Maggi M, Bettocchi C, Lenzi A. Clinical and metabolic evaluation of subjects with erectile dysfunction: a review with a proposal flowchart. ACTA ACUST UNITED AC 2009; 32:198-211. [DOI: 10.1111/j.1365-2605.2008.00932.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Foresta C, Caretta N, Zuccarello D, Poletti A, Biagioli A, Caretti L, Galan A. Expression of the PDE5 enzyme on human retinal tissue: new aspects of PDE5 inhibitors ocular side effects. Eye (Lond) 2007; 22:144-9. [PMID: 17585311 DOI: 10.1038/sj.eye.6702908] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE We tested the effect of two phosphodiesterase type-5 (PDE5) inhibitors, sildenafil and tadalafil, on ophthalmic artery (OA) blood flow velocity and investigated the presence of the PDE5 enzyme on human retinal tissue in comparison with the PDE6 enzyme localization. METHODS Using Colour Doppler ultrasonography (CDU) we investigated, in 30 healthy young subjects (27.8 years of age; range, 24.3-33.7 years), the effects of a single oral dose of sildenafil (100 mg), tadalafil (20 mg), and placebo on OA blood flow velocity. Western blot for PDE6 and PDE5 protein expression was performed on frozen samples of human retina, testis, sperm, skin, and corpus cavernosum. Immunohistochemistry was performed on two ocular globes from dead donors. RESULTS CDU showed a relationship between the administration of PDE5 inhibitors and OA blood flow velocity modifications in a time-dependent manner. Western blot and immunohistochemical analysis showed PDE6 and PDE5 presence in human retinal tissue and gave a map of its distribution. CONCLUSION We demonstrated that (a) tadalafil and sildenafil are able to modify the OA flux in a time-dependent manner; (b) the PDE5 enzyme is expressed on retinal and choroid vasculature (smooth muscle and endothelial cells), on ganglion and bipolar cells; (c) human retinal tissues express the PDE6 enzyme in the rod and cone photoreceptors; (d) visual side effects after PDE5 inhibitors administration may be linked to a specific effect on the PDE5 enzyme; and (e) the PDE5 enzyme may have a physiologic role on ganglion and bipolar cells that need to be further investigated.
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Affiliation(s)
- C Foresta
- Department of Histology, Microbiology and Medical Biotechnologies, University of Padova, Padova, Italy.
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Caretta N, Foresta C. Clinical diagnostic approach to erectile dysfunction. Minerva Ginecol 2007; 59:51-61. [PMID: 17353874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Erectile dysfunction (ED) has been defined by the National Institutes of Health (NIH) as the inability to achieve and/or maintain an erection for a satisfactory sexual intercourse. Data on ED epidemiology estimate a prevalence of 12-52%; the prevalence in Italy is 12.8%. ED is a symptom, sometimes the first, of numerous internal diseases. ED can mark the point where the evaluation and prevention of illnesses (diabetes, arterial hypertension, atherosclerosis) hitherto unknown by the patient can begin. The andrologist's task is to identify the disorder underlying ED and to plan the appropriate diagnostic work-up.
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Affiliation(s)
- N Caretta
- Clinical Pathology Unit, Department of Histology, Microbiology and Medical Biotechnologies, University of Padua, Via Modena 9, 35128 Padua, Italy
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Foresta C, Caretta N, Lana A, De Toni L, Biagioli A, Ferlin A, Garolla A. Reduced number of circulating endothelial progenitor cells in hypogonadal men. J Clin Endocrinol Metab 2006; 91:4599-602. [PMID: 16926245 DOI: 10.1210/jc.2006-0763] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Endothelial dysfunction seems to be the first step of the atherosclerotic process. In the past few years, it has been demonstrated that injured endothelial monolayer is restored by a premature pool of circulating progenitor cells (PCs) and a more mature one of circulating endothelial PCs (EPCs). Even though there is increasing evidence that estrogens play a beneficial role on EPCs and, even if debated, on the cardiovascular system, less is known about androgens. OBJECTIVE Our objective was to evaluate the levels of circulating PCs and EPCs in men with hypogonadotropic hypogonadism (HH) and the effect of prolonged testosterone (T) replacement therapy on these cells. DESIGN AND SETTING We conducted a prospective study on males with HH at a university andrological center. PATIENTS The study included 10 young HH patients (28.6 +/- 3.1 yr) and 25 age-matched controls. INTERVENTIONS Idiopathic HH patients were treated with T gel therapy, 50 mg/d for 6 months. MAIN OUTCOME MEASURES We assessed circulating PC and EPC concentrations and immunocytochemistry for androgen receptor expression on cultured EPCs. RESULTS At baseline, HH patients showed a significant reduction of both PCs and EPCs with respect to controls. T replacement therapy induced a significant increase of these cells with respect to baseline. Immunocytochemistry on cultured EPCs showed strong expression of the androgen receptor. CONCLUSIONS Hypotestosteronemia is associated with a low number of circulating PCs and EPCs in young HH subjects. T treatment is able to induce an increase in these cells through a possible direct effect on the bone marrow.
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Affiliation(s)
- C Foresta
- Department of Histology, Microbiology, and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, University of Padova, Padova, Italy.
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Foresta C, Ferlin A, De Toni L, Lana A, Vinanzi C, Galan A, Caretta N. Circulating endothelial progenitor cells and endothelial function after chronic Tadalafil treatment in subjects with erectile dysfunction. Int J Impot Res 2006; 18:484-8. [PMID: 16541115 DOI: 10.1038/sj.ijir.3901465] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We evaluated the effect of a chronic treatment with Tadalafil on progenitor cells (PCs) number and endothelial function in patients with erectile dysfunction (ED) with or without cardiovascular risk factors. Twenty-six subjects with ED and 23 aged matched controls were studied. All subjects underwent blood tests, International Index of Erectile Function (IIEF-5), Nocturnal Penile Tumescence Rigidity Monitoring test (NPTRM), brachial artery flow-mediated dilation (FMD) and PCs count. International index of erectile function, FMD and PC count were re-evaluated in all subjects at the end of Tadalafil and placebo treatment. With respect to controls patients had lower basal FMD (P < 0.05) and basal PCs (P < 0.05). Treatment with Tadalafil determined a significant increase in PCs (P < 0.001) and FMD (P < 0.001) with respect to basal level. Positive correlation was found between basal FMD and PCs (P < 0.05) and between basal FMD and PCs increase after Tadalafil treatment (P < 0.05). Tadalafil promotes a mobilization of PCs and improves endothelial function in ED patients.
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Affiliation(s)
- C Foresta
- Department of Histology, Microbiology and Medical Biotechnologies, University of Padova, Padova, Italy.
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Caretta N, Palego P, Roverato A, Selice R, Ferlin A, Foresta C. Age-matched cavernous peak systolic velocity: a highly sensitive parameter in the diagnosis of arteriogenic erectile dysfunction. Int J Impot Res 2005; 18:306-10. [PMID: 16319943 DOI: 10.1038/sj.ijir.3901413] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recently it has been reported that there is a strict correlation between erectile dysfunction (ED) and cardiovascular diseases, but the importance of such relationship still needs to be addressed. Ultrasonographic peak systolic velocity (PSV), is considered a reliable parameter for the diagnosis of arteriogenic ED. However, the cut-off value of PSV<30 cm/s has sufficient sensitivity only in the diagnosis of advanced arteriogenic ED and it is not representative of peripheral vascular alterations. In the present study, we set up an age-adjustment of PSV - calculated with the formula PSV <6.73+age x 0.7 - that permits a more accurate diagnosis of vascular aetiology in ED patients and may predict the presence of carotid wall alterations. We studied 179 consecutive subjects (mean age 52 years, range 23-79 years), with a history of ED of at least 6 months, by means of penile colour doppler ultrasonography (P-CDU) and common carotid arteries colour doppler ultrasonography (CCA-CDU) between June 2003 and September 2004. Statistical analysis was carried out with the statistical software R. PSV and CCAD values showed a statistically significant negative correlation. Age adjustment further improved this relationship permitting to identify an age-dependent PSV cut-off given by the formula PSV <6.73+age x 0.7. The age-adjusted PSV cut-off allows an accurate interpretation of vascular aetiology in ED patients and predicts the presence of carotid wall alterations, from the intima-media pathologic thickness to the plaque formation, with high values of both sensitivity and specificity.
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Affiliation(s)
- N Caretta
- Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, University of Padua, Padua, Italy
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Abstract
Erectile dysfunction (ED) has been defined by the National Institute of Health (NIH) as the inability to achieve and/or maintain an erection for a satisfactory sexual intercourse. Discordant data have been reported on ED epidemiology with prevalence ranging from 12% to 52%. A recent study reported an ED prevalence of 12.8% in Italy. ED is a symptom, sometimes the first, of different internal diseases. ED can mark the point where evaluation and prevention of important diseases (such as diabetes, arterial hypertension, atherosclerosis) hitherto unknown by the patients, can begin. The andrologist's cultural baggage must include the ability to identify the pathology that can determine ED and the capacity to programme a specific diagnostic workup.
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Affiliation(s)
- C Foresta
- Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, University of Padova, Padova, Italy.
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Abstract
Erectile dysfunction (ED) is often the first clinical sign of endothelial dysfunction and may precede overt cardiovascular diseases. Bone marrow-derived endothelial progenitor cells migrate into the peripheral circulation to promote endothelial repair. The number of circulating progenitor cells is reduced in patients with cardiovascular risk factor. The objective of our study was to determine the number of these cells in patients with ED both with and without cardiovascular risk factors. These subjects have lower number of circulating progenitor cells, confirming the existence of an endothelial dysfunction and supplying the evidence that ED may be the first symptom of an endothelial damage.
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Affiliation(s)
- C Foresta
- Department of Histology, Microbiology, and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, University of Padova, Padova, Italy.
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Caretta N, Palego P, Ferlin A, Garolla A, Bettella A, Selice R, Foresta C. Resumption of Spontaneous Erections in Selected Patients Affected by Erectile Dysfunction and Various Degrees of Carotid Wall Alteration: Role of Tadalafil. Eur Urol 2005; 48:326-31; discussion 331-2. [PMID: 16005378 DOI: 10.1016/j.eururo.2005.01.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Accepted: 01/19/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the possible improvement of sexual activity following a non on-demand administration of a long half-life selective inhibitor of phosphodiesterase type 5 (PDE-5) in elderly patients without major cardiovascular risk factors. METHODS Sixty subjects with erectile dysfunction (ED) aged 60-70 years and 30 control patients aged 18-40 years, affected by psychogenic ED, were studied. All underwent routine and hormonal blood tests, Nocturnal Penile Tumescence Rigidity Monitoring test (NPTRM), ultrasonographyc evaluation of common carotid artery intima-media thickness (IMT) and penile colour Doppler ultrasonography (P-CDU). All patients underwent therapy with tadalafil 20 mg in alternative days, non on-demand, at 5.00 p.m., for three consecutive months. IIEF-5, NPTRM test and P-CDU were re-evaluated one month after the end of the therapy. RESULTS Among elderly subjects 20 (33%) had normal carotid IMT (< 0.9 mm), 15 (25%) minimal increase of carotid thickness (IMT = 0.9-1.2 mm) and 25 (42%) one or more carotid plaques (IMT > 1.3 mm). NPTRM and P-CDU parameters were inversely related to different degrees of carotid wall alteration and showed a significant improvement respect to pre-treatment only in patients without atherosclerotic plaques. Also IIEF-5 showed significant improvements only in patients without atherosclerotic plaques. CONCLUSIONS In elderly subjects with slight or no signs of vascular disease at the carotid level, chronic and non on-demand treatment with tadalafil can induce spontaneous resumption of erections, probably through the improvement of endothelial function, but direct evidences to confirm this hypothesis are required.
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Affiliation(s)
- N Caretta
- Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, University of Padova, Via Giustiniani 2, 35128-Padova, Italy
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Foresta C, Lana A, Cabrelle A, Ferigo M, Caretta N, Garolla A, Palù G, Ferlin A. PDE-5 inhibitor, Vardenafil, increases circulating progenitor cells in humans. Int J Impot Res 2005; 17:377-80. [PMID: 15829988 DOI: 10.1038/sj.ijir.3901325] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Bone marrow-derived endothelial progenitor cells (EPCs) originate from haematopoietic stem cells in bone marrow and migrate into the peripheral circulation to promote endothelial repair and neovascularization. The number of circulating progenitor cells is reduced in patients with cardiovascular risk factor. The aim of our study was to determine the number of these cells in healthy patients and to evaluate the effect of Vardenfil, a phosphodiesterases-5 (PDE-5) inhibitor, in the number of circulating EPCs. In our study, we found a significant increase in the number of these cells after the drug administration.
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Affiliation(s)
- C Foresta
- Department of Histology, Microbiology, and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, University of Padova, Padova, Italy.
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Caretta N, Ferlin A, Palego PF, Foresta C. Erectile dysfunction in aging men: testosterone role in therapeutic protocols. J Endocrinol Invest 2005; 28:108-11. [PMID: 16760637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Aging in men is accompanied by a decrease in libido and sexual activity. Recently, it has been demonstrated that a significant proportion of men >60 yr of age has biochemical hypogonadism. Hypoandrogenism, which is associated with other conditions that negatively influence erectile activity, may be an important cofactor in the induction of erectile dysfunction and in the response to phosphodiesterase type 5 (PDE5) inhibitors in aging. In these patients, administration of 50 mg sildenafil or 3 mg apomorphine has no influence on erectile function. Recently we showed that, in hypogonadal subjects, testosterone treatment might stimulate endothelial and neuronal production of vasoactive substances like nitric oxide (NO). Furthermore it can improve endothelial repair mechanisms by increasing bone marrow-derived endothelial progenitor cell (EPC) number in the peripheral circulation. Finally, the normal response to pharmacological stimulation with apomorphine or sildenafil, observed in hypogonadal men treated with testosterone, indicates a positive role of this hormone in the central and peripheral control of erection, confirming the possible positive influence on endothelial function and PDE5 expression. Therefore, we suggest measuring plasma testosterone levels in aged men with erectile dysfunction and recommend treating them barring clinical contraindications. Testosterone plus PDE5 inhibitors may be beneficial in improving erectile function in hypogonadal men with erectile dysfunction who were unresponsive to PDE5 inhibitors alone.
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Affiliation(s)
- N Caretta
- Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, University of Padua, 35128 Padua, Italy
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Abstract
PURPOSE Erectile response in mammals is centrally and peripherally regulated by androgens. Severe hypogonadism in men usually results in loss of libido and potency. The present studies were designed to evaluate the possible influence of circulating androgens in the regulation of sexual function. MATERIALS AND METHODS A total of 15 men with severe hypogonadism (testosterone less than 2.0 ng/ml) were recruited. The control group consisted of 20 patients with psychogenic erectile dysfunction. All subjects underwent nocturnal penile tumescence (NPT) and rigidity monitoring during 2 consecutive nights, evaluation of cavernous artery flow using penile color duplex ultrasound (P-CDU), and real-time visually stimulated erection evaluation at baseline and after administration of 50 mg sildenafil or 3 mg apomorphine. NPT, P-CDU and visually stimulated erection were evaluated after 6 months of therapy with a 5 mg daily testosterone patch. RESULTS NPT analysis in subjects with severe hypogonadism showed a significant decrease in sleep related erections. P-CDU showed a partial erectile response with an alteration of the parameters analyzed, and the visually stimulated erections test was pathological. Administration of 3 mg apomorphine and 50 mg sildenafil has no influence on erectile function. Testosterone treatment for 6 months induced normalization of NPT and P-CDU parameters, and of visually stimulated erection effects with the restoration of a normal response to pharmacological stimulation with apomorphine or sildenafil. CONCLUSIONS Our results show that testosterone has a key role in the central and peripheral modulation of erectile function even if the accurate testosterone plasma level threshold that may influence these processes remains to be established.
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Affiliation(s)
- C Foresta
- Department of Medical and Surgical Sciences, Clinica Medica 3, Center for Male Gamete Cryopreservation, University of Padova, Italy
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Abstract
Erectile dysfunction (ED) has been defined by the National Institute of Health (NIH) as the inability to achieve and/or to maintain an erection for a sufficiently long period of time so as to permit satisfactory sexual intercourse. ED affects millions of men throughout the world and could have a negative influence on the individual's well-being as well as on the quality of life of affected subjects. Discordant data have been reported on ED epidemiology with prevalence ranging from 12% to 52%, probably depending on the different criteria utilized in the different studies for patient selection. ED is a symptom, sometimes the first, of different pathological conditions. In 15.7% of 45-yr-old patients with vascular ED a dynamic ergometric test has shown electrocardiographic alterations in the absence of any cardiac symptom. In 15% of the patients with ED, high fasting glucose plasma levels are discovered for the first time and in patients with ED and normal fasting glucose plasma levels the prevalence of undiagnosed diabetes mellitus is 12.1% after an oral glucose tolerance test (OGTT). The different risk factors are often additive in the possible development of systemic vasculopathy, neuropathy and ED. ED, underestimated in clinical practice due to archaic prejudice which hinders the patient in spontaneously revealing the problem and the physicians in investigating it, can mark the point where evaluation and prevention of important diseases (such as diabetes, arterial hypertension, atherosclerosis) hitherto unknown by the patients, can begin. The physicians' cultural baggage must include the ability to identify the pathology that can determine ED and the ability to program a specific diagnostic workup. In this paper the different specialists involved in ED diagnosis agreed that a clinical approach which allows the identification of systemic pathologies contributing to the development of ED constitutes an improvement in disease prognosis and may either induce a spontaneous reduction of ED or facilitate its specific treatment.
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Affiliation(s)
- C Foresta
- Center for Male Gamete Cryopreservation, Department of Medical and Surgical Sciences, University of Padua, Italy.
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Foresta C, Caretta N, Garolla A, Rossato M. Erectile function in elderly: role of androgens. J Endocrinol Invest 2003; 26:77-81. [PMID: 12834027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Erectile function progressively declines with age, although most old men's erectile rigidity remains adequate for vaginal intercourses. Recently it has been demonstrated that a significant proportion of men over 60 years of age has a biochemical hypogonadism (defined as below the 2.5th percentile for young men). It is generally accepted that erectile response in mammals is regulated by androgens both centrally and peripherically, but in male ageing a casual relationship between androgen levels and erectile function has not been established yet. The present study was designed to evaluate the possible relationships between circulating androgens and sexual activity in a group of healthy old men without erectile dysfunction. Forty men with a mean age of 68 +/- 6 years (range 61-75 years) were recruited among healthy subjects undergoing periodic health screening. The control group consisted of 30 young volunteers with a mean age of 33 +/- 5 years (range 26-40 years). These subjects had good general health and stable relationship with at least one successful intercourse for week. All subjects performed: 1) hormonal assessment (total testosterone, free testosterone, DHT, FSH and LH); 2) nocturnal penile tumescence monitoring during two consecutive nights. The findings of this study show a significant decrease in frequency, duration and degree of nocturnal erectile episodes in old men with respect to those observed in young controls. The alteration of these parameters was more evident in old subject showing a reduction of testosterone plasma levels. In hypotestosteronemic subjects DHT treatment significantly improved nocturnal penile tumescence parameters even if these still differed from those of controls (p<0.001). On the basis of these observations we hypothesize that hypoandrogenism in old men, also in presence of normal sexual activity, may influence locally the erectile mechanisms. However hypoandrogenism, associated to other conditions negatively influencing the erectile activity, may be an important co-factor in the induction of erectile dysfunction in aging.
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Affiliation(s)
- C Foresta
- Department of Medical and Surgical Sciences, Clinica Medica 3, Center for Male Gamete Cryopreservation, University of Padova, Padova, Italy.
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Caretta N, Bettella A, Foresta C. [Ultrasonography in the prediction of sperm presence in the epididymis]. Arch Ital Urol Androl 2000; 72:350-6. [PMID: 11221070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Azoospermia represents approximately 10% of case of male infertility. Identification of etiological aspects is very important for prognostic and therapeutic evaluation. After the testicular analysis with fine needle aspiration cytology (FNAC) we reviewed the scrotal sonograms of 639 azoospermic patients. In the group of patients with obstructive azoospermia we have found a particular sonographic appearance. This consisted in a normal aspect of the testis, the epididymis have an enlargement, development of cysts and an inhomogeneous echo pattern. However we have found this particular sonographic appearance in same patients with other kinds of azoospermia. In conclusion, scrotal sonogram is a fundamental step in the diagnostic work-up of the azoospermic patient, but it does not allow to distinguish unequivocally patients affected by obstructive azoospermia.
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Affiliation(s)
- N Caretta
- Dipartimento di Scienze Mediche e Chirurgiche, Clinica Medica 3, Università degli Studi di Padova
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