Lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction: from physiology to clinical aspects

Abstract

Erectile dysfunction, prostatic hyperplasia and lower urinary tract symptoms hare important pathogenetic links. Endothelial dysfunction and hormonal alterations represent the main aspects. The present article examines the anatomical, physiological, and pathophysiological characteristics of this association, finalizing the text to an interpretation of the clinical management of these patients based on these functional considerations.     

Treatment of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction

Abstract

This article summarizes years of challenging research on erectile dysfunction (ED), a condition that has an important social and cultural relevance. Preclinical and clinical research progress has led to new therapeutic approaches to ED in patients with different comorbidities and particularly in those with low urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). These goals were possible only by combined work of specialists and researchers of different and intertwined medical disciplines. Currently, tadalafil (5?mg/d) is the best choice; other phosphodiesterase-5 inhibitors (PDE5i) are not included among options, despite the growing evidence of therapeutic effects. Different regimens of tadalafil may be prescribed based on patient needs, severity of LUTS/BPH – ED profile, and clinical experience. An integrated approach is necessary to choose for a combined therapy with PDE5i and α-blockers following urological and cardiac counseling in terms of outcomes and adverse effects.     

Cross‐Cultural Consistency of the Demand/Withdraw Interaction Pattern in Couples

In order to examine the cross‐cultural consistency of several patterns of couple communication, 363 participants from four different countries (Brazil, Italy, Taiwan, and the United States) completed self‐report measures about communication and satisfaction in their romantic relationships. Across countries, constructive communication was positively associated with relationship satisfaction, whereas demand/withdraw communication was negatively associated with relationship satisfaction. Woman demand/man withdraw communication was significantly more likely than man demand/woman withdraw communication. Also, some evidence suggested women wanted greater closeness versus independence in their relationships than did men. Differences between partners in desire for closeness versus independence were associated with greater demand/withdraw communication. The possible bases for the demand/withdraw pattern of communication and its gender linkage are discussed.     

Exploring the link between human resource practices and turnover in multi-brand companies: The role of brand units’ images

Using exploratory qualitative research undertaken in a multi-brand fashion company, this article investigates the role that brand units’ images play in the link between human resources management (HRM) practices and employee internal and external turnover. Our results suggest that the existence of imbalanced and differently attractive brand units’ images might weaken or remove the effectiveness of corporate HRM practices in keeping internal and external turnover rates low. This because employees may be interested in transferring to the most appealing brand(s) or, if not possible to do so, leaving the company. This article contributes to the debate regarding the use of HRM practices in multi-brand companies, especially in industries where both the brand and the product have a highly-symbolic content. Based on our conclusions, we recommend that brand units with less prestigious images compensate for their lower attractiveness with specific brand unit HRM practices to attract and retain their employees. Theoretical and policy implications of the findings are discussed.     

CLUSTERING IN N‐PLAYER PREEMPTION GAMES

We study a complete information preemption game in continuous time. A finite number of firms decide when to make an irreversible, observable investment. Upon investment, a firm receives flow profits, which decrease in the number of firms that have invested. The cost of investment declines over time exogenously. We characterize the subgame‐perfect equilibrium outcome, which is unique up to a permutation of players. When the preemption race among late investors is sufficiently intense, the preemption incentive for earlier investors disappears, and two or more investments occur at the same time. We identify a sufficient condition in terms of model parameters: clustering of investments occurs if the flow profits from consecutive investments are sufficiently close. This shows how clustering can occur in the absence of coordination failures, informational spillovers, or positive payoff externalities.     

Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction

Benign prostatic hyperplasia (BPH) is very common in aging men and causes lower urinary tract symptoms (LUTS), which decrease health-related quality of life. A number of evidence suggests that other than ageing, modifiable factors, such as increasing prostate volume, obesity, diet, dyslipidemia, hormonal imbalance, hypertension, metabolic syndrome, alcohol, and smoking, also contribute to the development of BPH and/or LUTS. More recently, erectile dysfunction (ED) has been linked to LUTS/BPH as a part of this syndrome, suggesting that patients with BPH or LUTS easily develop ED, and that LUTS/BPH symptoms often coexist with ED. This article focuses on the epidemiology and risk factors of the combined phenotype LUTS/BPH – ED.     

Is It Always Worth Waiting? The Effect of Autonomy‐supportive Teaching on Short‐term and Long‐term Learning Outcomes

Autonomy is known for its positive effects and its use in management practice. Recently an urgent debate has emerged on its drawbacks on individual outcomes. In this study, we investigate and test a model on the effect on individual learning of an autonomy‐supportive teaching style and its interplay with the learner's previous experience and perceived management support. Specifically, while research has emphasized the positive effect of similar contexts, this study focuses on its differential effect on short‐term and long‐term learning outcomes, challenging the traditional view of autonomy. We also explore how job experience and management support can improve the effects of autonomy on individual learning. We test our model by collecting longitudinal data on a sample of 200 individuals participating in a training programme on managerial skills. Our results show that (1) the extent to which teachers were perceived as autonomy‐supportive presents a linear relationship with short‐term learning outcomes (utility reactions) and a positive curvilinear relationship with training transfer in the long term; (2) learner job experience and perceived management support for learning have a positive moderating effect on the linear relationship between autonomy and learning outcomes.     

Menopause and sexual desire: the role of testosterone

The present short review underlines the role of testosterone (T) in the motivational and satisfaction components of women's sexuality and critically discusses the strategies to treat hypoactive sexual desire disorder (HSDD), a condition of low desire associated with personal and/or interpersonal difficulties, which is more common in surgical menopausal women. There are multiple ways androgens target the brain regions (hypothalamic, limbic and cortical) involved in sexual function and behaviour. Even though circulating available androgens have been implicated in several domains of sexual response, they seem to be related weakly to symptoms, such as low sexual desire, poor sexual arousal, orgasm and diminished well-being in postmenopausal women. The possibilities of treating low sexual desire/HSDD are multifaceted and should include the combination of pharmacological treatments able to maximize biological signals driving the sexual response, and individualized psychosocial therapies in order to overcome personal and relational difficulties. Transdermal T has been shown to be effective at a dose of 300 μg/day both in surgically and naturally menopausal women replaced with estrogen or not, without any relevant side-effects. However, the decision to treat postmenopausal women with HSDD with T is mainly based on clinical judgement, after informed consent regarding the unknown long-term risks.     

History as a coordination device

Coordination games often have multiple equilibria. The selection of equilibrium raises the question of belief formation: how do players generate beliefs about the behavior of other players? This article takes the view that the answer lies in history, that is, in the outcomes of similar coordination games played in the past, possibly by other players. We analyze a simple model in which a large population plays a game that exhibits strategic complementarities. We assume a dynamic process that faces different populations with such games for randomly selected values of a parameter. We introduce a belief formation process that takes into account the history of similar games played in the past, not necessarily by the same population. We show that when history serves as a coordination device, the limit behavior depends on the way history unfolds, and cannot be determined from a-priori considerations.     

Assessing switchability for biosimilar products: modelling approaches applied to children's growth

The present paper describes two statistical modelling approaches that have been developed to demonstrate switchability from the original recombinant human growth hormone (rhGH) formulation (Genotropin^®) to a biosimilar product (Omnitrope^®) in children suffering from growth hormone deficiency. Demonstrating switchability between rhGH products is challenging because the process of growth varies with the age of the child and across children. The first modelling approach aims at predicting individual height measured at several time‐points after switching to the biosimilar. The second modelling approach provides an estimate of the deviation from the overall growth rate after switching to the biosimilar, which can be regarded as an estimate of switchability. The results after applying these approaches to data from a randomized clinical trial are presented. The accuracy and precision of the predictions made using the first approach and the small deviation from switchability estimated with the second approach provide sufficient evidence to conclude that switching from Genotropin^® to Omnitrope^® has a very small effect on growth, which is neither statistically significant nor clinically relevant. Copyright © 2015 John Wiley & Sons, Ltd.