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Diabetes Side Effects: Breaking the Silence

Diabetes Side Effects: Breaking the Silence

Sexual and urologic complications among men and women with diabetes have historically received relatively little attention from clinicians. Diabetes impacts the function and structure of the lower urinary tract, including the bladder and prostate. Studies suggest that urologic complications resulting from diabetes may be even more common than that of widely recognized microvascular complications, such as retinopathy, neuropathy, or nephropathy. “Diabetes can lead to different types of sexual and urologic complications in both men and women,” says Jeanette S. Brown, MD (Table 1). “These include urinary incontinence (UI), poor bladder emptying, sexual dysfunction, lower urinary tract symptoms (LUTS), and urinary tract infections (UTIs). Treatment options are available for many of these sexual and urologic complications. Unfortunately, these problems often go unaddressed because patients oftentimes will not discuss these issues with their clinicians.” Caring for Women: Lower Urinary Tract Symptoms Urinary incontinence has been estimated to be more common in women with type 2 diabetes than in women with normal glucose levels (Table 2). There is also evidence that women with pre-diabetes are at higher risk for incontinence. The clinical diagnosis of UI—and more broadly, LUTS—is typically based on a variety of factors, and Dr. Brown says that clinicians can be proactive by paying attention to patient complaints when they arise. “It can often be difficult for women to speak up when they develop issues like UI, LUTS, or UTIs, but we should be asking them about these symptoms regularly during office visits,” Dr. Brown says. “When symptoms are identified, we can then take that opportunity to educate patients about the possible treatment options that are available to manage these...
Functional Outcomes After Treatment for Prostate Cancer

Functional Outcomes After Treatment for Prostate Cancer

Studies have shown that patients with localized prostate cancer have favorable long-term overall survival rates and cancer-specific survival regardless of the treatment that is selected. Few prospective, randomized trials have looked at differences in survival outcomes between radical prostatectomy and external-beam radiation therapy. As a result, the decision-making process for clinicians and patients shifts. Treatment decisions become more about predicting functional outcome than about survival. Investigations with short-term and intermediate follow-up have identified incremental differences in functional outcome between patients undergoing prostatectomy and those receiving radiotherapy. While much is known about what happens the first several years after treatment, less is known about outcomes extending beyond 5 years. “Most patients live 10 to 20 years after treatment,” says David F. Penson, MD, MPH. “A careful evaluation of long-term functional outcomes can help us better understand the experience of men living with a diagnosis of prostate cancer.” Long-Term Function of Prostatectomy Vs Radiotherapy In a study published in the New England Journal of Medicine, Dr. Penson and colleagues prospectively compared urinary, sexual, and bowel function in 1,655 men with clinically localized prostate cancer, 1,164 of whom underwent prostatectomy, while 491 received radiotherapy. The study team also examined the extent to which men were bothered by declines in function at 15 years after prostatectomy or radiotherapy. Most of the men were in their 60s when they first received treatment. According to the results, men receiving prostatectomy were significantly more likely than those in the radiotherapy group to report urinary leakage and erectile dysfunction at 2 and 5 years after treatment. However, these problems increased in both groups over time, including 15...

New Treatment Guidelines for ED

Erectile dysfunction (ED) is a common disorder of male sexual function that affects all age groups, especially older people and those with diabetes, vascular diseases, psychiatric disorders, and possibly hypogonadism. The general population continues to age and life expectancy is expected to increase. When combined with the high prevalence of diabetes and cardiovascular disease, the healthcare burden and quality-of-life issues associated with ED may be substantial. In 1995, more than 152 million men throughout the world had experienced ED, and its prevalence is predicted to reach 322 million worldwide by 2025. Furthermore, recent estimates suggest that the cost of treating ED in the United States could reach $15 billion if all affected men sought care. Current pharmacologic therapies for ED include phosphodiesterase-5 (PDE-5) inhibitors and hormonal treatment. On November 3, 2009, the American College of Physicians (ACP) published a guideline in the Annals of Internal Medicinebased on systematic reviews and current evidence, which presents recommendations on hormonal testing and pharmacologic management for ED. Initiating & Selecting Therapy The ACP strongly recommends that therapy with a PDE-5 inhibitor be initiated in men who seek treatment for ED and who do not have a contraindication for using these drugs (Figure). Oral PDE-5 inhibitors have demonstrated statistically significant and clinically relevant improvements in sexual intercourse and erectile function. Overall, PDE-5 inhibitors were well tolerated and were associated with mild or moderate adverse events. The incidence of adverse events did not significantly differ among the available PDE-5 inhibitors. Nitrate therapy, however, is a contraindication for therapy with oral PDE-5 inhibitors. The ACP also recommends that clinicians base their choices of a specific PDE-5...
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