Surgery News - September 2008 - (Page 15) SEPTEMBER 2008 • SURGERY NEWS GENERAL SURGERY Gastric Bypass Improves Sexual Function in Men BY DAMIAN McNAMARA Else vier Global Medical Ne ws O R L A N D O — Gastric bypass surgery leads to significant improvement in the sexual dysfunction experienced by many morbidly obese men, according to a recent study. The effects of surgical weight loss on sexual function are not well studied, although dramatic improvements in diabetes, hypertension, and cardiovascular disease risk have been associated with gastric bypass surgery in previous studies. “The reason this is newsworthy is we have an increasing problem with obesity worldwide,” said Dr. Ira Sharlip, moderator of a press briefing at the annual meeting of the American Urological Association. “One of the problems that arise[s] with morbid obesity is sexual dysfunction.” Dr. Sharlip, an ACS Fellow, practices internal medicine and urology in San Francisco. The decrease in sexual function can be considerable. “A male—obese or morbidly obese—has the same amount of sexual dysfunction as a male 20 years older than him,” study coauthor Dr. Jason A. Smith said during the briefing. Participants had substantially lower sexual function scores before surgery than did normal-weight men, said Dr. Smith, a urology resident at Albert Einstein Medical Center in Philadelphia. The researchers used sexual function scores from a reference group of normal-weight men who participated in a previous study ( J. Urol. 2007;177:1438-42). “We believe sex life is important to men, so this will be an incentive for men to seek gastric bypass,” Dr. Smith said. Dr. Smith, with lead author Dr. Ramsey M. Dallal, an ACS Fellow and bariatric surgeon in Elkins Park, Pa., and their associates assessed sexual function among 95 morbidly obese men before and after Roux-en-Y gastric bypass surgery. Their mean body mass index was 51 kg/m2 and the mean age was 48 years. No participant was taking a phosphodiesterase type 5 (PDE5) inhibitor. Participants rated their preoperative and postoperative sexual function using the 11question Brief Sexual Inventory. Postoperative assessment was conducted at a mean of 19 months after surgery. “Overall, in all sexual domains, all improved. This is what we expected to find,” Dr. Smith said. But “the degree to which they improved exceeded our expectations.” Sexual drive scores, for example, improved from 3.9 to 5.4 (scale of 0-8) in a bivariate analysis. Erectile dysfunction scores improved from 6.3 to 8.9 (scale of 0-12), ejaculatory function improved from 4.9 to 6.3 (scale of 0-8), problem assessment improved from 7.4 to 9.5 (scale of 012), and sexual satisfaction improved from 1.6 to 2.2 (scale of 0-4). All of these changes were statistically significant. The amount of weight loss predicted the enhancement in all sexual function domains in a multivariate analysis that controlled for age, diabetes, hypertension, and cigarette smoking. On average, participants’ mean weight fell from 155 kg (342 pounds) to 102 kg (225 pounds) after 1 year. Because the researchers controlled for confounders, “weight alone was responsible for sexual dysfunction [preoperatively], and weight loss alone was responsible for improvement in scores,” Dr. Smith said. Sexual dysfunction “should be considered one of the numerous reversible conditions in the morbidly obese,” Dr. Smith said, adding that this is the first study to look at sexual function in men following Roux-en-Y gastric bypass. Not stratifying patients according to prior use of PDE5 inhibitors is a potential limitation of the study, said Dr. Harkaway, a urologist who practices in Philadelphia. Also, the researchers did not account for psychogenic impotence, “which is supposed to be about 20% in all [impotent] men, but could be higher in obese men because body image plays a role.” The researchers plan to assess the impact of gastric bypass surgery on sexual dysfunction in females as well. ■ INDEX OF ADVERTISERS Ethicon Endo-Surgery, Inc. Echelon Flex General Scientific Corporation SurgiTel Surgi-Cam KCI InfoV.A.C. Nashville Surgical Instruments Kumar PRE-VIEW Wyeth Pharmaceuticals Inc. Tygacil 3 5 7 4 15-16 TYGACIL® (tigecycline) Brief Summary See package insert for full Prescribing Information. For further product information and current package insert, please visit www.wyeth.com or call our medical communications department toll-free at 1-800-934-5556. CONTRAINDICATIONS TYGACIL is contraindicated for use in patients who have known hypersensitivity to tigecycline. WARNINGS Anaphylaxis/anaphylactoid reactions have been reported with nearly all antibacterial agents, including tigecycline, and may be life-threatening. Glycylcycline class antibiotics are structurally similar to tetracycline class antibiotics and may have similar adverse effects. TYGACIL should be administered with caution in patients with known hypersensitivity to tetracycline class antibiotics. TYGACIL may cause fetal harm when administered to a pregnant woman. If the patient becomes pregnant while taking tigecycline, the patient should be apprised of the potential hazard to the fetus. Results of animal studies indicate that tigecycline crosses the placenta and is found in fetal tissues. Decreased fetal weights in rats and rabbits (with associated delays in ossification) and fetal loss in rabbits have been observed with tigecycline. (See PRECAUTIONS, Pregnancy.) The use of TYGACIL during tooth development (last half of pregnancy, infancy, and childhood to the age of 8 years) may cause permanent discoloration of the teeth (yellow-gray-brown). Results of studies in rats with TYGACIL have shown bone discoloration. TYGACIL should not be used during tooth development unless other drugs are not likely to be effective or are contraindicated. Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including TYGACIL, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile. C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated. PRECAUTIONS General Caution should be exercised when considering TYGACIL monotherapy in patients with complicated intra-abdominal infections (cIAI) secondary to clinically apparent intestinal perforation. (See ADVERSE REACTIONS.) In Phase 3 cIAI studies (n=1642), 6 patients treated with TYGACIL and 2 patients treated with imipenem/cilastatin presented with intestinal perforations and developed sepsis/septic shock. The 6 patients treated with TYGACIL had higher APACHE II scores (median = 13) vs the 2 patients treated with imipenem/cilastatin (APACHE II scores = 4 and 6). Due to differences in baseline APACHE II scores between treatment groups and small overall numbers, the relationship of this outcome to treatment cannot be established. Glycylcycline class antibiotics are structurally similar to tetracycline class antibiotics and may have similar adverse effects. Such effects may include: photosensitivity, pseudotumor cerebri, and anti-anabolic action (which has led to increased BUN, azotemia, acidosis, and hyperphosphatemia). As with tetracyclines, pancreatitis has been reported with the use of TYGACIL. The safety and efficacy of TYGACIL in patients with hospital acquired pneumonia have not been established. In a study of patients with hospital acquired pneumonia, patients were randomized to receive TYGACIL (100 mg initially, then 50 mg every 12 hours) or a comparator. In addition, patients were allowed to receive specified adjunctive therapies. The sub-group of patients with ventilator-associated pneumonia who received TYGACIL had lower cure rates (47.9% versus 70.1% for the clinically evaluable population) and greater mortality (25/131 [19.1%] versus 15/122 [12.3%]) than the comparator. As with other antibacterial drugs, use of TYGACIL may result in overgrowth of non-susceptible organisms, including fungi. Patients should be carefully monitored during therapy. If superinfection occurs, appropriate measures should be taken. Prescribing TYGACIL in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria. Information for Patients Patients should be counseled that antibacterial drugs including TYGACIL should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When TYGACIL is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by TYGACIL or other antibacterial drugs in the future. Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two http://www.wyeth.com http://www.wyeth.com
Table of Contents Feed for the Digital Edition of Surgery News - September 2008 Surgery News - September 2008 Contents Appreciation Low Scores News From the College: New Leader Practice Trends: High Price to Pay Surgery News - September 2008 Surgery News - September 2008 - Contents (Page 1) Surgery News - September 2008 - Contents (Page 2) Surgery News - September 2008 - Contents (Page 3) Surgery News - September 2008 - Appreciation (Page 4) Surgery News - September 2008 - Low Scores (Page 5) Surgery News - September 2008 - Low Scores (Page 6) Surgery News - September 2008 - Low Scores (Page 7) Surgery News - September 2008 - News From the College: New Leader (Page 8) Surgery News - September 2008 - News From the College: New Leader (Page 9) Surgery News - September 2008 - News From the College: New Leader (Page 10) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 11) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 12) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 13) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 14) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 15) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 16)
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