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- ItemAcesso aberto (Open Access)Avaliação do efeito da eletroestimulação funcional como reabilitação peniana na função erétil de pacientes submetidos à prostatectomia radical(Universidade Federal de São Paulo (UNIFESP), 2018-09-24) Bispo, Ana Paula dos Santos [UNIFESP]; Mesquita, Roberto Andre Soler [UNIFESP]; http://lattes.cnpq.br/9038872306641159; http://lattes.cnpq.br/2262290125054480; Universidade Federal de São Paulo (UNIFESP)Introduction: Erectile dysfunction (ED) after radical prostatectomy is a peculiar form of ED, which preserved with the direct causal event. Objective: To evaluate the effect of functional electrostimulation as a penile rehabilitation procedure on the erectile function of postprostatectomy patients. Methods: This was a prospective, blind, randomized, shamcontrolled trial with 49 patients at the Division of Urology of UNIFESPEPM, through 2014 to 2017. The study included patients undergoing radical prostatectomy with bilateral preservation of the neurovascular bundle, with previous unassisted normal erectile function (International Index of Erectile Function – Erectile Function domain [IIEFEF] score ≥ 26). Patients were undergo functional electrostimulation (FES) or sham procedure. Penile rehabilitation was performed for 6 months, with frequency: 50 Hz; pulse width: 250 microseconds; contraction: 6 seconds; rest: 12 seconds. Patients were evaluated at 1, 3, 6, 9 and 12 months after the start of the procedures. The primary endpoint was proportion of patients with IIEFEF score ≥ 22 after 12 months of the start of treatment. Secondary endpoints included rate of positive responses to Sexual Encounter Profile (SEP) questions 2 and 3 and to Global Assessment Question (GAQ) questions 1 and 2. Results: After 12 months of the start of the study procedures 52.2% and 19.2% of patients reached IIEFEF score ≥ 22 in FES and sham groups, respectively (p = 0,016). A significantly higher proportion of patients in FES group compared to sham group had positive responses to SEP2 and GAQ1 from the 6th month to the end of the study. There was numerical, but no statistical, difference in the rate of SEP3 and GAQ2 positive responses between the groups. Conclusion: Functional electrostimulation was efficacious and safe as a penile rehabilitation procedure in improving recovery of erectile function in patients undergoing radical prostatectomy.
- ItemSomente MetadadadosAvaliação objetiva do efeito do citrato de sildenafil nas artérias cavernosas de pacientes com disfunção erétil(Universidade Federal de São Paulo (UNIFESP), 2001) Ximenes, Sergio Felix [UNIFESP]; Claro, Joaquim Francisco de Almeida [UNIFESP]O citrato de sildenafil é um inibidor da fosfodiesterase tipo 5, específica do GMPc, que tem demonstrado bons resultados no tratamento clínico da disfunçao erétil. As repercussoes do uso do citrato de sildenafil nas artérias cavernosas ainda nao estao bem estabelecidas, com, poucos estudos demonstrando resultados antagônicos.) O objetivo de estudo foi avaliar objetivamente o efeito do citrato de sildenafil nas artérias cavernosas em pacientes com disfunçao erétil Foram avaliados prospectivamente 29 pacientes do sexo masculino, com nédia de idade de 53,8 anos (32 a 75 anos). O tempo médio de queixa de Disfunçao erétil foi de 50,5 meses (6 a 168 meses). Cada paciente foi o seu próprio controle. Os pacientes foram submetidos à mensuraçao da velocidade do pico sistólico antes e após a utilizaçao do citrato de sildenafil, através da velocitometria ultrassônica sistema Knoll/MIDUSO. No intervalo entre as mensuraçoes, aproximadamente 15 dias, os pacientes utilizaram 3 comprimidos do sildenafil em casa com a parceira. Sem a utilizaçao do citrato de sildenafil, a média da velocidade do pico sistólico foi de 23,9 cm/s, e após a utilizaçao da droga de 24,8 cm/s. Este pequeno aumento nao foi estatisticamente significante, Zcauculado=-0,695 NS (teste de Wilcoxon). Vinte e um dos 29 pacientes (72,4 por cento) apresentaram melhora global do desempenho sexual com a utilizaçao do citrato de sildenafil em casa. Nao houve correlaçao estatisticamente significante entre a resposta global ao citrato de sildenafil e o aumento do pico sistólico. Concluímos que a utilizaçao de 50mg de citrato de sildenafil nao proporciona aumento de velocidade do pico sistólico das artérias cavernosas de pacientes com disfunçao erétil e nao há correlaçao entre resposta global e aumento desta velocidade.
- ItemAcesso aberto (Open Access)Effects of sildenafil on autonomic nervous function during sleep in obstructive sleep apnea(Faculdade de Medicina / USP, 2010-01-01) Neves, Christiane [UNIFESP]; Tufik, Sergio [UNIFESP]; Chediek, Felipe [UNIFESP]; Poyares, Dalva [UNIFESP]; Cintra, Fátima Dumas [UNIFESP]; Roizenblatt, Marina [UNIFESP]; Abrantes, Fabiano [UNIFESP]; Monteiro, Marina Ariza [UNIFESP]; Roizenblatt, Suely [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the effects of sildenafil on the autonomic nervous system in patients with severe obstructive sleep apnea. METHODS: Thirteen male patients with severe obstructive sleep apnea (mean age 43±10 years with a mean body mass index of 26.7±1.9 kg/m²) received a single 50-mg dose of sildenafil or a placebo at bedtime. All-night polysomnography and heart rate variability were recorded. Frequency domain analysis of heart rate variability was performed for the central five-minute sample of the longest uninterrupted interval of slow wave and rapid eye movement sleep, as well as for one-minute samples during apnea and during slow wave and rapid eye movement sleep after resumption of respiration. RESULTS: Compared to the placebo, sildenafil was associated with an increase in the normalized high-frequency (HFnu) components and a decrease in the low/high-frequency components of the heart rate variability ratio (LF/HF) in slow wave sleep (p<0.01 for both). Differences in heart rate variability parameters between one-minute post-apnea and apnea samples (Δ= difference between resumption of respiration and apnea) were assessed. A trend toward a decreasing magnitude of ΔLF activity was observed during rapid eye movement sleep with sildenafil in comparison to placebo (p=0.046). Additionally, Δ LF/HF in SWS and rapid eye movement sleep was correlated with mean desaturation (sR= -0.72 and -0.51, respectively, p= 0.01 for both), and Δ HFnu in rapid eye movement sleep was correlated with mean desaturation (sR= 0.66, p= 0.02) and the desaturation index (sR= 0.58, p = 0.047). CONCLUSIONS: The decrease in arousal response to apnea/hypopnea events along with the increase in HFnu components and decrease in LH/HF components of the heart rate variability ratio during slow wave sleep suggest that, in addition to worsening sleep apnea, sildenafil has potentially immediate cardiac effects in patients with severe obstructive sleep apnea.
- ItemSomente MetadadadosErectile Dysfunction Symptoms in Polydrug Dependents Seeking Treatment(Taylor & Francis Inc, 2017) Clemente, Jales [UNIFESP]; Diehl, Alessandra [UNIFESP]; Santana, Paulo Roberto Oliveira Henrique; Silva, Cláudio Jerônimo da [UNIFESP]; Pillon, Sandra Cristina; Mari, Jair de Jesus [UNIFESP]Objective: To assess erectile dysfunction (ED) symptom prevalence, sexual behavior conditions, and risk factors associated to ED in a male polydrug dependent sample. Methods: A cross-sectional design study was conducted with 102 substance-dependent male polydrug users who sought outpatient treatment in Sao Paulo, Brazil. Sociodemographic data, drug of choice, chronic disease questions, sexually transmitted infections, International Index of Erectile Function (IIEF) scale, Sexual Addiction Screening Test (SAST), and WHOQOL-Bref instrument were used. Results: The erectile dysfunction prevalence was 32.3% and it was related to the marital status (single) (p < 0.001), occupational status (fully unemployed) (p < 0.001), presenting a chronic disease (p = 0.027), and with types of sexual partnerships (occasional partner) (p < 0.001). Alcohol (73.5%), tobacco (79.4%), cannabis (83.3%), and cocaine (snorted 78.4% and smoked 42.2%) were the drugs of choice. The ED risk decreased when marital status was married (odds ratio = 3.2 CI95% 1.411-7.518) and with chronic disease (odds ratio 0.06 CI95% 0.00-0.97), while having occasional sexual partners increased 14 times ED risk (OR 14.0 CI95% 1.62-122.18). There were no significant associations between quality of life, DOC and ED. Conclusion: Approximately one third of the substance dependents in this sample presented ED. There is a need to integrate psychiatric and clinical care in substance treatment services, and to improve the provision of sexual health care and support available for this population.
- ItemAcesso aberto (Open Access)Intracavernous injection in the treatment of erectile dysfunction after radical prostatectomy: an observational study(Associação Paulista de Medicina - APM, 2001-07-01) Claro, Joaquim de Almeida [UNIFESP]; Aboim, José Elêrton de [UNIFESP]; Maríngolo, Marcelo [UNIFESP]; Andrade, Enrico [UNIFESP]; Aguiar, Wilson [UNIFESP]; Nogueira, Marcos [UNIFESP]; Nardozza Júnior, Archimedes [UNIFESP]; Srougi, Miguel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT: Despite the recent improvements in performing radical retropubic prostatectomy that have led to a considerable decrease in the complication rate, erectile dysfunction still represents a major problem. Moreover, less invasive treatment options that are emerging for erectile dysfunction have not shown satisfactory results in managing these patients. OBJECTIVE: To study the efficacy and side effects of self-injection therapy in the treatment of men who had become impotent after undergoing radical prostatectomy due to prostate cancer, over a study period of 96 months. DESIGN: Observational study. SETTING: University Referral Center. PARTICIPANTS: 168 patients with erectile dysfunction, aged 43 to 78 years old, who underwent radical retropubic prostatectomy due to localized prostate cancer. PROCEDURES: The patients were treated with self-injection therapy using papaverine, phentolamine and prostaglandin E1, at home. RESULTS: This study showed an acceptable 94.6% success rate, with no life-threatening complications. In addition to this, our series presented a 13.1% cure rate with this therapy. CONCLUSION: Self-injection therapy with papaverine, phentolamine and prostaglandin E1 is effective and safe in the treatment of erectile dysfunction after radical prostatectomy.
- ItemSomente MetadadadosPrevalence of erectile dysfunction complaints associated with sleep disturbances in São Paulo, Brazil: A population-based survey(Elsevier B.V., 2010-12-01) Andersen, Monica L. [UNIFESP]; Santos-Silva, Rogerio [UNIFESP]; Bittencourt, Lia R. A. [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: the aims of this study were to estimate the prevalence of erectile dysfunction (ED) complaints in a population-based sample from São Paulo and to determine the associations of ED prevalence with sleep disturbances, testosterone levels, age, body mass index (BMI), socioeconomic factors and selected-medical history indicators.Methods: the Epidemiologic Sleep Study (EPISONO) is a population-based study of sleep and risk factors for sleep disturbances in Brazil's largest city, Sao Paolo. This study adopted a probabilistic three-stage cluster sampling approach for the city of São Paulo. Questionnaires that covered medical conditions and sexual and erection complaints were administered and poly-somnographies and fasting blood samples were collected. the patient cohort of the current study of ED consisted of 467 men, aged 20-80 years at the time of their enrollment in EPISONO. the percentage of men who participated in EPISONO but refused to participate in our study was 2.3%.Results: the prevalence of ED complaints in the study cohort was 17.08% overall. ED complaints ranged from 7.3% in younger men (20-29 years old) to 63.25% in older men (>50 years old) (adjusted odds ratio [OR] = 21.65). the logistic regression model showed that both reduced time spent in REM sleep and fragmented sleep had significant effects as risk factors for ED complaints. Obesity (OR = 1.8), low testosterone levels (OR = 4.28), low quality of life (OR = 4.4), an apnea-hypopnea index over 15 (OR = 2.75), and obstructive sleep apnea syndrome (OR = 2.13) were also significantly associated with a higher risk of ED complaints.Conclusion: EPISONO study indicates that ED complaints are relatively common phenomena, especially among older men. Adequate sleep patterns and normal or high levels of testosterone, which serve as markers for sexual motivation, may be protective against ED. the prevalence of sleep apnea showed a strong impact on erectile function and subsequently negatively affects sexual activity. (C) 2010 Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosSexual function in teenagers after multimodal treatment of pelvic rhabdomyosarcoma: A preliminary report(Elsevier B.V., 2010-12-01) Macedo, Antonio [UNIFESP]; Ferreira, Pedro Vanalle [UNIFESP]; Barroso, Ubirajara [UNIFESP]; Demarchi, Guilherme T. [UNIFESP]; Garrone, Gilmar [UNIFESP]; Liguori, Riberto [UNIFESP]; Caran, Eliana [UNIFESP]; Ortiz, Valdemar [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: the multimodal approach to treatment of genitourinary rhabdomyosarcoma (RMS) has improved survival rates, but there is now a focus on the effect on quality of life. Our aim was to evaluate erectile function in children with rhabdomyosarcoma (RMS) who underwent chemotherapy, radiotherapy, cystectomy and continent urinary diversion.Material and methods: We evaluated four eligible patients (age > 14 years) from our genitourinary RMS database. in two patients the reservoir was constructed at the same time of the cystectomy and in two after undiversion of an ileal conduit. All patients were treated with chemotherapy and radiation therapy before cystectomy. We used a questionnaire to estimate erectile function in adolescents and young adults. There were four questions, each one to be scored 1-5, assessing capability to masturbate.Results: Mean follow up after cystectomy was 9.75 years. We considered that two patients had erections of good quality (scores 18 and 20) and two of moderate quality (scores 8 and 10). One patient had a good response to sildenafil administration.Conclusion: Our data demonstrate that it is possible to keep erectile function during masturbation in children with RMS who have undergone chemotherapy, radiotherapy, cystectomy and continent urinary diversion. (C) 2010 Journal of Pediatric Urology Company. Published by Elsevier B.V. All rights reserved.