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Re: Systematic Review of the Impact of Testosterone Replacement Therapy on Depression in Patients with Late-Onset Testosterone Deficiency.

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available at https://pubmed.ncbi.nlm.nih.gov/30017901/ Editorial Comment: Testosterone deficiency and depression are common clinical conditions in elderly men. Clinical guidelines indicate that testosterone replacement therapy (TRT) is indicated in those with hypogonadism… Click to show full abstract

available at https://pubmed.ncbi.nlm.nih.gov/30017901/ Editorial Comment: Testosterone deficiency and depression are common clinical conditions in elderly men. Clinical guidelines indicate that testosterone replacement therapy (TRT) is indicated in those with hypogonadism to bring testosterone back to normal therapeutic levels. There has been interest in the role of TRT to help with depressive symptoms in elderly men. This systematic review sought to identify the relationship between these conditions and the efficacy of TRT. Standard systematic review methodology was used. A total of 15 published studies were analyzed, including 6 randomized controlled clinical trials of TRT vs placebo in men with clinically significant depression, and 9 similar trials in men without depression. Overall, TRT appeared to improve depressive symptom scores, although the impact was limited to cases with mild symptoms. TRT did not significantly improve psychiatric outcomes in men with an actual diagnosis of major depressive disorder. The authors indicate that use of TRT may be considered during shared decision making in elderly men with mild depressive symptoms. However, additional work is needed to better clarify the optimal length of therapy and routes of administration, interactions with other antidepressive treatments, and long-term risks and benefits of TRT in patients with this condition. More research will also be needed to assess outcomes in regard to sexual health in this type of clinical population. Tomas L. Griebling, MD, MPH Re: Epidural Anesthesia May be Associated with Increased Postoperative Complications in the Elderly Population Undergoing Radical Cystectomy: An Analysis from the National Surgical Quality Improvement Project (NSQIP) Database S. Y. Patel, R. S. Ackerman, D. Boulware and M. A. Poch Department of Anesthesiology, H. Lee Moffitt Cancer Center, Tampa, Florida, Morsani College of Medicine, University of South Florida, Tampa, Florida, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, Department of Biostatistics, H. Lee Moffitt Cancer Center, Tampa, Florida, and Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida World J Urol 2020; Epub ahead of print. doi: 10.1007/s00345-020-03212-0 Abstract available at https://pubmed.ncbi.nlm.nih.gov/32318858/available at https://pubmed.ncbi.nlm.nih.gov/32318858/ Editorial Comment: Radical cystectomy is a major surgical procedure that can be associated with a substantial risk of morbidity in elderly patients. Most geriatric patients undergoing this surgery have comorbidities that influence clinical outcomes. Multiple studies have evaluated methods to reduce complications in this relatively vulnerable population. Combined general and epidural anesthesia has often been advocated as a method to reduce overall narcotic requirements, improve postoperative pain management, and potentially improve outcomes and reduce cardiopulmonary events after radical cystectomy and urinary diversion. This study used national level information from the NSQIP database to examine this research question. Interestingly rates of overall major complications were higher (18.5%) among patients who received general anesthesia and an epidural compared to those receiving general anesthesia alone (17.8%). Although these rates appear quite close, due to the large numbers of patients analyzed, the results were statistically significant (p[0.0046). Subgroup analysis by age revealed this was more apt to occur in those older than 75 years (p[0.0301). GERIATRICS 1359 Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.

Keywords: therapy; depression; testosterone deficiency; systematic review

Journal Title: Journal of Urology
Year Published: 2020

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