Treating erectile dysfunction with penile implant

R. Andrianne Published in the journal : October 2016 Category : Pathologie sexuelle masculine

In patients suffering from organic erectile dysfunction that proves resistant to medical treatment, penile implant is a reliable, efficient, and long-lasting third-line treatment option. Postoperative complications are well-codified and rather limited, if the intervention is performed by surgeons with implants expertise. In Belgium, the number of implantations is proportionally five times lower than in the USA, which can be accounted for by various factors including a lack of promotion and information of therapists, limited number of experimented "implanters", and lack of knowledge by patients who could benefit from the procedure. The overall management of this common sexual disorder using a penile implant is associated with high satisfaction rates for both the patients and their partners.

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Stem cell therapy for the treatment of erectile dysfunction: where do we stand?

E. Weyne, D. De Ridder, F. Van der Aa, M. Albersen Published in the journal : October 2016 Category : Pathologie sexuelle masculine

Nowadays, erectile dysfunction (ED) can only be managed with symptomatic treatments. Regenerative medicine, which is based on administering stem cells, has the potential to provide the first curative treatment for ED. Two types of stem cells were tested preclinically in animal models, namely mesenchymal (stromal) stem cells isolated from either bone marrow or adipose tissue. The application of both cell types yielded positive effects in various animal ED models. In acute animal models, such as cavernous nerve injury-induced ED, neither engraftment nor differentiation was observed, and stem cells are believed to interact with the host tissue in a paracrine fashion. In chronic disease models, some evidence suggested that engraftment and paracrine factors might boost function improvement. Clinical trials are currently enrolling patients so as to confirm the beneficial effects observed in rodents. If confirmed, this could pave the way for a broad use of stem cell therapy and thus revolutionize the treatment of ED.

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Dapagliflozin (Forxiga®), a novel sglt2 inhibitor. What’s its place in the modern management of Type 2 diabetes?

M. Buysschaert Published in the journal : November 2016 Category : Diabétologie

SGLT2 inhibitors, when administered to patients with Type 2 diabetes, result in an improved glycemic control, which is attributable to the agents' glucuretic effect, in addition to weight loss and reduced blood pressure. Dapagliflozin (Forxiga®), a new SGLT2 inhibitor, has been available in Belgium since October 2016. This article sought to review recent scientific data from controlled trials assessing dapagliflozin versus placebo or active comparators in Type 2 diabetic patients. Forxiga® was found to be associated with a reduction in HbA1c, along with weight loss and decreased blood pressure levels. The reported adverse events included mild urinary and genital infections. In Belgium, Forxiga® is approved for use in a dual- or triple-therapy regimen, also in combination with basal insulin.

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The transition from impotence to premature erectile insufficiency: an unknown revolution

P. Bondil Published in the journal : October 2016 Category : Pathologie sexuelle masculine

In the space of 20 years, impotence has transformed into erectile insufficiency, a relevant clinical marker for quality of life, and more surprisingly, for poor men's health. Between the age of 30 and 65 years, it has been found to be a marker of both cardiovascular and overall mortality, which represents a major breakthrough and thus renders its proactive opportunistic screening unequally valuable. Any clinician dealing with chronic diseases, particularly cardiometabolic conditions or mood disorders, can no longer ignore the recommendation (Grade A, Level 1) to assess the physical and mental health status in terms of benefits for the primary prevention of acute cardiovascular events, but also for the secondary and tertiary prevention of chronic diseases.

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"The heart is only the heart when it gives itself… "1

P. De Neuter Published in the journal : October 2016 Category : Pathologie sexuelle masculine

The heart is not only a hollow muscle. Since very ancient times, the heart has been considered as the symbol of life, desire, and passion. True love and desire both require a great amount of psychic work in order to give up narcissism, and abandon both egocentricity and hold over the other. Under these conditions, and even more so when they are mutual, love and desire bring up a lot of happiness and jouissance. However, in the event of non-reciprocity, or breaking up of the relationship, they may entail serious physical and psychic decompensation (depression, sexual impotence, cardiomyopathy, etc.), and even death (suicide or murder).

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Is sex dangerous for the heart?

Ch. Brohet Published in the journal : October 2016 Category : Pathologie sexuelle masculine

Sexual intercourse results in a modest amount of energy expenditure comparable to that of mild-to-moderate physical exercise like brisk walking or climbing two flights of stairs (3-5 METS). The cardiovascular risk linked to sexual activity is therefore rather low, with some caution needed for cardiac patients. While sexual activity may be resumed as early as the first week after myocardial infarction, it is generally recommended to abstain from sexual intercourse for 6-8 weeks following open heart surgery. The issue of sexual activity in cardiac patients should be addressed at every medical visit, and the practitioner should deliver a message in line with official guidelines.

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Are PDE5 inhibitors safe in patients with cardiovascular diseases?

D. Vancraeynest Published in the journal : October 2016 Category : Pathologie sexuelle masculine

Phosphodiesterase 5 inhibitors (PDE5i) are an effective and well-tolerated first-line treatment for erectile dysfunction. Cardiovascular risk associated with the use of PDE5i appears very low, and there is no convincing evidence that PDE5i increase the risk of myocardial infarction or CV death. However, given that little clinical data exist about the prescription of PDE5i after a recent CV event, it is advised not to prescribe PDE5i during 4 to 6 weeks following the event. Moreover, PDE5i should never be prescribed in patients receiving nitrates. After the intake of sildenafil or vardenafil, at least 24 hours should elapse before using nitrates. For tadalafil, this nitrate-free period is increased to 48 hours.

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Alexandre Persu Published in the journal : September 2015 Category : Pathologie sexuelle masculine

Sexual dysfunction is associated both with hypertension and its treatment. However, most studies focusing on undesirable sexual effects of antihypertensive drugs display significant methodological biases. It is nevertheless widely accepted that diuretics and most beta-blockers do worsen erectile dysfunction, whereas renin-angiotensin system inhibitors and alpha-blockers exert neutral or favorable effects. An open and empathic discussion of sexual problems, followed by the consultation of an urologist if necessary, is likely to influence the selection and acceptability of antihypertensive drug treatment, and to improve drug adherence, thereby preventing dramatic cardio- and cerebro-vascular complications without unacceptable effects on quality of life.

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Erectile dysfunction: a sentinel symptom of a subclinical or beginning cardiovascular disease?

Thierry Roumeguère Published in the journal : October 2016 Category : Pathologie sexuelle masculine

Erectile dysfunction: a sentinel symptom of a subclinical or beginning cardiovascular disease? Erectile dysfunction (ED) affects millions of men worldwide, and its implications reach far beyond sexual activity. Nowadays, ED is recognized as an early marker for cardiovascular diseases and diabetes mellitus. While being an essential quality-of-life component, ED is also associated with an independent risk of future cardiovascular events. ED has a similar predictive value for cardiovascular events as traditional risk factors.

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Hepatic glycogen phosphorylase kinase deficiency, a challenging diagnosis

Coralie De Bruyne, Joseph Dewulf, Mina Komuta, Etienne Sokal Published in the journal : May 2015 Category : Pediatrics

Glycogen storage diseases (GSD) are inherited metabolic diseases characterized by glycogen accumulation in the liver and/or muscles. Among liver GSDs, glycogen phosphorylase-phosphorylase kinase deficiency is responsible for GSD Type IX or VI. GSD Type IX results from a glycogen phosphorylase kinase deficiency and is primarily caused by a damage to one of the four different genes coding for the enzyme subunits. The most commonly affected gene is PHKA2, located on X chromosome. These GSDs are usually suspected in the event of hepatomegaly, elevated liver transaminases, and increased postprandial lactate levels, with a trend towards hypoglycemia, though fasting is often well tolerated. The diagnosis is generally made based on enzyme activity measurement in red blood cells and confirmed by genetic analysis. In boys, however, some variants are not characterized by a decreased erythrocyte activity. As a result, and if clinical manifestations are suggestive, the genes involved in GSD IX and VI must be analyzed in order to exclude this diagnosis, with the PHKA2 gene being analyzed first, followed by the PYGL gene (GSD VI).

This report presents our assumptions and diagnostic reflections regarding a clinical case with hepatomegaly, as well as elevated transaminases and postprandial lactate levels. The genetic study allowed us to detect a mutation in the PHKA2 gene that is responsible for the X-linked GSD Type IX, though this condition had previously been excluded.

What is already known about the topic?

The diagnosis of glycogen storage disease Type IX can generally be made based on enzyme activity measurement in red blood cells.

What does this article bring up for us?

• Normal erythrocyte phosphorylase kinase activity does not exclude the diagnosis of GSD Type IX.

• Among boys, some variants are not associated with decreased erythrocyte enzyme activity. Thus, if clinical manifestations are suggestive, the genes involved in glycogen storage diseases IX and VI should be analyzed in order to exclude this diagnosis.

• In this article, we have also reviewed the differential diagnosis of liver glycogen storage diseases

Practical recommendations

• Think of a glycogen storage disease type IX when a patient presents a hepatomegaly, elevated liver transaminases and postprandial high lactate. A tendency to hypoglycemia may be observed through a glycemic profile, but fasting is generally well tolerated.

• Even if the phosphorylase kinase activity is normal in erythrocytes, it is useful to conduct a genetic analysis of PHKA2 and PYGL genes, among boys, to formally exclude a type IX glycogen storage disease.

Key Words

Glycogen storage diseases, phosphorylase kinase, PHKA2, hepatomegaly, hypoglycemia, lactic acid, ketones

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