Urethroplasty among Elderly Men, Surgical Techniques and Outcomes

Introduction: Urethroplasty remains the gold standard for the management of urethral stricture. However, the treatment of stricture disease in the elderly tends to be less invasive due to the presumption that they might not be able to stand long hours of surgery and might have higher rates of recurrence due to poor wound healing from microangiopathy. We present our experience with the outcomes of urethroplasty among elderly men seen at the Komfo Anokye Teaching Hospital from January 2012 to December 2021. Methods: This was a retrospective review of data captured in the urology database on all patients 65 years and above who underwent urethroplasty at the hospital over the study period. Data was obtained on patients’ demographics, stricture characteristics, urethroplasty technique, and outcome. A successful outcome was defined as peak flow rate > 15 mls/s, a patent urethra on retrograde urethrogram, patient satisfaction with urine stream, or restoration of the normal stream of urine with only one attempt at urethral calibration or internal urethrotomy postoperatively. Data was analyzed using PASW Statistics for Windows, Version 18.0. Results: Overall, 43 urethroplasties were done over the study period in elderly men. The age range was 65 to 87 years. The commonest aetiology was catheterization (62.79%) followed by urethritis (32.56%). Stricture length ranged from 0.5 cm to 16 cm with a mean of 3.93 cm. Most patients (60.46%) had bulbar urethral strictures. The repair methods employed were anastomotic urethroplasty (62.80%), fasciocutaneous flap (FCF) ventral onlay (13.95%), buccal mucosa graft (BMG) ventral onlay urethroplasty (4.65%), and staged urethroplasty (4.65%). Three of the patients (6.98%) had a combination of anastomotic and tissue transfer urethroplasty. The overall success rate was 88.37%. Complications included three surgical site infections, two urethral diverticula and one glans dehiscence. Conclusion: Elderly men tolerate urethroplasty well and the procedure should not be denied solely based on age.

To Explore the Relationship between Lower Extremity Vascular Sclerosis and Osteoporosis in Elderly Men with Type 2 Diabetes Mellitus

Objective: To investigate the correlation between lower extremity vascular sclerosis and osteoporosis in elderly men with type 2 diabetes mellitus. Methods: A total of 359 elderly male patients with type II diabetes hospitalized in the First Affiliated Hospital of Chongqing Medical University from January 2018 to June 2023 were retrospectively collected. According to the BMD (Bone Density Value), the patients were categorized into osteoporotic (T ≤ -2.5, n = 248) and non-osteoporotic groups (T > -2.5, n = 111). T test and Chi-square test were used to evaluate the differences in clinical data, biochemical markers and ABI between two groups. Multivariate logistic regression was used to analyze the risk factors of osteoporosis in elderly men with type 2 diabetes mellitus. Results: Compared with the non-osteoporotic group, the differences in diabetes course, systolic blood pressure, ABI, BMI, uric acid, triglyceride, and HDL in the osteoporotic group were statistically significant (P < 0.05). Logistic multivariate regression analysis showed that lower extremity vascular sclerosis was an independent risk factor for osteoporosis in elderly men with type 2 diabetes mellitus (P Conclusion: Atherosclerosis of the lower extremities in elderly men with T2DM is closely related to osteoporosis, and can lead to a decrease in bone mass, and an increase in osteoporosis.

Low DHEAS levels are associated with depressive symptoms in elderly Chinese men： results from a large study

This study investigated the association between depressive symptoms in elderly Chinese men and the total testosterone, dehydroepiandrosterone （DHEA）, DHEA sulphate （DHEAS）, oestradiol and sex hormone-binding globulin （SHBG） levels, and the free androgen index. Cross-sectional data from 1147 community-dwelling elderly men, aged 65 and older, were used. Depressive symptoms were measured using the Chinese Geriatric Depression Scale （GDS）. Total testosterone, free testosterone, DHEA, DHEAS, total oestradiol, the free androgen index and SHBG levels were assessed. DHEA was significantly associated with GDS score, and there was a trend towards DHEAS association, but this was not significant （p=-0. 110, P=0.015; p=-0.074, P=0.055）. However, no association was seen between depressive symptoms and total testosterone levels, free testosterone levels, oestradiol levels or SHBG levels. In terms of the presence of clinically relevant depressive symptoms, there were no statistically significant differences between patients in the lowest quartile of sex steroid hormone levels and those in other quartiles of sex steroid hormone levels. Similarly to Western studies, our study shows that DHEA and DHEAS levels are associated with depressive symptoms.

The Association between Interpersonal Relationship and Erectile Dysfunction of Middle-Aged and Elderly Men in a Rural Area of Zhejiang,China

Objective:To explore the association between interpersonal relationship and erectile dysfunction(ED)of middle-aged and elderly men.Methods:A population-based cross-sectional research was conducted in the rural area of Jiashan County,Zhejiang Province,in 2016.Middle-aged and elderly men(aged 40-80)were selected as study participants.The face-to-face questionnaire was collected,including basic information,lifestyles,interpersonal relationship,and sexual function.The interpersonal relationship was evaluated based on marital relationship,neighborhood relationship,and relatives/friends relationship.According to the International index of erectile function,the study participants were divided into ED group(mild ED,moderate-to-severe ED),and non-ED group.Correlations were evaluated between interpersonal relationship indices and the prevalence or the severity of ED.Potential confounders were adjusted by the logistical regression model.Results:There were 674 study participants with average age of 60.4±8.5 years,and 489 ED patients with prevalence of 72.6%.With age increasing,the prevalence and the severity of ED increased significantly.The men who could get help from spouse when an emergency occurred or who were more cared about by their neighbors had lower ED risk,and odds ratios(ORs)(95%confidence intervals[CIs])were 0.23(0.13-0.42)and 0.58(0.46-0.75),respectively.After the adjustment of the covariates(age,education degree,household income,smoking,and drinking),the ORs(95%CIs)were 0.29(0.14-0.60)and 0.54(0.39-0.74),respectively.Good marital relationship and good neighborhood relationship were associated with a less severity of ED.