NEW YORK (May 23, 2006) — Physician-scientists from Weill Medical College of Cornell University and NewYork-Presbyterian Hospital/Weill Cornell Medical Center are presenting significant research at the 101st Annual Scientific Meeting of the American Urological Association from May 20 to May 25 in the Georgia World Congress Center in Atlanta.
Featured research includes:
Combination of an Alpha Blocker, Alfuzosin SR, and a PDE-5 Inhibitor, Sildenafil Citrate (Viagra), Is Superior to Monotherapy in Treating Lower Urinary Tract Symptoms (LUTS) and Sexual Dysfunction
Alpha-blockers are commonly used to treat lower urinary tract symptoms (LUTS) and PDE-5 inhibitors are commonly used to treat erectile dysfunction (ED.) LUTS and erectile dysfunction occur simultaneously in many older men and this study investigated the simultaneous use of an alpha-blocker (Alfuzosin SR) and a PDE-5 inhibitor (sildenafil citrate, i.e., Viagra) to see if there was a greater synergistic benefit superior to monotherapy. With the participation of 62 men whose mean age was 63, study authors Dr. Steven Kaplan and Dr. Alexis Te utilized a variety of indicators, including symptom scores, urinary flow rates and frequency of maintained erections to determine the safety and efficacy of the combination treatment. This study suggests that the combination of alfuzosin and sildenafil citrate was safe and the most effective therapy to enhance both LUTS and sexual function in men at risk.
Dr. Steven Kaplan
Neuroanatomic Maps for Nerve Sparing Robotic Prostatectomy: A Study Describing the Importance of the Neurovascular Plate and Its Relationship to the Steps of Surgery
Robotic prostatectomy has become a common procedure in the management of prostate cancer. Integral to this procedure is the preservation of the neural pathways involved in bladder and sexual function. This study fused data from cadaveric dissections, 3-D reconstructions, and digital video of 100 nerve-sparing surgeries into a neural map. From this map, lead author Dr. Ashutosh Tewari worked with a multi-site team of researchers to create a 3-D computer simulation model for nerve-sparing robotic prostatectomy, which surgeons can view via the robotic equipment while performing the procedure. This simulation allows surgeons to facilitate spatial relationships of various structures while standardizing the steps of robotic prostatectomy that incorporate the intraoperative decision-making regarding excision of neurovascular bundles.
The Role of GR/GR Deletion in Infertile Men Still Remains to Be Answered
Previous work at Weill Cornell has shown the importance of genetic testing of infertile men on the chance of successful fertility treatment. In this study, the effects of a specific genetic defect (gr/gr deletion, a missing region on the Y chromosome) on spermatogenesis was evaluated. This study assessed the prevalence of gr/gr deletions in a large population of patients with low sperm production to analyze the effect of this deletion on semen parameters, hormonal profiles, testicular volume, and history. Out of 1,136 patients studied, 50 (4.4%) were identified with AZFc deletions and 54 (4.8%) had gr/gr deletions. However, no significant differences were found between patients with gr/gr deletions and patients without deletions in terms of mean sperm count, testosterone, FSH, LH, and combined testicular volume. The researchers determined that presence of gr/gr deletion is not an independent risk factor for male infertility. The ultimate role of gr/gr in male infertility remains to be elucidated.
The Age-Related Decline in Testosterone Is Significantly Exacerbated in Obese Men with the Metabolic Syndrome: What Are the Implications for This for the Relatively High Incidence of Erectile Dysfunction Observed in These Men?
Studies have shown that age-related decline in testosterone in men is exacerbated by obesity and the metabolic syndrome (MetS), a constellation of abnormalities that is associated with atherosclerotic vascular disease and diabetes. In addition, aging men with MetS have been shown to have a greater incidence of erectile dysfunction compared to aging, otherwise healthy men. The study assessed the data of 864 men participating in two lipid treatment studies and concluded that almost 70% of the obese, aging men with MetS had a baseline total testosterone level of less than 400 ng/dL, which was affected by the presence of diabetes, high BMI, and elevated triglycerides. The analysis by Dr. Steven Kaplan demonstrated that aging men with obesity and MetS have a clinically significant decrease in total serum testosterone levels compared to aging, healthy men without the MetS. This strongly suggests that the well-established association between erectile dysfunction and pre-diabetes/diabetes involves a hypoandrogenic component.
The Impact of Infertility on Quality of Life (QOL) in Men
Infertility has been associated with increased levels of anxiety and stress for both male and female partners, but little information exists on the association between infertility and depression or reduced quality of life. This study examined 39 coupled men with an average age of 37.5 who presented for the evaluation of infertility and utilized self-reported inventories for depression (CES-D) and quality of life (SF-36). While most of the men reported a significantly lower quality of life, 23% had moderate depressive symptoms and 8% had severe depression. Data analysis by senior author Dr. John Mulhall and his colleagues indicates that men in infertile relationships have a significant incidence of mental health alterations with almost one-third having documented depression. In addition, this study's data suggests that younger men were more likely to be depressed than older men and those who are married.
High-Grade Varicocele and Low Sperm Density Are Associated with a High Degree of Sperm Chromatin Damage in Infertile Men
Varicoceles, an abnormal enlargement of the veins draining the testicles, are found in 30%-40% of men evaluated for primary infertility. Other than varicocele grade, there are few tests that predict the likelihood of fertility. Because varicoceles may have a negative impact on sperm maturation and DNA integrity, this study evaluated how sperm chromatin structure assay (SCSA) can be integrated in the decision-making paradigm in men with varicoceles. An analysis of the 72 men who were studied showed that only low sperm density (below 10 mil/mL) was a significant predictor of abnormal SCSA results and DNA-damaged sperm. Because high grade and bilateral varicoceles seem to be associated with a higher incidence of sperm with damaged DNA, senior author Dr. Marc Goldstein and his fellow researchers concluded that SCSA may be a useful additional diagnostic test in men with high-grade varicoceles and sperm density below 10 mil/mL.
NewYork-Presbyterian Hospital/Weill Cornell Medical Center
NewYork-Presbyterian Hospital/Weill Cornell Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and its academic partner, Weill Medical College of Cornell University. NewYork-Presbyterian/Weill Cornell provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian is recognized as one of America's top ten hospitals and Weill Cornell, as one of America's top fifteen medical colleges, according to U.S. News & World Report.
John Rodgers
jdr2001@med.cornell.edu