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Biomedical subjects

Kevin T McVary

Publications and source records attributed to Kevin T McVary.

At least 19 recordsLinked to original sources
PubMed2006

Erectile function, sexual drive, and ejaculatory function after reconstructive surgery for anterior urethral stricture disease.

OBJECTIVE: To evaluate the effect of urethral reconstructive surgery on sexual drive, erectile function and ejaculation. PATIENTS AND METHODS: The study group consisted of 52 men with a median (range) age of 44 (18-79) years who underwent 59 urethral reconstructive procedures for anterior urethral stricture disease between 2001 and 2004. We evaluated sexual functioning using the O'Leary Brief Male Sexual Function Inventory (BMSFI) before and after surgery. RESULTS: The mean (sd) follow-up was 22.3 (14.8) months. The mean BMSFI scores were only statistically significantly different for an improvement in ejaculation after surgery (P = 0.04). When separated by age, only the men aged 50-59 years reported decreased erectile function after surgery (P < 0.001) and only those aged <40-49 years reported an improvement in ejaculatory function (P = 0.05). Men at <1 year after surgery reported lower sexual drive (P = 0.025) and erectile function (P = 0.05) than men with longer periods of recovery. CONCLUSIONS: The BMFSI is useful for evaluating sexual function after urethroplasty. Overall, the men did not report a decline in erectile function or sexual drive after surgery; however, older men might have a higher incidence of erectile dysfunction after surgery. Erectile function might recover with time. Younger men had the most pronounced improvement in ejaculatory function, but further studies are necessary to evaluate the clinical significance of this.

Adolescent↗
PubMed2006

Systematic evidence-based analysis of plaque injection therapy for Peyronie's disease.

OBJECTIVE: We evaluated the peer-reviewed urology literature for intraplaque injection of medication for Peyronie's disease and assessed the quality of studies via rigorous evidence-based medicine criteria. METHODS: We performed a search of peer-reviewed literature looking at all agents used to treat Peyronie's disease by intraplaque injections. These were then evaluated using the Oxford Centre for Evidence-Based Medicine criteria, which ranks studies from strongest (level 1) to weakest (level 5) strength of evidence. RESULTS: Of the 19 studies found involving injection therapy for Peyronie's disease, 17 showed positive results. Six studies using injectable corticosteroids were identified and though all showed positive results, they were of level 4 quality. Two collagenase injection studies (one level 4 and one level 2 study) were identified, both of which showed positive results. All four verapamil injection studies found (three level 4 and one level 2 study) showed positive results. Seven papers involving interferon alpha2-beta injections were evaluated (six level 4 and one level 1 study), five of which showed positive outcomes and two of which showed no significant benefit. CONCLUSIONS: Ninety percent of the studies regarding Peyronie's disease showed positive outcomes. Unfortunately, most of these have not offered convincing evidence-based data, with only one positive study meeting level 1 Oxford criteria for clinical efficacy. Standardised outcome measures were not used, making comparisons difficult. These results reveal the need for the development of validated outcome measures and well-designed controlled trials to determine optimal therapeutic intervention for this disorder.

Adrenal Cortex Hormones↗
PubMed2006

Regulation of cavernous nerve injury-induced apoptosis by sonic hedgehog.

Thirty to eighty-seven percent of patients treated by radical prostatectomy experience erectile dysfunction (ED). The reduced efficacy of treatments in this population makes novel therapeutic approaches to treat ED essential. We propose that abundant apoptosis observed in penile smooth muscle when the cavernous nerve (CN) is cut (mimicking the neural injury which can result from prostatectomy) is a major contributing factor to ED development. We hypothesize that decreased Sonic hedgehog (SHH) signaling is a cause of ED in neurological models of impotence by increasing apoptosis in penile smooth muscle. We examined this hypothesis in a bilateral CN injury model of ED. We found that the active form of SHH protein was significantly decreased 1.2-fold following CN injury, that SHH inhibition causes a 12-fold increase in smooth muscle apoptosis in the penis, and that SHH treatment at the time of CN injury was able to decrease CN injury-induced apoptosis (1-3-fold) in a dose-dependent manner. These results show that SHH stabilizes the alterations of the corpora cavernosal smooth muscle following nerve injury.

Animals↗
PubMed2006

Metabolic syndrome and lower urinary tract symptoms secondary to benign prostatic hyperplasia.

Increasing evidence recently has pointed toward a relationship between lower urinary tract symptoms (LUTS) and the presence of metabolic syndrome. This relationship has been supported by recent epidemiologic findings. Possible pathophysiologic links also have been proposed to explain the relationship between these two syndromes. The increasing prevalence of obesity in the United States makes this an increasingly relevant problem. Animal studies support a link between autonomic nervous system (ANS) overactivity and the development of urinary symptoms, low bladder compliance, compensatory prostatic hyperplasia, and blockage of the same using alpha-blockade. There appears to be a significant link between ANS overactivity as part of the metabolic syndrome and LUTS secondary to benign prostatic hyperplasia (BPH). However, it is unlikely that ANS overactivity could be responsible for the development of LUTS. Rather, ANS overactivity plays a key role in increasing the severity of LUTS above an intrinsic basal intensity that is determined by the genitourinary anatomic/pathophysiologic characteristics of each BPH patient. This paper defines metabolic syndrome as a collection of abnormalities, including being overweight (visceral abdominal fat distribution), dyslipidemia, hypertension, impaired glucose metabolism, elevated C-reactive protein (chronic inflammation), and autonomic-sympathetic overactivity, with insulin resistance as the hypothesized underlying pathogenic mechanisms.

Animals↗
PubMed2006

Management of lower urinary tract symptoms secondary to benign prostatic hyperplasia with open prostatectomy: results of a contemporary series.

PURPOSE: Surgical therapy remains the definitive treatment in patients with benign prostatic hyperplasia sequelae. Many patients with a markedly enlarged prostate are often not amenable to minimally invasive therapies. In these patients open prostatectomy is a preferred treatment. Most studies of this procedure are quite dated. Therefore, we describe the clinical results and complications of open prostatectomy performed in a modern setting using serum prostate specific antigen, the American Urological Association symptom index and quality of life scores to determine outcomes. MATERIALS AND METHODS: We performed a prospective study in 56 patients who underwent open prostatectomy at our institution. Patients were evaluated by history and physical examination, American Urological Association symptom index, quality of life forms, prostate specific antigen, transrectal ultrasound and post-void urine volume. RESULTS: Patients were followed up to 11 years postoperatively (mean 39.2 months). Of the patients 80.3% presented in acute urinary retention while on medical therapy. Baseline American Urological Association symptom index decreased from a mean +/- SD of 18.5 +/- 1.9 to 4 +/- 1.7 within 1 month. Similarly the quality of life score was 3.1 +/- 0.5 preoperatively, which decreased to 0.6 +/- 0.5 postoperatively. These improvements were maintained throughout followup. The most common complication was blood loss requiring transfusion in approximately 36% of cases. Three patients had urethral strictures and 3 had bladder neck contractures that required dilation. Baseline average prostate specific antigen was 13.34 +/- 1.70 ng/dl, which stabilized at less than 1 ng/dl postoperatively. CONCLUSIONS: Open prostatectomy may be curative in a select population of men with a large prostatic burden. To our knowledge this is the first study to demonstrate durable improvements in American Urological Association symptom index, quality of life score and prostate specific antigen along with a rare need for any further treatment after open prostatectomy.

Aged↗
PubMed2006

Alfuzosin for symptomatic benign prostatic hyperplasia: long-term experience.

PURPOSE: Evidence of the long-term efficacy and safety of alfuzosin treatment for LUTS indicative of BPH was examined. MATERIALS AND METHODS: An English literature search of MEDLINE, PubMed and proceedings from scientific meetings from 1974 to 2004 was done. Search terms included benign prostatic hyperplasia, alfuzosin, treatment, alpha(1)-adrenergic receptor blocker, long-term, followup, lower urinary tract symptoms, complications or adverse events, sexual, retention and cardiovascular. RESULTS: Currently alpha(1)-adrenergic receptor blocking agents are first line treatment for BPH. Although all alpha-blocking compounds show similar levels of efficacy for LUTS treatment, newer agents such as alfuzosin tend to demonstrate improved selectivity for the prostate and bladder with few vasodilatory effects and they have tolerability advantages over older alpha-blocking compounds. Immediate, sustained and newer extended release alfuzosin formulations significantly improve LUTS indicative of BPH but extended release alfuzosin may be more convenient to administer and it tends to show better vasodilatory tolerability than the older immediate release formulation. CONCLUSIONS: When used to treat BPH, alfuzosin provides symptom relief, decreased residual post-void urine volume and a decreased risk of acute urinary retention, which are maintained during long-term use. Most vasodilatory side effects occur early in treatment and they become less frequent thereafter. Patient quality of life also improves with maximal improvements observed after 12 months of treatment. Continued study will further clarify the physiological, clinical and personal benefits produced by alfuzosin when used for the management of LUTS indicative of BPH.

Adrenergic alpha-Antagonists↗
PubMed2006

Beneficial effects of extended-release doxazosin and doxazosin standard on sexual health.

The prevalence of benign prostatic hypertrophy (BPH) and erectile dysfunction (ED) both increase with age, and increasing evidence suggests a common cause rather than independent age-related changes. Arterial hypertension often accompanies these urological disorders, suggesting the possibility that increased alpha-adrenoceptor activity may be causal in all three conditions. As evidence for this model, alpha-adrenoceptor antagonists such as doxazosin produce therapeutically beneficial effects in lowering blood pressure, reducing prostate growth and BPH symptoms, and relieving ED. At postjunctional alpha(1)-receptors in the corpus cavernosa, noradrenaline causes vascular smooth muscle cell contraction, restricting blood flow, resulting in penile detumescence. Just as alpha-adrenoceptor antagonism results in systemic vasorelaxation to lower blood pressure, the same mechanism in the penis modulates the effects of noradrenaline to favour vasodilatation, resulting in improved erectile function. Increasing clinical evidence attests to the effectiveness of doxazosin in relieving ED, even in patients refractory to ED-specific treatment, as well as in reducing BPH symptoms and elevated blood pressure.

Adrenergic alpha-Antagonists↗
PubMed2006

BPH: epidemiology and comorbidities.

Recently published data suggest that clinical benign prostatic hyperplasia (BPH), which is hallmarked by the occurrence of moderate-to-severe lower urinary tract symptoms (LUTS), occurs in about one quarter of men in their 50s, one third of men in their 60s, and about half of all men 80 years or older. Although effective treatments for LUTS/BPH are available, this condition often occurs in the context of common, age-related comorbidities such as cardiovascular disease, hypertension, and erectile dysfunction. Alpha1-selective adrenergic receptor (a1-AR) antagonists (eg, alfuzosin, doxazosin, tamsulosin, terazosin) remain the cornerstone of therapy for LUTS/BPH. In addition, 5-alpha-reductase inhibitors (ie, dutasteride, finasteride) have been associated with improvements in LUTS/BPH in men with larger prostates, especially when used in combination with a1-AR antagonists. Although all these drugs have been shown to be beneficial for the treatment of BPH, there are differences in side-effect profiles. When selecting an appropriate course of therapy, these side effects and any impact they may have on existing comorbid conditions must be considered.

5-alpha Reductase Inhibitors↗
PubMed2005

Erectile dysfunction and lower urinary tract symptoms secondary to BPH.

INTRODUCTION: The relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) have received increased attention recently because both diseases are highly prevalent, frequently co-associate in the same aging male group, and contribute significantly to the overall quality of life. The association between these two diseases has also garnered attention as investigators have hypothesized a common pathophysiology to explain the assertion that they are causally linked. METHODS: A causal association between LUTS and ED cannot be established on the basis of the ever-increasing number of epidemiological studies. Attempting to explain a causal relationship between ED and LUTS needs to be examined using Hill's criterion, which is used by many epidemiologists to separate causal from non-causal explanations. RESULTS: Given the epidemiological components of the Hill's Causality method, it is clear that there is a strong strength of association, internal consistency, and dose response effects between ED and LUTS. Because of the strong cross-sectional flavor to the epidemiological studies, the temporal relationships between ED and LUTS remain unknown. The issue of an "alternate explanation" to describe the LUTS-ED association appears to be accounted for in that several large studies have provided convincing multiple regression analyses in which the ED-LUTS relationship remains significant. The link between ED and LUTS has biologic plausibility given the four leading theories of how these diseases interrelate. These explanations fall into four theories each with a variable amount of supporting data. These include: (1) NOS/NO levels decreased or altered in the prostate and penile smooth muscle, (2) Autonomic hyperactivity effects on LUTS, prostate growth and ED., (3) increased Rho-kinase activation/endothelin activity, and (4) prostate and penile ischemia. CONCLUSIONS: LUTS and sexual dysfunction are highly prevalent in aging men. Both conditions are also significant contributors to overall quality of life. New data has emerged to indicate potential links in epidemiological, physiologic, pathophysiologic and treatment aspects of these two entities.

Age Factors↗
PubMed2005

Lower urinary tract symptoms and erectile dysfunction: epidemiology and treatment in the aging man.

Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are common urologic problems that are seen in the aging male population. Until recently, aging itself was considered the common link between ED and LUTS. However, recent studies have shown that the links between these two disease processes are much more complex and are possibly inter-related with a common mechanism. This newly recognized independent relationship between ED and LUTS has the potential to have a profound impact on the way we diagnose and treat these common urologic disorders.

Age Factors↗
PubMed2005

Autonomic nervous system overactivity in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia.

PURPOSE: The relationship of lower urinary tract symptoms (LUTS) to objective measures of benign prostatic hyperplasia (BPH), such as prostatic size and urodynamic parameters, has proved difficult to evaluate. Studies in animal models of BPH suggest that autonomic nervous system (ANS) activity is an important determinant of prostatic growth. We investigated the relationship of ANS activity to LUTS as well as to objective measures of BPH in men with BPH. MATERIALS AND METHODS: This study was done in 3,047 men with LUTS secondary to BPH during screening for enrolment at 1 center in a large, multicenter, double-blind, placebo controlled trial designed to assess the long-term effects of medical therapy on BPH progression. A total of 38 men with an American Urological Association (AUA) symptom score of 8 or greater and a maximum urinary flow rate of 4 to less than 15 ml per second had ANS activity assessed based on heart rate, blood pressure, the response to circulatory stress via tilt table, and plasma and urinary catecholamine. These ANS related variables were compared with subjective measures of LUTS (AUA symptom score, quality of life score and BPH impact index), overall health measures (RAND 36-Item Health Survey) and objective clinical measures of BPH (prostate size, post-void residual volume and maximum urinary flow rate). Pearson correlation coefficients were calculated for each ANS variable vs each LUTS and BPH variable. These correlations were further assessed using stepwise multiple regression analysis to determine which BPH and LUTS variables were independently related to the ANS variable. Relationships that were identified as significant then underwent final multiple regression analysis together with control variables to exclude known extraneous and confounding influences on ANS activity. RESULTS: After adjusting for extrinsic influences on ANS activity AUA symptom score (p <0.01), BPH impact index score (p <0.001) and quality of life score (p <0.05) were independently associated with the change in systolic and diastolic blood pressure 1 and 5 minutes after tilt. Additionally, prostate transition zone volume (p <0.001) and the RAND 36-Item Health Survey mental subscale score (p <0.001) were independently associated with the plasma norepinephrine response to tilt. CONCLUSIONS: ANS hyperactivity is significantly associated with the most commonly used measures of LUTS, namely AUA symptom score and BPH impact index score. Also, the magnitude of the serum norepinephrine increase after tilt predicts prostate size. These relationships persist after controlling for extrinsic influences on ANS activity. The current findings may have important implications concerning the pathophysiological mechanisms underlying or influencing LUTS as well as its optimal treatment in men with BPH.

Aged↗
PubMed2005

Interrelation of erectile dysfunction and lower urinary tract symptoms.

The association between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) has garnered attention as investigators have hypothesized a common pathophysiology to explain the assertion that they are causally linked. This relationship between LUTS and ED has received increased attention because both diseases are highly prevalent, frequently co-associate in the same aging male group, and significantly influence the overall quality of life. A causal association between LUTS and ED cannot be established on the basis of the ever-increasing number of epidemiological studies. Attempting to explain a causal relationship between ED and LUTS requires the use of Hill's criterion, which is used by many epidemiologists to separate causal from non-causal explanations. A review of the epidemiological evidence reveals a strong degree of association, internal consistency and dose response effects between ED and LUTS. The temporal relationships between the two remain unknown because of the strong cross-sectional flavor of the epidemiological studies. The issue of an "alternate explanation" to describe the LUTS-ED association appears to be accounted for in that several large studies have provided convincing multiple regression analyses in which the ED-LUTS relationship remains significant. Biologic plausibility is an important issue if the link between ED and LUTS is to have credence. There are four leading theories of how these diseases interrelate. These explanations have a variable amount of supporting data. These include: 1) autonomic hyperactivity effects on LUTS, prostate growth and ED; 2) nitric oxide synthase/nitric oxide levels decreased or altered in the prostate and penile smooth muscle; 3) prostate and penile ischemia; and 4) increased Rho-kinase activation/ endothelin activity. LUTS and sexual dysfunction are highly prevalent in aging men. Both conditions are also significant contributors to overall quality of life. New data has emerged to indicate potential links in epidemiological, physiologic, pathophysiologic and treatment aspects of these two diseases. Using Hill's causality method to separate causal from non-causal explanations linking ED with LUTS, it appears that most epidemiological components are fulfilled.

Adrenergic alpha-Antagonists↗
PubMed2005

Sexual Function and alpha-Blockers.

Community-based studies and surveys have found an association between lower urinary tract symptoms (LUTS) and sexual dysfunction, in particular, erectile dysfunction (ED). The link between ED and LUTS has biologic plausibility. The following 4 theories have been used to explain how these disorders interrelate: 1) decreased or altered nitric oxide synthase/nitric oxide levels in the prostate and penile smooth muscle; 2) autonomic hyperactivity effects on LUTS, prostate growth, and ED; 3) increased Rho-kinase activation/endothelin activity; and 4) prostate and penile atherosclerosis. The relationship of LUTS and sexual dysfunction suggests that treatment of one condition may impact the other.

Journal Article↗