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Biomedical subjects

E J Meuleman

Publications and source records attributed to E J Meuleman.

At least 19 recordsLinked to original sources
PubMed2003

[Obstructive azoospermia in men who wish to father children; diagnosis and surgical sperm retrieval].

OBJECTIVE: To evaluate diagnostic procedures and surgical sperm retrieval in men with suspected obstructive azoospermia who wish to father children. DESIGN: Descriptive, retrospective. METHOD: During the period 1 April 1999-31 December 2001 93 men suspected of having obstructive azoospermia underwent surgical sperm retrieval by means of percutaneous epididymal sperm aspiration (PESA). In each patient a testicular biopsy was performed to determine the Johnsen score (a score > or = 8 is equivalent to a normal spermatogenesis). Cryopreservation was performed whenever possible. The findings in both percutaneous and surgical sperm retrieval were compared. RESULTS: In 76 patients (82%) epididymal motile sperm were obtained using PESA. Their Johnsen score on the testis biopsy was 9.1 (range: 7.4-10). In 73 of the patients the Johnsen score was > or = 8. In the 17 patients (18%) in whom no sperm were found with PESA, the median Johnsen score was 5.8 (range: 2-9.8). Epididymal sperm were not found in patients with a testicular volume < 15 ml. In all 28 patients who had undergone a vasectomy in the past, motile sperm were found along with a Johnsen score > or = 8. In 23 of the 24 patients with congenital bilateral absence of the vas deferens (CABVD) the Johnsen score was > or = 8. Cryopreservation was possible in 45 (59%) of all patients and in 5 (35%) of the 13 patients with an unknown cause for the obstructive azoospermia. CONCLUSION: In men with suspected obstructive azoospermia in whom sperm were found using PESA, a diagnostic testis biopsy provided no additional relevant information about the spermatogenesis. There was always a good spermatogenesis after vasectomy. CBAVD patients probably had at least some focal areas in the testes with normal spermatogenesis. Sperm retrieval and cryopreservation could be carried out less frequently in the case of obstructions with an unknown cause.

Adult↗
PubMed2003

[Obstructive azoospermia in men who wish to father children; initial clinical results of intracytoplasmatic sperm injection (ICSI) with surgically retrieved epididymal semen].

OBJECTIVE: To evaluate the results of intracytoplasmatic sperm injection (ICSI) with surgically retrieved epididymal semen. DESIGN: Prospective, descriptive. METHODS: Patients with an obstructive azoospermia confirmed by cytological examination of a testis biopsy, and conforming to the regular IVF/ICSI criteria as laid down in 2001 at the University Medical Centre St Radboud Nijmegen, the Netherlands, were included for percutaneous epididymal sperm aspiration (PESA) and ICSI. The main outcome measure was the ongoing pregnancy rate per initiated cycle. RESULTS: A total of 44 cycles were started in 31 couples. In 43 cases (98%) an ovum pick-up was performed and 41 (93%) embryo transfers were carried out. In 19 (43%) cases, treatment resulted in a positive pregnancy test and 15 (34%) ongoing pregnancies were recorded. In total, 17 healthy children were born (11 boys and 6 girls). CONCLUSION: ICSI with surgically retrieved semen was successfully used as a treatment for childlessness caused by obstructive azoospermia.

Adult↗
PubMed2002

A shared care approach to the management of erectile dysfunction in the community.

Erectile dysfunction (ED) affects men of all ages and results in considerable distress and impact on quality of life for those who suffer from it. As ED is associated with a wide variety of under-lying conditions and cardiovascular co-morbidities, there is a requirement for diversity of treatment options and several factors must be considered to customise and optimise therapy. In the ideal holistic approach to management of the ED patient, both primary care and specialist physicians have an important role to play. This article reports on a sequential approach for the diagnosis and treatment of ED, with an emphasis on 'shared care'. The deliberations are based on a pan-European inter-disciplinary group that met at the Lygon Arms, UK on 22 February 2002.

Erectile Dysfunction↗
PubMed2001

[Disappointing long-term experiences of patients with penile prosthesis].

OBJECTIVE: To describe the long-term experience with the implantation of a penile prosthesis as a last resort treatment for erectile dysfunction. DESIGN: Retrospective and descriptive. METHOD: During the period 1986-1996, 124 men received a penile prosthesis. Basic information was obtained from medical files. Seventy-six men could be traced and were sent a questionnaire. Sixty patients and 44 partners participated in the study. RESULTS: The median time since the implantation was 81.3 months (range: 13-139). The chance of reoperation was 35%. Seventeen percent of the patients and 25% of the spouses regretted the decision to have the implantation. Thirty-one percent no longer used the prosthesis and 15% had never used it. Twenty percent of the patients and 31% of the partners noticed an improvement in their sexual relationship whereas 26% and 23% respectively noticed a decline. Twenty percent of the patients sometimes failed to penetrate despite the prosthesis. Nevertheless, 66% would advise implantation to someone else. Almost 50% of the men reported spontaneous tumescence during sexual arousal. CONCLUSION: After the implantation of a penile prosthesis, the reoperation rate was high, and many patients and their partners were dissatisfied with their sexual relationship despite regaining a functional erection. Implantation requires thorough sexological counselling both before and after the operation.

Adult↗
PubMed2001

[Erectile dysfunction: prevalence and effect on the quality of life; Boxmeer study].

OBJECTIVE: To assess the prevalence of erectile dysfunction (ED), and its influence on both the quality of life, and health care seeking behaviour. METHOD: An age-stratified random sample was drawn from men aged 40-79 years in Boxmeer, the Netherlands (n = 1771), together with their partners. A questionnaire was mailed to the study population to collect data on ED, and the quality of life, both general and disorder related. The prevalence of ED was measured with the direct question 'Do you have problems getting an erection?'. The influence of ED on sexual function was measured with the Dutch version of the Sexual Function Inventory questionnaire. RESULTS: Seventy percent of all men (n = 1233) and 73% of their partners (n = 1071) responded to the questionnaire. The prevalence of ED increased with age class. To the question regarding problems to get an erection, 13% (95% confidence interval: 11-15%) of all men answered affirmatively (40-49 years: 6%; 50-59: 9%; 60-69: 22%; 70-79: 38%). All men aged 40-49 years of age with ED and 16% of men aged 70-79 with ED considered their ED as bothersome. Amongst 40 to 49 year old men with ED, 64% considered their ED as a big or rather a big problem. Amongst older men this percentage was much smaller: 50-59 years: 38%; 60-69: 37%, and 70-79: 27%. Thirty-four percent of all men with ED and 16% of their spouses were dissatisfied with their sex life. Twenty-five percent of men with ED consulted a doctor, with a mean delay of 13 months. ED bore a strong correlation with the general quality of life and comorbidity. CONCLUSION: ED was a common disorder within the population. Its prevalence was higher among older age groups, but they regarded ED as less of a problem than the younger age groups. Only a quarter of all men with ED consulted a physician.

Adult↗
PubMed2001

[Drug treatment of erection disorders in patients with cardiovascular disease].

Erectile dysfunction is a frequent condition in cardiovascular patients. Since the arrival of oral erection-supporting medication, patients want to know how safe sexual activity is in cardiovascular disease in general and during use of erection-supporting medication in particular. Sexual intercourse with a steady partner causes no more cardiovascular risk than normal daily activities such as ironing, 2 kilometers of walking without climbing, paperhanging, playing golf or gardening. The relative risk of myocardial infarction during sexual activity is not significantly higher than for healthy persons. The incidence of cardiovascular morbidity and mortality is not higher among users of sildenafil. Sildenafil is contraindicated in patients using long-acting nitrates or who may need to use short-acting nitrates, because the combination may cause a sharp fall of the blood pressure. No interactions have been observed with beta-receptor blockers, calcium antagonists, thiazide and loop diuretics and ACE inhibitors. Before prescribing a symptomatic (pharmaceutical) treatment for patients with an erection disorder, attention should be given tot the sexological, psychological and medical backgrounds of the disorder. Secondary prevention of atherosclerotic risk factors is also important: regulation of blood pressure and blood sugar level, hyperlipidaemia and obesity, as well as a change of lifestyle (giving up smoking, adapting of diet and more physical exertion). Patients with a very low cardiac capacity should be advised to refrain from treatment of the erection disorder.

Cardiovascular Diseases↗
PubMed2001

The value of sildenafil as mode of stimulation in pharmaco-penile duplex ultrasonography.

The purpose of this work was to assess whether a single intracavernous injection (ICI) of a low dose of the combination of papaverine-phentolamine is replaceable by a high dose of the oral erectogenic agent sildenafil as mode of stimulation during pharmaco-penile duplex ultrasonography (PPDU). Eleven patients with complaints of erectile dysfunction were included in a crossover study. With an interval of two weeks the patients were exposed to ICI with papaverine/phentolamine (3.75 mg/0.125 mg) and oral administration with sildenafil (100 mg) preceding PPDU. Five patients started with ICI. Six patients started with sildenafil. In the sildenafil stimulation mode, visual erotic stimulation (VES) was used to initiate erection. VES was applied by personal LCD monitor. Cut-off values to define sufficient arterial response were: peak flow velocity (PSV) >25 cm/s and acceleration time (AT) <72 ms. Cut-off value to define sufficient veno-occlusion was a resistance index > or =1.00. Statistical analysis of PPDU parameters shows no significant difference between the two modes of stimulation for arterial response (PSV, AT), whereas the resistance index, as a parameter of veno-occlusive response was significantly higher in the sildenafil mode. This finding is confirmed in the clinical translation of the results: two patients with an insufficient arterial response to ICI had a sufficient arterial response to sildenafil and only one patient showed an insufficient arterial response following sildenafil, whereas the response following ICI was sufficient. Analysis of veno-occlusive responses shows remarkable differences between both modes of stimulation. Whereas following the administration of sildenafil all veno-occlusive responses were classified as sufficient, seven patients showed an insufficient veno-occlusive response following ICI. As mode of stimulation in PPDU, high dose sildenafil yields significantly less false positive diagnoses of 'veno-occlusive dysfunction' than intracavernous injection of the combination papaverine/phentolamine. No difference was found in the quality of the arterial response. Based on this study we conclude that sildenafil may replace ICI as mode of stimulation during PPDU.

Administration, Oral↗
PubMed2001

The Dutch cohort of sildenafil users: baseline characteristics.

OBJECTIVE: To identify a Dutch cohort of sildenafil users and describe their baseline characteristics. PATIENTS AND METHODS: Each pharmacy in The Netherlands (n = 1571) was asked to identify prospectively the first 20 sildenafil prescriptions in their pharmacy over 1 year, and to complete and return a registration form. The collected data included patient characteristics, the details of the sildenafil prescription (date, prescriber, number of prescriptions, dosing), and the use of co-medication by the patient in the year preceding the sildenafil prescription. RESULTS: Data were collected from 4460 sildenafil prescriptions during the year under study, relating to 3477 individual patients. Most of the cohort had cardiovascular morbidity or diabetes. Sildenafil seems to have been used by a new, previously untreated population of patients with erectile dysfunction. In addition, 69 men were identified who could have been using nitrates and sildenafil concomitantly. CONCLUSION: A cohort of patients using sildenafil was identified and characterized; they appeared to be representative of sildenafil users in The Netherlands. This cohort will be followed prospectively to evaluate the medical status (particularly cardiovascular) of the patients with time.

Adult↗
PubMed2001

Lower urinary tract symptoms after renal transplantation.

PURPOSE: We investigated the prevalence and nature of lower urinary tract symptoms after renal transplantation. In addition, we studied how these symptoms affect the quality of life and whether function of the lower urinary tract before transplantation was related to postoperative occurrence of lower urinary tract symptoms. MATERIALS AND METHODS: Data were gathered by a written questionnaire. The research group consisted of 63 patients who underwent renal transplantation in 1998 at the University Medical Center St Radboud Nijmegen. The control group consisted of 74 patients with nonurological complaints who visited an outpatient clinic at the same university. RESULTS: The most important finding was that patients who underwent renal transplantation needed to void more often than controls, both during the day and at night. After renal transplantation, almost 50% of the patients complained of frequency and 62% nocturia. Patients with a transplant had tended to perceive frequency and nocturia less as problems than those in the control group. CONCLUSIONS: No relation was found between the functioning of the lower urinary tract before transplantation, and occurrence of frequency and nocturia after. The amount of fluid intake at the interview was not related to the occurrence of frequency and nocturia. No abnormalities were found regarding bladder evacuation.

Adolescent↗
PubMed2000

Cost utility analysis of sildenafil compared with papaverine-phentolamine injections.

OBJECTIVE: To compare the cost effectiveness of sildenafil and papaverine-phentolamine injections for treating erectile dysfunction. DESIGN: Cost utility analysis comparing treatment with sildenafil (allowing a switch to injection therapy) and treatment with papaverine-phentolamine (no switch allowed). Costs and effects were estimated from the societal perspective. Using time trade-off, a sample of the general public (n=169) valued health states relating to erectile dysfunction. These values were used to estimated health related quality of life by converting the clinical outcomes of a trial into quality adjusted life years (QALYs). PARTICIPANTS: 169 residents of Rotterdam. MAIN OUTCOME MEASURES: Cost per quality adjusted life year. RESULTS: Participants thought that erectile dysfunction limits quality of life considerably: the mean utility gain attributable to sildenafil is 0.11. Overall, treatment with sildenafil gained more QALYs, but the total costs were higher. The incremental cost effectiveness ratio for the introduction of sildenafil was pound sterling 3639 in the first year and fell in following years. Doubling the frequency of use of sildenafil almost doubled the cost per additional QALY. CONCLUSIONS: Treatment with sildenafil is cost effective. When considering funding sildenafil, healthcare systems should take into account that the frequency of use affects cost effectiveness.

Adolescent↗
PubMed2000

Sexual dysfunction after renal replacement therapy.

The existence of a sexual problem as the subjective evaluation of sexual function was assessed with a simple questionnaire. Those questioned were patients undergoing dialysis treatment (n = 400) or with a functioning renal transplant (RTx; n = 300) and both men and women in the general Dutch population (n = 591). In the Dutch control population, 8.7% of the men and 14.9% of the women reported a sexual problem, showing a significant gender difference but unrelated to age. In patients, the prevalence of a sexual problem was significantly greater (hemodialysis, men, 62.9%; women, 75.0%; peritoneal dialysis, men, 69.8%; women, 66.7%; renal transplantation, men, 48.3%; women, 44.4%). In RTx recipients, sexual problems were significantly less prevalent than in patients undergoing dialysis (P < 0.001). Only in male patients was an association between prevalence of a sexual problem and age found. The results of the simple questionnaire were sufficiently validated when 102 of 104 patients confirmed their responses in a subsequent structured interview. This study shows that the prevalence of sexual problems in patients undergoing renal replacement therapy is high and clinically relevant.

Adult↗
PubMed1999

Sexual function following high energy microwave thermotherapy: results of a randomized controlled study comparing transurethral microwave thermotherapy to transurethral prostatic resection.

PURPOSE: We evaluate changes in sexual function in patients treated with high energy transurethral microwave thermotherapy compared to transurethral resection of the prostate. MATERIALS AND METHODS: A total of 147 patients randomized to undergo transurethral microwave thermotherapy or transurethral resection of the prostate were asked to complete a self-administered questionnaire evaluating sexual function before, and 3 and 12 months after treatment. The questionnaire dealt with such items as social status, libido, quality of erection, ejaculation and overall satisfaction of sexual functioning. RESULTS: There was a statistically significant improvement of micturition in both groups. The improvement in the transurethral prostatic resection group was significantly better than in the transurethral microwave thermotherapy group. Antegrade ejaculation occurred at 3 months following treatment in 27% of the transurethral prostatic resection group compared to 74% of the transurethral microwave thermotherapy group and at 1 year in 37 and 67%, respectively. Significantly more patients undergoing transurethral prostatic resection (36%) had changes in sexual function compared to the transurethral microwave thermotherapy group (17%). The transurethral microwave thermotherapy group was more satisfied with the sex life. Of these patients 55% graded sex as very satisfying compared to 21% in the transurethral prostatic resection group. The severity of symptoms was not correlated with sexual function in this study. In general, older patients had sexual dysfunction more often, while younger patients had pain during sexual activities more frequently. CONCLUSIONS: Although clinically less effective, high energy transurethral microwave thermotherapy is a better therapeutic option than surgery for patients who want to preserve sexual function. In particular ejaculation is often preserved after transurethral microwave thermotherapy while there is significant deterioration following transurethral prostatic resection. In general, older patients have greater sexual dysfunction.

Aged↗
PubMed1999

The use of acupuncture in the treatment of erectile dysfunction.

The efficacy of acupuncture as a mono-therapy was evaluated in a pilot study of 16 patients suffering from erectile dysfunction (ED). In nine patients no organic co-morbidity was encountered. In a period of four weeks, acupuncture treatment was performed twice a week for a total of eight sessions. Each treatment session consisted of puncture of the same eight acupoints, four of which were connected to a Swiss made constant current Doltron ESA 600 stimulator. Low frequency electrical stimulation (5 Hz and 10 mA) was applied to these four acupoints, whereas no stimulation was applied to the other four points. After 30min, the electrical stimulation was terminated and all needles removed. Blood samples were drawn according to a fixed time schedule, to study the profile of a number of stress hormones, for example, adrenocorticotropic hormone, antidiuretic hormone and cortisol, the gonadotrophines follicle stimulating hormone and leutinizing hormone, and the sex steroid testosterone and its binding globulin, within the treatment period. Based on a diary of both patient and partner, and an interview one month after the end of treatment, the changes of sexual activity were evaluated over a period of 12 weeks, starting from the four weeks prior to the treatment, the four weeks during the treatment period and the four weeks after the treatment. An improvement of the quality of erection was experienced by 15% of patients, while 31% reported an increase in their sexual activity. No changes in the profiles of hormones were detected. The use of acupuncture as a mono-therapeutic modality in ED, did not influence the profile of the stress and sex hormones, but did improve the quality of erection and restored the sexual activity with an overall effect of 39%. No definite conclusions can be drawn from this pilot study. A controlled and blinded study including more patients will be needed before any definitive conclusion can be reached.

Acupuncture Therapy↗
PubMed1999

Transurethral deroofing of midline prostatic cyst for subfertile men.

We evaluated the efficacy of transurethral deroofing of a midline prostatic cyst in subfertile men with one or more of the following semen abnormalities: decreased ejaculatory volume, decreased sperm motility and oligo- or azoospermia. Results from treatment of a series of 11 subfertile men with a midline prostatic cyst by transurethral deroofing of the cyst are presented. Five patients showed an improvement of seminal volume. Only one patient demonstrated an improvement of sperm count. Sperm motility was not influenced. No relationship was found between positive outcome following operation and either size of the cyst or dilatation of the seminal vesicles. Spontaneous pregnancies did not occur after transurethral deroofing of the midline prostatic cyst. In conclusion, our study suggests a poor efficacy of transurethral deroofing of a midline prostatic cyst in subfertile men with the above mentioned semen abnormalities.

Adult↗
PubMed1998

[Sildenafil (Viagra) for the treatment of erectile disorder].

Erectile dysfunction is a common but underreported condition. It is to be expected that the number of patients consulting their physician with the complaint of erectile dysfunction will increase considerably with the introduction of sildenafil (Viagra), the first oral drug that enhances penile erection. Sildenafil is an inhibitor of the enzyme phosphodiesterase type 5. It causes erection of the penis by allowing the relaxation of the smooth musculature of the cavernous body to persist. The first clinical results indicate that the treatment with sildenafil is safe and effective in the hands of a sexologically qualified physician. An erection disorder is essentially not more than a symptom which primarily requires causal therapy.

Adult↗
PubMed1998

[Ovum fertilization using surgically obtained sperm: additional risk to offspring unlikely with meticulous procedure].

In the Netherlands a presumed higher risk of transmission of genetic abnormalities to the offspring in programmes of intracytoplasmatic sperm injection (ICSI) using surgically retrieved sperm (microscopic epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE)) has triggered a moratorium. However, the ICSI-MESA/TESE-programme should be resumed under conditions for the following reasons: the source of the sperm is not a accurate standard of its genetic contents: the cause of the male infertility and the morphology and function of the injected spermatozoon appear to be better criteria; animal experiments and clinical results are reassuring as to the proposed risk; it is uncertain whether the complex genetical mechanisms involved in spermiogenesis and sperm maturation can be unraveled in the laboratory in due course; the exodus of patients to neighbouring countries will be stopped and biological material necessary for human research will become available. The conditions are that (a) only morphologically normal and motile sperm should be used, (b) ICSI should be preceded by genetical screening and succeeded by long term follow up of the offspring.

Chromosome Aberrations↗